Differences and advantages of indirect fixation of brackets from direct positioning. Metal braces - the pros and cons of the material Ligature braces and non-ligature braces - which are better

Metal braces are used to correct a misaligned bite or tooth position. This is a complex non-removable structure, which is fixed with orthodontic glue on the inner or outer tooth surface. Braces consist of grooves where an arc is placed, the pressure of which gradually aligns the dentition.

For a week after the installation of metal braces, a person feels discomfort, expressed in pain when chewing food, pressing, talking. The inconvenience will disappear when the system ceases to be a foreign body for the body. When rubbing the mucous membranes, lips, cheeks or tongue, medications are required that can relieve pain.

Metal braces require correction once every 30 days. This is necessary in order to increase the efficiency of the installation. When visiting a doctor, the patient is changed the arc, the integrity of the metal locks is checked. The orthodontist will determine how long to wear metal braces. It depends on the degree of unevenness of the molars and age. The average correction rate is two years.

The rapid movement of the teeth will have an effect on the bone. With strong pressure on the bone tissue, inflammation may occur, it will become less durable, lose the ability to hold the molar in the hole. As a result, there will be no normalization of the bite, but looseness of the teeth. The doctor monitors how they move. Based on observations, the pressure on the tooth increases or decreases.

Dmitry Sidorov

Dentist-orthopedist

Important! Metal braces, installed in adolescence, align teeth faster than in an adult, as the tissue is only being formed

Types of metal braces

There are several types of dental aligners made of metal. Types of metal braces depend on the place of attachment: and vestibular installation. Other types depend on the presence or absence of an auxiliary element that contributes to the connection of the arc and locks. Such elements are presented in the form of an elastic band or thin wire.

The vestibular metal bracket system is attached to the outer surface of the dentition, is not capable of distorting diction, and adaptation takes a shorter period of time. Vestibular installation will quickly correct malocclusion or uneven dentition. The disadvantage is the visibility to others and the violation of the integrity of soft tissues.

They are attached to the inside of the dentition, so it is not visible. The duration of addiction and the cost is increased compared to other installations, but the result appears 3-4 weeks after installation.

Braces made of metal, in which there is no auxiliary element, are fixed with latches or clamps. The arc is blocked, the friction force is close to the maximum, so that the person does not experience discomfort, and the duration of correction of irregularities is reduced.

Orthodontic appliances that align teeth with a ligature or metal wire are used for severe tooth deformity. They are in demand and have an effect two to three months after installation.

When are they assigned?

There are indications when the installation of metal braces is necessary. These include:

1. Violated. The problem is characterized by improper closing of the teeth, resulting in uneven abrasion. Periodontal disease appears and develops, respiratory activity is disturbed, it is difficult to chew food. Jaws grow incorrectly. The installation of an orthodontic structure is a necessary, not an aesthetic correction of the teeth.
2. If there is an indication to correct the bite after the removal of the molar. The lack of a tooth in the row provokes the displacement of adjacent teeth to the empty area that was formed after the removed element.
3. If it is necessary to prepare the oral cavity for prosthetics or implantation.
4. If necessary, correct the dental arch. If the teeth are tilted, there is crowding, they are pushed forward or have not fully erupted, the required type of metal braces is installed.

In the absence of correction of malocclusion, the risk of impaired diction, enamel abrasion, and the appearance of microcracks increases. Appears, a person is tormented by migraines, diseases of the gastrointestinal tract due to poor-quality chewing of food. In addition, there is the emergence of uncertainty, low self-esteem.

Advantages and disadvantages

The structures with which the dentition is aligned have some advantages and disadvantages, presented in the table:

Advantages	Flaws
With the help of steel braces, a severe degree of malocclusion is eliminated.	Visible to people around, which lowers the level of aesthetics.
The construction with ligatures is durable, which eliminates breakage.	The mucous membrane is injured due to the wings and their platforms.
The maximum effect of the metal structure, the duration of wear is reduced to one or two years.	After installing the corrective structure, it is necessary to take an anesthetic and a sedative drug, which will alleviate the condition during the period of addiction.
Correction, which is carried out every thirty days, is painless for a person.	There is a high probability that occurs under braces due to demineralization of the enamel.
The cost of metal braces is lower than for other designs.	Maintain regular doctor visits.
They are not able to change color when exposed to dyes in food or drinks.	Adhere to increased oral hygiene so that inflammation of the gums does not appear, teeth do not collapse.

