Orthodontic appliance /certified fixed orthodontic courses by Indian dental academy

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

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Removable Appliances
Introduction:-

• Definition:Orthodontic appliance are devices
by means of which mild pressure may
be applied to a tooth or group of teeth
& their supporting structure so as to
bring about necessary changes within
the bone which will allow tooth
movement.
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Classification:• Broadly classified into two groups
Mechanical
-removable
-fixed
Myofunctional
-removable
-fixed
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• Classification of removable
appliances:1)According to Graber & Neumann:a) Active appliances-force within the
appliance.
b) Functional appliances-use muscular
forces.

2)According to the function of
removable appliances:-

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a)For buccal or labial movement:
-Z spring
-T spring
b) For lingual movement:
-Canine & premolar spring
-Molar spring
-Soldered auxillary spring
c) For mesial & distal movement:
-Finger spring
-Expansion screw
-Canine retractors
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d) Spring for expansion:
-Coffin spring
-Screw appliance
e)Extrusion & intrusion of teeth:
-Anterior bite plane
-Posterior bite plane
-Inclined plane
f) Habit breaking appliances:
-Tongue spikes,cribs for tongue thrust.
-Lip bumper for lip sucking.
-Oral screen for mouth breathing.
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g)According to attachment:i) Attachment at one end- Cantilever spring
ii) Attachment at both end- Labial bow
h)Number of arms in spring:i) Single cantilever- Finger spring
ii) Double cantilever- Z spring
i)According to the coil:i) Spring with coil- U shape canine retractor
ii) Spring without coil- Helical coil canine
retractor
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j)According to the placement:i)Buccal spring/Labial springHelical canine retractor
ii)Palatal/Lingual springFinger spring, Z spring
k)According to force applied:i)Push type-Labial wire of removable
appliance
ii)Pull type- Retraction ligature

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l)According to amount of pressure applied:-Heavy pressure
-Light pressure
m)According to mode of adhesion:-Bonding
-Banding
n)Functional/muscle motivating orthodontic
appliance are divided into thre broad
categories[Graber Neumann]
Group I-Teeth supported appliance
eg:Inclined planes,Oral sheilds
Group II-Teeth/tissue supported appliance
eg:Activator , Bionator
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Group III- Vestibular positioned appliance
eg: Frankel functional regulator
Oral screens
o) Schwarz recognized the intimate relationship
of force magnitude & tissue response &
classified orthodontic force into four degrees
of biological efficiency [Graber Neumann]
i) First degree of efficiency:
The orthodontic force in the first degree of
efficiency are below the threshold of
stimulation needed to activate orthodontic
tooth movement or they are balanced by
compensatory forces.
eg: Frankel appliance m

ii) Second degree of efficiency:
are that type of forces that are most
favorable to achieve continuous tooth
movement without root resorption.
Resorption of alveolar bone in the
pressure zone will happen at the same
rate as deposition in the area of tension.
iii) Third degree of efficiency:
are that forces that can interrupt the
blood circulation in the periodontal
membrane. They are of medium strength
20-50 gm/cm. The tissue are not yet
crushed.
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iv) Fourth degree of efficiency:
are of such magnitude that the periosteal
membrane is crushed between the root &
alveolar bone in the area of greatest
pressure. If continuous, the consequence is
extensive necrosis of alveolar bone & root
resorption. Irreparable may be caused to the
tissue involved.

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Components:• In removable orthodontic appliancesI. Active components
spring
bows
screws
elastics
II. Passive components
clasp
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III. Base plate
• In fixed orthodontic appliancesI. Active components
seprators
archwires
elastics
elastomerics
springs
magnets
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II. Passive components
bands
bracket
buccal tubes
lingual attachments
→lingual buttons
→lingual seating lugs
→lingual eyelets
→lingual cleats
→lingual sheaths
→ lingual elastilugs
→lingual ball hooks
→lock pins
→ligatures wires
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Ideal requirements
• Biologic requirements
• Mechanical requirements
• Esthetic requirements
• Hygienic requirements

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• Classification of spring:
According to attachment:i) Attachment at one end- Cantilever spring
ii) Attachment at both end- Labial bow
Number of arms in spring:i) Single cantilever- Finger spring
ii) Double cantilever- Z spring
According to the coil:i) Spring with coil- U shape canine retractor
ii) Spring without coil- Helical coil canine
retractor
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Spring wrapped around heavy wire:
eg: Apron spring.

