FIXED APPLIANCE Prepared by Prepared by Dr. Hana Omar AL. Balbeesi Dr. Hana Omar AL. Balbeesi Orthodontic consultant Orthodontic consultant

Fixed Appliances : Are appliances attached to the teeth surfaces &are capable to generate a range of tooth movement more than RA. Are appliances attached to the teeth surfaces &are capable to generate a range of tooth movement more than RA. Brackets + Arch wires Brackets + Arch wires {generate force that can move teeth in three planes of space vertically, apically & rotationally }. {generate force that can move teeth in three planes of space vertically, apically & rotationally }.

Edge Wire Brackets :

Fixed appliances achieve tooth movement in 3 spatial planes First-order bends. Compensate tooth widths. First-order bends. Compensate tooth widths. Second-order bends. Achieve correct angulations or tilt of the tooth. Second-order bends. Achieve correct angulations or tilt of the tooth. Third-order bends. Only for rectangular arch wires. It exert bucco-lingual force on the tooth apex to torque it. Third-order bends. Only for rectangular arch wires. It exert bucco-lingual force on the tooth apex to torque it.

Indications for the use of FA: 1. Correction of mild to moderate skeletal discrepancies. 2. Intrusion/extrusion of teeth. 3. Correction of rotations.

4. Overbite reduction. 5. Multiple tooth movement. 6. Closure of extraction spaces,or spaces due to hypodontia. FA close the spaces + produce good contact between teeth. FA close the spaces + produce good contact between teeth.

Patient selection: 1. Patient maintain good oral hygiene. 2. Avoid hard or sticky food. 3. Cooperative patient. 4. Attend appointments regularly to adjust the appliance.

Components of fixed appliance : 1. Bands : a. Seated on molars or any tooth especially in crossbites. a. Seated on molars or any tooth especially in crossbites. b. Headgear can be used with them. b. Headgear can be used with them. c. Separation is a must. c. Separation is a must. d. Approximate the size in a study models. d. Approximate the size in a study models.

e. The edges should be flushed with marginal ridges. f. Bracket in the midpoint of the clinical crown or 90 % to the long axis of the tooth. g. Glass ionomer is used.

2. 2. Bonds : a. Acid etch and composite is used. a. Acid etch and composite is used. b. Mechanical interlock between bracket mesh & the composite. b. Mechanical interlock between bracket mesh & the composite. c. They are made of metal or ceramic. c. They are made of metal or ceramic.

Disadvantages of Ceramic Brackets: 1. Chemical bond between bracket & enamel surface causing tooth Fx during debonding. 2. Brittle they break easily & wings breaks, so tying of the wire is very difficult. 3. Hardness of it cause notching of the arch wire which make sliding of teeth difficult. 4. Wearing of opposing teeth not advisable to be used in the lower incisors.

3. Orthodontic adhesives : a. Cementation with glass ionomer because it can release fluoride & better affinity to stainless steal & enamel surface. b. Bonding with composite is better than glass ionomer.

c. Light-cure or self-cure acrylic resin. d. No mix-orthodontic composite. e. Despite any material used excess should be removed.

4. Auxiliaries : a. Elastomeric modules are easier to place & more comfortable to the patient. b. Ligatures are better in the late stages of treatment. c. Intra-oral elastics in 2, 3.5, & 4.5 oz strengths & a variety of sizes 1\8 or 3\4 inches changed every day. d. Palatal & lingual arches,quad helix some are preformed or made in the laboratory.

5. Arch wires : Presented in different cross sectional diameters, &/or different material construction a. Flexible wires in initial stages or alignment stage. b. Rigid wires in the late stages of treatment.

Arch Wires Physical Properties : 1. Spring back : wire returns to original shape & resist deformation. 2. Stiffness : greater diameter stiffness. 3. Formability : bending of the wire to any desirable shape.

4. Resilience : the stored energy after deflection without deformities. 5. Biocompatibility. 6. Joinability : if the material can be soldered or welded. 7. Frictional characteristics: wires with low surface friction is preferred.

Types of wires : 1. Stainless steal : preferred in later stages of treatment (multi-strand & or twistflex ). 2. Nickel titanium : more flexible, greater resistance to deformation but expensive.

3. Cobalt chromium (can be readily formed & R & S by heat ). 4. TMA or B-Titanium. 5. They are either round (0.016 = 0.4 mm) or rectangular (0.016 × = 0.4 × 0.55 mm, can be straight or coil in a spool or preformed.

Treatment planning for fixed appliances : 1. Anchorage is important headgear &/or a palatal or lingual arch should be placed. 2. Lower arch form should be preserved.

Practical procedures : 1. Pre-adjusted system brackets will be in the middle of the tooth along the long axis. 2. Improper bracket position incorrect tooth position,& affect function & esthetics. 3. Mesiodistal movement of the teeth can be achieved by sectional or sliding teeth along the arch wire. 4. Patient should be seen every 4-6 weeks.

Fixed Appliance System : 1. Pre-adjusted appliance or straight wire appliance (Andrews’ & Roth systems are the best). 2. Begg appliance. 3. Tip edge appliance.

Tip edge appliance : It combines the advantages of both Straight Wire & Begg systems. It combines the advantages of both Straight Wire & Begg systems. It allows tipping of the tooth in the initial stages with round wires & better tooth positioning in the final stages with rectangular arch wires. It allows tipping of the tooth in the initial stages with round wires & better tooth positioning in the final stages with rectangular arch wires.

Decalcification of fixed appliance : Fixed appliance plaque accumulation Fixed appliance plaque accumulation demineralization by %. demineralization by %.

Approaches to Reduce Decalcification 1. Fluoride mouth rinses regularly. 2. Fluoride containing cements & bonding adhesives. 3. Dietary advise chewy sweets, sugared beverages & fizzy drinks between meals should be avoided during treatment.

Starting with Fixed Appliance Starting with Fixed Appliance Skillful orthodontist : Skillful orthodontist : Knowledge with diagnosis & treatment planning before treating any patient. Knowledge with diagnosis & treatment planning before treating any patient.

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