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Types of dental braces and their placement techniques
Termiz University of Economics and Service
Yuldashov Shoxjahon Ilhomovich
Email- yuldashovshoxjahon@gmail.com
Abstract
: This article provides information about dental briquettes. The article
explains the techniques for the correct placement of dental briquettes.
Key words:
braces, Ribbon arc, E-arc, Vestibular braces, Gold braces.
Braces ( from English
"bracket"), orthodontic
braces complex orthodontic non-removable structures (appliances) for correcting
the position of human teeth in case of bite disorders and unevenness of the dentition.
They are devices that are fixed with orthodontic glue ( bond ) to the outer or inner
surface of the teeth. The bracket has a groove in which an orthodontic arch lies,
which
has
a
" shape
memory "
(for
example,
a nitinol alloy
based
on nickel and titanium ) or steel. The resistance of this arch when it is fixed by means
of braces on crooked teeth is a force that slowly but steadily aligns the teeth and
dentition under the influence of heat in the oral cavity.
Story Edward Angle is considered the father of braces and modern
orthodontics not only for his contributions to classification and diagnosis, but also
for his ingenuity in developing new orthodontic appliances. With only a few
exceptions, the fixed appliances used in modern orthodontics are based on Angle's
design, developed in the early 20th century. Angle developed four basic systems of
appliances:
E-arc
In the late 19th century, the typical orthodontic appliance was some kind of
rigid frame in which the teeth were mounted so that they could be expanded along
the arch. Angle's first appliance, the E-arch, was of this type. Bands were placed
only on the molars, and a strong vestibular archwire was placed along the teeth. The
ends of the archwire were threaded, and a small nut screwed onto the threaded
section allowed the archwire to be advanced to increase the perimeter. Individual
teeth were simply tied to this expanding archwire. Such appliances could still be
found in some orthodontic laboratory mail-order catalogues until the 1980s,
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probably due to their simplicity, but despite this they provided only heavy
intermittent forces.
Pin and tube
The E-bow was only capable of tilting teeth into a new position. It could not
provide precise positioning of individual teeth. To solve this problem, Angle began
to place bands on other teeth and used vertical tubes on each tooth that contained a
pin soldered to a small wire arch. With this device, tooth movement was achieved
by changing the position of each pin individually.
The construction and adjustment of such a pin-and-tube device required
enormous effort, and although it theoretically had great precision in tooth movement,
it was impractical for clinical use. It was said that only Angle himself and one of his
students succeeded in making such a device. The relatively heavy supporting arch
had poor elasticity, and the problem was precisely that it required a large number of
adjustments to the device.
Ribbon arc
In his next appliance, Angle modified the tube on each tooth into a vertically
positioned rectangular slot. A ribbon archwire of 10 x 20 gold wire was placed in
the slots and secured with pins. The ribbon archwire was an immediate success,
primarily because it was small and flexible enough, unlike its predecessors, to be
effective in aligning misaligned teeth. Although the ribbon archwire could be twisted
when placed in the slot, the appliance's major weakness was that it provided
relatively little root control. The elasticity of the ribbon archwire simply did not
allow for the moments needed to create root torque.
Edgewise technique
To correct the shortcomings of the band arch, Angle reoriented the slot from
vertical to horizontal and inserted rectangular wires rotated at 90° into the slots, and
this device was called the Edgewise system. The slot dimensions were changed to
0.022 x 0.028 inches, and a precious metal wire of 0.022 x 0.028 was used
(nowadays, the slot size is usually indicated in an abbreviated form, for example,
.022, removing the first 0 or 022, also removing the period). These dimensions were
obtained as a result of numerous experiments and provided really good control of
the position of the crown and root in three planes of space.
After its invention in 1928, this device became the mainstay of treatment using
multi-ring fixed devices, although tape arches continued to be used for another
decade.
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Design of braces
The simplest design includes a slot for the wire arch, ligature wings for fixing
the arch with ligatures, and retention elements on the base for attachment to the
surface of the tooth enamel. The vertical movement of the teeth will be ensured by
the simple presence of the arch in the bracket slot, lateral movement - by the ability
to slide the arch inside the slot, and the rotational moment - by the mesiodistal size
of the bracket. The vertical size of the bracket does not affect the movement of the
teeth, but determines the strength of the ligature wings. The design of the retention
points on the base of the bracket is responsible for the degree of mechanical fixation.
