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


What is a bracket???

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What is a bracket??? ď Ž

Bracket- an attachment that serves to deliver the necessary tooth moving forces.

ď Ž

Bracket may be defined as an orthodontic attachment secured to a tooth for the purpose of engaging an arch wire - Thurow

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Ancient orthodontics

splint of ivory www.indiandentalacademy.com


E.H ANGLE 

Father of orthodontics

Valuable contributions

Latest – edgewise app

Angle’s line of occlusion

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E.H ANGLE 

All you can do is push, pull or turn a tooth.

Edgewise appliance - ‘‘Latest and the best’’

Evolution of edgewise appliance….

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Evolution of edgewise appliance 

Angle graduated in 1878

1888 – angle system

Standard Orthodontic appliance should have 5 properties

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Evolution of edgewise appliance 

Simplicity

Stability

Efficiency

Delicacy

Inconspicuousness www.indiandentalacademy.com


Evolution of edgewise appliance

Angle patented the jackscrew – he gave the credit for the regulating screw to dwinelle 1849- did not give credit to farrar who had described a similar appliance in 1876 – his rival. www.indiandentalacademy.com


Evolution of edgewise appliance

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Evolution of edgewise appliance ď Ž

1907 – angle discontinued the use of jack screws

E Arch

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Evolution of edgewise appliance ď Ž

Heavy archwires supplied in 4 designs Basic E arch Ribbed E arch E arch without threaded ends E arch with hooks

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Evolution of edgewise appliance

Basic E arch www.indiandentalacademy.com


Evolution of edgewise appliance

Ribbed E arch www.indiandentalacademy.com


Evolution of edgewise appliance

E arch without threaded ends www.indiandentalacademy.com


Evolution of edgewise appliance

E arch with hooks

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Evolution of edgewise appliance 

Problems with Angle’s E arch appliance

1.

Removal of retention app – malocclusion. Axial relationship of teeth can not be accomplished Unstable results

2. 3.

Teeth should be moved bodily www.indiandentalacademy.com


Evolution of edgewise appliance Pin and tube-1910

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Evolution of edgewise appliance Pin and tube-1910 Adv - root movement Disadv – technique sensitive and time consuming - rotational adjustments difficult to achieve

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Evolution of edgewise appliance The Ribbon Arch-1915

Brackets

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Evolution of edgewise appliance ď Ž

Advantages

ď Ž

Disadvantages

1.

Rotations readily accomplished Incisogingival Labiolingual

1.

Enmasse movement of teeth Mesial and distal tipping bends

2. 3.

2.

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Evolution of edgewise appliance contrast to ribbon arch??? 0.022Ă—0.028 0.050 Inch wide Gold bracket Gold band Ligature tie

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Evolution of edgewise appliance

Gold alloy archwires First order bends Second order bends Third order bends

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Cornerstones of modern edgewise orthodontics 

Tooth movement in all 3 planes

Philosophy of treating to ideal arch form

Use of rectangular arch wires

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Single width bracket

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Siamese twin bracket

swain Interbracket span 050’’

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Posterior brackets 

Twice the width of single width bracket 010’’

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Curved base twin bracket

Positive control

Mechanism of action www.indiandentalacademy.com


Twin bracket – important points  

Rotational control : mainly by deflection of arch wire Positive control Disadvantages

1. 2. 3. 4.

10% play of arch wire Inter bracket span is reduced  Resiliency Closing loop arch wires Second order bends www.indiandentalacademy.com


Lewis bracket

Soldered auxiliary rotation arms Single width feature- retained www.indiandentalacademy.com


Lewis bracket ď Ž

Types:

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Lewis bracket ď Ž

Advantages: Does not interfere with resiliency ,closing loops &second order bends 100% correction & over corrections

Wings though rigid can be bent

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Curved base lewis bracket

Increase contact with band . Reduces trapping of the food.

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Vertical slot Lewis bracket

020 x020 vertical slot www.indiandentalacademy.com


Steiner bracket ď Ž

Flexible rotation arms - did not rely entirely on the resiliency of archwire for tooth rotation.