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Removable orthodontic
appliances
• Active components
* Springs
i) Finger spring:-most important
removable orthodontic
appliances.
-used for mesiodistal
movement of the teeth.

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ii) Z spring:It is used for labial
movement of
incisors &
correction of minor
rotations.

iii) T spring:It is used for the
buccal movements
of the premolars &
canine.
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iv) Mattress spring:used for the
correction of labial
movement of the
teeth in crossbite
where sufficient
space available for
tooth movement.
v) Helical coil
spring:used to regain lost
extraction space.
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vi) Coffin spring:Introduced by
WALTER COFFIN in
1881.
It is an omega
shaped spring
which helps to
bring about arch
expansion.

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vii) Canine
retractors:#Buccal self
supported canine –
→ It is made up of
0.7mm wire. It consists
of active arm, helix of
3mm diameter & a
retentive arm. Coil is
placed distal to long
axis of canine.
→ indicated in case
where canine is
buccally place &
placed high in
vestibule.
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#Palatal canine
retractor:→Made up of 0.6mm
stainless steel wire. It
consists of active arm,
helix coil,& a guiding
arm.
→It is indicated in case of
palatally placed canine
which required
retraction.

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#Helical canine
retractor:→Also called reverse loop
canine retractor. Made up
of 0.6mm wire.
→It consist of active arm,
retentive arm & coil of
3mm of diameter.
→Activation done either by
opening the coil by 2mm
or by cutting 2mm of free
end & readapt it around
the canine.
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# U loop canine
retractor:→Made up of 0.6-0.7mm
round stainless steel
wire.It consists of U loop,
active arm & retentive
arm.
→U loop placed 2-3mm
below the cervical margin.
→It is used when minimum
retraction (12mm)required.
→ It is easy in fabrication &
less bulky.
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• Bows:i)Short labial bow:→Made up of 0.7mm
round stainless steel
wire.It is constructed in
such a way that the bow
contacts the most
prominent labial
surfaces of anterior
teeth.
→It is used for retention
purpose as well as
minor overjet reduction
& anterior space
closure.
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ii) Long labial
bow:→It is just the modification of
short labial bow. It extends
from first premolar to first
premolar of opposite side.

iii)Split labial bow :→Modification of short
labial bow. It is split in
the middle.Effective in
anterior retraction &
closure of midline
diastema.
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iv)Robert’s
retractor:Made up of 0.5mm
wire.It extends from
labial surface of
canine to canine
instead of a regular
loop it incorporates a
3mm internal
diameter helix at the
base of the loop.The
distal arm of the loops
are supported in
softened stainless
steel tubes of 0.5mm
internal diameter.

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v) Reverse labial bow
It’s the modification of
conventional bow. In
this there is a U loop &
activation of the
applianceis done by
opening the loop.
vi) Mills retractor:It’s also modification of
conventional bow.It is
used in patients with
increased overjet.But
due to it’s complex
design & poor patient
complience it is not
widely used.

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vii)High labial bow
with apron spring:It extends high in the
vestibule. It is made up of
thicker gauge wire & onto
which thinner gauge of
wire of 0.4mm wire is
attached for the retraction
of one or more upper
anterior teeth.