Allowed the installation of metal braces for adults and children. Ligature constructions are shown for teenagers. To eliminate the complexes, the doctor is able to install multi-colored rubber bands. After the age of thirty, it is necessary to install a non-ligature corrective system. They have a more aesthetic appearance, invisible to strangers.

Installation steps

To install a metal bracket system, the doctor will need an hour or an hour and a half. The exception is lingual constructions, which require 3-4 hours. There are several steps to follow to install:

1. Initially, the doctor collects information about the person, studies the malocclusion, and as a result, prohibitions on the use of the metal system and allergic reactions are revealed.
2. Treatment of the oral cavity, removal of caries is prescribed.
3. The surface of the teeth is cleaned and polished.
4. Etching with a special paste of molars is carried out in several stages.
5. Teeth dry out.
6. After preparing the enamel, the doctor applies orthodontic glue. Some modern braces are lubricated with such glue.
7. After the glue is applied, the bracket system is firmly bonded.
8. The doctor removes excess glue so that there is no void under the structure.
9. The glue is illuminated, as a result of which it becomes solid.
10. The surface is polished.
11. The doctor threads the arc into the locks. Threading occurs with the help of ligatures or snap fasteners.

After the above measures, the patient is allowed to go home, and a visit is scheduled in one and a half to two months.

Are there any contraindications?

The installation of a metal system is a serious medical procedure, therefore, in addition to indications, there are contraindications that require their observance. You can not install braces if a significant number of molars, which serve as the basis for fixation, have been lost.

Do not use metal structures for diseases of the cardiovascular system, reduced immunity, viral or infectious diseases. Under the ban falls the presence of cancer, which has a severe form, blood diseases. The doctor will not install braces if a person is diagnosed with an articular or bone disease, frequent epileptic seizures

Nuances of care

After installing a metal system to correct the bite and align the teeth, the doctor advises on how to properly care for the oral cavity. The duration and effectiveness of the treatment will depend on compliance with the rules for care, as well as the condition of the teeth after the structure is removed. The basic rules for care include:

1. It is necessary to thoroughly brush your teeth in the morning and evening.
2. For cleaning, you should purchase a special orthodontic brush that can more effectively clean the enamel and metal system. In the first few days, the duration of the cleansing procedure can take half an hour. Then the person will adapt, and the cleaning time will decrease.
3. Purchase a specialized brush with which to clean the space between the molars and under the structure.
4. It is necessary to refuse chewing gum, sticky sweets.
5. It is necessary to have an irrigator, which is a device for cleaning the dentition and gums. Cleaning is carried out using a pressurized water jet. Thanks to the irrigator, you can get rid of plaque in a hard-to-reach place, massage the gums.
6. While wearing a metal structure, refrain from eating solid food so as not to violate the integrity of the staples.
7. Use professional plaque and calculus removal to keep molars and gums healthy. You can remove plaque and stone during the adjustment, which involves replacing the arc.

Price

In addition to the cost of a metal installation, it is necessary to remember the additional costs, which consist in passing additional tests, a doctor's examination, regular correction, which should be done once a month, and cleaning. After the person removes the braces, it is required to fix the result, which consists in wearing a retainer. Its cost can reach 5000-6000 rubles. The price differs by type.

The cost of the vestibular orthodontic system varies from 50 thousand rubles to 55 thousand. If the installation of lingual braces is indicated, a person should have an amount of 100 to 125 thousand. Using a ligature system will cost a person 25,000-35,000 rubles. The non-ligature construction reaches 40,000 rubles. If you need to put mini braces, you should have an amount of 25,000 to 33,000 rubles.

It follows from the above that malocclusion should be treated as early as possible. To eliminate the problem, there are metal bracket systems that differ from other installations in cost and reliability. By installing such systems, you can hide the use of tooth correction. It is enough to install the brackets on the inside of the teeth. Shown for both adults and children. The alignment period, subject to the recommendations of the doctor, will not take much time.

