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Hugo Lloyd has is a dentist from Dublin city centre. He practises modern and exciting cosmetic dentistry, 6 month braces and places dental implants in Dublin, from his modern dental surgery.
Fixed appliances are so called because they can not be intentionally removed from the mouth by a [url=http://www.seattlesoycandles.com]hollister[/url] patient. The most common form of a fixed appliance is brackets that are attached to the teeth which receive an arch wire that is ligated into the bracket to allow a force to be place on the tooth. Other appliances can be fixed into the mouth which includes rapid maxillary expanders and Herbst appliances.
How are they [url=http://www.achbanker.com/home.php]www.achbanker.com/home.php[/url] attached?
Brackets are commonly bonded to the labial or palatal/lingual surface of the teeth. Bonding to enamel (and subsequently dentine) has been hailed one of the greatest developments in the last 50 years of dentistry. Initial success bonding to enamel occurred in the early 1960s. Bands that carry brackets can also be placed in areas where it is difficult to get a good bond or where significant occlusal forces are expected. Bands are cemented on [url=http://www.rtnagel.com/airjordan.php]jordan pas cher[/url] using conventional glass ionomer cement.
History
Until the mid 1970s the majority of fixed appliance therapy was carried out using the standard edgewise bracket having a 90 degrees base and bracket slot angulations. [url=http://www.1855sacramento.com/woolrich.php]woolrich parka[/url] The major disadvantages of the edgewise system was the amount of arch wire bends needed in order to produce a satisfactory end result. The archwire bending required many clinical hours and even in the hands of experienced operators the bends were imprecise and hard work. The bracket system also had shortcomings resulting in undertreated cases. Many cases would often appear artificial, first molars were not in a true class 1 relation and upper incisors often lacked torque. The Begg approach was also popular in the 1960s and 1970s. It originated in Adelaide, Australia. This technique had similar disadvantages as the edgewise approach [url=http://www.mansmanifesto.com]doudoune moncler[/url] requiring many clinical hours to treat and needing extensive archwire bending. Dr Lawrence F Andrews developed the straight wire appliance which became widely available in the mid 1970s. The development of this system came from the analysis of 120 non [url=http://www.orlando-apts.com/nfljerseys/]nfl jerseys[/url] orthodontic normal study models. The six keys to occlusion were developed and the brackets were designed to place teeth in the correct position three dimensionally.
The initial straight wire appliance had problems, traditional heavy forces accustom to the edgewise system were still being used resulting in problems such as the roller coaster effect. From clinical experience Andrews introduces a number of modifications, including different brackets for extraction cases and differing torque values for incisors etc . Roth was anxious to avoid a large inventory and developed a series of brackets that could be used to treat almost all cases; this has been described as the second generation of the straight wire appliance. McLaughlin and Bennett published a series of articles in the journal of clinical orthodontics from 1989 to1991 which became a book in 1993. This book provided details of treatment mechanics that had been refined over 15 years of clinical experience. Emphasis was placed on sliding mechanics and continuous light forces. Recommendations were made for lacebacks and bendbacks for anchorage reinforcement during levelling and aligning, light archwire forces and sliding mechanics on a. 019 /.025 stainless steel rectangular wire. Through 1993 to 1997 McLaughlin and Bennett worked with Trevisi to redesign the entire bracket system to work with their treatment mechanics and to overcome the inadequacies of the original straight wire appliance, therefore the MBT system is a version of the preadjusted bracket to be used with light continuous forces, lacebacks and bendbacks.
Use of fixed orthodontic appliances
The use of fixed orthodontic appliances is very common place. They allow movement of teeth in three dimensions through the interaction of an archwire with a bracket slot. The three dimensional movements have traditionally been known [url=http://www.lcdmo.com/hollister.php]hollister co france[/url] as: First order movements - Labialpalatal movement of the crown with its center of rotation at the root centroid.
Second order movements - Movement of the tooth along its plane of the long axis, results in intrusive and extrusive movement Third order movements - movement of the root in the labiopalatal direction with the center of rotation being the bracket on the crown of the tooth. [url=http://www.getconversational.com]hollister france[/url] Known as providing torque to the root.
Components
The basic components of a fixed appliance include brackets that are bonded to the middle of the facial surface of the crown. Tubes are either directly bonded to the buccal surface of the molar teeth or are carried by a band that is cemented onto the tooth. Archwires are ligated into the brackets using either steel ligatures or elastic ligatures; they vary in shape, size and composition. Other components are also used that include power chain elastics, nickel titanium springs and intraoral elastics.
Orthodontic brackets
Brackets vary in four ways; 1) Slot dimension 2) Composition 3) Method of ligation 4) Size Slot dimension can either be.018 inches or.022 inches. The SWA was originally designed for the.022 inches bracket. The main advantages of the.022 brackets is reduces forces because of the increased play between the bracket and archwire and working wires of.019 /.025 can be used which work well with sliding mechanics.
Brackets can be made from metals (gold, chromium, stainless steel, titanium etc), Polymers (polycarbonate, polyurethane), and ceramics (Zirconium oxide, mono and polycrystalline aluminium oxide).
The traditional method of ligation of the archwire into the bracket slot was by using stainless steel ligature ties, although still used the more popular method of ligation is to use flexible elastomeric o-ring ties. Recently there has been an increase in the number of self ligating bracket systems (Damon, Smartclip, time etc). These use a sliding door that closes and opens with the use of a special instrument. The proposed advantage of these systems is the reduction of friction between the bracket base and the arch wire and hence more efficient sliding mechanics Size of the bracket base can vary. Patients may opt for smaller brackets for aesthetic purposes . SizeCompositionLigationBracket slot largemetalSteel lig.018 inches Mid sizeceramicElastic lig.022 inches smallpolymerSelf ligating (active or passive).022 x. 027 inches
Archwires
Variations include; 1) Dimensions 2) Material Archwires must be available in many different diameters. Initial archwires are of small diameter to enable archwire flexibility. This is important to allow engagement of brackets on malpositioned teeth. Larger archwires are used to consolidate rotations, begin torque expression and allow sliding mechanics. The table below summaries the main differences; Dimensions (common sizes) Material (sample) .012,.014,.016,.018,.020 round wireStainless steel .14 x. 025,.16 x. 025,.18 x0.25 0.19 x. 025 rectangular wiresNickel titanium Square wires also availableCopper nickel titanium
Cost
Because of the associated costs to the dentist to provide the large and expensive armentarium needed to place fixed appliances and the financial and time investment that dentist had made in education to be able [url=http://www.maximoupgrade.com/hot.php]hollister france[/url] to used fixed appliances they are the most expensive option of the three compared in this assignment. They are also the most predictable when used in skilled hands. The cost of upper and lower fixed appliances in Southern Ireland varies from about 3500 to 6000 Euros depending on system used (Damon or conventional SWA, clear brackets Vs Metal brackets) and the overall treatment time.
Compliance
It is a common misconception that compliance is not needed with fixed appliances. [url=http://www.sandvikfw.net/shopuk.php]hollister outlet sale[/url] Patients will often be required to comply with elastics, oral hygiene and maintenance of appropriate appointments. With a fixed [url=http://www.1855sacramento.com/peuterey.php]peuterey outlet[/url] maxillary expander the patient will be required to turn the expansion screw as directed. Fixed appliances may need less compliance than removable and functional appliances.
Problems
Patients are required to have excellent oral hygiene during fixed appliance therapy. Because brackets, bands and archwires are a plaque trap failure to maintain oral [url=http://www.rtnagel.com/louboutin.php]louboutin pas cher[/url] hygiene can result in new carious cavities and unsightly facial enamel decalcification.
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