Development of Contemporary Fixed Dental Appliances

DEVELOPMENT OF
CONTEMPORARY FIXED
APPLIANCE
INDIAN
ACADEMY

DENTAL

Leader in continuing dental education
www.indiandentalacademy.com


CONTENTS
□
□
□
□
□

INTRODUCTION
FAUCHARD
MAGILL
EDWARD H.ANGLE
ANGLE’S FIRST APPLIANCE MECHANICALLY
FLAWED
□ CAVIN S.CASE
□ ANGLE’S GREAT DILEMMA
□ QUEST

INTRODUCTION
□ Even the Ancient Egyptians (~3000 BC) were
concerned with straightening teeth, as
mummies have been found to have crude
metal bands wrapped around individual
teeth with catgut to close spaces
□ But regulation of teeth, as orthodontic
alignment was formerly referred to, did not
gain significant attention until Pierre
Fauchard 1678-1793, French, who is
considered the “Father of Modern Dentistry”
and “Orthodontia,” developed the
bandeauor bandolet in 1723

FAUCHARD
□ This was the first expansion
appliance,consisting of a heavy
maxillary labial arch of precious metal
to which teeth were ligated, and was
the basis for Angle’s E(expansion)-Arch
□ Western Europe continued to be the
center of orthodontic developments
during the 18th and early 19th
centuries

FAUCHARD ( 1728 )
□ Fauchard from
France introduced
a bow , affixed to
external surfaces of
teeth
□ This was the
forerunner of
modern arch wire


FAUCHARD’S APPLIANCE


MAGILL
□ Used a plain band cemented to tooth
by oxychloride of zinc cement


EDWARD H.ANGLE ( 1855 – 1930 )
□ Edward Angle referred as
“FATHER OF MODERN
ORTHODONTICS” has
contributed to the
development of new
orthodontic appliances
□ With few exceptions, fixed
appliance used in
contemporary orthodontics
are based on Angle’s
design from the early 20th
century
□ Developed four major
appliance systems

Edward H.Angle

ANGLE'S FIRST APPLIANCE ALSO
MECHANICALLY FLAWED
□ Ironically, both Angle's first and last
published appliances had similar flawsneither facilitated the retraction of teeth to
close spaces or correct anteroposterior
discrepancies
□ The first appliance, presented in 1887
(Irregularities of the teeth, presented before
the Ninth International Medical Congress,
Washington DC,USA), was intended to
retract a canine distally into a first premolar
extraction site

MECHANICALLY FLAWED
□ However, careful analysis of the mechanics
involved, followed by analysis of the
application of force and subsequent tooth
responses, reveals that the second molar,
which was intended to offer resistance to
the traction force, was free to rotate
distobuccally
□ The tube on the canine, being horizontal,
set up anchorage in the very tooth to be
moved. Angle would later refer to such
teeth as being stationary anchorage

MECHANICALLY FLAWED
□ The following year, Angle corrected
the mechanical errors at both ends of
his traction force in an article with a
title giving an indication of this 32-yearold's growing sense of confidence:
"New System of Regulation and
Retention."


Angle's first appliance intended to retract a canine
distally. Faulty design set up anchorage in the
canine and permitted rotation of the second molar.

The Edgewise Slot: Angle's Orthodontic Albatross
Peter C. Kesling, DDS, ScD, Private Practice of Orthodontics, Westville,
Indiana, USA.

MECHANICALLY FLAWED
□ In his revised appliance, the second
premolar and the first permanent molar
were transformed into a stationary
anchorage unit by soldering a horizontal
tube onto bands around both teeth
□ The canine crown was permitted to tip
distally by placing a tube horizontally on its
mesial surface
□ Angle would later refer to such tipping
movement as "simple anchorage."

Corrected design permitted distal
tipping of the canine and provided anchorage
from both the second premolar and first molar

Indiana, USA.

MECHANICALLY FLAWED
□ The importance of this new arrangement-tipping of the tooth to be moved and bodily
movement of the resistance teeth--was
stressed by Angle in his sixth edition,
published 10 years later, by an illustration
that appeared 4 times along with the
following words: "Be it remembered that the
tube attached to the cuspid band must
always stand at right angles to the long axis
of the tooth, that a free hinge-like
movement of the tooth in retraction may be
gained...."

