Materials in Orthodontics / orthodontic courses by Indian dental academy

MATERALS IN MATERALS IN ORTHODONTICSORTHODONTICS

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INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

IMPRESSION MATERIALSIMPRESSION MATERIALSACRYLIC MATREIAL –REMOVABLE PLATEACRYLIC MATREIAL –REMOVABLE PLATEBANDSBANDSBRACKETSBRACKETSCEMENTSCEMENTSARCH WIRESARCH WIRESBONDING MATERIALSBONDING MATERIALSELASTICSELASTICSMAGNETS IN ORTHODONTICSMAGNETS IN ORTHODONTICS


IMPRESSION MATERIALIMPRESSION MATERIAL

ALGINATEALGINATE compositioncomposition type- fast & slow settingtype- fast & slow setting properties properties


BAND MATERIALBAND MATERIAL

STAINLESS STEELSTAINLESS STEEL PREFORMEDPREFORMED FABRICATEFABRICATEDifferent sizesDifferent sizesPreformed – according to diff. manufacturesPreformed – according to diff. manufactures

Fabricate- band material -150X0.005”Fabricate- band material -150X0.005” 180x 0.005”180x 0.005”


S S BANDSPreformed


BRACKETSBRACKETS

GOLDGOLDSTAINLESS STEEL STAINLESS STEEL CERAMIC(TOOTH COLOURED)CERAMIC(TOOTH COLOURED)TITANIUMTITANIUM


STAINLESS STEEL BRACKETSTAINLESS STEEL BRACKET

Pre-adjusted edgewise bracket www.indiandentalacademy.comwww.indiandentalacademy.com

Beggs bracket – vertical slot


Nickel sensitivity – Nickel sensitivity – titanium titanium as an as an alternative to SS bracketalternative to SS bracketCutaneous sensitization to nickel develop Cutaneous sensitization to nickel develop from skin contact with any jewelryfrom skin contact with any jewelryMost common in femalesMost common in females


CERAMIC BRACKETCERAMIC BRACKET


Introduced in late 1980sIntroduced in late 1980sAdvantage – tooth coloredAdvantage – tooth coloredDisadvantage – Disadvantage –

1.1. Staining and discoloration in patient who smoke & Staining and discoloration in patient who smoke & drink coffee moredrink coffee more

22 .Poor dimensional stability .Poor dimensional stability 33 ..FrictionFriction b/n plastic bracket and arch b/n plastic bracket and arch wirewire


CEMENTSCEMENTS

Cementing orthodontic bandsCementing orthodontic bandsZINC PHOSPHATEZINC PHOSPHATEGIC(LUTING) GIC(LUTING) MODIFIED GIC-LIGHT CUREMODIFIED GIC-LIGHT CURE


GICGIC


For a patient visiting to orthodontistsFor a patient visiting to orthodontists The only Medicine Will BeThe only Medicine Will Be

ForceForcewww.indiandentalacademy.comwww.indiandentalacademy.com

WIRESWIRESCompositionComposition

Manufacturing & Heat TreatmentManufacturing & Heat Treatment

PropertiesProperties


ARCH WIRESARCH WIRES CLASSIFICATIONCLASSIFICATION

1] 1] According to the material usedAccording to the material used : : S.SS.S ElgiloyElgiloy NitiNiti TMATMA2] 2] According to shapeAccording to shape Round: 0.014 , 0.016 , 0.018 etcRound: 0.014 , 0.016 , 0.018 etc Rectangular : 0.016x0.16 ;0.016 x0.022 ; Rectangular : 0.016x0.16 ;0.016 x0.022 ; 0.017x0.0250.017x0.025

3] 3] According to the properties of springiness :According to the properties of springiness : Elastic / SpringyElastic / Springy IntermediateIntermediate RigidRigid



BASIC PROPERTIES OF ELASTIC BASIC PROPERTIES OF ELASTIC MATERIALMATERIAL

STRESS – is internal distribution of load STRESS – is internal distribution of load defined as force per unit area.defined as force per unit area.

STRAIN – is internal distortion produced STRAIN – is internal distortion produced by load defined as deflection per unit by load defined as deflection per unit length.length.