Indirect bracket fixation is a relatively new and more accurate bracket positioning method than the classic direct brackets. In Europe and the USA, it is already successfully used everywhere, while in domestic clinics the technique is only gaining popularity.

How does indirect bracket positioning differ from direct bracket positioning?

In orthodontic dentistry, two methods of fastening braces are used: direct and indirect or one-stage.

The first one consists in the stage-by-stage fixation of each bracket (bracket body or bracket) on a separate tooth. Although direct fixation is more common in Russian dentistry, it is more complex. The orthodontist needs to calculate the position of the brackets directly in the patient's mouth. And this is difficult, because because of the soft tissues there is no complete view of the jaws. Therefore, the risk of error is high, which affects the correctness of the entire treatment.

In addition, direct bonding is lengthy and uncomfortable for the patient. The procedure takes 1 - 2 hours. The patient must keep his mouth open at all times.

Single-stage fixation of orthodontic systems eliminates errors and discomfort. All brackets are simultaneously transferred from the tray to the teeth in a few minutes.

Important! Regardless of the method of attachment, there are mandatory preparatory procedures: x-ray diagnostics, choice of design for correction, sanitation of the oral cavity. And immediately before the enamel is etched with phosphoric acid, ceramics or metal from which the staples are made are isolated, access is improved using a retractor (to lift the lips) and a special stop for the tongue.

Stages of one-stage fixation

Indirect fixation of the bracket system consists of several stages:

1. Removing an impression. It will be used to make a diagnostic model from supergypsum.
2. Drawing out the resulting print. The vestibular slopes of molars and premolars are contoured, the incisal surfaces of the anterior teeth are outlined, and longitudinal and vertical axes are applied. At the point of their intersection is the median center. You need to understand that this is exactly the place where the brackets will be attached.
3. Bracket positioning. They are attached to plaster crowns with a special adhesive (bond). In the same position, they will be on the real teeth of the patient.
4. Making a silicone portable mouthguard. A special material is applied to the model and evenly distributed. After solidification, the resulting shape is removed along with the brackets, cut off from excess silicone.
5. Transferring braces to teeth. A kappa is put on crowns etched with phosphoric acid and dried. Pre-enamel and staples are treated with adhesive solutions. The cap is left for 1 hour until the fixative hardens. At this time, the patient can close his mouth and rest.
6. Removal of mouthguards and fastening of a power arc. Onlays are removed, teeth and braces are cleaned of silicone and adhesive residues. An arc is threaded into the brackets and fixed with ligatures or in slots-locks.

Additional Information! Since full bonding of the adhesive takes place within 24 hours, the clinician may postpone the installation of the power arc until the following day.

The installation of braces using the indirect fixation method looks better on professional training videos.

Advantages of indirect fixation of braces

The method of indirect fixation is preferable to direct fixation due to numerous pluses:

• less stress for the patient and the orthodontist due to the quick installation of the brackets;
• on the diagnostic model, it is possible to determine the position of each bracket to fractions of a millimeter and correct it in a timely manner, this is impossible with direct bonding, since it is impossible to fully assess the size and position of the crowns due to soft tissues and the lack of a normal view of the inner surface of the teeth;
• due to the high accuracy of the location of the brackets are reduced;
• complications associated with positional errors are excluded - bite opening, the formation of excessive interdental spaces, and others.

Important! The only disadvantage of the technique is the long-term production of casts and mouthguards. But it is more than offset by significant benefits.

Both methods of fixation of braces - direct or indirect - are successfully used in orthodontics. But, if possible, it is better to prefer the second. It eliminates the risk of errors and associated complications. If you have to use direct positioning, you need to choose a dentist with more experience. This technique is complex, and its implementation, in fact, is a jeweler's work. Therefore, it can be difficult for young doctors with insufficient practice.

0:00 → First, the bracket system is fixed on one jaw, most often it is the upper jaw. Further, after 2-3 months, the second jaw is connected. Hello. In this video you will learn all the most important things about the stages of installing braces. Please watch this video until the end to understand this issue. Before starting the installation of the bracket system, a professional oral hygiene is performed by a general practitioner. After that, the patient is put on a special apparatus that isolates the teeth from the lips and cheeks. Thanks to this, we can safely fix the bracket system. The first stage of fixation is the application of a special material that prepares the surface of the tooth for bracket fixation and better bonding of the tooth and bracket. Further, glue is applied to the tooth itself with a special primer and illuminated ...

