Presentation is loading. Please wait.

Presentation is loading. Please wait.

BONDINGIN ORTHODONTICS ORTHODONTICS 25.02.2015 Dr.Gyan P. Singh, KGMU Orthodontics&Dentofacial Orthopedics.

Similar presentations


Presentation on theme: "BONDINGIN ORTHODONTICS ORTHODONTICS 25.02.2015 Dr.Gyan P. Singh, KGMU Orthodontics&Dentofacial Orthopedics."— Presentation transcript:

1 BONDINGIN ORTHODONTICS ORTHODONTICS Dr.Gyan P. Singh, KGMU Orthodontics&Dentofacial Orthopedics

2 Fixed orthodontic Appliance BANDING BANDING The chief parts of modern fixed appliances are tooth bands,brackets and arch wires. The chief parts of modern fixed appliances are tooth bands,brackets and arch wires. Tooth bands are made up of metals and cemented to the teeth and provides place for attachment of other auxiliaries like brackets, buccal tubes, lingual buttons etc. Tooth bands are made up of metals and cemented to the teeth and provides place for attachment of other auxiliaries like brackets, buccal tubes, lingual buttons etc. The tooth moving forces derived from the arch wires are transmitted to the teeth through the bracketThe tooth moving forces derived from the arch wires are transmitted to the teeth through the bracket 2

3 MAGILL was the 1 st to use plain band MAGILL was the 1 st to use plain band Preformed steel bands came into widespread use during the 1960s and are now available in anatomically correct shapes for all the teeth.Preformed steel bands came into widespread use during the 1960s and are now available in anatomically correct shapes for all the teeth. Teeth that will receive heavy intermittent forces ( for the anchorage purpose-extraction cases) against the attachments for the extra oral force like Head gear. E.g.: upper 1 st molars Teeth that will receive heavy intermittent forces ( for the anchorage purpose-extraction cases) against the attachments for the extra oral force like Head gear. E.g.: upper 1 st molars 3

4 Banding Technique: Separation Separation Selection of band material Selection of band material Fabrication and fitting Fabrication and fitting Cementation Cementation 4

5 Elastomeric separators;Elastomeric separators; which surrounds the contact point and squeeze the teeth apart over period of few days which surrounds the contact point and squeeze the teeth apart over period of few days 5

6 6

7 PrefabricationPrefabrication Lower molar bands are designed to be seated initially with hand pressure on the proximal surface and then heavy biting force along the buccal but not the lingual margins.Lower molar bands are designed to be seated initially with hand pressure on the proximal surface and then heavy biting force along the buccal but not the lingual margins. 7

8 BONDING For the patient to whom esthetics being the prime consideration even during the treatment, the metallic look of the orthodontic appliance has always been the bone of contention. 8

9 History:History: Acid etching M. G. Buonocore in 1955 using 85% phosphoric acid for 30 sec Acid etching M. G. Buonocore in 1955 using 85% phosphoric acid for 30 sec Newman (1965) was the first to apply bonded orthodontic brackets Newman (1965) was the first to apply bonded orthodontic brackets Smith (1968) - zinc polyacrylate and bracket bonding with this cement Smith (1968) - zinc polyacrylate and bracket bonding with this cement 9

10 . Advantages over bonding Advantages over bonding It is esthetically superior.It is esthetically superior. It is faster and simple.It is faster and simple. There is less discomfort for the patientThere is less discomfort for the patient Arch length is not increased by band material.Arch length is not increased by band material. 10

11 It allows more precise bracket placement.It allows more precise bracket placement. Bonds are more hygienic than bands Partially erupted teeth can be controlled.Bonds are more hygienic than bands Partially erupted teeth can be controlled. Mesiodistal enamel reduction ( proximal reduction) is possible during treatment.Mesiodistal enamel reduction ( proximal reduction) is possible during treatment. Attachments may be bonded to artificial tooth surfaces (eg., amalgam, porcelain, gold) and to fixed bridge work.Attachments may be bonded to artificial tooth surfaces (eg., amalgam, porcelain, gold) and to fixed bridge work. 11