Orthodontic arch wires are like elastic material Orthodontic arch wires are like elastic material which shows typical forcewhich shows typical force

deflection curvedeflection curve Point of arbitrary clinical loading

stiffness

Rangewww.indiandentalacademy.comwww.indiandentalacademy.com

Orthodontic material propertiesOrthodontic material properties

STRENGTHSTRENGTHSTIFFNESSSTIFFNESSRANGERANGE


STRENGTHSTRENGTHIt is a force value that is a It is a force value that is a measure of the maximum possible measure of the maximum possible load i.e., load i.e., the greatest force that a the greatest force that a wire can sustain or deliverwire can sustain or deliver, if it is , if it is loaded to the limit of the material.loaded to the limit of the material.

Strength measured in stress units Strength measured in stress units

i.e gm/cmi.e gm/cm22


STIFFNESSSTIFFNESSIt is the rate of force delivery It is the rate of force delivery required for a unit activation .required for a unit activation . It is the measure of the force It is the measure of the force required to bend or otherwise required to bend or otherwise deform the material to a definite deform the material to a definite distance.distance.


RANGERANGE

Range is defined as the distance Range is defined as the distance that the that the wire will bend elastically wire will bend elastically before permanent deformation before permanent deformation occurs.occurs.Range is usually determined Range is usually determined from the 0.1% offset point on the from the 0.1% offset point on the force – deflection diagram.force – deflection diagram.


Strength,Stiffness and Range have Strength,Stiffness and Range have an important relationship,i.e.,an important relationship,i.e.,

Strength = Stiffness x RangeStrength = Stiffness x Range



Resilience –represents the energy Resilience –represents the energy storage capacity of the wirestorage capacity of the wire

Formability- amount of permanent Formability- amount of permanent deformation that wire sustain before deformation that wire sustain before failingfailing


IDEAL WIRE MATERIAL FOR IDEAL WIRE MATERIAL FOR ORTHODONTIC PURPOSEORTHODONTIC PURPOSE

IT SHOULD POSSESSIT SHOULD POSSESS High StrengthHigh Strength Low StiffnessLow Stiffness High RangeHigh Range High FormabilityHigh Formability


The material should be The material should be Weldable or SolderableWeldable or Solderable Low costLow cost


ORTHODONTIC ARCH WIRE ORTHODONTIC ARCH WIRE MATERIALMATERIAL

PRECIOUS METAL ALLOYSPRECIOUS METAL ALLOYSSTAINLESS STEELSTAINLESS STEELCOBALT-CHROMIUM ALLOYS(ELGILOY)COBALT-CHROMIUM ALLOYS(ELGILOY)NICKEL-TITANIUM (NiTi) ALLOYSNICKEL-TITANIUM (NiTi) ALLOYSBETA TITANIUM( TMA)BETA TITANIUM( TMA)COMPOSITE PLASTICCOMPOSITE PLASTICTOOTH COLORED WIRESTOOTH COLORED WIRES


PRECIOUS METAL ALLOYSPRECIOUS METAL ALLOYS

Use routinely before 1950s Use routinely before 1950s Gold , platinum, palladium etcGold , platinum, palladium etc


GOLD ALLOY WIRESGOLD ALLOY WIRES

TThe first wire introduced for orthodontic he first wire introduced for orthodontic purpose was made of goldpurpose was made of gold

Gold arch wires were the ideal choice Gold arch wires were the ideal choice of archof arch wires with good bio-wires with good bio-compatibility.compatibility.


Composition of many gold alloy wires Composition of many gold alloy wires corresponds to the type IV gold casting corresponds to the type IV gold casting alloys alloys

They are also subjected to softening and They are also subjected to softening and hardening heat treatments.hardening heat treatments.

Crozat applianceCrozat appliance was orignally made from was orignally made from gold in 1900sgold in 1900s


STAINLESS STEEL ALLOYSTAINLESS STEEL ALLOYStainless steel wires began to Stainless steel wires began to replace gold wires in the 1930’s .replace gold wires in the 1930’s .

Steels are iron – based alloys Steels are iron – based alloys that usually contain less than that usually contain less than 1.2% carbon. 1.2% carbon.