1:05 → After fixing each bracket, a wire is placed on each tooth, which is fixed either with ligatures or locks installed in the bracket itself. A ligature is a small rubber band that is worn around a ligature bracket. There are non-ligature systems in which, instead of an elastic band, a lock is installed on the bracket itself. At the initial consultation, after examination by an orthodontist, the patient is sent for additional research methods. They include: an orthopantomogram - a picture that shows all the teeth in the dentition and the location of the wisdom teeth, whether there are any changes behind the tops of the roots and whether any further treatment is necessary before starting orthodontic treatment or the removal of wisdom teeth.

1:55 → The image allows you to calculate the position of the teeth in the bone, inclined and further treatment plan. Casts are also taken, diagnostic models are cast to calculate the position of the teeth. Also, intraoral and frontal photographs are taken, in profile, it is necessary to draw up a treatment plan. All right. Fixation of braces without prior preparation is not possible. Before installing a bracket system, it is necessary to sanitize the oral cavity and a diagnostic study, which will allow you to choose the most optimal treatment option for this particular situation. After the patient prepares all the teeth for fixing the bracket system, and this is the treatment of all carious processes, periodontal inflammation and the removal of wisdom teeth according to indications, the patient comes to fix the bracket system. Bracket system is selected individually with each patient. It takes into account the individual characteristics of the case, the preferences of the doctor and the patient, the aesthetic aspect. After that fixed...

3:14 → On average, adaptation takes 2-3 days, during which pain, inability to bite food and pain effects are possible. Most often, after 2-3 days, the pain disappears. Patients who use painkillers are few. All this is very individual and depends on the threshold of pain sensitivity and physiology. In most cases, the adaptation of patients takes from 3 to 7 days. After that, the patient forgets that he wears a bracket system and feels comfortable. And the patient most often comes to the next appointment, talking about the fact that he was more worried than it was actually worth it.
Few people know that after the removal of braces, orthodontic treatment does not end, and a waiting period is necessary. It is the retention period that allows you to consolidate and preserve the result of your beautiful smile...

Fixation of braces is the most important stage of orthodontic treatment.

The positioning of the locks on the teeth determines how successful and fast the correction of the anomaly will be.

The strength of the braces is also of great importance. A detached lock will require an urgent visit to the doctor for gluing it, and, possibly, correction of the treatment.

Preparatory activities

All actions to prepare for the fixation of braces can be divided into three groups:

• ensuring a healthy state of the oral cavity (sanation);
• contributing to qualitative correction (removal of problematic elements);
• performing preventive functions (professional cleaning).

Sanitation of the oral cavity is a mandatory event carried out before any orthodontic treatment.

Its implementation includes:

• treatment of visible and hidden(they appear on the radiograph, give themselves out as a change in the color of the teeth) carious cavities;
• elimination of inflammatory processes in the pulp(vital or devital depulpation);
• restoration of broken crowns(depending on the nature of the lesion, intracanal pins are installed, artificial crowns are put on, or restoration is carried out with composite materials);
• treatment of inflammatory processes on the oral mucosa(gingivitis, periodontitis).

Maintaining a clean oral cavity is essential. Before fixing the bracket system, it is desirable to carry out professional cleaning with the removal of subgingival and supragingival deposits.

Sick, non-viable elements and roots are removed before installing the orthodontic system.

Surgical correction of pathological frenulums and removal of wisdom teeth is carried out only if they cause a functional disorder of the jaw apparatus.

Positioning Methods

Before you go to the clinic to install braces, you need to eat (to reduce salivation) and brush your teeth.

The locks of the system are attached to the outer or inner surface of the teeth with adhesives. The correct vertical position of the castle depends on the type of the latter (canine, incisor, painter or premolar), its anatomical structure and position.

In addition to individual requirements, there are general rules for positioning braces:

• The center of the lock groove must match the center of the clinical crown. vertically and horizontally.
• The value of the compensatory height changes from the central incisors to the side, and on to canines, premolars and molars.

