Orthodontics II Lab PDF

ORTHODONTICS II LABORATORY / MIDTERM AND FINALS – FIRST TERM 4TH YEAR LESSON 1: ORTHODONTIC MATERIALS Instruments & Pliers BAND CUTTING SCISSORS Brackets...

ORTHODONTICS II LABORATORY / MIDTERM AND FINALS – FIRST TERM 4TH YEAR LESSON 1: ORTHODONTIC MATERIALS Instruments & Pliers BAND CUTTING SCISSORS Brackets Available in either straight or curved pattern, and Wires long and short cutting edge pattern It is made from especially hardened stainless ORTHODONTIC INSTRUMENTS & PLIERS steel with tungsten carbide inert cutting tip FEATURES OF ORTHODONTIC INSTRUMENTS Purpose: for cutting thin metal bands or band material FEATURE & RATIONALE Stainless steel extremely corrosion material resistant Tungsten carbide stiffer and denser tips steel Gold brazing for longer instrument life Serration on for grip MERSHON BAND PUSHER working ends improvement Handle is cylindrical and working end is serrated Bow out handles comfortable A hollow anatomically formed grip handle handling makes the band pusher light Rounded tips for patient comfort The serrated rectangular tip provides a good and safety transfer of force when positioning bands Purpose: used to push bands so as to seat them and/or adapt them to the exact contour of the CLASSIFICATION OF ORTHODONTIC PLIERS / teeth INSTRUMENTS INSTRUMENTS USED FOR PLACEMENT OF SEPARATORS o Separator Placement Plier BAND PREPARATION INSTRUMENTS o Band Cutting Scissors o Mershon Band Pusher o Nylon Band Seater o Band Crimping Plier BAND REMOVING PLIER NYLON BAND SEATER o Posterior Band Removing Plier Generally made of high impact plastics or wood The biting surface is a tin inlay. Its shape may be SEPARATOR PLACEMENT PLIER round, square, or triangular (allows easy access Made of stainless steel with sprint back action to interproximal area) with a serrated surface Barrel-shaped tip prevents slippage of the finish module, reduces the risk of tissue damage Purpose: for patient to bite on the surface with Angled beaks facilitate easier placement of the tin inlay tip resting on the lug or the band elastic separators in posterior areas edge Purpose: for expanding elastic separators or separating rings before positioning them interdentally DE LUNA, FIONA YSABELLA Z. | 1  BAND CRIMPING PLIER Purpose: to contour the gingival surface of preformed bands to provide better tooth anatomy DIRECT BONDING BRACKET HOLDER With reverse action type handle wherein the beak opens up upon pressing the handle Beaks are diamond shaped with serrations to grip the bracket POSTERIOR BAND REMOVING PLIER Flat end of the handle used to press the bracket Purpose: to remove posterior metal bands with into position for bonding maximum patient comfort Purpose: holds any type of bracket CLASSIFICATION OF ORTHODONTIC PLIERS / INSTRUMENTS BRACKET POSITIONING INSTRUMENTS BRACKET REMOVING PLIER o Boone gauge the wide tip wedge between both the edges of o Bracket positioning height gauge the base of the bracket and the tooth surface, o Direct bonding bracket holder easily lifting off the bracket BRACKET REMOVING PLIER Available in two forms: o Anterior Bracket Removing Plier o Straight: for anterior debonding o Posterior Bracket Removing Plier o 60 degrees angled tip: for posterior Purpose: for removing bonded brackets BOONE GAUGE most frequently used bracket positioning aid Accurately measures height of bracket placement from the incisal edge Purpose: simplifies seating the bracket on the teeth with exactly the right distance between bracket slot and incisal edge with pencil lid or metal tips CLASSIFICATION OF ORTHODONTIC PLIERS / INSTRUMENTS WIRE CUTTING INSTRUMENTS o Pin & Ligature Wire Cutter o Distal end wire cutter o Heavy wire cutter PIN & LIGATURE WIRE CUTTER designed for accuracy right to the tip, for smooth BRACKET POSITIONING HEIGHT GAUGE cutting of soft ligature wires and lock pins and accurately measures height of bracket elastomerics placement from the incisal edge Purpose: used on ligatures or wires not more than Purpose: simplifies seating the bracket on the 0.015mm in diameter teeth with exactly the right distance between bracket slot and incisal edge DE LUNA, FIONA YSABELLA Z. | 2  DELA ROSA ARCH CONTOURING PLIER has guiding grooves for forming round and square arches 0.016” to 0.022” Purpose: used to accentuate the curvature in the arch wire DISTAL END WIRE CUTTER Is capable of cutting archwires up to 0.022 x 0.028” both intraoral