Silicon,phosphorous,sulphur, Silicon,phosphorous,sulphur, manganese, tantalum, and niobium manganese, tantalum, and niobium may also be present in small may also be present in small amounts. The balance is iron.amounts. The balance is iron.These alloys are often designated These alloys are often designated as American Iron and Steel as American Iron and Steel Institute(AISI) Series 400 stainless Institute(AISI) Series 400 stainless steels. steels.


When 12-30% chromium is When 12-30% chromium is added to steel the alloy is added to steel the alloy is commonly called STAINLESS commonly called STAINLESS STEEL. STEEL. For orthodontic purpose 18:8 For orthodontic purpose 18:8 stainless steel is used stainless steel is used

( 18% chromium and 8% nickel)( 18% chromium and 8% nickel)


S S replaces Gold wire because of its S S replaces Gold wire because of its better strength and springinessbetter strength and springinessProperties of steel wires controlled by Properties of steel wires controlled by amount of cold working and annealingamount of cold working and annealingSteel is soften- by annealingSteel is soften- by annealingHarden –by cold workingHarden –by cold workingFully annealed wire – making ligature Fully annealed wire – making ligature wire. (dead soft wire)wire. (dead soft wire)


Ligature wire


AUSTRALIANAUSTRALIAN ORTHODONTIC ORTHODONTIC ARCHWIRE –stainless steelARCHWIRE –stainless steelA. J. Wilcock of Victoria, Australia, A. J. Wilcock of Victoria, Australia, produced the orthodontic archwire to produced the orthodontic archwire to meet Dr. Begg’s needs for use in meet Dr. Begg’s needs for use in Begg technique.Begg technique.

The wire produced has certain The wire produced has certain unique characteristics different from unique characteristics different from usual stainless steel wiresusual stainless steel wires



Grading and colour coding of Grading and colour coding of Australian Orthodontic Arch Australian Orthodontic Arch

wireswiresREGULAR GRADE : White labelREGULAR GRADE : White labelREGULAR PLUS GRADE : Green LabelREGULAR PLUS GRADE : Green LabelSPECIAL GRADE : Black LabelSPECIAL GRADE : Black LabelSPECIAL PLUS GRADE : Orange LabelSPECIAL PLUS GRADE : Orange Label


Each grade of wire is available in Each grade of wire is available in diameters of 0.010″, 0.012″, 0.014″, diameters of 0.010″, 0.012″, 0.014″, 0.016″, 0.018″, 0.020″, 0.022″. They 0.016″, 0.018″, 0.020″, 0.022″. They are supplied in the form of are supplied in the form of spoolsspools or or cut lengths of the wire.cut lengths of the wire.


CLINICAL USE OF STAINLESS CLINICAL USE OF STAINLESS STEEL WIRESTEEL WIRE

Orthodontic stainless steel is the most Orthodontic stainless steel is the most widely used alloy in orthodontics.widely used alloy in orthodontics.

Its application asIts application asArch wires Arch wires Auxillaries -springs Auxillaries -springs RetainersRetainersRemovable appliancesRemovable appliancesBands etc. Bands etc.




The wires are available both in round as The wires are available both in round as well as rectangular cross-sectionswell as rectangular cross-sections..

The Australian stainless steel wires The Australian stainless steel wires described previously are used in the described previously are used in the Begg’s technique as well as in the Begg’s technique as well as in the preadjusted edgewise techniquepreadjusted edgewise technique


MULTISTRANDED WIRES

Twist flex- UNITEKForce 9 - ORMCOD-rect – ORMCORespond – ORMCO


Nickel Titanium Wires Nickel Titanium Wires (NiTi)(NiTi)

William F. Buehler in 1960’s William F. Buehler in 1960’s invented Nitinolinvented Nitinol NOL (Naval Orddnance Laboratory)NOL (Naval Orddnance Laboratory)

Ni – Nickel Ni – Nickel ti-titaniumti-titanium


Andreasen G.F. and co-Andreasen G.F. and co-workers introduced the use of workers introduced the use of nickel-titanium alloys for nickel-titanium alloys for orthodontic use in the 1970’s.orthodontic use in the 1970’s.


