Newer advances in orthodontic

materials
Dr Ameet
Contents
Wires FRC/FRP ; Composite wires.

Brackets Composite brackets
APC
ACP

Bonding materials New generation flowable composites
ACP bonding materials
Ormocers

Flouride Releasing wires

Clear tooth aligners - Invisalign

/Orthoclear





Changing times Changing materials
A New Beginning
The Composite Revolution
Changing times Changing materials
Composite
A multiphase material brought about by combining
materials that differ in composition or form on a
macroscale in order to obtain specific characteristics
& properties Graber Vanarsdall

May be defined as as a compound of 2 or more
distinctly different materials with properties that are
superior or intermediate to those of the individual
constituents - Anusavice
Composite wires
High Strength
Corrosion Resistant to many chemicals
Light Weight- Weighs nearly 80% less than a steel profile of
similar dimension.
Electrically Non-Conductive
Non-Metallic
Flame Retardant: Fire Retardant Polyester and Vinylester
Resin Series both exhibit flame spreads of 25 or less when
tested per ASTM E-84
Lower Life Cycle Cost
Non-Leaching. Environmentally Friendly
Dimensional Stability
Manufacture
Pultrusion 1951 W.B Goldsworthy

Extrusion v/s pultrusion
Push v/s pull
Pultrusion
Pultrusion
Pultrusion
Fiber glass rovings are commonly used.

Other fibers: Carbon, graphite, polyramid(Kevlar

)


Resins
Thermoset: Thermoplastic
1.Polyester
2.Epoxy
3.Vinyl ester

Pultrusion
Pultrusion
Pultrusion
Pultrusion
Pultrusion
Drawbacks of pultrusion
- Zheng-Ming Huang et. al Biomaterials 2003
Fiber filaments are
readily damaged

Fabricated wire is a
straight cylinder


Tube Shrinkage
method
Prototype archwire- tube method
Tube shrinkage method
Comparison
Epoxy v/s NiTi(Reflex

TP)
14 mm test specimen = Avg. interbracket span
Watari F et al. J. Material Science 98
Comparison
Comparison
Other Studies
Burstone & Goldberg
US Patent
application#4717341
Orientation of crystals in composite
Properties vary depending on :
1.% of fiber content
2.Orientation & length of fibers
For eg
1.Short fibers(1/8 inch or less)
provide extremely low stiffness
0.5x10
6
psi
2.Long continuous fibers can provide
E 1.5 to 30x10
6
psi.
Excellent springback

Orientation of crystals in composite
Production of anisotropic materials:
Accomplished by providing different
orientation of fibers in the same material.
Advantages over isotropic metals:
Providing diff properties in torsion & flexure
such that appliance is stiff in flexure & flexible
in torsion.
Properties of Composite wires
Aesthetically superior.
Wide range of E not attainable with metals.
Anisotropism a reality.
Good springback(1.5>Braided ss).
Good formability.


Fiber reinforced composites in
orthodontics JCO May 2000
S- glass long fiber
reinforced composite
with bis-GMA
matrix(light cured
thermoset)

Splint-It
TM
(Jeneric
Pentron)
Properties of Splint-It
TM
E is 70% > Highly filled restorative
composites.

Yield strength 6 times more.

Resilience is 24 times more




Splint-It
TM
Configurations

Rope

Woven Strip

Unidirectional strip
Procedure
Direct

Indirect
Bonding Hooks & other attachments
Before final curing

Added later
Intermaxillary elastics
Adv. Over conventional
techniques
1. Eliminates wire
bracket play.
2. Ideal positioning
possible.
3. Repositioning as R
x

progresses easy.


Applications
Intersegmental Mechanics
Molar uprighting
Clinical Reports
Vittorio Cacciafesta et
al. Univ. of Pavia, Italy

45 F periodontally
compromised

Everstick
R
(Forestadent) long
fiber FRC.

Pitor Stawinski
Private practice
Wrocklaw, Poland
49 F periodontally
compromised
C/C- Elongated
lateral incisor
Deitmar Segner, Hamburg
36 F needed fixed
mechanotherapy in the
anteriors.

FRC labially for anchorage
reinforcement in
conjunction with
segmented lingual
appliance
Lingual tech. with FRC
Silvia Geron Univ Tel Aviv, Israel
29 F
C/C Rt. Canine hidden
prevented her from smiling
Treatment strategy
6 months post treatment
Advantages
1.
Advantages
2. Stiffness can be controlled by modifying the
no. of layers during manufacture.

3. Virtually bracketless therapy.

4. No nickel allergies.

5. Is compatible with MRI.
Disadvantages
1.Only in cases requiring partial or compromise
R
x

2.Weak in shear & torsion

3.Bonding

Aesthetics in the new millennium
Alternatives to unsightly metallic braces?

- Partially aesthetic brackets
- Lingual brackets
- Clear teeth aligners(Invasalign &
orthoclear)
Disadvantages of the alternatives
1.Polycarbonate brackets cannot resist
torsional stresses generated by ss wires.

2.Ceramics Brittle, high co-eff of friction,
expensive, enamel abrading, debonding ?