viii) Fitted labial
bow:It adapts the contours of
the labial surface of
the teeth & used for
retention purpose.
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• Screw:It’s active component of
the removal
appliance.It is
activated by the
patient by using a
key.Mainly it can bring
about three types of
movements-Expansion of arch.
-Movement of teeth or
group of teeth in buccal
or labial direction.
- Movement of teeth or
group of teeth in
mesial or distal
direction.
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• Advantage of screw over the
spring:1) Easier to manage.
2) Less chair side time required.
3) Fewer tendencies to get dislodged
ideal tooth movement is achieved by
turning the screw a quarter turn
every 3-7 days.
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• Elastics:-seldom used .
-generally used for
anterior retraction
with labial bow.
-Advantage
:Aesthetically
acceptable.
-Disadvantage
: can cause gingival
trauma.
:risk of arch form
getting flattened.
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• Passive components
Clasp:
It is a retentive component of the
removable appliance which helps in
keeping the appliance in place &
resist the displacement of the
appliance.
Mode of action:
Clasps acts by engaging certain
constricted areas of the teeth that
are called undercuts
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• Two types of undercuts are found in
natural dentition
1)Buccal & lingual undercuts“C”clasp & Jackson’s clasp.
2)Mesial & distal undercutsAdam’s clasp & Crozat clasp.

• Requirement of the clasp
1)Should offer adequate retention.
2)Can use in partially & fully erupted teeth.
3)Easy to fabricate.
4)Should not apply active force.
5)Should not impinge soft tissue.
6)Should not interfere with normal
occlusion.
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1) Circumferential clasp:
→also called Three quarter or C
clasp.
→Parts :-Circumferential
retentive tip, interocclusal
arm, retentive arm.
→Advantages:
i)Easy to fabricate.
ii)Simple in design.
→Disadvantage:
Can not used in partially
erupted teeth.
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2)Jackson’s clasp:
→Also called U clasp or Full
clasp.
→Advantage:
-Easy to construct.
-Offer adequate retention.
→Disadvantage:
-Inadequate retention in
partially erupted teeth.

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3) Adams clasp:-By C.P.Adams.
-Also called as Liverpool
clasp,Universal
clasp,Modified
arrowhead clasp.
-Parts…Two
arrowheads,Bridge,Two
retentive arms.
Advantagesi)Rigid & offer good
retention.
ii)Can used in partially
erupted teeth.
iii)Can give in permanent
& deciduous teeth.
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• Modifications of Adams clasp:-

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4)South end clasp-Used for retention purpose
in anterior region.
-The wire adapted on the
cervical margin of both
central incisors.
5)Triangular clasp-Small triangular shaped
clasp between two
adjacent posterior teeth &
engages the proximal
undercut.
-Use: whenever additional
retention needed.
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6)Ball end claspThis appliance have a
ball like structure on
one end.This ball can
be made with the help
of silver solder. The
ball engages the
proximal undercut
between two adjacent
posterior teeth.
Indication:
Whenever additional
retention is needed.
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7)Crozat clasp-Resembles full clasp but an
additional piece of wire
soldered which engages in
mesial & distal proximal
undercut.

8)Schwartz clasp-Also called arrowhead clasp.
-Engages in interproximal
area between premolar &
molar.
-Provide adequate retention.

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• Disadvantage of
Schwartz clasp:1)Need special
arrowhead forming
plier.
2)Occupies large amount
of space in buccal
vestibule.
3)Can injure inter dental
soft tissue.
4)Difficult to fabricate &
time consuming.
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• Base plate:-It is made up of cold cure acrylic resin.
-The primary function of base plate is to
incorporate all the components together
as a functional unit.
-Helps in anchoring the appliance in place.
-Provide support to wire components.
-Helps in distributing forces over a larger
area.
-It’s thickness should be 1.5-2 mm
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FIXED ORTHODONTIC
APPLIANCES
• Advantages:1)Precise tooth control is possible.
2)Multiple tooth movement is possible.
3)Patient co-operation is reduced.
• Disadvantage:1)Difficult to maintain oral hygiene.
2)Unesthetic
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3)Special training required.
4)Increased cost of treatment.
5)Increased chair side time.
6)Anchorage control is difficult.
a) Active components:
1)Separatorsthey are used to create space
between two adjacent teeth
generally for the purpose of
banding.
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i)Soft brass wires:
-0.5-0.6mm diameter
wire passed
interdentally &
twisted to create
space.
-Painful & can cause
gingival trauma.
ii)Ring separators:
-Small elastic rings that
are stretched &
passed through
interdental contacts
with separator
placing pliers.