COMPOSITIONCOMPOSITION55% nickel55% nickel45% titanium 45% titanium

1.6% cobalt also is added to obtain 1.6% cobalt also is added to obtain desirable properties.desirable properties.


NiTi can exists in more than one form or NiTi can exists in more than one form or crystal structure.crystal structure.MARTENSITIC FORM – exists at lower MARTENSITIC FORM – exists at lower temperaturetemperatureAUSTENTIC FORM - at higher AUSTENTIC FORM - at higher temperaturetemperature


PROPERTIESPROPERTIESShape MemoryShape Memory Super elasticitySuper elasticityBoth of these properties occur at Both of these properties occur at low transition temperature b/n low transition temperature b/n the martensitic and austenitic the martensitic and austenitic forms.forms.


Shape memoryShape memory - This indicates that a - This indicates that a material will return to its desired shape material will return to its desired shape after being plastically deformed while after being plastically deformed while in martensitic form. in martensitic form.


THERMOELASTICITYTHERMOELASTICITY

When alloy is cooled below transition When alloy is cooled below transition temperature it deforms plastically, but temperature it deforms plastically, but when it is heated again the original when it is heated again the original shape is restored----this property called shape is restored----this property called thermoelasticity.thermoelasticity.


ThermodynamicThermodynamic –refers to the –refers to the ability of an archwire to return to its ability of an archwire to return to its intended shape once heated through intended shape once heated through its transition temperature. To be of its transition temperature. To be of clinical value, thermodynamic clinical value, thermodynamic archwires must have a transition archwires must have a transition range close to mouth temperature.range close to mouth temperature.


Andreasen introduced 0.019 inch Andreasen introduced 0.019 inch thermal nitinol wire with a thermal nitinol wire with a transition temperature range transition temperature range between 31° C and 45° C. between 31° C and 45° C.


Martensitic NiTi first marketed by Martensitic NiTi first marketed by Rocky Mountain & is now Rocky Mountain & is now commercially available as commercially available as M NiTiM NiTi In later 1980s NiTi wires with an In later 1980s NiTi wires with an active austenitic grain structures active austenitic grain structures ((A NiTiA NiTi) appeared- with property ) appeared- with property of of superelasticitysuperelasticity


Super elasticitySuper elasticity – – This property This property can be produced by stress and can be produced by stress and not temperature difference.not temperature difference.

Therefore it is called as Therefore it is called as stress induced martensitic stress induced martensitic

transformationtransformation


A NiTi – force applied is not the same A NiTi – force applied is not the same as force applied to activate it. i.e as force applied to activate it. i.e means unloading curve differs from means unloading curve differs from its loading curve its loading curve E.g Copper NiTi E.g Copper NiTi



Type IType IType IIType IIType IIIType IIIType IVType IV

advantage of cu- NiTiadvantage of cu- NiTi produced light continuous forces for long produced light continuous forces for long

duration.duration.

Cu NiTi (copper NiTi)Cu NiTi (copper NiTi)


TYPE I wire –Af 15TYPE I wire –Af 1500

generate very high forcesgenerate very high forces

TYPE II wire- A f27TYPE II wire- A f2700

generate highest force among allgenerate highest force among all

Uses-Uses- in pt with higher pain thresholdin pt with higher pain thresholdnormal periodontal healthnormal periodontal healthrapid tooth movement is requiredrapid tooth movement is required


Type III Wire- Af 35Type III Wire- Af 3500

generate midrange forcegenerate midrange force normal pain threshold patientnormal pain threshold patient generate light force generate light force use in normal or slightly compromiseduse in normal or slightly compromised periodontal patientperiodontal patient


PROPERTIES OF COPPER PROPERTIES OF COPPER NiTi WIRESNiTi WIRES

1.1. Copper Ni Ti generates a Copper Ni Ti generates a more more constant force over long constant force over long activation spans than other activation spans than other nickel titanium alloysnickel titanium alloys and does and does so on a consistent basis, from so on a consistent basis, from archwire to archwire.archwire to archwire.