12 Caries risk under loose bands is eliminated and interproximal caries can be detected and treated.Caries risk under loose bands is eliminated and interproximal caries can be detected and treated. No band spaces are present to close at the end of treatment.No band spaces are present to close at the end of treatment. Lingual brackets, invisible braces, can be used when patient rejects visible orthodontic appliance.Lingual brackets, invisible braces, can be used when patient rejects visible orthodontic appliance. 12

13 The protection against the inter proximal caries of well contoured cemented band is absent.The protection against the inter proximal caries of well contoured cemented band is absent. Bonding is more complicated when lingual auxiliaries are required or where headgears are attached.Bonding is more complicated when lingual auxiliaries are required or where headgears are attached. Debonding is more time consuming than debanding, since removal of adhesive is more difficult than removal of cementDebonding is more time consuming than debanding, since removal of adhesive is more difficult than removal of cement 13

14 Bonding procedures can be performed in 2 waysBonding procedures can be performed in 2 ways Direct bonding Direct bonding Indirect bonding Indirect bonding Direct bonding : Direct bonding : This procedure is quite simple and involves following steps This procedure is quite simple and involves following steps CLEANING CLEANING ENAMEL CONDITIONING ENAMEL CONDITIONING SEALING SEALING BONDING BONDING 14

15 15

16 Cleaning Cleaning This requires rotary instruments, either a rubber cup or a polishing brush. This requires rotary instruments, either a rubber cup or a polishing brush. Studies have shown enamel loss due to prophylaxis. Studies have shown enamel loss due to prophylaxis. Mark Daniel pus et al ( AJO 1980) showed that 10.7µm of enamel loss during initial prophylaxis with bristle brush was greater than the 5.0µm lost when a rubber cup as used and the difference was statistically significant.Mark Daniel pus et al ( AJO 1980) showed that 10.7µm of enamel loss during initial prophylaxis with bristle brush was greater than the 5.0µm lost when a rubber cup as used and the difference was statistically significant. 16

17 Enamel conditioning:Enamel conditioning: Moisture control Moisture control Enamel pretreatment Enamel pretreatment MOISTURE CONTROL : MOISTURE CONTROL : After the rinse, salivary control and maintenance of a completely dry working field is absolutely essential. Its presence may prevent the good bond between the sealant and bonding agent After the rinse, salivary control and maintenance of a completely dry working field is absolutely essential. Its presence may prevent the good bond between the sealant and bonding agent 17

18 Enamel pretreatmentEnamel pretreatment The conditioning solution or gel (usually 37% phosphoric acid ) is then lightly applied over the enamel surface with a foam pellet or brush for 15 to 30 sec.The conditioning solution or gel (usually 37% phosphoric acid ) is then lightly applied over the enamel surface with a foam pellet or brush for 15 to 30 sec. When etching solutions are used, the surface must be kept moist by repeated applications.When etching solutions are used, the surface must be kept moist by repeated applications. 18

19 Is etching time is different for young and old teeth?Is etching time is different for young and old teeth? K J. Nordenvall et al (AJO 1980) did a comparison between the effects of 15 and 60 seconds of etching with a 37 percent phosphoric acid solution on enamel surfaces of deciduous and young and old permanent teeth.K J. Nordenvall et al (AJO 1980) did a comparison between the effects of 15 and 60 seconds of etching with a 37 percent phosphoric acid solution on enamel surfaces of deciduous and young and old permanent teeth. For deciduous teeth, no difference was found in effect between the etching periods. For deciduous teeth, no difference was found in effect between the etching periods. For young permanent teeth, 15 seconds of etching created more retentive conditions than 60 seconds.For young permanent teeth, 15 seconds of etching created more retentive conditions than 60 seconds. 19

20 How much enamel is removed by etching and how deep are the histological alterations?How much enamel is removed by etching and how deep are the histological alterations? Are they reversible? Is etching is harmful? Are they reversible? Is etching is harmful? A routine etching removes 3 to 10 μm of surface enamel. Another 25 μm reveals subtle histological alterations creating necessary mechanical interlocks. A routine etching removes 3 to 10 μm of surface enamel. Another 25 μm reveals subtle histological alterations creating necessary mechanical interlocks. Deeper localized dissolutions will generally cause penetration to a depth of about 100µm or more. Deeper localized dissolutions will generally cause penetration to a depth of about 100µm or more. 20