Physiology of tooth movement with braces
The movement of teeth with the help of a bracket system occurs as a result of
applying pressure to the crown of the tooth. Traditionally, four main elements are
used in the treatment process: brackets, adhesive material , an arch and ligatures (in
traditional brackets). Teeth are moved due to the effect of the arch force on the tooth
through the bracket. Sometimes additional elements are used: opening springs and
elastic chains, their main purpose is to apply additional forces in the required
direction.
The orthodontist sets the arch shape determined by each specific clinical case.
After that, it is placed in the slots of the brackets glued to each tooth of the upper
and/or lower jaw. The arch tends to return to its original shape, applying a constant
force to the tooth, thereby gradually moving it. That is, the bracket system initiates
the emergence of constant forces that contribute to the movement of teeth to the
desired position. The brackets are positioned on the teeth in such a way that the
forces initiated by the arch move the teeth in the desired direction, bringing the
dentition to a natural and aesthetic state. The result of this process is bone
remodeling - resorption of the alveolar bone tissue on the side to which the tooth
movement is directed, and the formation of new bone tissue on the opposite side.
Depending on the magnitude of the force applied to the tooth during its
movement, two types of bone resorption can be distinguished: directed (direct)
resorption and indirect (subsurface, retrograde) resorption, which occurs in cases
where the periodontal ligament is subjected to excessive loads in terms of force and
time.
Another important physiological process initiated by the tension of the
periodontal ligament and providing tooth movement is the deposition of bone tissue
along the stretched periodontal fibers. The combination of these two factors provides
tooth movement during orthodontic treatment .
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It was found that the fastest and most physiological tooth movement occurs
when applying forces equal to the blood pressure in the capillaries of the periodontal
ligament - 20-26 g / cm. The use of forces exceeding these values by at least 0.5 g
leads to compression of blood vessels, oxygen starvation, cessation of cellular
activity and such pathological processes as necrosis and hyalinization. As a result,
subsurface resorption occurs instead of the desired physiological directed one,
ensuring comfortable and rapid tooth movement.
Types of braces
Depending on their location on the tooth surface, there are vestibular (located
on the outer side of the tooth) and lingual (internal) braces. Depending on the type
of material used in their manufacture, brace systems are divided into metal, plastic,
polymer (ceramic, sapphire) and combined. Depending on the method of attaching
the arch to the braces, there are classic braces (using ligatures) and self-ligating (non-
ligature). There are also aesthetic braces. These include equipment made from
materials that are less noticeable on the teeth than metals (plastics, ceramics,
sapphire), as well as completely invisible lingual systems.
Vestibular braces
The largest group of bracket systems that are located on the front surface of the
tooth. Vestibular bracket systems essentially include all bracket systems with rare
exceptions. The advantages of vestibular brackets compared to lingual (internal)
brackets are the predictability of treatment results, a significantly lower price, ease
of hygienic care and other manipulations with brackets. The main disadvantage of
vestibular brackets is their high visibility. On the other hand, in 2017 and 2022 there
was a trend of popularizing brackets as a fashion accessory, which levels out this
disadvantage.
Lingual braces
Unlike vestibular braces, lingual braces are attached to the inner (lingual) side
of the teeth and are completely invisible to others. Lingual braces are also classified
as aesthetic braces. It is believed that this is the most aesthetic method of orthodontic
treatment using non-removable systems. The disadvantage of lingual systems, in
addition to their high cost, is the reduction of the inner part of the oral cavity.
Therefore, patients initially experience diction disorders. As a rule, after 2-3 weeks
the tongue adapts to the reduced size of the oral cavity, and diction becomes normal.
In the case of using lingual braces, more labor-intensive oral care is also required.
In addition, when using lingual braces, there is increased discomfort for the patient
due to constant contact of the tongue with the brace system. In the Russian
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Federation, you can find three models of lingual braces: WIN, Incognito ( 3M ), STB
(Ormco).
