Cosmetic orthodontics1 /certified fixed orthodontic courses by Indian dental academy

COSMETIC ORTHODONTICS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

What is Aesthetics?
Aesthetics is purely and simply
the science of expression,expression
being itself so defined as to be Identical
with every form of Appreciation,Intuition
or Imaginative Synthesis.
“HENFREY”

How Far Have We Gone?
In Aesthetics!!
In Orthodontics!!!
We have gone as far as developing
materials which are tooth colored
or (Invisible)in..

1. Brackets
2. Wires
3. Rings or Chains
4. Auxiliaries
TOGETHER IN A HARMONY BETWEEN

“ function and esthetics ”

HISTORICAL PRESPECTIVE

FIXED APPLIANCES INTRODUCED IN 1800’s

BANDING OF ANTERIOR &POSTERIOR TEETH

BONDING OF ANTERIOR ATTACHMENTS


REDUCTION OF BRACKET SIZES

CERAMIC /COMPOSITE BRACKETS

COMPOSITE ARCHWIRES

LINGUAL ORTHODONTICS

INVISALIGN SYSTEM

ANTERIOR BAND1NG :


TWIN BRACKETS

MINI-TWIN BRACKETS


DESIGN VARIATIONS


TOOTH COLOURED BRACKETS
1. PLASTIC BRACKETS
introduced by NEUMAN (1969)
Acrylic, nylon, epoxies, polysulphones, polycarbonates

USED IN
a. Minimal torque situations
b.Treatment of short duration
STEEL SLOTED PLASTIC BRACKETS ----BEST SUITED

ADVANTAGES
1.Nontoxic
2.Easy fabrication
3.Good abrasion resistance
4.Good impact strength
5.No bad odour /distaste

DISADVANTAGES
1.Lack of strength
2.Wire - slot wear
3. Water absorption & degradation
3.Discoloration and staining
4.Poor dimensional stability

2.CERAMIC BRACKETS
Introduced by MICHEAL SWARTZ (1987)
 FULL CERAMIC BRACKETS
 CERAMIC BRACKETS WITH METAL INSERTS


Full ceramic brackets

With metal inserts


 MONOCRYSTALLINE /POLYCRYSTALLINE ALUMINA
( 2100`C )

 ZIRCONIA (1000`C )

------Made of 3D inorganic molecules

Extremely high hardness and compressive strength.

Both are highly biocompatible

BONDING OF CERAMIC BRACKETS TO ENAMEL:

1. Mechanical retention via indentation / undercuts
in base.
2. Chemical bonding with silane coupling agents.


DISADVANTAGES
1. BRACKET FAILURE
* Fracture of brackets
* Friction within bracket slots
* Tooth wear on bracket contact

2. BULK OF THE BRACKETS
3. SURFACE ROUGHNESS
4. INHIBITION OF POLYMERISATION
5. DEBONDING DIFFICULTIES
* ENAMEL DAMAGE
* Pulpal damage

CASE SELECTION CRITERIA
Ceramic brackets are contraindicated in
1.Deep bite cases
2.Bruxism patients
3.Large restorations
4.Need for significant torque
5.Children

3.COMPOSITE BRACKETS
A Composite is a multiphase material brought about by
combining materials that differ in composition /form to
obtain specific characteristics and properties. The
constituents retain their identities and properties.
Can be simplified as ‘dispersion of fillers(particles /fibres
/whiskers ) in a binder or matrix (metals /ceramics /resins)’.
Reinforcement of polymer with ceramic metals –most common
combination in ORTHODONTICS

COMPOSITION
Manufactured by ‘INJECTION MOLDING TECHNIQUE’.
COMPOSITE PRECURSOR
-Plasma treated high strength Polyethylene fibers
REINFORCED WITH
1.Glass
2.Mineral filler
3.Metal
4.Ceramic liner
5.Metal liner

ADVANTAGES
1.SUPERIOR IMPACT RESISTANCE
2.INCREASED COMPRESSIVE STRENGTH
3.FATIGUE RESISTANCE
4.RESISTANCE TO DISCOLORATION

DISADVANTAGES
1.CREVICE CORROSION
2.DISINFECTION PROBLEMS
3.DIFFICULTY TO DETECT CRACKS

4.EXPENSIVE & CANNOT BE RECYCLED

ARCH WIRES-COSMETIC ADVANCES
1. Arch wires with plastic tubing coating
2. Marsenol
3. Lee-white
4. Composite archwires
5. Optiflex archwires
6. Fibre reinforced composite