and extraoral method Has a “safety” mechanism to hold the cut archwire so it does not fall intro the patient’s BIRD BEAK PLIER mouth an extremely versatile utility plier designed for Purpose: used exclusively to cut the distal end of working round wire up to 0.030” in diameter the wire protruding out of the molar tubes Purpose: used to bend appliance and orthodontic wires HEAVY WIRE CUTTER Heavier and larger than the pin & ligature wire JARABAK LIGHT WIRE PLIER cutter longer and more gradually tapered beaks than Purpose: used to cut all wires up to 0.020 round the bird beak pliers It comes with or without serrations on its flat beak Purpose: used for arch form and spring preparations; may be used for hard wires up to 0.020” diameter CLASSIFICATION OF ORTHODONTIC PLIERS / INSTRUMENTS ARCH FORMING INSTRUMENTS o Turret o Dela Rosa Arch Contouring Plier o Bird Beak Plier o Jaraback light wire plier CLASSIFICATION OF ORTHODONTIC PLIERS / INSTRUMENTS TURRET UTILITY PLIER the wire slotter body is made of stainless steel o Howe plier Available in different versions and colors - blue, o Weingart Universal black, gold, purple, green depending on torque o Three-prong plier adjustments and wire size OTHERS Purpose: used for preparation of archwires with o Mathieu Needle Holder or without torque adjustment HOWE PLIER Purpose: used to hold arch wires and to seat individual anterior bands in place DE LUNA, FIONA YSABELLA Z. | 3  IDENTIFICATION SYSTEM WEINGART UNIVERSAL PLIER color code quadrant where you will place the the bend in the beak facilitates easy grasping of quadrant the archwire and guiding into buccal tubes By quadrant with a removable colour coded dot Capable of bending wires up to 0.020” diameter for easy selection Purpose: used to guide and move the archwire Yellow = 1st Quadrant in and out of placement and used to bend the Yellow part / colored part dapat nasa distal part end of archwires ng ngipin VERTICAL SCRIBE LINE for easy and accurate placement on the long axis GENEROUS UNDER TIE-WING AREA for easy ligation THREE-PRONG PLIER SMOOTH FACIAL CONTOURS Has three precision aligned tips, which ensures for maximum patient comfort consistent bends in lingual bars and wires Allows a V-shaped bending curve 80 GAUGE FOUL MESH BASE Purpose: used for the activation or adjustment of for increased bond strength appliances like quadhelix appliance At the back of bracket Where we put the cement TORQUE IN BASE for precise level slot lineup during the finishing phase METAL INJECTION MOULDING (MIM) MATHIEU NEEDLE HOLDER Technique for accurate bracket structure has a convenient and practical design that is ideal for ligation INTEGRATED BALL HOOK Its serrated tips allow better gripping of the thin for easy engagement of elastics ligatures and elastomeric modules Purpose: used for the placement of ligatures and THE BRACKET MATERIAL MUST BE: elastomeric modules Hygienic, nontoxic Resistant to corrosion Must resist forces applied to it by the wire Esthetic Not absorb water Not be discolored by oral liquids Have minimal bracket-wire friction ORTHODONTIC BRACKETS BASED ON MATERIAL, BRACKET CAN BE BROADLY GROUPED AS: A. Metal bracket o Stainless steel 316 and 318 type o Low nickel SS (stainless steel) 2205 o Nickel free pure titanium/titanium alloy (Ti-6A1- 4V) o Cobalt-chromium o Gold-brackets B. Non-metal brackets o Plastic brackets o Porcelain brackets o Polycarbonate brackets o Polycarbonate brackets with metal slots DE LUNA, FIONA YSABELLA Z. | 4  MANUFACTURING METHODS OF METAL BRACKETS METAL BRACKETS Most of the conventional metal brackets are STAMPED BRACKETS made up of stainless steel o this process feeds sheet metal into a press Low cost where a tool and die form it into a metal part Sufficient strength to withstand forces of o Almost routinely used until the prescription deformations straight wire appliances were introduced Resistance to corrosion due to chromium Excellent formability and good mechanical CAST BRACKETS properties o molten metal is poured into a pre-made mold The stainless steel of 316 and 318- type steel is o More accurate and durable used for manufacturing orthodontic brackets o Clearly are superior so most the brackets and with 18-8 SS formulation (18% chromium and 8% tubes for contemporary appliances now are nickel) castings Stainless steel brackets have been in extensive use and have shown reasonable strength, bio- NON METALLIC BRACKETS