There are two main fixing methods:

• straight;
• indirect.

direct method

The technique of the direct method involves the fastening of each lock separately. The following materials and tools are used.

materials

• Etching Gel or a 37% phosphoric acid solution.
• Glue for fixing braces. Various adhesives can be used - two-component composite compositions (base solution + catalyst), No-Mix materials (activator + adhesive), composites and light-cured glass ionomers.

Tools and fixtures

• Crescent scaler.
• Cotton tongs.
• Saliva ejector.
• Reverse tweezer.
• Lip retractors.

Sequence of operations

Fixation of braces using the No-Mix adhesive composition is performed in the following sequence:

• markup(a vertical and horizontal axis is drawn on the surface of the tooth, the intersection point of which during installation must coincide with the center of the bracket groove).

• Etching of enamel.
• Washing the "pickling" with water or a special neutralizer.
• Drying blown air or dryer.
• Checking the quality of etching. With normal etching, the surface of the tooth becomes matte. The presence of gloss indicates poor etching.

  Its cause may be the properties of the patient's enamel (increased acid resistance), the use of fluoride pastes, enamel hyperplasia, saliva or moisture that got on the tooth during etching, insufficient rinsing or drying.

• Application of the activator on the enamel and base of the bracket.
• Adhesive application on the supporting surface of the lock, pressing the bracket to the tooth and keeping it under load for 10 seconds. Then the excess glue is removed.

The advantages of the direct method are time saving (no need to take impressions, mold a plaster mold, make a cap for transferring braces).

The disadvantages include:

• positioning errors sometimes leading to treatment failure. The situation with the position of the teeth may be worse than before the treatment.
• High requirements for professionalism doctor.
• Significant physical and emotional stress dentist.

The video shows the process of the direct method of fixing braces.

indirect method

The indirect method involves the installation of braces in two stages - first on a plaster model, then transferring them to the dentition.

Various technologies for transferring brackets from a plaster model to the teeth are used - BEST, CLASS, TOP, Esipovich cap, etc.

They differ in some parameters (using 1 or 2 caps, transferring in 1 or 2 steps, etc.), but their basic principle of operation is the same and is as follows:

• The braces fixed on the plaster model are covered with a silicone or other compound, which, when cured, turns into a cap with locks fixed in the position in which they were on the model.
• After etching and smearing the teeth and bases of the brackets with adhesive, the cap is installed, pressed tightly and removed again.

As a result of this operation, the braces remain on the teeth in the same position as they were on the plaster model. Sometimes a mouthguard with braces is cut into segments that are easier to put on and take off.

With the indirect method, most of the work is done in the laboratory.

Sequencing

• Removal of impressions from the jaws.
• Making plaster models from impressions.
• Installation of braces on a plaster model.
• Transferring them to the cap.
• Preparing the surface of the enamel (the same steps are performed as with direct fixation - etching and smearing with glue the teeth and the bases of the locks in the cap).
• Installing a mouth guard with braces on the teeth, crimping it.
• Cap removal (brackets remain on the enamel).

Advantages of indirect fixation:

• Predictability results.

• Patient comfort, getting rid of the need to spend a lot of time in the chair.
• Exclusion of medical errors and their corrections. Ultimately, the time spent on treatment with an indirect method is often less than with a direct one.
• Comfort for the doctor and a technique that can do the main work in the laboratory without haste and psychological stress.

The only but significant drawback of the indirect method is the increased labor intensity associated with the need to make impressions, plaster models, and caps.

See in the video how braces are installed indirectly.

Thomas Pitts table

One of the main difficulties when installing braces is their vertical positioning on the tooth. Many protocols have been developed to facilitate this work for the orthodontist (MBT, Alexander, etc.).

Their essence is that the location of the bracket on a particular tooth is determined by adding or subtracting from the basic value of the compensatory height, the value of which is different for each element.

The base value is the height of the bracket on the premolars. The value of compensatory heights for different teeth are summarized in tables that dentists use when installing orthodontic systems.

Dentist researcher Dr. Tom Pitts and his colleague Dr. Thomas Castellanos developed their table for the vertical positioning of brackets. Its difference from other methods is that it provides not only teeth alignment and normalization of occlusion, but also an aesthetic component, called the “smile arc”.