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iii) Dumb-bell
separators:
- Dumb-bell shaped
pieces of elastics
that is stretched &
passed through the
contact between
adjacent teeth.
- The elastics of the
separators
constricts over a
period of time to
regain it’s original
space & cause
separation.
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2)Elastics:-Can be of latex or no

latex.Non latex deteriotes
less than latex in oral
environment.

i) Class I elastics:
It is used for closing the
extraction space.

ii) Class II elastics:
These intermaxillary
elastics are used to
produce intrusion of
maxillary anterior or
decrease the overjet by
retracting maxillary
anterior teeth.
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iii) Class III elastics:
Used in treatment of
Class III
malocclusion to
bring about
retraction of
mandibular anterior
& protraction of
maxillary molars.
iv)Diagonal elastics:
For correction of
midline deviations
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v)Cross bite elastics:
Mainly to correct the
cross bites in
buccal segments.
vi)Box elastics:
-Used to correct the
anterior open bite.
-Causing distal
tipping of maxillary
anteriors &/or
force eruption of
maxillary &/or
mandibular
incisors.
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vii)Extraoral elastics:
-Used in conjuction
with the extraoral
appliances like a
face mask.
-Generally exert
high forces.

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3) Elastomerics:
Made up of synthetic
polyurethane
material

i) Elastic chain:
-Also called E chain.
-Mainly used for space
closure.

ii) Elastic threads:
-Made of specialized
elasticized cotton.
-Used to exert forces
which are used to
correct derotations &
reduction of anterior
spacing.
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iii) Elastic ligatures:
-Used to secure the
arch wire in
edgewise or
preadjusted
edgewise bracket.
-They can be easily
engaged under the
bracket wings.
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4)Spring :
These are used along
with the fixed
orthodontic
appliances.They are

i) Uprighting spring-Made up of 0.012-0.014”
Australian wire.
-Move tooth root in
mesial or distal
direction.
-Standard spring used in
Begg’s and Tip
edgewise bracket
-Side winder design made
for Tip edge bracket.
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ii)Rotating spring:
- Provide simple &
effective means of
derotating teeth without
removal archwire.

iii)Torquing spring:
- Made of 0.012-0.014”

Australian wire.
-Capable of moving tooth
roots in labial or lingual
direction
-Force is transmitted to
the crown by spurs,
which contact the teeth.
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iv)Open coil spring:
-Made up of stainless
steel wire or Ni-Ti
wire.
-Used for opening of
the space.
v) Closed coil spring:
-Made up of stainless
steel wire or Ni-Ti
wire.
-Used for closing of
the space.
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5) Magnets :
Are used for opening or closing spaces.
Normally used magnets are-Samarium cobalt magnets
-Neodymium iron boron magnets
6) Archwires:
i)According to the cross section
-Round
-Square
-Rectagular
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2) Based on the material constituent:
-Gold
-Stainless steel
-Chrome cobalt
-Nickel titanium
-Beta titanium
-Alpha titanium
-Titanium niobium alloy
-Multistranded wires
-Composite wires
-Optiflex wires
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3)Based on diameter of wire:
a) Round
-0.08”
-0.010”
-0.012”
-0.014”
b) Square
-0.16”x0.16”
-0.17”x0.17”
c) Rectangular
-0.17x0.25”
-0.17x0.28”
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4) Based on microstructural
arrangement:
- Simple cubic
- Face centered cubic
- Body centered cubic
i) Gold:
Gold alloy is used prior to the
1930s.They were
inert, biocompatible &
enviromentally stable.
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• Composition:
Gold – 15-65%
Copper- 11-18%
Silver- 10-25%
Palladium – 5-10%
Nickel – 1-2%
Zinc – traces
Advantageous properties:1) Extremely formable.
2) Strength can be increased by heat treatment as
well as cold working.
3) Low modulus of elasticity.
4) Good environmental stability.
5) Excellent biocompatibility.
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Disadvantageous properties
1) Low yeild strength.
2) Low spring back.
3) High cost.