21 Bonding Bonding Direct technique in which the brackets are placed directly on the enamel surface by the operator, as was initially described by Newman. Direct technique in which the brackets are placed directly on the enamel surface by the operator, as was initially described by Newman. The second method of bracket placement is the indirect technique, which was first described by Silverman et alThe second method of bracket placement is the indirect technique, which was first described by Silverman et al The recommended bracket bonding procedure consists of the following steps 1.TRANSFER 1.TRANSFER 2.POSITIONING 2.POSITIONING 3.FITTING 3.FITTING 4.REMOVAL OF EXCESS 4.REMOVAL OF EXCESS 21

22 TRANSFER: TRANSFER: The bracket is gripped with a pair of cotton pliers or a reverse action tweezer (bracket holding forceps) and the mixed adhesive is applied to the back of the bonding base.The bracket is gripped with a pair of cotton pliers or a reverse action tweezer (bracket holding forceps) and the mixed adhesive is applied to the back of the bonding base. 22

23 POSITIONING: A placement scaler, such as the RM 349 or one with parallel edges is used to position the brackets mesiodistally and incisogingivilly and angulate them accurately.A placement scaler, such as the RM 349 or one with parallel edges is used to position the brackets mesiodistally and incisogingivilly and angulate them accurately. The placement scaler with parallel edges allows visualization of the bracket slot relative to the incisal edge and long axis of the teeth, with the scaler seated in slot.The placement scaler with parallel edges allows visualization of the bracket slot relative to the incisal edge and long axis of the teeth, with the scaler seated in slot. 23

24 FITTING 24

25 REMOVAL OF EXCESSREMOVAL OF EXCESS Excess must be removed with the scaler before the adhesive has set or it must be removed with bur after setting.Excess must be removed with the scaler before the adhesive has set or it must be removed with bur after setting. 25

26 INDIRECT BONDING INDIRECT BONDING Several techniques for indirect bonding are available. Most are based on the procedures described by Silverman and Cohen ( JCO 1976).Several techniques for indirect bonding are available. Most are based on the procedures described by Silverman and Cohen ( JCO 1976). H. Stuart ( Jco 2003 ) suggested most indirect bonding techniques are successful in accurately placing brackets but can be expensive, he introduced a simplified method that has reduced lab cost and chair time.H. Stuart ( Jco 2003 ) suggested most indirect bonding techniques are successful in accurately placing brackets but can be expensive, he introduced a simplified method that has reduced lab cost and chair time. 26

27 Indirect bonding with silicone impression tray Take an impression and pour up a stone modelTake an impression and pour up a stone model Select brackets for each toothSelect brackets for each tooth Apply a small portion of water soluble adhesive on each toothApply a small portion of water soluble adhesive on each tooth Position the brackets on the model, check all the measurements and allignments, reposition if neededPosition the brackets on the model, check all the measurements and allignments, reposition if needed 27

28 28

29 Indirect bonding Indirect bonding In this technique temporary adhesive is used to attach the brackets to the patients stone model In this technique temporary adhesive is used to attach the brackets to the patients stone model The bracket is placed on the model and excess adhesive is removed from the periphery of the baseThe bracket is placed on the model and excess adhesive is removed from the periphery of the base Before forming the indirect bonding tray use of light separating spray is recommended to facilitate the easy removal of the tray from the brackets.Before forming the indirect bonding tray use of light separating spray is recommended to facilitate the easy removal of the tray from the brackets. After 10 min placement tray is vacuum formed for each arch After 10 min placement tray is vacuum formed for each arch 29

30 30

31 31

32 Tray is removed by peeling from the lingual towads the buccalTray is removed by peeling from the lingual towads the buccal Excess flash of sealant is carefully removed from the gingival contact areas of the toothExcess flash of sealant is carefully removed from the gingival contact areas of the tooth AdvantagesAdvantages clean up is simple because little flash is present clean up is simple because little flash is present 32

33 33 DEBONDING

34 34 Definition/Objective of debonding :-Definition/Objective of debonding :- --To remove the attachment and all the adhesive resin from the tooth and restore the surface as closely as possible to its Pre- treatment condition without inducing iatrogenic damage. --To remove the attachment and all the adhesive resin from the tooth and restore the surface as closely as possible to its Pre- treatment condition without inducing iatrogenic damage.