acceptability and proven track record of clinical tooth colored or clear brackets acceptability However, it has 2 disadvantages: PLASTIC BRACKETS o Not aesthetic initially made of polycarbonate and plastic o May release nickel and chrome into the oral molding powder (Plexiglas) environment It is useful only when complex tooth movements ▪ If nickel is leached from orthodontic are not required appliances, Type IV hypersensitivity reaction Disadvantages OF NON-METALLIC BRACKETS: can occur. (Type IV hypersensitivity is like 1. Staining and Discoloration contact dermatitis) 2. Fragile (breaks under stress) 3. Poor dimensional stability (arch wire slot) NICKEL 4. Friction between plastic bracket and metal most brackets currently used are made of archwire austenitic (more anti corrosion) stainless steel containing 18% chrome and 8% nickel The significant nickel content of stainless steel can induce mucosal allergic reactions About 10% of the population have some degree of nickel sensitivity GOLD CERAMIC BRACKETS was abandoned as a metal alternative because made of monocrystalline and polycrystalline of its performance and cost ceramic material Durable & stain-resistant TITANIUM Can be custom-molded for individual teeth AS AN ALTERNATIVE TO STAINLESS STEEL Dimensionally stable high success rate in bonding DISADVANTAGES: Resilient than steel and absorbs impact better 1. Fracture tendencies Nickel-free content 2. Friction with bracket slots Hypoallergenic properties 3. Wear on teeth contacting a bracket Biocompatible 4. Enamel damage during debonding FRACTURES OCCUR IN TWO WAYS: Modern edgewise appliances uses brackets or 1. Loss of part of the brackets during archwire tubes that are custom-made for each tooth, with changes or eating the goal of minimizing the number of bends in 2. Cracking of the bracket when torque forces are archwires need to produce an ideal applied arrangement of the teeth, hence, the “straight wire” name. DE LUNA, FIONA YSABELLA Z. | 5  A new design of the ceramic bracket is ORTHODONTIC WIRES borrowed from the design of the metal Archwires are the base wires, which are reinforced plastic brackets in which a metal slot engaged in brackets of the various appliance is incorporated in ceramic bracket. This is to systems reduce friction between bracket and wire Used to provide a proper arch form and/or Another feature of this appliance is the ease of provide a stable base to which the auxiliaries debonding (bracket removal) via a vertical can be attached to generate the tooth moving scribe line placed in the base of the bracket forces SELF - LIGATING BRACKETS MANUFACTURING OF ORTHODONTIC WIRES They have a built-in metal face, which can be The starting point: casting of an ingot having the opened and closed appropriate alloy composition. ACTIVE - have a sliding sprint clip, which This ingot is then subjected to a series of encroaches on the slot from the labial aspect, mechanical reduction operations until the cross potentially placing an active force on the section is sufficiently small for wire drawing archwire. Slot Depth between 0.0175” - 0.020” PASSIVE - have a slide that opens and closes The elastic behavior of ang material is defined in vertically and creates a passive labial surface to terms of its stress - strain response to an external the slot with no intention to invade the slot. Slot load Depth approx. 0.028” STRESS o Internal distribution of the load, defined as force per unit area STRAIN o Internal distortion produced by the load, defined as deflection per unit length DIRECTIONS OF FORCES RELATED TO STRESS AND STRAIN If there is an increase in the length of a piece of TYPES: metal due to stress, this is referred to as Tensile 1. Spring Clip Strain. Tension 2. Retaining Clip 3. Rigid Clip If there is a reduction in length, this is referred to The principal advantage of a rigid clip is the as Compressive Strain. Compression reduction of friction between the wire and Shear Strain is the bending or twisting of wires. bracket - Shear (arrows magkapatong) o Speed Bracket Spring Clip – Active For orthodontic purposes, three major properties of beam materials are critical in defining their clinical usefulness: 1. Strength - a force value, that is a measure of the maximum possible load. Greatest force a wire o SmartClip Bracket Retaining Spring – Passive can sustain or deliver. 