Buccal view of Angle's perfected traction screw
Note: Dotted lines indicate Angle's perception
that heavy forces caused the canine to tip about a
fulcrum near the gingival crest and the molar to
move bodily

Indiana, USA.

CALVIN S.CASE ( 1847 – 1923 )
□ Calvin S. Case, had
invented and
promoted appliances
that could tip crowns,
"force the roots," or
move teeth bodily.
□ Upper and lower arch
bars with threaded
ends were loosely
connected to the ends
of vertical bars
soldered to bands on
the anterior teeth

Calvin S.Case

CALVIN S.CASE ( 1847 – 1923 )
□ Contributed greatly to the orthodontic
literature but was the first to try bodily
tooth movement with the contouring
apparatus, to use light wires (0.016”
and 0.018”gold)


(a)Contouring appliance to "bodily" protrude root tip. Power
bow (P) is activated by tightening the nut mesial to its sheath.
Fulcrum bar (F) provides traction by tightening the nut at its
end.


(b)Apparatus for retracting the root and moving the incisal
edge forward. Both bars are activated by
tightening the nuts against their respective sheaths. Designs
of both appliances permit movement by the power bars
without adjusting the nuts on the fulcrum bars. By placing the
nuts of both the upperand lower arch bars on the same ends
of the buccal sheaths, teeth can be moved bodily--labially
or lingually


CALVIN S.CASE
□ Case had an extremely capable, although
cumbersome and potentially powerful, new
appliance to both tip and upright teeth
□ He later termed this his "Contouring
Apparatus," because he felt that when
maxillary roots were moved forward and
laterally more than their crowns, the middle
features of the face achieved a fuller
contour

ANGLE'S GREAT DILEMMA
□ Sometime after the publication of his sixth
edition in 1900, which is replete with
extraction devices, Angle found himself in a
dilemma
□ His new text included appliances designed
to tip teeth, yet by then he realized nature
could not be relied upon to subsequently
upright them
□ He had no efficient mechanism to direct the
roots

ANGLE'S GREAT DILEMMA
□ Angle appreciated that it was not
advantageous to attempt to move a tooth
while keeping it upright--a tooth that cannot
tip is, in effect, an anchor tooth
□ Angle came up with the only instant solution
to the problem--stop extracting teeth
□ Angle presented his nonextraction stance in
a paper read before the American Society
.
of Orthodontists in October 1902

QUEST FOR THE ULTIMATE
NON EXTRACTION APPLIANCE

□ For the next 25 years, Angle continued his
search for a better "mousetrap."
□ This led him through a series of nonextraction
appliances, including the E (expansion)
Arch.
□ These were followed by the pin-and-tube
appliance of 1910 and the ribbonarch
appliance of 1915.
□ Both the 1910 and 1915 Angle appliances
were designed to expand the crowns and
then move the roots labially. The pin-andtube was extremely difficult to manipulate

□ The ribbon-arch bracket contained
the first practical archwire slot, which
facilitated archwire changes and
could provide torque with a ribbon
archwire
□ However, since the slots faced
vertically, the teeth were free to tip
mesially or distally

□ Finally, in 1925, as a means to provide positive
mesiodistal angular control, Angle invented what
would become known as the edgewise appliance.
The "open face“ or tie bracket was a clever
modification of the ribbon-arch bracket
□ He cut an archwire slot in its face and added an
extension (wing) to its gingival end
□ The labial wall of the original vertical archwire slot
formed the incisal wing
□ The original ribbon archwire was rotated 90 degrees
and inserted "edgewise" into the horizontally facing
slot
□ P. R. Begg, a student of Angle's in 1925, cut the first
prototypes on a lathe

□ This resulted in the first positive, yet simple, 3dimensional tooth control between an archwire
and slot
□ An archwire, round in cross section, could be used
for initial expansion to permit buccal or labial
tipping of the crowns
□ Subsequently, a rectangular archwire could be
used to torque roots labially or buccally with hopes,
in some cases, of stimulating bone growth
□ The appliance, like the ribbon-arch, was small and
delicate, yet relatively easy to manipulate.