For every small activations, For every small activations, Copper NiTi Copper NiTi generates near generates near constant force,constant force, unlike other unlike other nickel titanium alloys.nickel titanium alloys.

Copper NiTi is Copper NiTi is more resistant more resistant to permanent deformationto permanent deformation compared with other nickel compared with other nickel titanium alloystitanium alloys;; it exhibits it exhibits better spring back better spring back characteristics.characteristics.


Type IV – Af 40Type IV – Af 4000

generate tooth driving forcegenerate tooth driving force forces are intermittentforces are intermittent use in pt who are sensitive to painuse in pt who are sensitive to pain periodontal compromised casesperiodontal compromised cases


Another wire called the Another wire called the Japanese NitiJapanese Niti wire introduced wire introduced by Fujioby Fujio Miura is manufactured Miura is manufactured by a different process and by a different process and demonstrates super elasticity.demonstrates super elasticity.


Another nickel titanium alloy Another nickel titanium alloy introduced by Burstone introduced by Burstone developed by Dr Tien Hua developed by Dr Tien Hua Cheng called as Cheng called as Chinese Niti Chinese Niti alloyalloy exhibits superior spring exhibits superior spring back property when compared back property when compared to Nitinol to Nitinol


Due to little work hardening and Due to little work hardening and presence of the parent phase presence of the parent phase which is austenite yielding better which is austenite yielding better mechanical properties. mechanical properties.


CLINICAL USE OF NICKEL CLINICAL USE OF NICKEL TITANIUM WIRESTITANIUM WIRES

Nickel titanium wire can produce Nickel titanium wire can produce an an uniform constant forceuniform constant force which which is delivered for a long period of is delivered for a long period of time during the de-activation of time during the de-activation of the wire. the wire.


Because of its superior spring back, Because of its superior spring back, superelasticity, shape memory, and superelasticity, shape memory, and its ability to produce light force for its ability to produce light force for longer duration ,longer duration , NiTi is NiTi is

ideal wire for initial levellingideal wire for initial levelling and and

aligning.aligning.


BEFOREBEFORE

AFTER ALIGNMENT


Rectangular NiTi allows full Rectangular NiTi allows full engagement of the bracket slot engagement of the bracket slot and give better torque control in and give better torque control in the initial phase of treatment. the initial phase of treatment.

Recently a NiTi palatal expanderRecently a NiTi palatal expander


NiTi is also available in the form NiTi is also available in the form of of coil springscoil springs. . Used for Used for distalisationdistalisation of molars. of molars.


Reverse curve NiTi, also known Reverse curve NiTi, also known as as Rocking chair NiTiRocking chair NiTi helps in helps in bite opening and when placed bite opening and when placed down helps in bite closure along down helps in bite closure along with levelling and aligning.with levelling and aligning.


Cobalt Chrome alloy (Elgiloy)Cobalt Chrome alloy (Elgiloy)

Developed during the 1950’s by the Developed during the 1950’s by the Elgiloy Corporation(Elgin, IL,USA).Elgiloy Corporation(Elgin, IL,USA).

Manufactured for watch springs by Manufactured for watch springs by

Elgin watch company,Elgin watch company, hence the hence the name Elgiloy. name Elgiloy.


COMPOSITIONCOMPOSITION

40% cobalt, 40% cobalt, 20% chromium, 20% chromium, 15% nickel, 15% nickel, 7% Molybdenum,7% Molybdenum, 2% manganese, 0.16% carbon, 0.04% 2% manganese, 0.16% carbon, 0.04%

beryllium and 15.8% ironberyllium and 15.8% iron..


Supplied in softer form and harden by Supplied in softer form and harden by heat treatment heat treatment Heat treatment – increases the Heat treatment – increases the strengthstrength


TYPES OF CHROME TYPES OF CHROME COBALT ALLOY WIRESCOBALT ALLOY WIRES

Blue(soft) elgiloyBlue(soft) elgiloy : : bent easily with finger pressure bent easily with finger pressure pliers. pliers. Heat treatment of blue elgiloy Heat treatment of blue elgiloy increases its resistance to increases its resistance to deformation.deformation.