ARCH WIRES WITH PLASTIC TUBING COATING :
Earliest to be introduced

Stainless steel arch wires were coated with plastics
DISADVANTAGES
1. Easy peeling off of the coating
2. Loss of friction control


MARSENOL:
E.T.E COATED NICKEL TITANIUM
It exhibits all the characteristics of NiTi . The coating is
adherent and is flexible,fracture resistant, delivers force
over long periods.
LEE WHITE:
STAINLESS STEEL NiTi bonded to EPOXY COATING
Coating is completely opaque, does not peel ,chip , stain
or discolor

COMPOSITE ARCH WIRES:
Made of S-2 glass fibres and acrylic resin.
Manufactured by 1. Photopulstration
2. Electromagnetic radiation

ADVANTAGES
Translucent
Strong & Springy
Variable Stiffness
Dimensional Stability
Minimal Staining

‘OPTIFLEX’ ARCH WIRES
Designed by Dr. Taloss
Composite of ceramic fiber-plastic-nylon.
Made of 3 layers:
1. Silicon dioxide core –force production
2. Silicon resin middle layer - protection
3. Nylon outer layer –stain resistance

ADVANTAGES
 Highly esthetic
 Stain resistant
 Light continuous force
 Greater flexibility and resiliency
 Low friction
 Corrosion resistance
 High biocompatibility

DISADVANTAGE

‘ No formability’

FIBRE REINFORCED COMPOSITE
Made of S GLASS FIBRES in a matrix of THERMOSET BIS-GMA
Available as –1.Rope type
2.Woven strip
3.Unidirectional strip


USES:
1.Retainers
2.After initial aligning can replace main arch wire
3. Any attachments can be directly bonded

LINGUAL ORTHODONTICS
“INVISIBLE BRACES”


CASE SELECTION CRITERIA
NON EXTRACTION CASES
1.Cl.I , Deep bite , mild crowding
2Cl..I , Deep bite , generalized spacing
3.Cl.II , Deep bite
4.Cl.II div.2 , mand. retrusion
5.Diastema closure
EXTRACTION CASES
1.Cl.I, low FMA , severe crowding
2.Cl.II with minimal crowding

ADVANTAGES
1. Totally invisible

2. Facial surfaces are not damaged
3. Lip contour not distorted
DISADVANTAGES

1. Decreased accessibility
2. Small interbracket span –freq. adjustments
3. Difficulty to perform complex movements
4. Speech distortion and tongue irritation

CASE REPORT

PRETREATMENT


DURING TREATMENT


POST TREATMENT


INVISALIGN
The invisible way to align teeth without braces,
using a series of clear removable aligners

ADVANTAGES


Invisible,

 Removable,
 Comfortable.
Invisalign also allows a person to view his own virtual
treatment plan, he can see how his teeth will look when
the treatment is complete.

The Technology Behind Invisalign
Invisalign is a high-volume, customized manufacturing
process by advanced computer technology
|

Using advanced imaging technology, Invisalign
transforms the plaster models into a highly accurate 3-D
digital image.


A computerized movie - called ClinCheck- depicting
the movement of the teeth from the beginning to the final
position is created .
From the approved ClinCheck file, Invisalign uses laser scanning to
make a customised set of aligners , sent to the clinician .


CASE REPORT
BEFORE

AFTER


RETAINERS
QCM RETAINER

ESSIX RETAINER

FRC RETAINER


AUXILIARIES
Easy to tie ligatures

Elastomeric modules

Rotation wedges


CONCLUSION
“An orthodontic patient smile is
no more a metallic smile”
It’s in our hands to keep in pace with the
recent advances in esthetic dentistry to meet
the increasing esthetic concern of the patient .

Brackets

Auxiliaries
Wires


ACKNOWLEDGEMENT
PRINCIPAL :

Dr. E . Munirathnam Naidu M.D.S
VICE PRINCIPAL AND HEAD OF THE DEPARTMENT:

Dr. P. Jaya Kumar M.D.S.
Staff Members And P.G. Students,
Meenakshi Ammal Dental College,
CHENNAI.


Leader in continuing dental education


Cosmetic orthodontics1 /certified fixed orthodontic courses by Indian dental academy

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