□ However, Angle's "latest and best" provided so
much control it was difficult to make the
anteroposterior interarch corrections necessary to
treat Class II or III discrepancies
□ The archwire slot did not permit mesial or distal
crown tipping.
□ Angle had forgotten the lesson he had learned 38
years before, "...[A] free hinge like movement of the
tooth in retraction [must] be gained…." His last
modification to the appliance, second-order bends
in the archwire, could not provide the free tipping
required

ANGLE’S PROGRESSION FROM
E – ARCH TO EDGEWISE
APPLIANCE


E – ARCH ( 1900 )
□ Angle’s first appliance
□ Basic design : Had rigid framework to which
teeth has been tied so that they could be
expanded to arch form dictated by the
appliance
□ Bands were placed only on molar teeth and
a heavy labial archwire extended around
the arch
□ End of the wire was threaded and a small
nut placed on the threaded portion of the
arch allowed archwire to be advanced so
that arch perimeter increased

E - ARCH
□ The E-arch was
comprised of
ligatures from a
heavy (0.036” –
0.060” gold) labial
arch that brought
misaligned teeth to
the line of occlusion


E – ARCH ( 1900 )
□ Individual teeth were
simply ligated to this
expansion arch
□ First to utilize stationary
anchorage or bosily
control of first
permanent molar teeth
which were fitted with
clamp bends
□ Expansion arch was
threaded to form a
traction screw
arrangment attached
to the buccal of www.indiandentalacademy.com
anchor bands

E - ARCH
DISADVANTAGES:
□ It can deliver only
heavy interrupted
force
□ Capable only of
tipping teeth to a
new position
□ Was not able to
precisely position
any individual teeth

Angle’s E - Arch


PIN AND TUBE APPLIANCE
(1910)
□ First appliance that employed a bracket
and used bands on most of the teeth
□ Angle placed bands on other teeth apart
from molars and used a vertical tube on
each tooth into which a soldered pin from a
smaller archwire was placed
□ Tooth movement was accomplished by
repositioning the individual pins at each
appointment

(1910)
□ These pins were
repositioned at
each appointment
through the process
of resoldering to
effect gradual
straightening of the
arch to ideal


( 1910 )
DISADVANTAGES:
□ An incredible degree of craftsmanship was
involved in constructing and adjusting this
pin and tube appliance
□ Relatively heavy base arch meant that
spring qualities were poor
□ Many small adjustments were needed
□ Only Angle himself and one of his students
ever mastered the appliance

RIBBON ARCH APPLIANCE ( 1915 )
□ Angle attempted to achieve threeaxis control of tooth movement when
he introduced the Ribbon Arch in 1916
, a rectangular 0.036” x 0.022” gold
arch wire held firmly with pins into
vertically positioned rectangular slots


RIBBON ARCH APPLIANCE


(1915)
□ Angle modified the tube on each tooth to
provide a vertically positioned rectangular
slot behind the tube
□ A ribbon arch of 10 X 20 gold wire was
placed into the slot and held with pins
□ Was an immediate success primarily
because the archwire was small enough to
have good spring qualities and was quite
efficient in aligning malposed teeth

(1915)
□ The ends of the ribbon arch were threaded,
and the malocclusion was “ironed out”
through expansion
□ The ribbon arch wire was smaller in the
horizontal direction, therefore possessing
better spring qualities, and this was the first
appliance with full three-axis control of tooth
movement (especially the incisors and
canines)
□ However, the ribbon arch still had relatively
poor control of root positions, especially in
the premolar regions

DISADVANTAGES
□ Provided relatively poor control of root
position
□ Resiliency of the appliance did not
allow generation of moments
necessary to torque roots to a new
position


EDGEWISE APPLIANCE (1928 )
□ Angle re oriented the slot from vertical to
horizontal and inserted a rectangular wire
rotated 90 degrees to the orientation it had
with the ribbon arch
□ Dimensions of the slot were altered to 22 x 28
mils and a 22 x 28 precious metal wire was
used
□ These dimensions arrived after excessive
experimentation did not allow excellent
control of crown and root position in all
three planes of space