2. Stiffness (or its inverse springiness) - the rate of force delivery require for a unit activation. Proportional to the modulus of elasticity and o Damon Bracket Rigid Clip – Passive cross section of a given wire. The measurement of force required to deform the material. 3. Range - maximum amount of elastic activation before the onset of a permanent or plastic deformation. Determined from the 0.1% offset point on the force-deflection diagram. Kung hanggang san kaya ng wire na di siya permanently madadamage. CHARACTERISTICS OF ORTHODONTIC WIRES Large Springback Low stiffness DE LUNA, FIONA YSABELLA Z. | 6  High formability YIELD STRENGTH High stored energy The stress at which a material exhibits a specified Low surface friction limiting deviation from proportionality of stress to Biocompatibility and environmental stability strain Capability to be welded or soldered to auxiliaries The property that represent the stress value at or attachments which a small amount of plastic deformation occurred SPRINGBACK The wire will not return to the original state after maximum elastic deflection or working range the deformation It is also a measure of how far a wire can be deflected without causing permanent TENSILE STRENGTH deformation The maximum stress that a material can Related to the ratio of yield strength (YA) to the withstand before failure in tension modulus of elasticity (E) of the material (YS/E). The wire will not return to its original shape, but clinically useful springback will occur unless the STIFFNESS OR LOAD DEFLECTION RATE failure point is reached. This is the force magnitude delivered by an appliance and is proportional to the modulus of PROPORTIONAL LIMIT elasticity (E). the highest stress at which stress is directly Measurement of material’s elasticity and its proportional to strain resistance to deformation. FORMABILITY high formability provides the ability to bend a wire into desired configurations such as loops, coils, etc. without fracturing the wire. MODULUS OF RESILIENCE this property signifies the energy storing capacity of the wire It is represented by the area under the line describing elastic deformation of the wire. How well the wire can handle the force without deformation. FRICTION The preferred wire material for moving teeth relative to the wire should produce the least amount of friction at the bracket/wire interface. Excessive friction can result in loss of anchorage or binding accompanied by little or no tooth movement. BIOCOMPABILITY AND ENVIRONMENTAL STABILITY Biocompatibility includes resistance to corrosion and tissue tolerant to elements of the wire. WELDABILITY / JOINABILITY the ability to attach auxiliaries to wires by soldering or welding A filler metal may or may not be used to join the work pieces DE LUNA, FIONA YSABELLA Z. | 7  LESSON 2: CLASSIFICATION OF ARCHWIRE MATERIALS CLASSIFICATION OF ARCHWIRE MATERIALS BASED STAINLESS STEEL ON MATERIAL CONSTITUENT a. Gold b. Stainless steel c. Chrome - cobalt d. Nickel o Matensitic and austenitic o Superelastic, and thermodynamic/temperature Introduced in 1929 by Wilkinson. transforming Its stiffness and resiliency were of great e. Beta titanium importance f. Alpha titanium Stainless steel was derived by addition of g. Titanium niobium alloy chromium to iron h. Multi-stranded archwires The austenitic form is made use of in orthodontics i. Composite/coated wires 18/8 stainless steel - 18% chromium 8% nickel - j. Optiflex archwires austenitic form ADVANTAGE DISADVANTAGE GOLD 1. High stiffness 1. Soldering is demanding 2. High yield strength – 2. Lower springback 1400 MPa approx. than Nickel-titanium alloys. 3. Good formability 3. High modulus of Gold alloys were used prior to the 1930s. elasticity They were inert, biocompatible and 4. Good environmental 4. More frequent environmentally stable. stability activations are required According to American Dental Association to maintain the same classification gold alloys are of two types: force levels. o Type I - increased gold content 5. Good joinability 5. Heating to o Type II - relatively lesser content of gold temperatures of 400- Addition of copper permitted age hardening 900 degrees causes the Silver was mainly added to counter the color of release of nickel and copper. chromium, thereby Palladium and platinum increased the melting decreasing the temperature. corrosion resistance of Nickel increased the strength and tarnish the alloy resistance of the alloy. 