ii) Stainless steel:
Introduced by Wilkinson in 1929.
Composition:
Iron – 71%
Chromium- 18%
Nickel- 8%
Carbon – Less than 0.2%
Advantageous properties:
1) High stiffness.
2) High yield strength.
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3)High resilience.
4)Good formability.
5)Good environment stability.
6)Adequate spring back.
7)Biocompatible
8)Corrosion resistance.
9)Economical.
Disadvantageous properties
1)Lower spring back.
2)High modulus of elasticity.
3)Most frequent activation required to maintain
same force level.

iii)Chrome cobalt :
Also known as Elgiloy.

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Composition :
Cobalt- 40%
Chromium- 20%
Nickel- 15%
Iron – 15.4%
Molybdenum- 7%
Manganese- 2%
Beryllium- 0.4%
Others – 0.05%
The alloy is manufactured in four tempers
depending on the amount of cold work.
→Blue : Soft and easy to bend.
→Yellow : Ductile
→Green : Semi resilient
→Red : Resilient www.indiandentalacademy.co
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Advantages:
1)Excellent tarnish & corrosion.
2)Good resistance to distortion.
3)Good resistance to fatigue.
4)Good formability.
5)Functionally remains active for longer duration.

Disadvantages:
1)Has to be heat treated.
2)Soldering is demanding.
3)High modulus of elasticity cause higher forces to
be delivered.

iv) Nickel titanium:
-Also called Nitinol. Develops in 1971.
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Composition:
Nickel- 55%
titanium- 45%

Advantage:
1)High spring back.
2)High stored energy.
3)High elasticity.

Disadvantage:
1)High friction as compared to stainless steel.
2)Low stiffness can’t be used at the completion
stage of orthodontic treatment.
3)Fracture easily if bent over a sharp edge.
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4)Limited bending is possible.
5)Can’t be welded or soldered.
6)Expensive.

v) Beta titanium:
Also called as TMA wire. In these wire BCC structure is
found.
Composition:
Titanium- 79%
Molybdenum- 11%
Zirconium- 6%
Tin -4%
Advantage:
1) High spring back.
2) High formability.
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3) Low modulus of elasticity.
4) Low load deflection rate.
5) Low stiffness .
6) Environmentally stable.
7) Excellent corrosion resistance.
Disadvantages:
1) More friction than stainless steel.
2) Become brittle on overheating.

vi)Alpha titanium:
Composition:
Titanium-90%
Aluminium-6%
Vanadium- 4%
This is made up of closely packed hexagonal
crystals.
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Vii) Titanium nobium alloy:
-Less stiffness as compared to TMA wires.
-Ideal as finishing wires.

viii) Composite wires:
-They are tooth colored wire which includes
fiberglass & aramid.

ix) Optiflex wires:
-these are composed of silicon dioxide core which
provides the force or resiliency to the wires.
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b)Passive appliance:
i) Bands:
These are the metal attachment that are cemented
to individual teeth provide a place for
attachment of other auxillaries like buccal
tubes, lingual buttons, etc. They can be
soldered or welded on band.Banding is
preferred on tooth that are likely to experience
excessive forces.

ii) Brackets:
A bracket is defined as a device that projects
horizontally to support auxillaries & is open on
one side usually in vertical & horizontal
direction.
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Classification:
1) According to type of slota)Ribbon arch
b)Edgewise

2) Based on mode of attachmenta)Weldable
b)Bondable

3)Based on material used to fabricate
the bracketa)Metallic
b)Ceramic
c)Plastic

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• Ribbon arch
bracket:
-vertical slot on
gingival direction.
-can bring about
tipping of teeth in
labiolingual &
mesiodistal
direction.
- used in Beggs fixed
appliance.

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• Edgewise
bracket-

-horizontal slot facing
labially.
-has rectangular slots
and accepts
rectangular cross
section wire.