Yellow elgiloyYellow elgiloy : : Relatively ductile and more Relatively ductile and more resilient than blue elgiloy. resilient than blue elgiloy. Further increase in its resilience Further increase in its resilience and spring performance can be and spring performance can be achieved by heatachieved by heat


Green elgiloyGreen elgiloy : : More resilient than More resilient than yellow elgiloy and can be shaped yellow elgiloy and can be shaped with pliers before heat treatment.with pliers before heat treatment.

Red elgiloyRed elgiloy : : Most resilient of elgiloy wires, with Most resilient of elgiloy wires, with high spring qualities, high spring qualities, . Heat treatment makes it . Heat treatment makes it extremely resilient.extremely resilient.


β – TITANIUM – TITANIUM β – TITANIUM – TITANIUM MOLYBDENUM ALLOY OR MOLYBDENUM ALLOY OR

T.M.A.T.M.A.high temperature” form of high temperature” form of titanium alloy became available. titanium alloy became available. At temperature above 1625°F At temperature above 1625°F pure titanium rearranges into a pure titanium rearranges into a body centered cubic lattice body centered cubic lattice (B.C.C.), referred to as ‘(B.C.C.), referred to as ‘Beta’ Beta’ phase.phase.


Addition of elements as Addition of elements as molybdenum or columbiummolybdenum or columbium, , a titanium based alloy can a titanium based alloy can maintain its beta structure maintain its beta structure even even when cooled to room when cooled to room temperature.temperature. Such alloys Such alloys are referred as beta are referred as beta stabilized titanium.stabilized titanium.


High temp Ti – Beta phaseHigh temp Ti – Beta phase

Molybdenum + Ti –TMA Molybdenum + Ti –TMA i.e in low temp maintain beta i.e in low temp maintain beta

phasephase


PROPERTIES TMAPROPERTIES TMA

Excellent formability]Excellent formability]Reduced load/deflectionReduced load/deflection Excellent resiliency Excellent resiliency


ElasticsElastics

Made up of latex Made up of latex Separator Separator E chain E chain module module






CLINICAL USECLINICAL USE

choice for utility arches.- choice for utility arches.- INTRUSION INTRUSION


TOOTH COLOURED TOOTH COLOURED ORTHODONTIC WIRESORTHODONTIC WIRES

current generation are built of current generation are built of composite plastics,composite plastics,Optiflex WIRE Optiflex WIRE Made of clear optical fibre, it Made of clear optical fibre, it comprises of three layers.comprises of three layers. CV NiTi WIRES CV NiTi WIRES


Indirect bondingIndirect bonding



SILVERMAN AND COHEN – 1972SILVERMAN AND COHEN – 1972MMA and UV light activated unfilled MMA and UV light activated unfilled BISGMABISGMAMMA was applied to the plastic bracket MMA was applied to the plastic bracket base on the patient’s model base on the patient’s model BISGMA –intermediary adhesive BISGMA –intermediary adhesive between the patients etched enamel & between the patients etched enamel & pre set adhesive on the bracket basepre set adhesive on the bracket base



Updated technique – 1974 by same Updated technique – 1974 by same authorsauthorsUsed perforated metal bracket bases and Used perforated metal bracket bases and only one adhesive- BISGMA[ UV light only one adhesive- BISGMA[ UV light activated]activated]Increased operator working time as Increased operator working time as polymerization did not occurpolymerization did not occur


INDIRECT BONDING INDIRECT BONDING ADVANTAGESADVANTAGES

Accurate bracket placementAccurate bracket placementDecreasing the chair side timeDecreasing the chair side timeAvoiding band fitting on the posterior teethAvoiding band fitting on the posterior teethEliminating the need for separatorsEliminating the need for separatorsImproved ability to bond the posteriorsImproved ability to bond the posteriorsImproved patient comfort and hygieneImproved patient comfort and hygiene


INDIRECT BONDINGINDIRECT BONDINGDisadvantagesDisadvantages

Technique sensitiveTechnique sensitiveAdditional set of impressions need to be Additional set of impressions need to be takentakenPosterior attachments more likely to fail if Posterior attachments more likely to fail if the patient chews on hard foodthe patient chews on hard food