6. Adequate Zinc provided the antioxidant properties to the springback alloy 7. Biocompatible ADVANTAGE DISADVANTAGE 8. Corrosion resistant, 1. Extremely formable 1. Low yield strength except at weld sites 2. Strength can be 2. Low springback 9. Economical increased by heat treatment as well as COBALT CHROMIUM cold working Also known as Elgiloy 3. Low modulus of 3. High cost These wires have properties similar to those of elasticity stainless steel but can be supplied in the softer 4. Good environmental and more formable state and then could be stability hardened by heat treatment 5. Good joinability This process increases the strength of the wire 6. Excellent significantly. biocompatibility This alloy is manufactured in four tempers, depending on the amounts of cold work: o Blue – soft and easy to bend, o Yellow – ductile o Green – semi-resilient DE LUNA, FIONA YSABELLA Z. | 8  o Red - resilient These wires are more flexible and were very The wires made from this alloy are generally frequently used for initial alignment of teeth supplied in the ductile form, allowing them to be before the advent of Ni-Ti wires. easily deformed and shaped into appliances. These are then heat treated to increase their strength. ADVANTAGE DISADVANTAGE 1. Excellent tarnish and 1. Has to be heat corrosion resistance treated ORTHODONTIC AUXILLARIES 2. Greater resistance to 2. Soldering is Elastomeric Products fatigue than stainless demanding. A low 1. Elastomeric ligatures steel fusing solder has to be 2. Elastomeric chain used. These wires should 3. Elastomeric thread be soldered with a silver 4. Elastomeric tube solder in the presence 5. Elastic bands of a fluoride flux or can Metallic Products be joined by spot 1. Coil spring welding 2. SS ligatures 3. Greater resistance to 3. The modulus of 3. SS auxiliary springs distortion elasticity is high causing higher forces ELASTOMERIC LIGATURE to be delivered for similar activations as stainless steel wires. 4. Good formability 5. Functionally remains active for longer Other names: Elastomeric ligatures, Elastomeric duration if used as a ties, E-ties resilient spring Used to secure the arch wire in the bracket Faster to place and replace compared to NICKEL - TITANIUM ligature wires This alloy was developed in 1971, and marketed as “Nitinol” ELASTOMERIC CHAIN It had excellent springback properties. Newer alloys are even thermal activated, i.e. exert tooth moving forces only after reaching a certain temperature. This was achieved with the addition of small amounts of copper. CROSS SECTION This can be stretched and used for moving single a. Round or multiple groups of teeth b. Square Long, Short, Closed c. Rectangular d. Miscellaneous e. Twisted COAXIAL ARCHWIRES ELASTOMERIC THEEAD Coaxial archwires are made of a central core Used for the application of traction to individual wire of 0.006 inch diameter wire with 5 or 6 outer teeth wires DE LUNA, FIONA YSABELLA Z. | 9  OPEN COIL SPRING o Has an open configuration o threaded around the arch wire and used to create space by pushing teeth apart ELASTOMERIC TUBE Other name: Archwire sleeve Used for the covering the exposed sections of the archwire CLOSED COIL SPRING o Nickel titanium coil springs can be stretched to For protection provide a light continuous force for space closure and tooth movement ELASTOMERIC BAND LIGATURE WIRE Used for application of inter- or intramaxillary force They provide the cheapest and relatively reliable force delivery May be used around individual brackets to provide more secure ligation to the archwire than elastomeric ties Extraoral elastics deliver consistent and accurate force for extraoral applications May be used to ligature groups of teeth together or lace them back AUXILIARY SPRINGS COUL SPRING Made from Stainless steel, Cobalt Chromium, or Nickel titanium Used primarily in conjunction with light wire appliances, being threaded through a vertical slot in the bracket Used to apply uprighting or rotational force onto individual teeth DE LUNA, FIONA YSABELLA Z. | 10  LESSON 3: ORTHODONTIC SEPARATORS INSTRUMENTS USED FOR THE PLACEMENT OF DUMB-BELL SHAPED ELASTIC SEPARATOR SEPARATORS USE Separator Placing Pliers o Used to create space between two adjacent o Used to place the elastic ring separator in the teeth for banding procedure. interproximal area between the tooth to be APPLICATION PROCEDURE banded and the two adjacent teeth on either o Dumb-bell shaped elastic separator is stretched side of it. and passed through the contacts between adjacent teeth TIME REQUIRED FOR SEPARATION o Separation of teeth takes place in about 4 days. ADVANTAGE o Special pliers are not required for the placement. ORTHODONTIC SEPARATORS Used to create space between two adjacent teeth for banding procedures Four types of separators: BRASS WIRE SEPARATOR 1. Elastic ring separator USE 2. Dumb-bell separator o Used to create space between the two 3. Brass wire separator adjacent teeth for banding procedure. 