• Weldable &
bondable
brackets-

-bondable brackets
bonded directly over
the tooth.It has
meshwork under the
surface.
-weldable brackets are
welded over the band.

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• Mettalic Brackets:
-made up of stainless steel.
-most commonly used.
Advantage:
-they can be recycled.
-can be sterilized.
-resists deformation & fracture.
-least friction at wire bracket
interface.
-not expensive
Disadvantage:
-esthetically not pleasing.
-can corrode & staining of tooth
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• Ceramic Bracket:
-introduce in 1980s.
-made of aluminium oxide
or zirconium oxide.
Advantage-dimensionally stable.
-durable & resists
staining.
-esthetically pleasing.
Disadvantage-brittle.
-exhibit greater friction at
wire bracket interface.
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• Plastic brackets
-made up of polycaronate
or modified form of
polycarbonate.
-improves the esthetic
value.
Disadvantage:
-Tends to discolour in
patient who smoke.
-Poor dimensional
stability.
-Slot tends to distort.
-Friction between plastic
brackets & metal arch
wire is high.

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iii) Buccal tubes:
These are horizontal hollow tubes which are used
in molars.
Classification:
• Based on mode of attachment:
-Weldable
-Bondable
• According to lumen shape:
-Round
-Oval
-Rectagular

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• According to number of tubes:
- Single
- Double
- Triple

• According to the technique:
-Begg tube
-Edge wise
-Preadjusted edgewise
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iv)Lingual
attachments:• Lingual buttonFor attachment of elastics &
elastomerics.

• Lingual seating
lugs:Helps in seating bands.
Flat-Anterior & molar.
Curved-Cuspid & bicuspid.

• Lingual eyelets:Used to tie elastic threads or
ligature wire.

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• Lingual cleatsUsed for attachments of elastic
thread & ligature wire.

• Lingual sheathsUsed for attaching accessories
such as transpalatal arch.

• Lingual elastilugsUsed for attaching elastics.
Curved – for posteriors
Flat – for anterior
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• Elastic ball hooks:-

-Ball attach to weldable
flat arm.
-Offset can be mesial or
distal.
-Used to attach elastics or
elastomeric chain from
lingual aspect.

• Lock pins:-

-Made of brass or soft
steel.-Used to hold the wire in
bracket slot.

• Ligature wire:-

-Are soft stainless steel
wire of 0.008-0.010”.
-Used to hold or ligate the
arch wire in bracket.

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FUNCTIONAL APPLIANCES
• Also called
Myofunctional
appliance.
• These appliance are
used for growth
modification
procedure that are
aimed at intercepting
& treating jaw
discrepancies.

Myofunctional appliances
Removable

Fixed

Activator, Bionator

Herbst appliance
Jasper jumper

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• Activator: By Anderson in 1908.
 Also called Norwegian
appliances.

Components-Labial bow
-Jack screw(Optinal in maxillary
arch)
-Acrylic portion

Indication1)Class
2)Class
3)Class
4)Class
5)Class

II Div 1 malocclusion
II Div 2 malocclusion
III malocclusion
I openbite malocclusion
I deep bite malocclusion
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Contraindication :1)Not used in correction of Class I problems.
2)In children with excess lower facial height.
3)Children with procumbent incisors.
4) Children with nasal stenosis.

Advantage :1)It uses existing growth of jaws.
2)Minimum oral hygiene problem.
3)Interval between appointment is more.
4) Appointments are usually short.
5) More economical.
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Disadvantage:1)Require patient cooperation.
2)Can’t produce precise detailing & finishing of
occlusion.
3)May produce moderate mandibular rotation.

