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Advances in Orthodontics INDIAN DENTAL ACADEMY Leader in continuing dental education

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Introduction History of Orthodontics Advances In Orthodontic Materials    

Brackets Arch wires Bonding materials Alternative force delivery systems

Recent Orthodontic Appliances Biomechanical Principles Changing Esthetic Concepts Conclusion



Every generation of man, admires his own wisdom, skill, science, art & progress;

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It calls its own whatever it has learnt from men of former days, & counts the few improvements which have had their birth in its own time as triumphs & distinctions which elevates it above the past.

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Advances in orthodontics has made possible a constant improvement in the quality of orthodontic treatment over a period of last two centuries, ultimately benefiting the patient.

An analysis of the various dimensions of orthodontic advancement reveals two important truths: 1. 2.

The biologic problem have remained singularly unchanged. Advancement in orthodontic material and their cascading effect on appliance design and treatment strategies has added new solution to old problems.

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This area has been greatly taken advantage by the manufacturers & the engineer orthodontist, who due to their basic knowledge of the materials have introduced newer and more efficient orthodontic appliances.

 Every

important science must be correlated to another.  Similarly dentistry has borrowed from many different disciplines and specialties.  Engineering is only one of them.

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The profession of dentistry itself, includes many disciplines, each important in its own right in the development and preservation of the portal that admits all food and sometimes the air that fuel the living body.

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The interests of dentistry, as the name implies, are centered on the teeth; but the teeth are an integral part of a much larger structure.

The Tooth 

Teeth exist in a dual environment, partly inside the body and partly out. The external part is called “crown”. The internal part consist of the “root” and the supporting structures, the periodontal ligament.

PDL Root


Division in Dentistry Working division in dentistry is based on the area of their function, such as  Operative dentistry  Endodontics  Prosthodontics  Periodontics  Orthodontics  Oral Surgery

Operative dentistry ď ľ

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Is responsible for the preservation of the crowns of the teeth. These are the working ends that are seen in the mouth, exposed to a wide variety of chemical, bacterial and mechanical hazards.

Endodontics ď ľ

Endodontics treats the pulp (the living part of the tooth mostly by replacement) along with related diseases of the periapical tissues.


Prosthodontics ď ľ

Replaces missing crowns, with or without support from remaining teeth.

Periodontics ď ľ

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Periodontics bridges the gap between the tooth and its environment. The central responsibility is the periodontal membrane that attaches tooth to bone.

Orthodontics ď ľ

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Orthodontic therapy is accomplished by manipulating the external environment of the crown to stimulate changes in the internal environment that will alter tooth positions. He is concerned with the dental environment.

Oral Surgery ď ľ

Most of you must be familiar with this branch of dentistry.

History of Orthodontics

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Although we can hide our political and religious beliefs or our IQ with silence,

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camouflage many physical shortcomings with clothing,

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we generally appearance.





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The face especially the mouth, is visible in most social interactions.

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It has been argued that disfiguring malocclusion is a physical handicap because it limits a person’s employment, career advancement, social stereotype, and marriage opportunities.

“Treatment of the face is more than moving teeth or cutting and rearranging bones; it is even more than the sculpture of living tissues noted earlier, for it often involves serious alterations in the personality and social interactions” Moyers

Pierre Fauchard (1728) 

“Bandelette” plates used to “straighten” teeth by tying them to crude metal plates with brass or silver wire.

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Farrar’s appliance

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Dr Angle’s appliances, 1887 using cemented bands, retraction screws, soldered attachments

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Dr Angle’s E (expansion) arch appliance.

Advances in Brackets (design) Pin & Tube Ribbon arch

Edgewise Begg Pre-Adjusted Edgewise

Advances in Brackets (design) Pin & Tube Ribbon arch

Edgewise Begg Pre-Adjusted Edgewise

Advances in Brackets (design) Pin & Tube Ribbon arch

Edgewise Begg Pre-Adjusted Edgewise

Advances in Brackets (design) Pin & Tube Ribbon arch

Edgewise Begg Pre-Adjusted Edgewise

Advances in Brackets (design) Pin & Tube Ribbon arch

Edgewise Begg Pre-Adjusted Edgewise

Advances in Orthodontic Materials Brackets Arch wires Bonding materials Alternative force delivery systems


Brackets 

A door handle allows us to open or close a door. Similarly a bracket acts as a handle to a tooth. We can push, pull or rotate a tooth with the help of these attachments. Bracket Arch wire

Bonding material

Advances in Brackets (materials) Stainless Steel

Esthetics Allergic reaction to Nickel Polycarbonate Titanium

Nickel free SS

Magnetic Brackets


Stainless Steel Brackets  

Austenitic steel AISI = 303, 304, 316, 316L & 317L

(L =

low carbon content) 

AISI series 630 SS called as “precipitation hardening SS”, contains very low chromium and nickel. Manufacturing techniques 1. 2. 3.

Milling Sintering Metal injection moulding

Titanium Brackets ď ľ

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Current concept about heavy metal poisoning and their biologic effects led to banning the use of nickel releasing alloys in European countries. Therefore, Titanium based bracket were developed.

Ceramic Brackets ď ľ

Demand for esthetics in treatment.

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Modifications include: 1. 2. 3. 4.

Mini sized steel brackets, Lingual orthodontics Poly carbonate brackets Ceramic brackets (1987).