4. Kesling metallic ring separator APPLICATION PROCEDURE o A soft brass wire of 0.5 to 0.6 mm is passed around the contact and the ends are twisted tightly together. The end is made short and then tucked between the teeth ADVANTAGE o Ease in application DISADVANTAGES ELASTIC RING SEPARATORS a. Soft tissue damage can occur USE b. Poor patient acceptance o Used to create space between two adjacent teeth for banding procedure. APPLICATION PROCEDURE: o Elastic ring separator is grasped in separator placing pliers and then stretched and placed interdentally TYPES a. Round KESLING METALLIC RING SEPARATOR b. With edges Parts of Kesling Metallic Ring Separator TIME REQUIRED FOR SEPARATION o Coil/helix o Separation of teeth takes place in about seven o Occlusal arm days o Gingival arm ADVANTAGES o Retentive arm o The most comfortable for the patient. o Fit snugly in the interdentally region DE LUNA, FIONA YSABELLA Z. | 11  Wire used: Australian austenitic arch wire of 0.016 round wires. Plier used: Light wire pliers or bird beak pliers or Weingart pliers are used Placement: Kesling metallic ring separator is grasped in tight wire pliers and then placed in such a way that coils part of separator should be on buccal side of the teeth Time Required for Separation: Separation for banding in about two days. Advantage: Faster as compared to other types of separator. Disadvantage: It can be dislodged and can cause tissue damage. DE LUNA, FIONA YSABELLA Z. | 12  LESSON 4: SPACE MAINTAINERS ETIOLOGY OF EARLY PRIMARY TOOTH LOSS IDEAL SPACE MAINTAINERS Extraction or destruction 1. Simple to construct and maintain o Extensive caries or traumatic injury 2. Durable and stable Premature exfoliation 3. Passive o Abnormal root resorption (ectopic eruption) 4. Easily cleanable and does not enhance dental o Systemic disorders or hereditary syndromes caries or soft tissue pathology ▪ Hypophosphatasia 5. Readily adjustable for flexible application ▪ Acrodynia ▪ Dentinal dysplasia INDICATIONS OF SPACE MAINTAINERS ▪ Cherubism 1. One or more primary teeth have been ▪ Leukemia prematurely lost ▪ Juvenile periodontitis 2. There is no loss of arch length 3. MDA is favorable A SPACE MAINTAINER MAY NOT BE REQUIRED IF THERE IS: 1. Widely spaced primary dentition 2. If succeeding tooth is expected to erupt within 6 months 3. If present space is not adequate for the succeeding tooth 4. The possibility of future orthodontic work 5. Where the opposing 6’s are locked into a FUNCTION OF SPACE MAINTAINERS desirable and stable relationship Preserves arch length following the premature loss of primary tooth SUGGESTED THAT SUCCEEDING TOOTH WILL Permits the permanent tooth to erupt MOST LIKELY ERUPT WITHIN 6 MONTHS IF: unimpeded into proper alignment and occlusion 75% of the root is present on the succeeding Prevents undesirable tooth movement tooth o Mesial migration of posterior segments and Less than 1 mm of alveolar bone is covering lingual collapse of anterior segments succeeding tooth Destruction of the alveolar bone occurred when the primary tooth was lost Mixed dentition is in its later stage ADVERSE EFFECTS 1. Dislodged, broken and lost appliances 2. Plaque accumulation 3. Caries 4. Interference with successor eruption 1. Maintains space 5. Undesirable tooth movement 2. Prevents movement of adjacent teeth 6. Soft tissue impingement 3. Provide masticatory fx 7. Pain 4. Prevents overeruption of opposing teeth 5. Improve esthetics FACTORS TO CONSIDER 6. Assist in speech (anterior segments) 1. Tooth loss 7. Aid in control of deleterious oral habits 2. Segment involved 3. Age of the patient DE LUNA, FIONA YSABELLA Z. | 13 4. State of health of the remaining teeth Pedo cast (lower) 5. Type of occlusion Sticky wax 6. Patient’s cooperation Flux 7. Manual dexterity and preference of the operator 3-prong plier/ 139 plier PROCEDURE 1. Knock down tooth 2. Place molar band on tooth 3. Anterior curve: o Bend the 0.030” wire at midpoint using 3-prong plier/139 plier o Make sure the curve is shaped to approximate the width of the distal surface of 1st primary molar BAND & LOOP INDICATIONS 4. Form the maintainer arm into a gradual curve to Loss of primary molar follow the contour of the ridge but slightly off the o Prior/during eruption of 1st permanent molar surface (approx. 