Indirect bonding techniquesIndirect bonding techniques

Thomas techniqueThomas techniqueSilicon transfer traySilicon transfer trayDouble sealant techniqueDouble sealant techniqueMoin & Dogon techniqueMoin & Dogon techniqueIndirect method – Anoop SondhiIndirect method – Anoop SondhiIndirect bonding for light cured Indirect bonding for light cured compositescomposites


Indirect bonding Indirect bonding Moin & Dogon technique AJO 1977Moin & Dogon technique AJO 1977Pour impression in Pour impression in stone stone A drop of sticky wax A drop of sticky wax is placed on teeth is placed on teeth surfaces of cast surfaces of cast Brackets are Brackets are warmed over flame warmed over flame and set on the castand set on the cast


Indirect bonding - Indirect bonding - Moin & Dogon techniqueMoin & Dogon technique

Impression made with Impression made with polyether materialpolyether materialTray separated from Tray separated from cast but brackets remain cast but brackets remain in situin situBracket is removed from Bracket is removed from the cast &warmed to the cast &warmed to remove residual waxremove residual waxThey are placed into the They are placed into the impressionimpression


Teeth are pumiced,etched & isolatedTeeth are pumiced,etched & isolatedEnamel surface is sealed with mixture Enamel surface is sealed with mixture of universal & catalyst sealant of universal & catalyst sealant bracket base is covered with the bracket base is covered with the adhesive adhesive tray is seated tray is seated

Indirect bonding - Moin & Dogon technique


Indirect bonding - Indirect bonding - Moin & Dogon techniqueMoin & Dogon technique

Use of sticky wax-corrections can Use of sticky wax-corrections can easily &readily be made until optimal easily &readily be made until optimal bracket alignment is obtainedbracket alignment is obtainedPreviously usedPreviously usedAdhesive tape - bracket displacement Adhesive tape - bracket displacement Bonding resin – cleaning of bracket Bonding resin – cleaning of bracket base prior to bonding difficult and time base prior to bonding difficult and time consumingconsuming


Indirect bonding – Indirect bonding – ANOOP SONDHIANOOP SONDHI AJO 1999 AJO 1999

NEW INDIRECT BONDING MATERIALNEW INDIRECT BONDING MATERIAL3 M UNITEK / SONDHI RAPID SET3 M UNITEK / SONDHI RAPID SETUnique featuresUnique featuresIncreased viscosity - silica fillers[5%]Increased viscosity - silica fillers[5%]Quick set time – 30 secs Quick set time – 30 secs Decreases the time needed for holding the Decreases the time needed for holding the bonding traybonding trayCompletely cured 2 min allowing rapid Completely cured 2 min allowing rapid removal of the trayremoval of the tray


Indirect bonding – Indirect bonding – ANOOP SONDHIANOOP SONDHI

Alginate impressions Alginate impressions made made

working models poured working models poured in stonein stone



APC brackets used APC brackets used and positioned over and positioned over the teeth excess the teeth excess adhesive removedadhesive removed



Bracket positions Bracket positions checked checked Models are placed Models are placed in the TRIAD in the TRIAD curing unit 10 curing unit 10 minutesminutes


Indirect bonding – Indirect bonding – ANOOP ANOOP SONDHISONDHI

Block the Block the undercutsundercutsConstruct tray with Construct tray with bioplast material bioplast material [1mm] thick [1mm] thick overlayered with overlayered with bioacrylbioacryl



Excess tray Excess tray material is trimmed material is trimmed off with scalpeloff with scalpelTrays placed in the Trays placed in the TRIAD unit to TRIAD unit to ensure that ensure that uncured resin is uncured resin is curedcured



Prepare patient Prepare patient Pumice , Etch & Pumice , Etch & isolateisolateTray can be Tray can be sectioned if there sectioned if there is severe is severe crowdingcrowding



Small amounts of Small amounts of resin A and B are resin A and B are poured into the poured into the wellswells

Resin A – tooth Resin A – tooth surface surface

Resin B – resin Resin B – resin pads in the traypads in the tray



Seat the tray over Seat the tray over the teeth the teeth Hold with uniform Hold with uniform pressure for 30 pressure for 30 seconds seconds Leave the tray on Leave the tray on for another 2 for another 2 minutes to ensure minutes to ensure complete complete polymerizationpolymerization


not really a bracket not really a bracket placement deviceplacement deviceRather it orients the arch Rather it orients the arch wire slot of the bracket wire slot of the bracket relative to the facial relative to the facial surfacesurfaceAccomplished by holding Accomplished by holding the archwire slot stationary the archwire slot stationary while manipulating each while manipulating each tooth to any tip angle , tooth to any tip angle , torque, rotation & height .torque, rotation & height .

