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Bracket prescription(Orthodontics)

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Bracket prescription(Orthodontics)

  1. 1. BRACKET PRESCRIPTION DR. MUHAMAMAD SHARIQ SOHAIL PGR ORTHODONTICS FMH COLLEGE OF MEDICINE AND DENTISTRY
  2. 2. PRESENTATION OUTLINE • Introduction • Types of Brackets • Types of Brackets prescriptions
  3. 3. ORTHODONTIC BRACKET Orthodontic brackets are passive components of fixed Orthodontic Appliance bonded to enamel which provide means to transfer the force applied by the activated arch wire to the tooth.
  4. 4. TYPES OF BRACKETS • Metal brackets • Ceramic brackets • Plastic brackets • Self ligating brackets • Active and passive self ligating • Invisalign-Invisible braces • Lingual braces
  5. 5. METAL BRACKETS: SS BRACKETS • Most brackets currently used are made of austenitic stainless steel containing 18% chrome and 8% nickel. • SS brackets have most of the basic characterstics expected from a bracket • It is resistant to all kinds of corrosion, hygienic and economical DISADVANTAGES: • Non Esthetic • May release nickel and chrome into oral environment • Alternatives: ceramic, plastic, compositic, titanium etc
  6. 6. PLASTIC BRACKETS: • Can be made up of acrylic, polycarbonate, polyurethane metal reinforced slots DISADVANTAGES: • Staining and discoloration • Poor dimensional stability • Friction between bracket slot and metal wire(difficult sliding) • Poor abrasion resistance and permanent deformation reduce torque capacity
  7. 7. CERAMIC BRACKETS: • Made of monocrystalline or polycrystalline material • Improved esthetics • Dimensionally stable over plastic brackets • Durable and stain resistant DISDVANTAGES: • Friction within slot • Wear of teeth contacting the bracket • Debonding difficult • Cracking of bracket when torque forces are applied • Bulkier than metal • Enamel fracture while bitting
  8. 8. TITANIUM BRACKETS: • Titanium is more wettable and bonding materials adhere better to retention pad • Titanium is more resilient than steels and absorbs impact better • Alternative in nickel allergy cases
  9. 9. SELF LIGATING BRACKETS • Types of system available: a)A Springy latch up(Innovation, speed) b)Springy retaining clips(smart clips) c)Rigid latching clips(Damon) • Advantages: a)Full arch wire engagements b)Less chair side assitent required c)Reduced friction d)Assits in maintaining good oral hygiene • Disadvantages: a)Requries skill b)Clips may fracture or open b/w appointments c)Expensive
  10. 10. WHY BRACKET SELECTION IS NECESSARY FUNDAMENTALS OF TREATMENT MECHANICS: • Bracket selection • Archwire selection • Bracket positioning • Force levels CHOOSING A BRACKET PRESCRIPTION: • Torque • Tip • In –Out: • Rotation: • Slot:
  11. 11. BRIEF HISTORY ANGLE’S PROGRESSION TO THE EDGEWISE APPLAINCE: E Arch  Pin and Tube  Ribbon arch  Edge wise  Contemporary edge wise. CONTEMPORARY EDGEWISE: 1) Automatic rotational control 2)Alteration in bracket slot dimension 3)Straight wire prescription. *Andrews developed straight wire appliance to eliminate need for wire bending needed to compensate for varations in individual tooth anatomy
  12. 12. ANDREW’S • 1ST Generation of preadjusted brackets • He empahsized on Wagon wheel effect where tip was lost as torque added so he chose to add additional tip to anterior brackets. • He used basal bone of mandible as an arch form reference • Rolar coaster effect: due to excessive force and use of elastic retraction mechanics  deeping of anterior bite with creation of lateral open bite • Modifications of Andrew’s: 1)Wide range of brackets 2)Extraction cases: Canine bracktes with anti tip, anti rotation, power arms
  13. 13. ROTH • 2ND generation of preadjusted brackets • He selected range of brackets to create single appliance system • Wider arch forms than Andrew’s to avoid damage of canine tips and to aid in good protusive function • Over correction and anchorage control in bracket systems a)Upper and lower canines with more tip b)Upper anterior teeth with more torque c)Decreased tip in both upper and lower buccal segments d)Upper molars with less torque.
  14. 14. MC LAUGHIN AND BENNETT • Sliding mechanics and continous light forces using SWA • Mechanics: accurate bracket postioning Lacebacks and bend backs for early anchorage control with light arch wire force • Anterior tip reduced and Torque increased in incisor and molar region. Additional anterior tip disadvantage: 1)It Creates significant strain on anterior and posterior anchorage 2)Increased tendency of bite deepining during alignment stage 3)Brought upper canine roots close to premolar roots in some cases.
  15. 15. MC LAUGHIN AND BENNETT Overview of MBT treatment philosophy: • Bracket selection • Versatility of bracket system • Accuracy of bracket positioning with help of gauges • Light continous force • .022 vs 0.18 slot • Anchorage control In early treatment • Group movement • Use of 3 arch forms • 1 size of rectangular steel wire • Arch wire hooks • Methods of archwire ligation • Awareness of tooth size discrepancies • Persistence in finishing
  16. 16. MC LAUGHIN AND BENNETT MBT DIFFERENCES WITH OTHER BRACKET PRESCRIPTIONS: • Increased palatal root torque in upper central incisor brackets(Andrews: 7 degreee, roth : 12 degree, MBT 17 degree) • Increase palatal root torque in upper lateral incisor brackets(andrews: 3 degree, Roth 8 degree, MBT 10 degree) • Increased lingual crown torque in lower incisor brackets(Andrews -1 degree, Roth: -1 degree, MBT -6 degree • Decrease tip in the upper canine brackets(Andrwes 11 degree, Roth 13 degree, MBT 8 degree) *Palatal root torque in upper incisors improves under torqued appearance produced by other prescriptions and increased labial root toqure in lower incisor conteracts the forward tipping during levelling.
  17. 17. VERSATILITY Seven main aspects of versatility: • Options for palatally displaced upper lateral incisors (-10) • Three torque options for upper canines (-7, 0 ,+7) • Three torque options for lower canines( -6, 0, +6) • Interchangeable brackets- the same tip and torque • Interchangeable upper premolar brackets- same tip and torque • Use of upper second molar tubes on first molars, in non HG cases • Use of lower second molar tubes for the upper first and second molars of the opposite side when finishing cases to class II molar relationship
  18. 18. SELECTION BETWEEN MBT AND ROTH • Critical anchorage • Posterior crossbite • Class I cases • Class II cases • Non ex vs extraction cases • Class II elastics use • Class III elastics use

Hinweis der Redaktion

  • TO MINIMIZE FRICTION: 1)metal ss slots 2)Ceramic fillers(stable and have low friction)
  • Anchorage control: light force reduced tip
    Laceback
    bendback
  • Positive torque: root lingual crown labial
  • Ceritical anchroage roth drains more anchorage than mbt
    Posterior crossbite roth… scissor bite mbt
    Clas II elastics: mbt in lower anteriors
    Class III elastics roth in lower anteriors

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