3. Lingual Pt. discomfort, BioMech.
Restraints, Tech. sensitivity more.
Composite Brackets
NUS US patent Application
#2005/0008984 A1
Aesthetic Brackets
Image
R
Gestenco International AB

Prescriptions
Self ligating aesthetic brackets
Selfligating Esthetic brackets
OYSTER
TM
Fiber glass reinforced composite
Poly carbonate 70%
Polyethylene terephthalate(PET)
30%
OYSTER
TM
Ligation properties of a self ligating
composite bracket: An Invitro study
Masters Thesis Seifi Esmaili
Goteborg Univ. Sweden

Materials & methods:
Materials & methods
Results
Bilateral Test
Both SS & plastic brackets when ligated with
ss ligs. showed higher force resistance
values than SLCB.
When using elastomeric ligatures SLC
showed higher tolerance.
Results
Unilateral test
Tolerated force levels were in general lower
than the bilateral tests.
Elastomeric ligatures extended more than ss
ligs. or the SLCB cap before failure with all
types of brackets especially so with plastic
brackets & Ni-Ti wires.
Conclusion
The cap of the SLCB resisted lesser forces
than steel ligatures.
The cap of the SLCB resisted more forces
than elastomeric ligatures.
The max. resistance was shown by the SLCB
at 44.2 N in bilateral & 26.8N in unilateral
test.
Conclusion
The tolerated force levels were much higher
than that required for tooth movement(0.1-
1.2N)
The SLCB cap extended 1.7mm in the
bilateral & 3.3mm in the unilateral test =
SSB+SSW+SSL
Combination Brackets
Bondable tubes
Adhesive Precoated Brackets
Advantages
1. Better control over
flash removal
2. Better slot orientation
3. Moisture tolerant
4. Better resin hygiene
5. Convenience

Traditional Light cure bonding 11 steps
Clinical comparison of APC bracket v/s
uncoated ceramic bracket system
- Verstrynge et. al, OCFR 04
Materials & methods
RCT with APC Clarity

v/s Clarity

+ Transbond XT


20 pts. Requiring fixed mechanotherapy.

ARI at debonding was recorded.




Results
No significant diff. in ARI scores b/w the 2
groups.

The 2 groups performed identically.
Amorphous calcium phosphate
brackets
Polycrystalline
Monocrystalline
Alternatives to alumina YSZ (Yittria stabilized Zirconia)
Keith et al. AJODO 1994
-More friction than alumina type.
-Less aesthetic.
-Problematic in light curing (opaque).
Ceramic brackets Alumina
Poly carbonate brackets Failure. Hastened
Arrival of ceramic brackets in the 80s
Amorphous calcium phosphate
brackets
Tomy International Inc. Tokyo, Japan
Hyaline


1. Excellent biocompatibility.
2. Low friction properties.
3. Compatible hardness with human enamel.
SBS of ACP brackets to human enamel
- Daijiro Meguro et al.AO2006
Materials & methods

120 Human premolar teeth
8 protocols of 15 teeth each
4 different adhesives
- Kurasper F

- Light Bond

- Superbond C & B

- Transbond XT

With/out silane coupling agent (Porcelain Liner M

)
Hyaline

brackets(mean area11.118mm
2
)

Materials & methods
300 gm force for bonding( Bishara et al.)
Deionised water @ 37for 24hrs
Technograph machine (International org. for
standardization; Kawasaki et. al.)
Debonding 10 X magnification ARI
ARI
0 no adhesive on tooth
1 - < adhesive on tooth
2 - > adhesive on tooth
3 - all adhesive on tooth





Results
Conclusions
Reynolds Min. TBS of 6-7MPa
Reteif Enamel # at 14 MPa
12 15 MPa Kurasper, Light bond &
Superbond without Silane agent.
With Porcelain liner M 6-9 MPa (=RGIC)
Pickett et al. mean SBS invivo after
comprehensive ortho R
x
is significantly less
than invitro

Conclusions
Significant diff. b/w with/out Liner M

Light
Bond ( P<0.05 )
No significant diff. with/out Liner M

other 3
( P>0.05 )
Significant diff. b/w Transbond XT & others
without Liner M ( P<0.05 )
No significant diff. b/w the 4 with Liner M

(P>0.05)




Results
Previous Session
Wires FRC/FRP ; Composite wires.

Brackets Composite brackets
APC
ACP

Previous session
Wires FRC/FRP ; Composite wires.

