Simplified review on fixed orthodontic appliances , their indication , contra-indications , advantages , disadvantages and their types

1. FIXED ORTHODONTIC
APPLIANCES
BY : AHMED JAWAD
BAKH AKRAM
GROUP A1

2. • It’s a division of orthodontic appliance systems.
• They are fixed on the teeth surfaces.
• These appliances can't be adjusted or removed
by the patient.

5. INDICATION OF FIXED ORTHODONTIC APPLIANCES:
1-Correction of Intrusion/extrusion of teeth

6. 2-Correction of mild to moderate skeletal discrepancies.
3- Closure of extraction spaces ,or spaces due to hypodontia, to
ensure a good contact between teeth.

7. 4- Overbite / overjet reduction .
5-Multiple tooth movement .

8. 6-Correction of rotations .

9. CONTRA-INDICATION OF FIXED ORTHODONTIC APPLIANCES
• 1. Poorly motivated patient : The patient
should understand that his/her cooperation
will be required throughout treatment.

10. 2. Bad Oral Hygiene Patients with poor oral hygiene are more likely to suffer
from periodontal diseases.

11. • 3. Severe Skeletal problems : Malocclusions that are skeletal in nature or
otherwise beyond the scope of orthodontics should not be attempted.

12. • 4. Appropriate training of operator Only orthodontists are qualified to carry
out the treatment using the fixed orthodontic appliances.

13. ADVANTAGES OF FIXED ORTHODONTIC APPLIANCES:
• 1. Precise control of tooth movement : it is possible to move individual teeth
in the three planes of space to achieve perfect alignment of teeth both inter
and intra arch.
• 2. Multiple tooth movements are possible: Individual teeth can be moved in
all the three planes of space at the same time , for example a tooth can be
intruded as well as retracted. Also, different teeth can be moved in different
directions at the same time, i.e. while one tooth is being derotated another
can be retracted.

15. • 3. Patient cooperation is reduced in comparison to removable appliance wear .
• 4. More comfortable to the patient than removable and myofunctional
appliances .
• 5. Some tooth movement can't be produced by removable or myofunctional
appliances such as root bodily movement .

16. DISADVANTAGES OF FIXED ORTHODONTIC APPLIANCES:
• 1. Oral hygiene requirement : Oral hygiene
maintenance becomes more difficult. Food
debris tend to accumulate around the
attachments and their removal becomes
difficult.

17. • 2. Esthetics : Fixed appliances are generally made of metal that might not be esthetically
acceptable to the patient. The advent of the lingual technique and tooth-colored
brackets (made of ceramic/composites/fiber glass) has helped overcome this
disadvantage to a large extent.

18. • 3. Special training for operator: Only orthodontists are trained to handle and monitor
these appliances.
• 4. Increased cost of treatment Fixed orthodontic appliances are costly as compared to
removable appliances. The attachments used with these appliances are expensive and
hence, the cost of the treatment goes up.

19. • 5. Increased chair side time Since the appliance is fixed, and cannot be removed from
the patient’s mouth, hence, all adjustments have to be made in the patient’s mouth by
the operator. This increases the chair side time.
• 6. Anchorage control is more difficult as compared to removable appliances.
• 7. Treatment monitoring is more difficult. The patient has to be recalled at regular
intervals for appliance adjustments/reactivations. Long-term monitoring is essential to
achieve stable results.

22. COMPONENTS OF FIXED ORTHODONTIC APPLIANCES :
• A- Bands.
• B- Brackets.
• C- Archwires.
• D- Auxillaries such as elastics , coils spring , lingual wire .

23. Bands : These are rings encircling the
tooth to which buccal, or lingual
attachments are soldered or welded.
Brackets: Many types of brackets were
introduced over the years, to get better
biomechanical properties, better esthetic
appearance, better biocompatibility with
oral hygiene and less demineralization.

24. Brackets can be classified into:
Standard
edgewise
bracket system
(zero torque &
angulation )
Pre-adjusted
bracket
system
Begg brackets
system(the only
bracket system
with vertical
slot)
Self ligation
brackets ( no
need to use
elastics )
Tip edge
brackets (the
corners is removed
from the conventional
edgewise slot )

25. ARCHWIRES
• Archwires are made of variable materials and dimensions. Originally archwires were
made from gold alloy but because it is expensive, the stainless steel alloy becomes the
material of choice.
• Recently a super-elastic and flexible wire is introduced, made from Nickel - titanium
alloy .