1mm) Loss of 1 primary tooth Posterior segment o Following a time lapse b/w loss of tooth and eruption of its permanent successors 5. Position the pliers at the mesial end of the maintainer arm with the conical beak on the occlusal surface of the wire. Push the wire distal to the plier upward until a gentle bend is formed ADVANTAGES Easy to construct Inexpensive Easily adjusted Allows eruption of permanent tooth Non-invasive 6. Reposition the pliers 1.0 mm distally and make Painless another bend 7. Form the other maintainer arm DISADVANTAGES Masticatory function o Not restored Extrusion of opposing dentition o Not prevented Normal distal movement of primary cuspids during eruption of permanent lateral incisor 8. Bend distal ends of the loop to contact passively o Hindered if placed for the early loss of against the middle third of the band parallel to mandibular 1st primary molar the band’s occlusal margin. MATERIALS AND INSTRUMENTS Preformed molar bands for 36 or 46 4” long 0.030” ortho wire Wire cutter Silver solder and orthodontic blowpipe DE LUNA, FIONA YSABELLA Z. | 14 9. Fix loop into position with wax o Highly prone to caries 10. Solder. Carefully remove the appliance from the Can promote decay in non-compliant patients cast. Trim the ends of the wire opposite buccal groove and lingual groove of band. MATERIALS AND INSTRUMENTS 11. Polish Preformed molar bands for 36 or 46 0.036” ortho wire Wire cutter Silver solder and orthodontic blowpipe Pedo cast (MD stage with 36, 46, 41, 42, 31, 32) Sticky wax Flux 3-prong plier/ 139 plier PROCEDURE MANDIBULAR HOLDING ARCH 1. Take an impression of the indicated cast Lingual holding arch/ Fixed lingual arch 2. Place the molar bands for 36 and 46 on the correct area of the impression. Stabilize bands on INDICATIONS the impression Bilateral loss of single/multiple primary posterior 3. Pour cast stone teeth in mandibular arch 4. Bend 0.036” ortho wire in such a way that the Permanent 1st molars and 4 incisors present lingual arch rests on the cingulum of the incisors. Minor movement of anterior teeth The configuration results in a keyhole design that can incorporate adjustment loop mesial to the molar abutment teeth so that the appliance can ADVANTAGES be activated or adjusted to modify the fit Maintains arch form Allows eruption of permanent teeth w/o interference Not easily displaced Ease of cleaning for proper OH Can be modified easily Patient comfort ✓ Wire should contact the cingulum of mandibular incisors slightly above gingival papilla ✓ Should lie on gingival third of the primary molar ✓ Should rest at middle third of banded molar 5. Solder ends of the wire to the molar bands 6. Polish DISADVANTAGES TRANSPALATAL ARCH Does not prevent extrusion of opposing teeth Mixed Dentition Not advisable to band teeth which are prevents the mesial migration of the upper first o Hypoplastic molars during the transition from the second o Hypocalcified deciduous molars to the second premolars DE LUNA, FIONA YSABELLA Z. | 15  DESIGN 0.036 SS wire running along palate connecting upper molars The palatal portion incorporates an acrylic button resting directly on the palatal rugae o Prevents the abutment teeth from drifting mesially DESIGN 0.036 SS wire that goes across the palatal contour from one molar to contralateral molar Wire soldered to molar band at mesiolingual line angles ADVANTAGES Provides anchorage during alignment and levelling (Palatal vault and cortical anchorage) Antero-posterior anchorage in a case of canine or molar extraction ADVANTAGES Enhances anteroposterior anchorage in a case of canine or molar extraction No tissue inflammation and easily cleanable DISADVANTAGES Food debris may lodge under the button, creating a hygiene problem of the appliance if not thoroughly cleaned. DISADVANTAGES Lack of anterior stop leading to possible tooth shift NANCE APPLIANCE Maxillary fixed bilateral space maintainer Used to maintain space in the maxilla where there has been bilateral loss of deciduous molars DE LUNA, FIONA YSABELLA Z. | 16