Another feature of the Tom Pitts table is lack of compensatory height in it. Instead, it contains the absolute values ​​of the heights of the locks.

Reference. The harmony of the face during a smile depends not only on beautiful even teeth, but also on the correspondence of the contour of the edge of the upper frontal units to the shape of the lower lip.

Ideally, the line drawn through the tops of the center tops should be parallel to the top line of the lower lip.

Below is a table by Tom Pitts, which contains the required height for positioning brackets on different units.

Using the Pitts table

• Tooth length is measured- the distance from the edge (for incisors it is a cutting edge, for molars and premolars - a tubercle) to the edge of the gum.
• The Pitts table contains the value of GPS-A corresponding to the measured tooth height.
• By GPS-A in horizontal rows of the table are the positioning heights of brackets for specific teeth.

To get the perfect smile arc, the edges of the frontal units are sometimes recontoured (sanded) before using the Pitts chart.

Resilience adhesive system

Resilience adhesive is designed to fix braces and trainers made of various materials.

Characteristics

• Light cured(does not harden until it is irradiated with light, which allows you to work without haste).
• fluid(due to the low viscosity and the presence of various nozzles, it is possible to use in hard-to-reach places).
• Contains fluorine.
• Hardens immediately after light treatment, so there is no need to pause between irradiation with light and setting the arc.

Purpose

• fixation of lingual and vestibular braces and retainers made of metal, ceramic and composite.
• Making overlays in the lateral segments to open the bite when using the indirect method of attaching brackets.

Equipment

The package includes:

• Primer (1 pack 7 ml);
• Glue in syringes (4 pcs. 3.5 g each);
• Etching gel (1 syringe, 4 g);
• Replaceable tips, 5 pcs.;
• Mixing pad, 2 pcs.;
• Mixing sheets, 50 pcs.
• Holder, 1 pc.;
• Tassels 20 mm long (40 pcs.) and 50 mm long (10 pcs.).

The cost of one set is from 10,000 rubles. A trial set is also offered at a price of 2500 rubles.

Issue price

The cost of installing braces depends on their type (lingual or vestibular), manufacturer and brand, material (metal, ceramics, sapphire, plastic). The status of the clinic and its location also affect the price.

Estimated prices for the installation of braces, depending on their type and material

• Proper hygiene oral cavity.
• selective nutrition. Exclusion from the diet of solid, too cold and hot food.
• Regular visits to the dentist(immediate in case of braces coming off).

To keep your teeth with braces in perfect cleanliness, one brush is not enough. It is recommended to purchase additional products - a single-beam, orthodontic and lingual brush, floss, brushes, toothpicks, rinses, elixirs, deodorants, irrigators.

If the elements of the bracket system injure the mucous membrane, orthodontic wax should be used.

Braces are orthodontic devices used to align the position of individual dental units and correct bite.

In orthodontics, these designs have been used for a long time, and show excellent results even in the most difficult clinical cases.

Of no small importance is the way they are fixed on the surface of the teeth.

It is impossible to position the structure without preliminary preparation of the oral cavity and teeth. The whole process of therapy includes several mandatory steps.

Diagnostics

It begins with an initial examination, consultation with an orthodontist, and assessment of existing pathological conditions. After the patient is offered to undergo a series of standard examinations and several preliminary procedures:

• orthopantogram;
• radiography;
• computed tomography of the jaws;
• lateral teleroentgenogram;
• making impressions.

These measures are necessary to identify the anomaly and its degree, determine the duration of the treatment period and draw up a detailed step-by-step plan for correcting the defect.

Therapy

The oral cavity is cleaned before placing the braces. This stage involves the implementation of sanitation.

Correction of a defect in the dentition with braces takes a long time, so the implementation of a complex of preventive and therapeutic measures is the main condition before placing an orthodontic appliance.

The dentist treats the identified carious cavities, eliminates the inflammatory processes of soft tissues.

Extraction

The stage is not mandatory and is carried out only according to indications.

The doctor, after a visual examination and obtaining the results of research, can remove one or several teeth at once, but only if they are an obstacle to the effective correction of the defect.

