Fixed appliance

By Khalil Raziq

Definition
An appliance fixed to teeth by attachments through which force application is by archwires or auxiliaries.

indications
1)Correction of mild to moderate skeletal discrepancies :As fixed appliances can be used to achieve bodily movement it is possible, within limits, to compensate for skeletal discrepancies and treat a greater range of malocclusions.

indications
2)Intrusion/extrusion of teeth Vertical movement of individual teeth, or tooth Intrusion/extrusion of teeth form segments, requires someVertical of attachment movement of individual teeth, or tooth on the tooth surfacesome form which the force can segments, requires onto of attachment on the tooth surface onto which the force can act. act.

Indications
3)Correction of rotations

4) Overbite reduction by intrusion of incisors

5) Multiple tooth movements required in one arch

Indications
6) Active closure of extraction spaces, or spaces due to hypodontia :Fixed appliances can be used to achieve bodily space closure and ensure a good contact point between the teeth.

fixed appliances should only be embarked upon in patients who are willing to: 1)maintain a high level of oral hygiene; 2)avoid hard or sticky foods and the consumption of sugar-containing foodstuffs between meals; 3)cooperate fully with wearing headgear or elastic traction, if required; 4)attend regularly to have the appliance adjusted.

components
1)Bands 2)Bonds 3)orthodontic adhesives 4) Auxiliaries 5)Archwires 6)

components
Bands:These are rings encircling the tooth to which buccal, and as required, lingual, attachments are soldered or welded. It was very popular before the acidetching techniques were introduced Now its rarely used except in molars where band remain in situ if the cements fails

Bands

A lower first permanent molar band. Note the gingivally positioned hook, which is useful for applying elastic traction

Bands
Bands can be used on teeth other than molars, most commonly following the failure of a bonded attachment or where de-rotation or correction of a crossbite dictate the need for both lingual and buccal attachments. However, this must be balanced against the poorer aesthetics of a band (look at thye photo below)

Fixed appliance case where bands have been used for the canines, premolars and molar teeth. The impact of bands upon the aesthetics of the appliance can be readily appreciated

 Prior to placement of a band it may be necessary to separate the adjacent tooth contacts. The most widely used method involves placing a small elastic doughnut around the contact point

Bonds
2)Bonds:Bonded attachments were introduced with the advent of the acid-etch technique Adhesion to the base of metal brackets is gained by mechanical interlocksite

Brackets for bonding showing a mesh base which increases the surface area for mechanical attachment of the composite

A patient with ceramic brackets on the upper

anterior teeth.

Orthodontic adhesives
The most popular cement for cementing bands is glass ionomer ,mainly because of its fluoridereleasing potential and affinity to stainless steel and enamel. Glass ionomers can also be used for retaining bonded attachments, but unfortunately the bracket failure rate with this material is greater than that with composite. Much current research work is directed towards hybrid compomer materials which it is hoped will combine the advantages of composites and glass ionomer adhesives.

Orthodontic adhesive

Glass ionomer cement.

 Use of the acid-etch technique with a composite produces clinically acceptable bonded attachment failure rates of the order of 510 per cent for both selfand light-cured material.Following this, a small amount of the composite itself is applied to the bracket, which is then placed on the tooth surface under pressure. Squeezing the sandwich of composite and catalyst into a thin layer mixes the two components, and the material usually sets within a few minutes. s

No-mix composite for orthodontic bonding

Auxiliaries
Elastics or elastomeric modules/chain/thread springs.

Coloured elastomeric modules used to secure the archwire into the bracket slot.

This patient's upper archwire has been tied into place with wire ligatures in the upper arch and with elastomeric modules in the lower arch

Head gears

A palatal arch, which is used to help provide additional anchorage in the upper arch by helping to resist forward movement of the maxillary molars.

Archwires.
These may be round or rectangular. in treatment round active wire is used initially Usually, rrectangular passive wire with auxiliaries is used later

The physical properties of an archwire

material which are of interest to the orthodontist are

Springback: This is the ability of a wire to return to its original shape after a force is applied. High values of springback mean that it is possible to tie in a displaced tooth without permanent distortion. Stiffness: The amount of force required to deflect or bend a wire. The greater the diameter of an archwire the greater the stiffness. Formability: This is the ease with which a wire can be bent to the desired shape, for example the placement of a coil in a spring, without fracture.

as follows.

 Resilience :This is the stored energy available after deflection of an archwire without permanent deformation. Biocompatibility Joinability: This is whether the material can be soldered or welded. Frictional characteristics :If tooth movement is to proceed quickly a wire with low surface friction is preferable.

archwires

The most popular archwire material is stainless steel which is available in straight lengths, as a coil on a spool, or pre-formed into archwires.

 Material varies eg. Nickel Titanium alloy (NiTi), Titanium Molybdenum Alloy (TMA), Stainless Steel

Appliance types
Most common pre-adjusted appliances: 1)Edgewise.: Uses an individual bracket with a rectangular slot for each tooth to give it 'average' i nclination and angulation and to allow placement of flat archwires. Bracket prescriptions described by Andrews and Roth are available. 2)Tip-edge. :Based on the Begg philosophy but the narrow brackets also have preadjusted values to allow the placement of rectangular wires in the final stages of treatment

3)Lingual appliance: Uses brackets bonded to the lingual/palatal surfaces of the teeth and specially configured archwires. Aesthetic, but uncomfortable for the patient and difficult to adjust. 4)Sectional appliance: Components are attached to teeth in (usually) one segment of the arch, normally for localised alignment as part of adjunctive treatment, especially in adults

5)Fixed removable: URA with bands cemented to _6s for extraoral traction bracket bonded to a rotated incisor and whip spring hooked to labial bow for derotation; bracket bonded to a favourably inclined palatal canine and traction applied from the buccal arm on the appliance to the bracket via elastic

Preadjusted edgewise appliance

Tip edge appliance

URA with bands on 6s for extraoral traction

Reference
1) An Introduction to Orthodontics , 2nd Edition by laura mitchelle 2)orthodontics and paediatric dentistry by declan millet, richard wulbery 3) Kapila, S. and Sachdeva, R. (1989). Mechanical properties and and clinical applications of orthodontic wires