Mode of activation :The activator induces musculoskeletal adaptation
by a new pattern of mandibular closure. This
appliances fits loosely in the mouth. The patient
has to move the mandible forward to engage the
appliance. This results in stretching of elevator
muscles of mastication which starts contracting
thereby setting up a myotactic reflex. In addition
to this myotactic reflex, a condylar adaptation by
backward & upward growth occurs.
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• Bionator:-By Balters in 1950s.
-Less bulky & elastic than
activator.
-3 types:
 Standard bionator
 Class III appliance
 The open bite appliance

1. Standard Bionator
-Used in treatment of
Class II Div 1 & Class I
malocclusion having
narrow dental arch.
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2)Class III appliances:Used in mandibular prognathism.
The palatal arch is placed in
opposite direction. The vestibular
wire runs over the lower incisors
instead of terminating at lower
canines.

3)The open bite appliances:Used in open bite cases. The palatal
& the vestibular arch wires same
as standard appliance. The
maxillary acrylic portion is
modified so that even the anterior
area is covered.
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• Indication:-Class II Div 1 malocclusion in the mixed dentition using
standard bionator under following condition
 Well aligned dental arches.
 Function retrusion.
 Mild to moderate dental discrepancy.
 Evidence of labial tipping is seen.

• Contraindication: Class II relation caused by maxillary prognathism.
 Vertical growth pattern.
 Labially tipped lower incisors.
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• Advantage:Less bulky.
Can be worn full time except during
meals.
Appliance exert a constant influence
on tongue & perioral muscle.

Disadvantage:Difficulty in correctly managing it.
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• Frankel Appliance:-Developed by Prof. Rolf Frankel.
-Also known as Functional regulator, Functional
corrector, Oral gymnastic appliance.

Principles1.
2.
3.
4.
5.

Vestibular arena of operation.
Sagittal correction via tooth borne maxillary
anchorage.
Differential eruption guidance.
Minimal maxillary basal effect.
Periosteal pull by buccal shields & pads.
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Types of functional regulators:FR 1- For treatment of Class I & Class
II Div 1.
1a-Class I malocclusion where minor to moderate
crowding is present.
-Class I deep bite.
1b-Class II Div 1 malocclusion where overjet does not
exceed 5mm.
1c-Class II Div1 malocclusion where overjet is more
than 7mm.

FR 2-ClassII Div 1 & 2.
FR 3- Treatment of Class III.
FR 4- treatment of open bite &
bimaxillary protrusion.
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FR 5-Functional regulators that
incorporate head gear.
-indicated in long face patient having high

mandibular plane angle & vertical maxillary excess.

Parts of Frankel 1aAcrylic parts-2 vestibular screen
-2 lip pads
Wire parts-Palatal bow
-Labial bow
-Labial support wire.
-Lingual bow
-Canine loops
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Part of Frankel 1b
Acrylic parts:-Vestibular screen
-Lip pad
-Lingual acrylic pad
Wire components:-Palatal bow
-Labial bow
-Labial support bow
-Lingual bow
-Canine loops
-Lower lingual spring

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Part of Frankel 1c
Acrylic components:-Buccal shields are split horizontally & vertically into
two parts
-Lingual acrylic pads
-Lip pads
Wire components
-Palatal bow
-Labial bow
-Labial support wire
-Lingual bow
- Canine loops

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• Parts of Frankel 2
-Most commonly used.
Acrylic components
Buccal shields
Lip pads
Lower lingual pad
Wire component
Palatal bow
Labial bow
Canine extensions
Upper lingual wire
Support wire for lip
pads
Lower lingual spring

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Part of Frankel 3
Acrylic components:Two upper lip pad(Tear drop
shape)
Lingual acrylic pad
Lower lip pad
Wire components:Palatal bow
Labial bow
Labial support wire
Lingual bow
Canine loop

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Parts of FR 4:-Same as FR 1&2 but lack of canine loops & protrusion
bow (lingual stabilizing bow).
-4 occlusal rests on maxillary first molar to prevent
tipping of appliance.
-Palatal bow is like FR 3 place distal to last molar.

Parts of FR 5:-Have buccal tubes for the incorporation of head gear.