Hygiene procedures

Upon completion of the sanitation, professional hygiene (cleaning) of all tissues of the oral cavity begins. A specialist removes soft and hardened deposits on the enamel coating.

This procedure is important for the correction process, since in the presence of braces, the rate of reproduction and spread of pathogenic microorganisms in the mouth increases significantly. At the same stage, the orthodontist explains in detail to the patient the basic rules of oral hygiene when wearing a corrective system.

Immediately before the positioning of the braces, each dental element is ground, covered with a special composition. At the end, the oral cavity is washed with a jet of water and dried with air.

Direct Installation

The essence of this technique consists of its name, which means that it involves the installation of braces immediately on the teeth, and separately for each unit.

Braces have differences among themselves - each is designed for a specific group of teeth, i.e. some are defined for incisors, others for canines, and so on. Based on the results of the research, the specialist alternately fixes the locks on each dental element.

The whole process takes place in the following sequence:

1. Fits a retractor- a device that lifts the lips, restricting the movement of the tongue, preventing contact of the mucous membrane with the surface of the teeth.
2. The enamel coating of each dental element is processed. Immediately, the enamel is polished with a special abrasive wheel, and then wiped with hydrogen peroxide and dried.
3. Dry enamel for 20-50 sec. etched with composition containing phosphoric acid. It is this substance that transforms the surface of the teeth, making it rough. This procedure is harmless, and is required to improve fixation. The enamel is repeatedly washed with a stream of warm water and dried.

The following actions are performed by the doctor in turn for each tooth:

• Application of the composite.
• Drying the surface with compressed air.
• Monomer treatment.
• Applying a special fixing paste to the plate.
• Attaching the bracket with tweezers to the enamel, and pressing it.
• Removal of protruding excess paste.

The hardening of the paste and fixing the braces on the teeth occurs during the day. To reduce the load on the apparatus, a weak arc is initially set.

The main advantages of direct fixation are the ability to make changes to the initial treatment plan (if necessary) and control the quality of fixing of each bracket.

But still, this technique is time-consuming and difficult to implement for the orthodontist, tiring for the patient.

In addition, there is a high probability of making a mistake when positioning the locks, which later turns into a violation of the course of treatment and the occurrence of side effects. It is because of this that the indirect method of fixing becomes more popular.

\ The video shows a scheme for fixing braces by a direct method.

indirect method

In the end, according to a special technique, the design is moved to the patient's own teeth.

All actions take place in the following order:

1. An exact cast of the patient's dentition is created from plaster. Based on it, detailed diagnostic models of the jaws are made.
2. On the models, the points where the locks will be installed are indicated. To do this, visible landmarks are drawn in the form of vertical-longitudinal axes. Their intersection point is the middle center. It is on him that the braces will be attached.
3. Brackets are positioned. These elements are fixed with a bond (a special type of adhesive) on plaster crowns.
4. A portable mouthguard is made from silicone. To do this, a special mass is applied to the model and evenly distributed. As soon as the material hardens, the resulting form is removed along with the bracket. Trim off excess silicone.
5. The finished structure is moved to the teeth. H and acid-treated and dried crowns, a kappa is put on. Enamel coating and staples are pre-treated with an adhesive. Kappa is left for about an hour, i.e. for the time required for the fixative to harden.
6. The lining is removed, the teeth are cleaned from the remnants of the adhesive material. An arc is pulled into the brackets and fixed.

Important: Since it takes at least a day for the final adhesion of the adhesive, the orthodontist may postpone the placement of the wire to the next day.

The advantages of this technique are obvious:

1. The procedure is faster, more convenient and comfortable for the person.
2. On the sample of the jaws, the position of each lock can be calculated with high accuracy, and corrected if necessary.
3. High positioning accuracy reduces the overall duration of defect correction.
4. The development of negative manifestations associated with inaccurate placement of braces was excluded.

The only drawback is the lengthy processes for creating casts and mouthguards.

Important! Both techniques for fixing braces are successfully used today. But if you choose between them, experts recommend giving preference to the second, due to the absence of the likelihood of errors and the development of complications associated with them.

In the video, watch the process of fixing the system by an indirect method.