Metal braces
The oldest type of braces. They are made from stainless steel (usually grade 17-
4), titanium or nickel-titanium alloy. Metal braces are still widely used due to their
low price and wide range of different options. The appearance of modern metal
braces differs from their ancestors - they are now smaller in size, can have different
shapes and are much more effective than their predecessors. The main advantage of
metal braces over other types is the minimal friction force between the groove and
the arch, the value of which largely determines the duration of the entire treatment.
In addition, metal braces are the most resistant to any kind of external influences.
The main disadvantage of metal braces is their greater visibility on the teeth
compared to other types. Also, some manufacturers may use low-quality alloys in
the production of metal braces, which can lead to corrosion, deformation of the
braces, and unpredictable treatment results. Common examples of metal braces
include In-Ovation by Dentsply, Damon by Ormco, and SmartClip by 3M .
Gold braces
They are a type of metal braces. They are chosen by patients who want to
emphasize their status and individuality. As biologically neutral, gold braces are also
an option for patients who are allergic to other materials. In practice, at present
(2017), only Incognito lingual braces manufactured by the dental division of 3M ,
Unitek, are made of gold.
Plastic braces
The advantage of plastic braces over metal ones is their more aesthetic
appearance. However, they are characterized by a rather low strength compared to
metal braces, which can cause plastic braces to break right in the oral cavity, and
also have longer treatment periods due to the properties of plastic. Some
manufacturers use a metal groove in the design of such braces to increase the
strength and predictability of treatment results (for example, in Damon 3 braces
manufactured by Ormco). Also, plastic braces can be stained under the influence of
food dyes contained in coffee, tea and other products. Nevertheless, plastic
vestibular braces are widely used due to their low visibility and lower price
compared to ceramic, sapphire and lingual braces.
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Ceramic braces
Ceramic braces are aesthetic braces made of polycrystalline aluminum oxide
(for example, Damon Clear by Ormco, Clarity by 3M , Ovation C by Dentsply).
Compared to plastic, ceramic braces are more expensive, but also more durable. The
color of these braces is close to the natural color of tooth enamel, which makes them
almost invisible to others. The disadvantages of ceramic braces include higher
friction between the arch and the bracket groove (compared to metal braces), which
can increase the duration of treatment. To solve this problem, a metal groove is
sometimes introduced into the design, which worsens the aesthetics.
Sapphire braces
They are made of artificial sapphire crystal - monocrystalline aluminum oxide.
They have the highest transparency, are as invisible and aesthetic as possible. They
are more reliable than plastic and ceramic braces, and are more resistant to external
influences. The disadvantages of these braces include their high cost. Examples of
sapphire braces are Radiance (American Orthodontics), Inspire Ice (Ormco).
Classic braces systems
They are also called traditional braces, ligature braces. The oldest of the
currently used types of brace systems. The design feature of these systems is that the
bracket slot does not have a cover and the arch is attached to it using wire or elastic
devices - ligatures. Without additional mechanisms for attaching the arch, these
braces are easier to manufacture and cheaper (compared to self-ligating systems).
However, they require more manipulations on the part of the orthodontist, additional
costs for ligatures, more frequent visits to the doctor to change and tighten the
ligatures and special care (ligatures contribute to the deterioration of the hygienic
condition of the oral cavity).
Another disadvantage of such systems is the increased likelihood of increasing
the treatment period and obtaining negative results. The fact is that when planning
treatment, the orthodontist needs to calculate the forces that the arch applies to the
bracket and, accordingly, the movement of the tooth. At the same time, the ligature
with which the arch is fixed in the bracket groove exerts counter pressure, which
partially neutralizes the force of the arch. In the case of treatment with bracket
systems, even such a small counter pressure can significantly affect the timing and
outcome of treatment.