EDGEWISE APPLIANCE (1928 )
□ Rectangular brackets with gingival and occlusal
wings were soldered to bands at the center of the
labial surface, and ¾ rings (“doughnuts”) were
soldered off –center to correct rotations
□ This appliance soon became the most popular
appliance in the U.S., as it was the first to move
teeth in all three planes of space simultaneously,
and it controlled premolars because the wider
dimension of the arch wire was in the horizontal
dimension
□ Modern appliances are based on Angle’s edgewise
concept, only with several modifications and
variations

EDGE WISE BRACKETS


EDGEWISE BRACKETS BONDED ON
TEETH


OTHER EARLY FIXED APPLIANCE
SYSTEMS


LINGUAL ARCH
□ John V. Mershon
introduced his lingual
arch in 1908 , made of
0.036” or 0.040” gold
arch with auxiliary
spring that were used
during growth with
intermittent rest
periods, and was
considered the first
“invisible appliance.

LINGUAL ARCH

LABIOLINGUAL APPLIANCE
□ Between 1920 and 1940, Mershon
developed the Labio-Lingual appliance
made of labial and lingual 0.040” gold wires
with banded incisors and premolars
□ The attachments, limited only by the
practitioner’s creativity, were only able to tip
teeth, yet teeth had functional freedom
□ Bands were placed on first molars and a
combination of heavy lingual and labial
archwires to which finger springs were
soldered to move individual teeth

LABIO LINGUAL APPLIANCE


OPEN TUBE APPLIANCE
□ In 1922, James McCoy
developed the opentube appliance, in
which an 0.030” or
0.036” gold round arch
wire was inserted into a
horizontal bracket (a
tube with 40% cutout),
so there was no torque
control and this “selfligation” was brutal

OPEN TUBE APPLIANCE


UNIVERSAL APPLIANCE
□ Spencer R. Atkinson (1886-1970)invented the
Universal appliance in 1929,which was introduced in
1937 as a combination of the ribbon-arch and
edgewise appliances, and followed Oppenheim’s
theory of using light forces
□ All permanent teeth were banded and the
operator could use a round wire and/or a ribbon
arch wire; where the round gingival wire could
achieve mesio-distal and extrusion - intrusion
movements, and the ribbon occlusal wire would
accomplish rotations and buccolingual movements
□ The West’s first orthodontic supply house, Unitek
Corporation, made the first brackets for the
Universal Technique

ATKINSON’S UNIVERSASL
APPLIANCE


TWIN WIRE APPLIANCE
□ E. Johnson (1888-1969)
introduced the Twinwire appliance in 1932 ,
in which incisors and
molars were banded,
twin 0.010” steel arch
wires were used that
were more physiologic
than one heavy arch
wire
Joseph E. Johnson

TWIN WIRE APPLIANCE
□ Bands were placed on incisors and
molars
□ Twin 10 mil steel archwires for
alignment of incisor teeth
□ Delicate wires were protected by long
tubes that extended forward from the
molars to the vicinity of canines


TWIN WIRE APPLIANCE
□ The twin-wire
appliance
successfully aligned
incisor teeth,
effectively leveled
and derotated, and
was more
comfortable
because of lighter
forces

DISADVANTAGES
□ None of these appliance were
capable of more than tipping
movements except with special and
unusual modifications
□ Lacked anterior torque control, and
did not control canines or premolars,
and was not suitable for extraction
cases
□ Disappeared from contemporary use

Dr.R.D.Robinson ( 1915 )
□ Developed an appliance that utilized
light forces with constant control of
roots of teeth
□ Attachments and wire he used made
employment of differential forces
impossible


Dr.E.M.GRIFFIN ( 1930 )
□ Developed a resilient arch assembly
□ Center sections of brackets were
soldered to arch wire, preventing free
tipping and sliding of teeth on the wire
□ Lingual arch wires were also employed


CHARLES TWEED
□ C. H. Tweed perfected a technique in the
1940s using tip-back bends to facilitate
retraction and close spaces in spite of the
limitations imposed by Angle's slot
□ In 1941, he wrote, "…[C]uspid tip back
bends are necessary. Their purpose is to
break down the…toe hold…present in the
cuspid regions”
□ His results were excellent, but the price, as
measured in long appointments, wire
bending, and patient cooperation, was
extremely high