Thomas Pitts table

Today, in addition to a person-oriented approach to drawing up a plan for the correction of a defect, a similar approach to the positioning of structures is being implemented in orthodontics.

Dr. T. Pitts has developed a special protocol for the placement of corrective bite devices. Compliance with all its provisions guarantees a positive result in a shorter period.

Dr. T. Castellanos translated this procedure into a numerical form, taking into account the aesthetic parameters and the length of the teeth.

Vertical positioning is difficult for many professionals. But this problem is resolved if special devices and summary adapted tables are used for the process.

The summary table of T. Pitts on the formation of occlusion consists of two parts and looks like this:

For mandibular arch

For maxillary arch

The choice of the fixation height of the locks on the maxillary arch is made according to the following order:

1. The length of the coronal part is measured, the distance from the edge of the gum to the tubercle is set.
2. The resulting value is in the GPS-A column for the maxillary arch, and the options listed in the row are selected. The values ​​in the row indicate the bracket placement height for each dental unit.

In the same way, the fixation height of the locks for the elements of the lower jaw is determined. All parameters are determined by the length of the coronal part of the mandibular canine.

The advantages of using the Thomas Pitts table in practice:

1. The number of errors during fixation of the corrective apparatus has been reduced.
2. procedure predictability.
3. The possibility of displacement of the plates and the use of an excessive number of bends of the power arc is excluded.
4. Reduces discomfort and time spent by the patient in the medical chair.
5. The duration of the correction course is reduced by months, and this is an additional motivation for a person.
6. Improved control of torque values.

Important: this method allows doctors to achieve the desired result in the form of the correct closing of the jaws and even teeth.

Resilience adhesive system

To fix the locks on the tooth surface, most orthodontists prefer the Resilience system.

The composition is specially designed for fixing the elements of composite, metal, or ceramic models of corrective devices using the technique of curing the material with a stream of light.

The system has excellent characteristics for obtaining reliable and long-term fixation of locks. Light activation provides additional time for the correct attachment of the bracket.

The quality of fixation of the adhesive system allows you to stretch the arc immediately after the completion of the translucence of the locks.

The cost of the Resilience system varies between 10-14 thousand rubles. It is sold as a set that includes:

• adhesive syringes;
• syringe with pickling gel;
• primer;
• tips for syringes;
• platforms for mixing components;
• holder;
• brushes with three lengths;
• mixing sheets.

Issue price

The cost of installing braces on one jaw arch in clinics is always calculated and indicated separately from the price for the system. Usually the payment for this service is about 1/3 of the total cost.

Given that there are two ways of positioning systems, fixing their elements in the classical way for 1 jaw starts from 9 thousand rubles. This figure refers to the vestibular structure made of metal.

For placement of the device from other materials:

• artificial sapphire will have to pay about 26 thousand rubles;
• ceramics - 19 thousand rubles;
• metal + ceramics - from 15 thousand rubles.

The cost of indirect installation of these structures will differ by at least 5-7 thousand rubles.

Having decided to correct the defect of the dentoalveolar apparatus with braces, the patient must clearly understand that the speed and effectiveness of treatment depends on how responsibly he will treat the implementation of medical recommendations.

The entire period of treatment must adhere to the following rules:

1. Visit the orthodontist according to the schedule. This is necessary for timely adjustment of the position of individual elements of the system and detection of pathologies at an early stage of their development.
2. Clean your mouth and teeth after every meal. If it is not possible to perform a full treatment, you need to rinse your mouth well with plain water.
3. Complement daily hygiene with assistive devices: irrigator, floss, special brush for braces, dental brush.
4. Change your diet. It is important to exclude hard, sticky and hard products that can ruin the elements of the device. It is also not recommended to simultaneously consume food and drinks that contrast in temperature.
5. Don't ignore getting a professional dental cleaning. This manipulation allows you to qualitatively remove soft deposits and does not allow their transformation into stones.
6. To refuse from bad habits: smoking, nail biting, cracking seeds or nuts.
7. Do not engage in hazardous sports, i.e. those of its types in which injury to the face is possible.

Important: orthodontists pay special attention to oral hygiene during the treatment with braces. This procedure must be carried out in stages and take at least 10 minutes, since the presence of hard-to-reach areas complicates and lengthens the processing.