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With ceramic brackets, unlike traditional stainless steel braces, your smile will not look 'metallic.' In addition, ceramic brackets are designed so that they won't stain or discolor over long periods of time.

Classification of ceramic brackets ď ľ Crystal structure 1. 2.

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Mono-crystalline Poly-crystalline

Materials 1. 2.

Zirconia Alumina

Lingual Orthodontics

Arch wires ď ľ They

generate the required forces and moments to bring about tooth movement.

Advances in Arch wires Precious alloy Gold + Copper + Platinum + Palladium

Stainless Steel & Cobalt Chromium alloy Better strength and Springiness with Corrosion Resistance

Nickel Titanium alloy Developed for the space program 1. Shape memory 2. Super elasticity

Copper NiTi alloy Heat activated NiTi wires

Beta Titanium alloy

Alfa Titanium alloy

(Titanium Molybdenum alloy)

(Titanium + Aluminium + Vanadium)

Ion Implantation To improve surface properties of the TMA wires

Precious alloy  

 

Before the 1950s Nothing else would tolerate intraoral conditions But gold alone was too soft Therefore used as alloy: Gold Copper Platinum Palladium

Stainless Steel  

Increase in price of precious metals Introduction to: Stainless Steel (18:8 ss) Cobalt chromium alloy

Resistance to corrosion due to high chromium content. Properties depends on 1. 2.

Cold working & Anealing during manufacturing.

Nickel Titanium (NiTi) alloy 

 

The 1st titanium alloy introduced in orthodontics = Nitinol (Nickel Titanium Naval Ordnance Laboratory) It was developed for space program. Properties: 1. 2. 3. 4. 5.

Shape memory Super elasticity Superior spring back Light continuous force Long range of action

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Types: Stabilized Martensitic NiTi Active Austenitic NiTi Thermally activated NiTi Copper NiTi Chinese NiTi Japanese NiTi

Advances in Arch wires

Esthetic Arch wires

Coated Arch wires

Composite Arch wires

(elastomeric poly-tetra-fluorethylene emulsion)


Bonding Materials ď ľ

The brackets are attached to a tooth surface with the help of bonding materials.

Advances in Arch wires Composite Resins

Chemical Cure Single paste system

Two paste system

Light cure U.V. light

Visible light

Laser cure

Alternative force delivery systems

Advances in Orthodontic Appliances

Removable appliances 

Coffin Spring 1869

Bertoni expansion screw 2000

Retention Plates

Functional Appliances

Fixed Functional Appliances

Extra-oral anchorage

Biomechanical Approach to Growth Principles ď ľ Orthodontic

problems are the result of mechanical forces, and their correction depends on mechanical forces. ď ľ The force systems in the face can form or deform, and their conscious control is a continuing challenge in orthodontics.

ď ľ Altering

the balance of forces can arrest or reverse progressive deformities during growth, and it can correct many of their effects even in the adult.

Traditional use of Biomechanical Concept

Chinese Foot

Lip –Tongue-cheek System

Functional Deviation (Maxillary Constriction)

Environmental (Habits or Trauma)

Muscle Dysfunction ď ľ

Loss of part of musculature (unknown cause or birth injury or damage to the motor nerve).

Muscle Weakness ď ľ

Muscular dystrophy / Cerebral palsy / Muscle weakness syndromes.

Functions of the Jaws

Mechanical Principles in Jaws Functioning

ď ľ Thus

understanding of the fundamentals of mechanics must be the starting point for understanding orthodontics.

ď ľ The

principles of force analysis are the basic tools of the mechanical engineer, & their application is universal.

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applying them to oral environment, one combines engineering with dentistry, which requires a mixed terminology that is partly foreign to each discipline: BIOLOGY + MECHANICS ________________________


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Today we are about to enter a new era where the genetic coding is becoming part of daily diagnostic tool. May be tomorrow we have to approach dentofacial problems by means of genetic alterations.

Bioengineered Human of Future


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Hope you have become familiar with the variety of problems, their correct diagnosis and the best treatment solution possible. Every case is a challenge requiring versatile thinking and imagination rather than opting for a dogmatic conventional cook book approach .

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Our profession is at cross roads now. We are at a critical point in history where we should make conscious decisions which will determine the way the future unfolds.

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We should make a sincere effort to lay an enduring foundation for a robust and a lasting co-operation between the specialities for the sake of providing excellent care for our patients.

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We should be open to criticisms and update ourselves. We should be careful not to get entangled in dogmatic philosophies and treatment approaches.

QuickTime Movie

So! Where are we?

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Let us work together to usher in a new era of integrated multidisciplinary treatment philosophy.

I would like to leave you with an inspirational saying

“Coming together is a beginning Keeping together is progress Growing together is success”.

Let’s Begin, Progress & Succeed!

Thank You !

Golden Proportions (Divine Proportion)

Rickett’s 1982 AJO

Bracket positioning simulation & Computerized wire bending

CAD/CAM Fabrication of occlusal splint for orthognathic surgery ď ľ

Laser scanning of the cast

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Image of cast on monitor

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of study casts and facial skeleton combined for simulation

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Sagittal split ramus osteotomy simulated on a 3-D image

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Contact areas of occlusal splint drawn from computer image of study cast

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Finished 3d image of occlusal splint

ď ľ Occlusal

splint polymerized by Laser Lithography Unit

Thank you

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