CHARLES TWEED
□ Adapted the edge wise
appliance for extraction
treatment
□ Tweed moved the teeth
bodily and used the
subdivision approach for
anchorage control, first
sliding the canines distally
along the archwire , then
retracting the incisors

CHARLES H.TWEED

P.RAYMOND BEGG
□ In 1933, P.Raymond Begg (1889 1983 ) developed his own bracket
because he found it difficult to close
extraction spaces and correct deep
overbites using the edgewise
appliance


BEGG APPLIANCE
□ RAYMOND BEGG had
been taught use of ribbon
arch at ANGLE SCHOOL
□ Working independently, he
concluded that extraction
of teeth was often
necessary and set out to
adapt the ribbon arch
appliance so that it could
be used for better control
of root position

Raymond S.Begg

BEGG APPLIANCE
□ By the late 1920s, Begg had reverted to the
use of ribbon-arch brackets
□ They permitted all teeth to tip to facilitate
anteroposterior interarch corrections and to
close extraction spaces. However, at that
time Begg also lacked an efficient means of
mesiodistal axial control
□ This forced him to select cases for
publication, as Angle did with his traction
screws, that required little or no root
uprighting

BEGG APPLIANCE
□ The Begg appliance consists of a narrow ribbonarch bracket turned upside down, single stainless
steel round archwires (0.016” or less), greater
interbracket distance, and interbracket loops to
control the degree and duration of force
□ In the 1960s, Begg invented both the uprighting
spring and torquing auxiliaries
□ These enabled him and many others to utilize
differential tooth movement, crown tipping
followed by root uprighting, to consistently treat the
most difficult of malocclusions


(a) Original mesiodistal uprighting spring
introduced by Begg in 1961 for use with
modified ribbon-arch brackets
(b) Combination spring and lock pin (1974)
eliminates need for ligation


BEGG APPLIANCE
□ Begg’s adaptation took three forms
1. He replaced the precious metal ribbon
arch with high strength 16 mil stainless steel
wire ( 1930 )
2. He retained the original ribbon arch
bracket but turned it upside down so that
the bracket slot pointed gingivally rather
than occlusally
3. He added auxiliary springs appliance for
control of root position

BEGG APPLIANCE
□ Treatment with this appliance was
challenging during the finishing stage due to
poor root torque control
□ To address the difficulties with final root
positions, some practitioners began using
the combination twin edgewise and lightwire technique : first stage using 0.016”
stainless steel single strand for tipping,
second stage of multistrand (6 x 0.008” or 4 x
0.009”) wires for controlled general
alignment, and a third stage of engaging a
final edgewise wire

BEGG APPLIANCE
□ Friction was minimized because the area of
contact between the narrow ribbon arch
bracket and archwire was very small and
force of the wire against the bracket was
small
□ Begg’s strategy for anchorage control was
TIPPING / UPRIGHTING
□ Begg appliance is still in use though it has
declined in its popularity and often appears
now in a hybrid form, with brackets that
allow the use of rectangular wires in finishing

CONTEMPORARY EDGEWISE
□ Contemporary edgewise appliance
has evolved far beyond the original
design while retaining the basic
principle of a rectangular wire in a
rectangular slot and now is more
efficient than the begg appliance –
which is the reason for its almost
universal use now

TIP EDGE BRACKETS
□ Peter C. Kesling developed the Tip-Edge bracket
(trademarked by TP Orthodontics) in 1986, by
removing opposite corners of the edgewise
bracket, to allow mesial and distal crown tipping
during initial stages and engagement of
rectangular wires for torque control during finishing
stages
□ The effective Tip-Edge slot increases with tipping,
while the conventional edgewise slot size decreases
□ The bracket also features lateral wings for rotational
control, and tie wing notches and a vertical slot for
use with auxiliaries

Modification of Angle's edgewise archwire slot into
a Tip-Edge slot
(a) Original slot with parallel opposed upper and
lower surfaces
(b) Removal of diagonally opposed corners to
permit free crown-tipping in one direction only
(c) Addition of lateral wings for increased rotational
control plus tie wing notches and vertical slot for
auxiliaries