26. • Archwires are available in different cross section shape and dimensions
a) Round archwire.
b) Square archwire .
c) Rectangular archwire

27. Another Classification is according to arch form :
1- Oval.
2- Taper.
3- Wide.

28. And Finally it can be classified according to the material that are made from:
• Metal – Gold, Stainless steel : it is the most corrosion resistant when in direct contact
with biological fluid.
• Titanium, Nickel : Lighter and more flexible than the SS arch wire
• Plastics & Cermaic : which is more esthetically acceptable

29. Auxillaries
• These are used in conjunction with
archwires to produce tooth movement.
1. Elastic separators are used to create
spaces between two adjust teeth before
banding.

30. 2. Palatal arches can be utilized to reinforce the anchorage, to achieve expansion or de-rotation
of molars.

31. 3. Coil springs : either opening or closing, which made from stainless steel or
nickel titanium alloys, also used to move teeth along the archwire.

32. ORTHODONTIC BONDING AND BANDING TECHNIQUES
• Banding : The method of fixing attachments by welding them to a metal
band which are then cemented to the teeth with polycarboxylate cement.
 Indications of Banding
1. Teeth with excessive occlusal forces
2. Teeth that have large metal restorations ( weak ) or metal prosthesis.
3. When a headgear or cemented palatal arch needs to be used.
4. Failure of bonded attachment.
5. Teeth with short clinical crown
Bands must be placed accurately and the teeth have to be separated from
adjacent tooth contacts by using a separator around the contact area.

33. • Bonding : Is the method in which Brackets are fixed to the teeth directly with a composite
resin after acid-etching of enamel surface, and chemical or light cured resins are generally
used
• Unlike banding, there is no need for separation.

34. • Bonding procedure has several advantages over banding
1-More esthetic.
2-Less caries and gingival plaque.
3-Less discomfort.
4-Used on partially erupted teeth.
5-Teeth separation not required.
6-Detachment is more easily.
7-No spaces remain after treatment.

35. • Direct bonding : In which direct attachment of orthodontic appliances to etched teeth using
chemically and light cure adhesives.
• It is most popular due to its simplicity and reliability.

37. • Indirect bonding : In this technique, the brackets were first positioned on study casts with
water soluble adhesive and then transferred to the mouth with a custom tray. The advantage
of this technique is more precise location of brackets that is possible in the laboratory.

38. EXPANSION BY FIXED APPLIANCES
Quadhelix appliance
• Very efficient fixed slow expansion appliance.
• produce an anterior and posterior expansion.
• made of 1 mm stainless steel wire and attached to the teeth by bands
cemented to the molars.
Hyrax (rapid expansion screw)
• gives posterior expansion.
• It is designed to open mid-palatal suture and expand the upper arch by
producing skeletal expansion.
• It is used in early teens before the suture fuses.

39. Treatment with fixed appliance can be divided into four phases:
1. Alignment phase :
• Crowding And Rotation Are Rapidly Dealt With To Allow Placement Of More Rigid Archwires.
2. Working Phase :
• Horizontal And Vertical Dento-alveolar Correction Are Made.
3. Finishing phase :
• Tooth position is carefully detailed to achieve best esthetic and functional result.
4. Retention phase :
• The fixed appliance is removed and retainers are fitted.
• The retainers are worn full time for 4-6 months then at night-time for 4-6 months.
• The retainers usually are removable appliances so they can then be gradually withdrawn to ensure teeth stability.

40. ALTERNATIVE ORTHODONTIC APPLIANCES
• Lingual appliances
Brackets bonded to the lingualpalatal surfaces of the teeth and specially
configured arch wires are used.
The main advantage is esthetic.
While the disadvantages are uncomfortable to the patient and difficult to
adjust.
• Clear aligner therapy
Aligners used as devices for treatment of the mildly displaced teeth into
their correct positions .
The main advantage is esthetic because it is invisible or minimally visible.