• Patient role in the Orthodontic process
• Types of Orthodontic appliances and
The Patient with common terminology
• Advantages and disadvantages of these
Orthodontic Appliances Lecture Orthodontic appliances
• Enamel demineralization during orthodontics
Overview • Clinical procedures for debonding
Sarah Renneberg
While undertaking a course of orthodontic treatment
Aligner system
• An individual preventive program is required
• A series of customised transparent and removable aligners
• Specific instruction for oral hygiene and motivation used to straighten teeth.
• Professional supervision
Fixed appliance system
• Effort with biofilm control
• Bonded brackets a with an arch wire held in place by
The Patient • Fluoride regime Types of elastomers (latex elastic)
• The patient needs to understand their role in the process.
Role appliances • Palatal Expanders
Greater home care is required whilst under taking
orthodontic treatment. Retainer
• Can be fixed or removable. Fixed will be bonded to
individual or groups of teeth. Removable retainers are
plastic and can be removed for cleaning.
Aligner System Clear Aligners
Advantages Disadvantages
• Not suitable for more complex
orthodontic cases
• Need to be compliant with use.
Not clearly visible Work best for minor Fewer orthodontic
corrections appointments than Need to be worn for 20-22hrs a day
• Aligners can stain
traditional braces
• Can be inconvenient to remove
• Cost, traditionally greater cost than
Able to clean easily No restrictions on Custom fit so can be fixed orthodontic appliances.
eating more comfortable than
traditional braces
Fixed Appliance System
a – bonded bracket ; b – archwire; c – elastomers; d- elastic ligature
Advantages Disadvantages
Fixed • Precise control of tooth • Required greater
Orthodontic movement orthodontic appointments
a b
• Can be used in complex • Requires extensive training
Appliance malocclusions – partially to manage
erupted teeth • Oral hygiene can be an
systems • Multiple tooth movement issue. increased risk of
options caries and
• Tooth rotations can be demineralisation c
corrected • Aesthetics
d
• Not dependent on • Debonding of brackets
compliance for wear with incorrect use
Fixed Appliance System Fixed Appliances – common presentations
Ceramic bracket – ligature
Ceramic bracket – self ligating
Fixed Lingual Braces Lingual Braces
What are the factors to consider in
Advantages Disadvantages maintaining oral hygiene for this patient?
• Not clearly visible • Greater cost than traditional
What oral hygiene recommendations
• Less decalcification on the braces average price in Aust - would you give to a patient with TADs?
buccal surfaces $9500 - $15000 (orthodontics
Australia.org.au)
• Discomfort to the tongue
• Temporary difficulty with speech
• Can take longer than traditional TAD, Temporary
braces Anchorage
Device
Lingual Braces discussion
What advice would you give a patient who
presented with these lingual bands? Designed to widen the maxilla
• Corrects a cross bite
What methods would you use to debride this • Relieves dental crowding
mouth? Palatal Expanders • Widens the floor of the nasal cavity to
What recall interval would you suggest for this
improve nasal airflow
patient? • Widens the smile arc
Orthodontic Retainers can be either fixed or removable
• Placed to stabilize the teeth and supporting structures
Appliances – Rapid Maxillary Expander Retainers for following completion of orthodontic appliances
• It is a source of biofilm retention
Fixed Palatal retention • Customized instructions are required for maintenance
Expanders
Quad Helix Appliance
Removable Retainers
A) Hawley retainer B) clear removable retainers
Fixed Retainers
a b
• A & B – straight bonded ling
retainer
• C & D – zig zag (hygienic)
bonded retainer
• Regular oral hygiene appointments and
examinations
• Interproximal cleaning and brushing.
Disease control
• Rinse mouth following eating if brushing not • General instructions – disclosing
Oral Hygiene possible
• Toothbrush selection – manual and power brushes
measures for • Avoid certain foods and drinks • Brushing procedures – sulcular brushing, Stillman
the • Use of mouth rinses Oral Hygiene • Interdental aids
• Use of high concertation fluoride toothpaste continued • Oral irrigation
Orthodontic • Chemical agents
• Professional prophylaxis
patient
Toothbrush selection Oral Hygiene with fixed appliances
Water Irrigators Chemical Plaque
control
• Home maintenance for the patient
Poor Oral Hygiene and Fixed Orthodontic
appliances
Poor Oral Hygiene and
Orthodontic appliances –
Discussion
1. What are the clinical
findings in this image? • What Clinical issues can you
2. What treatment see in this image?
recommendations would • What would be your
you suggest for this patient? treatment recommendations?
1. Identify the extent and location of the
Air Polishing resin.
2. Use a tungsten carbide finishing bur in a
slow speed handpiece, cervical to
Steps for incisal/occlusal portion of the tooth.
Orthodontic 3. Frequent evaluation of the tooth surface
residual 4. Polish the tooth surface – aluminum oxide
cups and points
adhesive 5. Use of a rubber cup and pumice
resin removal 6. Brown polishing cup – maximum gloss to
the enamel suface
7. Green polishing cup
Identification of Residual Resin Tungsten Carbide and Aluminum Oxide burs
Polishing Cups • Each step of the debonding process
has an effect on the enamel surface
Aluminum oxide finishing
Post Bonding • The enamel surface can be damaged
by the clinician
cup evaluation • Etched enamel has a high fluoride
uptake
Green Polishing cup • Clinical photographs
• Examination for caries
• Fluoride therapy
Brown Polishing Cup • Maintenance program
Enamel demineralization and decay following Enamel
fixed appliances Demineralisation
• What are the clinical findings for this image?
• What would be the course of care for this
patient?
What clinical findings are
evident in this image?
What are the clinical
recommendations for this
patient?
Wilkins, Esther. Clinical Practice of the Dental
Hygienist, 11th Edition. (2013). Lippincott
Williams & Wilkins.
References Orthodontics Australia. (2021).
https://www.orthodonticsaustralia.org.au