ď Ž

Single width edgewise bracket

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Broussard bracket

Grayford broussard Modified edgewise bracket in which there is addition of 0.0185 x 0.046 slot –to accept doubled 0.018 auxiliary wire www.indiandentalacademy.com


Tweed-Merrifield appliance  

 

Double width bracket on 6 anteriors Intermediate Single width brackets on Premolar bands Twin brackets on molars 0.022 tubes on second molars

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Andrews straight wire appliance   

BRACKETS stand in between tooth and the orthodontist 1960 – concept of fully programmed appliance Advantage of FPA ELIMINATES WIRE BENDING

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Andrews ď Ž

Driving force for FPA

1.

Analysis of orthodontically treated final occlusion Analysis of naturally occurring optimal occlusion Six keys to normal occlusion

2. 3.

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Andrews

Andrews plane www.indiandentalacademy.com


Andrews

FACC FA point Angulation

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Andrews

Inclination

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Interarch relationship

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Crown angulation

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Crown inclination

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Crown inclination of posteriors

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Absence of rotations

Curve of spee

Tight contacts

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Andrews classification 1.

Non programmed appliance-a set of brackets designed the same for all tooth types ,relying totally on wire bending.

2.

Partly programmed appliance- a set of brackets designed with some in built features ,but always require some wire bending

3.

Fully programmed appliance- a set of brackets designed to guide teeth directly to their goal positions with unbent wires. www.indiandentalacademy.com


Features of Edgewise Bracket

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Non programmed bracket ď Ž

Angle’s edgewise app

FA point on FACC

All crowns will have equal facial prominences Extensive Wire bending www.indiandentalacademy.com


Non programmed bracket ď Ž

Design shortcomings

1. Bracket base perpendicular to bracket stem. 2. Bracket bases are not contoured. 3. Slots are not angulated 4. Bracket stem are of equal faciolingual thickness. 5. Maxillary molar offset is not built in. 6. Bracket siting techniques are unsatisfactory.

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Non programmed bracket 1.

Bracket base perpendicular to bracket stem.

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Non programmed bracket

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Non programmed bracket

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Non programmed bracket ď Ž

Bracket bases are not contoured occlusogingivally.

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Non programmed bracket

Greater than 2째 Greater than 0.5 mm

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Non programmed bracket

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Non programmed bracket

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Non programmed bracket

Mesio-distal base contour www.indiandentalacademy.com


Non programmed bracket ď Ž

Slots not angulated

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Non programmed bracket

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Non programmed bracket ď Ž

Bracket stem are of equal faciolingual thickness

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Non programmed bracket

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Non programmed bracket Maxillary molar offset is not built in.

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Non programmed bracket Bracket siting techniques are unsatisfactory. Angulation -Long axis-crown -Long axis-tooth -Incisal edges- curved ,worn -Marginal ridges -Contact points www.indiandentalacademy.com


Non programmed bracket 

Holdaway advocates that the bracket siting should be altered according to the malocclusion.

Tweed recommends siting brackets in specified number of millimeters from the incisal edge.

According to Jarabak bracket sites for inclination should be determined by the shape of the crown. www.indiandentalacademy.com


Non programmed bracket ď Ž

Saltzman recommends except for the maxillary lateral incisor ,brackets should be located in the middle third of the crown.

ď Ž

Lindquist brackets according to the ht of marginal ridges on posteriors.

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Non programmed bracket Accuracy-

Bracket base along FACC At FA point

1.

2 degrees

2.

.5 mm of the FA point.

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Wire bending 

Primary wire bends (1st, 2nd, 3rd order )

Secondary wire bends

tertiary wire bends

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Wire bending

angulation

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Wire bending

Occlusogingival slot positioning www.indiandentalacademy.com


Wire bending

Inclination www.indiandentalacademy.com


Wire bending

Prominence differences www.indiandentalacademy.com


Wire bending

Prominence differences www.indiandentalacademy.com


Wire bending

Total 76 bends

Fully programmed appliance www.indiandentalacademy.com


Thank you For more details please visit www.indiandentalacademy.com

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