• Twin block appliance:The twin block technique effectively combines inclined
planes with intermaxillary & extraoral traction. The
upper plate is retained by modified arrowhead clasp.
The clasp can incorporate a tube for attachment of a
face bow. Upper plate also have a jack screw in case
of maxillary expansion.
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It consists of bite block that covers
the palatal cusps of upper
posterior teeth extending
anteriorly till the mesial ridge of
upper second premolar.

The lower plate is retained by ballend clasp. The lower bite blocks
extend distally upon the distal
marginal ridge of second
premolar. The lower molar are
kept free to help in their eruption
if needed. The upper & lower bite
block interlock at 45°.
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• Herbst appliance:-Fixed functional appliance.
-Popularized by Pancherz(1979).
Indication-Dental Class II malocclusion.
-Skeletal Class II mandibular
deficiency.
Contraindication-Dental & skeletal open bite.
-Vertical growth with high
maxillomandibular plane angle.
-Excess lower facial height.
-Case prone to root resorption.
Disadvantage-Prone to breakage.
-Lateral movement www.indiandentalacademy.co
restricted.
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• Jasper jumper:Consists of two vinyl coated
auxillary spring which are fitted
to fully banded upper & lower
fixed appliances.

Indication –
- ClassII malocclusion.
- Deep bite with retroclined
lower incisors.

Contraindication :-Dental & skeletal open bite.
-Minimum buccal vestibule space.
-Vertical growth pattern with
increased lower facial height.

Disadvantage:www.indiandentalacademy.co
Oral hygiene compromised. m

Orthopaedic Appliances
•
•
•
1)

Head gear
Face mask
Chin cup
Head gear:-

-Most commonly used.
-Ideally indicated in patient with excessive
horizontal growth of maxilla with or without
vertical change along with some protrusion of
maxillary teeth.
-Most effective in prepubertal period.
-Used for distalization of molars.
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Components1)Face bow
2)Force element
3)Head cap /Cervical strap

 Face bow:
i)Outer bow- made up of 1.5mm
round stainless steel wire.This
can be short, medium or long.
ii)Inner bow- made up of 1.25mm
round stainless steel wire &
contoured around the dental arch
and fixed in buccal tube which is
fixed on maxillary first
molar.Stop are placed to prevent
sliding from tube.

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iii)The junction:It is a rigid joint of inner & outer bow. It is placed at
the midline of bows.
 Force element:It is the assembly which provide the force to bring
about the desired effect. This may comprises of
spring, elastics & any other stretchable material.
 Head cap:Used for anchorage purpose.

Principles of head gear: Centre of resistanceThe centre of resistance for a molar is usually at the
midroot region. Force applied through centre of
resistance cause bodily movement.
-if force pass below it- distal tipping of crown.
- if force pass above it- distal tipping of root.
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 Centre of resistance of maxilla:It is located above the roots of premolar teeth.
Force passing through it – translation of maxilla in
distal direction.
Force passing above and below it- rotation of
maxilla.
 Point of origin of force:i) Cervical
ii) Occipital
iii) Combination
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• Typesi)Cervical:
-Take anchorage from nape of
neck.
-Causes extrusion of molars.
-Can move maxilla & maxillary
dentition in distal direction.
-Indicated in low madibular angle
cases.
ii)Occipital:
-Take anchorage from back of
head.
-produce distal & superiorly
directed force on maxillary
dentition & maxilla.

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iii) Combination:Force exerted by both are equal
& distal & slight upward force
is exerted on maxillary
dentition & maxilla.

2)Face mask:-Also called Reverse pull head
gear or Protraction head gear.
-By Hickham in 1972.
-Parts
i)Forehead cap
ii)Metal frame
iii)Chin cup
-Used primarily for protraction
of upper teeth or www.indiandentalacademy.co
arch.
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Types of face mask:i)Delaire type of face
mask

ii)Tubinger type of face
mask

iii)Petit type mask

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• Chin cup:It is sometimes referred to is an
extraoral orthopaedic device that
covers the chin & is connected to
a head gear.
It is used to restrict the forward &
downward growth of mandible.
-Types :
Occipital pull chin cup
Vertical pull chin cup

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