The slot machine & indirect bonding


[ Orientation templates & rotation [ Orientation templates & rotation guides]guides]


SEALINGSEALING

Sealer / Primer / Intermediate resinSealer / Primer / Intermediate resin Low viscosity resin which is applied Low viscosity resin which is applied prior to bonding .prior to bonding .

Necessary to achieve proper bond Necessary to achieve proper bond strength strength

Improve resistance to microleakage Improve resistance to microleakage Both reasons Both reasons Not needed at all Not needed at all


Chemically cured Chemically cured SealantSealant

Light curedLight cured Ceen & GwinnettCeen & Gwinnett

FoundFound

Light cured sealant Chemically curedLight cured sealant Chemically curedProtect enamel Protect enamel Polymerize poorlyPolymerize poorlyadjacent to bracket adjacent to bracket Have low resistance Have low resistance from discoloration from discoloration to abrasionto abrasion


Evaluation of sealant in Evaluation of sealant in orthodontic bondingorthodontic bonding Wei Nanwang etalWei Nanwang etal AJO 1991 AJO 1991

Evaluated the Tensile bond strength with Evaluated the Tensile bond strength with and without use of sealant and without use of sealant

They found no statistically significant They found no statistically significant difference in the bond strength of the two difference in the bond strength of the two evaluated groups evaluated groups


However the use of sealantHowever the use of sealant

May offer extra protection to enamel May offer extra protection to enamel

during debondingduring debonding

As chances of enamel surface As chances of enamel surface

detachment with out use sealant was detachment with out use sealant was

greater.greater.


Self Etch PrimerSelf Etch Primer

Unique characteristic of some bonding Unique characteristic of some bonding system is that they combine the system is that they combine the Etchant + Primer into single productEtchant + Primer into single product

Saves timeSaves timeCost efficientCost efficient


Self Etch PrimerSelf Etch Primer

Prompt L PopPrompt L PopTransbond self etch primerTransbond self etch primer

Liquid begins to etch as soon as it is applied Liquid begins to etch as soon as it is applied


Etchant Etchant PrimerPrimer

When two hydroxideWhen two hydroxide ions are convertedions are converted hydrogen ions arehydrogen ions are releasedreleased


Procedure For Self Etch Procedure For Self Etch

Teeth are pumicedTeeth are pumicedSelf etch primer gently swirled on to each Self etch primer gently swirled on to each enamel surface for 2 to 5 secs enamel surface for 2 to 5 secs As pH rises , etchant is converted to As pH rises , etchant is converted to primerprimerPrimer is thinned with burst of air Primer is thinned with burst of air No rinsing with water No rinsing with water Bracket then bonded in usual way.Bracket then bonded in usual way.


ConclusionConclusion--No significant difference in bond strength No significant difference in bond strength between the two groups.between the two groups.

10 min delay in bonding after application 10 min delay in bonding after application of self etch primer might not be deleterious of self etch primer might not be deleterious for adhesionfor adhesion


Hydrophilic Primer ( MIP )Hydrophilic Primer ( MIP )

Bond failure – Moisture contamination Bond failure – Moisture contamination When etched enamel is wet most porosities When etched enamel is wet most porosities get plugged – Penetration of resin impaired get plugged – Penetration of resin impaired Second molars – Access difficult Second molars – Access difficult Hydrophilic primer (HEMA & Maleic acid) Hydrophilic primer (HEMA & Maleic acid) dissolved in acetone – 3M Unitek dissolved in acetone – 3M Unitek

( Transbond MIP )( Transbond MIP )


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Documents

Materials in Orthodontics / orthodontic courses by Indian dental academy