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Self-ligating braces
Ligature fixation of arches requires significant time expenditures. For example,
during a regular change or activation of an arch, the doctor's work directly with the
arch takes about 20-30% of the total time. Most of the appointment is associated
with removing old ligatures and installing new ones. The use of elastic ligatures at
many stages of treatment is a serious compromise. Therefore, a number of
orthodontists and engineers have been attempting for decades to create brackets that
have the function of fixing the arch in the groove without the use of ligatures or self-
ligating brackets. A great many such designs have been proposed, but they have not
received sufficient distribution. The first ligature-free brackets were bulky and
unreliable. Some designs existed only in the form of drawings and prototypes, others
experienced the rise and fall of their popularity. However, the entire variety of self-
ligating bracket designs has over time been reduced to a simple classification of self-
ligating brackets with a groove that closes with a lid:
Active locking brackets or
active self-ligating brackets
. The mechanical
shutter of the slot of such brackets exerts active pressure on the arch in order to move
it towards the base of the slot.
Passive self-ligating brackets or
passive self-ligating brackets
. Passive self-
ligating means that the cover does not exert active pressure on the archwire towards
the bottom of the bracket slot. A passive self-ligating bracket in its closed form can
be compared to a buccal tube.
Passive self-ligating brackets are the most advanced type of bracket systems.
They are distinguished by the greatest reliability of the design, stability and
predictability of treatment results. While in active self-ligating systems the
orthodontist must also take into account the force of pressure of the bracket slot
cover on the arch, in passive systems it makes sense to take into account only the
force directly applied by the arch to the brackets.
Among passive self-ligating braces, the brace system created by Dr. Dwight
Damon in 2000 stands out, which was named the Damon System . This system is
essentially a fundamentally new approach to orthodontic treatment using non-
removable equipment. It is an ecosystem of braces, arches, locks and other elements
developed in a complex and ideally suited to each other to ensure the specified
treatment results, subject to the integrity of the system and general treatment
algorithms on this equipment.
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Individualized braces
Modern CAD/CAM technology allows creating orthodontic equipment
(brackets and arches) that is completely individualized for each patient. Thanks to
computer precision, it reduces the number of errors, opens up new possibilities in
planning and managing the treatment process, and provides accurate, predictable
results in less time (up to 25%). Individual torque values and an individual arch
shape with applied first-order bends, calculated by a computer program, allow
achieving high-quality results with less effort. Brackets are placed on the teeth in
such a way as to move them to the position prescribed by the doctor in the shortest
possible time. Application of an individual preventive program scheme in treatment
with bracket technology.
Brief description of the technology
The orthodontist makes silicone impressions (casts) of the patient's teeth and
sends them to the laboratory, where the impressions are scanned. This creates a
three-dimensional computer model of the teeth. The program processes the image
so that each tooth is transformed into a separate geometric object with the ability to
move and change position in all planes. In accordance with the doctor's wishes,
technicians in a special program set the teeth in the position they will occupy as a
result of treatment, and also calculate and draw the ideal shape of the dental arches.
The program creates a "virtual setup" - places the braces selected by the doctor on
the teeth. After this, the file with the setup is sent to the doctor for approval. The
doctor has the opportunity to change the setup using a special program and send it
for rework. This continues until the doctor approves the setup. After this, the order
goes into production. The doctor receives 2 sets of portable templates for fixing the
braces on the teeth, made in full accordance with his order, containing braces made
individually for the patient. The doctor receives his order by mail and fixes the
braces directly to the patient's teeth using templates (a plaster model and a mouth
guard are not needed).
Examples of existing technologies for the production of individualized braces
are the Insignia (Ormco) and Orapix systems.
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Literature
Gerasimov S. N. Fixed orthodontic equipment. Publisher. St. Petersburg State
Medical University, 2002. - 64 p.
Proffitt W.R., Modern Orthodontics (3rd edition), MEDpress-inform, 2015,
560 p.
Borkowski RN The biologically based case for truly light-force mechanics,
Clinical Impressions, Vol 13 (1), 2004, p 19-22.
Toledo SR, Oliveira ID, Okamoto OK, Zago MA, de Seixas Alves MT, Filho
RJ, Macedo CR, Petrilli AS. "Bone disposition, bone resorption, and osteosarcoma."
Orthopedic Research Society. 28: 1142-8. doi :10.1002/jor.21120. PMID 20225287
Swartz LM. A history lesson, INSPIRE! Sapphire brackets. Clinical
Impressions. 2001;3:12-15.