LAWRENCE F.ANDREWS
□ The most revolutionary advancement in
orthodontics within the past 50 years has been
Lawrence F. Andrews’ development of the StraightWire Appliance (SWA) in 1970
□ This pre adjusted appliance soon became the
standard of the specialty
□ The SWA was based on measurements of 120 nonorthodontic normal cases, from which Andrews
described the “Six Keys to Normal Occlusion.”
□ He designed individual brackets for each tooth
type to work without wire bending, because he
found that when in optimal occlusion, there exists
extensive similarities in morphology and position of
normal tooth types

STRAIGHT WIRE APPLIANCE
□ From his extensive measurements, Andrews
determined the average tip and torque angles and
in/out dimensions of the labial surface of each
tooth relative to a flat labial arch wire plane,
coined the “Andrews’ Plane”
□ When each pre adjusted bracket was precisely
positioned at the midpoint of each tooth’s facial
axis, the brackets formed the Straight-Wire
Appliance
□ He also developed a series of extraction brackets
which include anti-tip and anti rotation
components not found in the Standard SWA
prescription

OTHERS
□ Use of Andrews’ prescription throughout the
specialty has shown that ideal tooth
positions are sometimes not achieved with
straight wires alone, and therefore numerous
additional prescriptions have been
developed by others, including Roth,
Ricketts, Alexander (1978 ), Hilgers, Burstone,
Root/Tweed, Cetlin, Bench, Creekmore,
Hasund, Orthos,and McLaughlin/Bennett
(1997 – 2001 ) / Trevisi

EVOLUTION OF BRACKETS


CONCLUSION
□ Orthodontic appliance technology
continues to develop
□ Self-ligating brackets, computerized bracket
placement, esthetic brackets and implant
anchorage are currently making history
□ However, without a good diagnosis and
treatment plan, and careful management
of the treatment process, improved
appliances cannot bring us closer to ideal
treatment goals

REFERENCES
□ Wahl, N. “Orthodontics in 3 millennia.”
(Chapter 1: Antiquity to the mid-19th
century.) Am J Orthod Dentofacial
Orthop;127:255-259; 2005.
□ ArchWired. “A Brief History of Braces.” p.
Review of Orthodontic History; 2005
(Chapter 2: Entering the modern era.) Am J
Orthod Dentofacial Orthop;127:510- 515;
2005

REFERENCES
□ Kesling, P. “The Edgewise Slot: Angle’s
Orthodontic Albatross.” World Journal
of Orthodontics;1:142-151; 2000.
(Chapter 5:The American Board of
Orthodontics, Albert Ketcham, and
early 20th-century appliances) Am J
Orthod Dentofacial Orthop;128:535540; 2005

REFERENCES
□ Proffit, W.R., White, R.P., Sarver, D.M.
Contemporary treatment of dentofacial
deformity. St. Louis, Mo.: Mosby;p. ix, 751 p.;
2003.
□ Dewel, B.F. “The ribbon arch. Its infl uence in
the development of orthodontic
appliances.” Angle Orthod; 51:263-268;
1981.
□ Strang, R.H. “Highlights of sixty-four years in
orthodontics.” Angle Orthod ; 44:101-112;
1974.

REFERENCES
□ Wahl, N. “Orthodontics in 3 millennia.” (Chapter 6:
More early 20th-century appliances and the
extraction controversy) Am J Orthod Dentofacial
Orthop; 128:795-800; 2005
□ Begg, P.R, Kesling, P.C. “The differential force
method of orthodontic treatment.” Am J
Orthod;71:1-39;1977.
□ Kesling, P.C. “Dynamics of the Tip-edge bracket.”
Am J Orthod Dentofacial Orthop;;96:16-25; 1989.
□ Graber, T.M, Vanarsdall RL. Orthodontics : current
principles and techniques. St. Louis: Mosby; 2000.


REFERENCES
□ Andrews, L.F. Straight Wire: The
Concept and Appliance.San Diego,
CA: L.A. Wells Co.; 2003.


Thank you
For more details please visit


Development of Contemporary Fixed Dental Appliances

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

En vedette

En vedette (10)

Similaire à Development of Contemporary Fixed Dental Appliances

Similaire à Development of Contemporary Fixed Dental Appliances (20)

Plus de Indian dental academy

Plus de Indian dental academy (20)

Dernier

Dernier (20)

Development of Contemporary Fixed Dental Appliances