35 35 Clinical Procedures Mainly divided into 2 stagesMainly divided into 2 stages -- Bracket removal -- Bracket removal -- Removal of residual adhesive -- Removal of residual adhesive

36 36 Bracket removal Metal bracketsMetal brackets -- Debonding pliers -- Debonding pliers Ceramic bracketsCeramic brackets -- Pliers -- Pliers -- Separation at bracket adhesive -- Separation at bracket adhesive interface (Bishara) interface (Bishara) -- Thermal debonding -- Thermal debonding -- Lasers -- Lasers

37 37

38 38 Removal of residual adhesive ScalerScaler Scraping with a sharp band or bond removing plierScraping with a sharp band or bond removing plier BursBurs -- Dome shaped TC bur -- Dome shaped TC bur -- Ultrafine diamond bur -- Ultrafine diamond bur -- White stone finishing bur -- White stone finishing bur

39 39

40 REFERENCES REFERENCES William R Proffit,Contemporary orthodontics Third Edition,2002William R Proffit,Contemporary orthodontics Third Edition,2002 Thomas M Graber, Robert L, Vanarsdall, Orthodontics :Current Principles and Technique Fourth Edition,2003Thomas M Graber, Robert L, Vanarsdall, Orthodontics :Current Principles and Technique Fourth Edition,2003 Robert E Moyers Handbook of orthodontics Fourth Edition,1988Robert E Moyers Handbook of orthodontics Fourth Edition,1988 Kharbanda.Diagnosis and Management of Malocclusion and Dentofacial deformities.Mosby,elsevier,2001Kharbanda.Diagnosis and Management of Malocclusion and Dentofacial deformities.Mosby,elsevier,

41 MCQs: 1.Complicated cases are most often treated by fixed appliances than removal appliance because (A)They apply heavy forces (B)Wide range of tooth movements possible (C)Require less anchorage (D)They cannot be removed by the patients 2. Which of the following are examples of fixed active appliances (A)Standard Edgewise and straight wire (B)Begg and Herbst (C) Activator and Herbst (D) Bionator and twin-block 41

42 3.All of the following can be classified as myofunctional appliances except (A)An anterior bite plane (B)Andresen appliance (C)Begg appliance (D)Oral screen 4. Rotation of teeth is best corrected by (A)Hawley appliance (B)Buccal retractor (C) Fixed appliance (D) All of the above 42

43 5.Which of the following is not true of an fixed appliance (A)Economical (B)Rotation and extrusion movement are possible (C)Patient cooperation is not required (D)Tipping and bodily movement is possible 6. Passive component of fixed appliance (A)Brackets (B)Arch-wire (C)Springs (D)Elastics 43

44 7.Which of the following components of the fixed appliance holds the arch- wire on the teeth except for that molars (A)Cleats (B)Brackets (C)Bands (D)Lock springs 8. The direct bonded orthodontic stainless steel brackets device retention with composite because of (A)The mechanical interlock with mesh at the bracket base (B)The chemical interlock of composite with bracket base (C)Both mechanical and chemical interlock of composite with the bracket base (D)Biological interlock between the tooth and the brackets. 44

45 9. Use of light cure in orthodontics is done in case of (A)Bonded retainer (B)Fixing the brackets (C)Correction of 1 mm midline (D)All of the above 10. A first order bend in an orthodontic wire is (A)A twist in the wire (B)In the vertical plane (C)In the horizontal plane (D)A horizontal bend with a twist 45

46 46


Download ppt "BONDINGIN ORTHODONTICS ORTHODONTICS 25.02.2015 Dr.Gyan P. Singh, KGMU Orthodontics&Dentofacial Orthopedics."

Similar presentations


Ads by Google