Brackets Composite brackets
APC
ACP


Newer advances in orthodontic
materials
Dr Ameet V
Current Session
Optiflex


Bonding materials New generation flowable comp
ACP bonding agents
Ormocers
Antibacterial bonding agents

Flouride Releasing wires
Clear tooth aligners - Invisalign

/Orthoclear




Optiflex Archwire Treatment of a
Skeletal Class III Open Bite - M.F.
TALASS:JCO 1992 Apr
Optiflex Archwire Clear
optical fiber
3 Parts
1.Silicon dioxide core
2.Silicon resin
3.Nylon layer
Properties
Aesthetically ultimate
Highly resilient
Practically no deformation
Wide range of action
Ability to apply light continuous force
Case Report
21/M Japanese adult
C/C long mandible & openbite
Severe skeletal classIII openbite
Reluctant for max. surgery
Overbite - -3mm Overjet - -2mm
1
st
molars in crossbite
Moderate lower ant. crowding
Max. left quadrant crowding
Cephalometrics
Underdeveloped midface
Retrognantic maxilla
Prognanthic mandible
Long lower face
High FMA
Rx decision
Rx Objectives
1.Achieve functional class I, align the arches, attain
ideal jet & bite.
2.Correct the mandibular prognanthism surgically.
3.Improve the facial balance
Rx plan-
1.Nonextraction aligning with optiflex.
2.Symmetrical mandibular setback & autorotation
Rx Progress
.018 PEA
.017 round optiflex
wires- o rings
Reciprocal push coil
spring b/w lower
laterals.
3 months down
enough space was
available for lower
incisor alignment
Rx Progress
8 months on round
wires
16x22 optiflex for 9
months
Surgery
Passive 16x22ss
archwires with
soldered hooks
Post IMF-IME
for 3 months
Summary
Active Rx for 24
months(Total 30) -
18 months optiflex
6 months of finishing
Fixed retainers for
retention
Flowable composites
Advantages
Nonstickiness
Fluid injectabilty
Disadvantages-
Inadequate bonding strength
High polymerisation shrinkage

New generation Flowables
Denfil flow

Vericom Korea

Bis GMA+TEGDMA with barium glass &
silica(0.01-2.5) 60%

SBS, bond failure & SEM analysis of a new
flowable Composite for orthodontic use
Michele DAttilio et. al; AO 2005
Materials & methods
80 extracted premolars
Transbond XT

v/s Denfil Flow

Randomly bonded by blind operator
SBS on INSTRON machine


Materials & methods
Results
SEM
SEM
Conclusion
Denfil Flow

can safely be used for

orthodontic bonding with adequate bonding
strength comparable to the traditional
composites with lesser chances of enamel #
during debonding.
A new one-step dental flowable composite
for orthodontic use:An invitro bond strength
study Simona Tecco et. al. AO 2005
Similar materials & methods


Also included 2 other groups
- Traditional flowable composite
- Denfil flow without primer

Results
Tetric Flow chroma

Bonding Fiber-Reinforced
Lingual Retainers with
Color-Reactivating Flowable
Composite(Tetric flow
Chroma

)

MARC GESERICK et al.
JCO
ACP orthodontic adhesive
Aegis

Ortho
Bosworth company

Light cured
Releases calcium & phosphate ions
Remineralising potential

Ormocers
Acronym
Need for newer matrix?
Shrinkage & Biologic factors
Bis-GMA (Bowen)
- estrogenic
- cytotoxic (schedle, franz; dent
materials 1998
Definition
Organically modified
non metallic inorganic
composite materials

Fraunhofer institute of
silicate research
Wurzburg 1998
Advantages
Low polymerization shrinkage
High abrasion resistance
Biocompatibility
Protection against caries
Hickel R et al. Int. Dent journal 1998

Cattani- Lorrente et. al shrinkage
same as hybrid composite.
Steps in ormocer manufacture
Best of both worlds
SEM of ormocer particles
Sol-Gel process modified alkoxysilanes batch&/continuous flow reactor
The use of ormocer as an alternative
material for bonding orthodontic
brackets
Sameer Bishara,
Ajlouni et. al AO 2005
Evaluation of SBS B/w
Transbond XT
& Admira Invitro


Materials & methods
Zwick Universal testing machine
40 extracted human molars
Mounting jig



No diff b/w SBS post 1hr
Results
Zwick universal testing machine
Antibacterial Adhesives
MDBP 12- methacryloyloxydodecyl-
pyridinium bromide.

Antibacterial agent quaternary
ammonium+methacrloyl group

Prevents bacterial adhesion possibly by
electrochemical means
Shear Bond strength of orthodontic
Brackets with newly developed antibacterial
self etch adhesive Neslihan et. al AO 2005
2 groups
12 extracted premolars each
1
st
group Transbond Plus

+ Transbond XT


2
nd
group - Experimental ABF+Transbond XT

(Kurary Japan)
Shear Bond strength of orthodontic
Brackets with newly developed antibacterial
self etch adhesive Neslihan et. al AO 2005
Methods:
Stored in deionised water for 48 hrs.
Zwick tester SBS computer
10X magnification for ARI
Scoring-
5- 100% adhesive on bracket
4- 100-75% on bracket
3- 75-50%
2- 50-25%
1- <25%
0- No adhesive on bracket

Results
Effect of antimicrobial monomer-containing
adhesive on SBS of orthodontic brackets S
Bishara et al. AO 2005
Group 1 20 molars Etch+sealant+APC

Group 2 20 molars - Etch+antibacterial
primer+NaF containing bonding agent+APC

Post 1/2hr SBS on Zwick tester
Results
Flouride Releasing archwires
Decalcification
Within a month around brackets invivo
Ogaard B. et al. AJODO1988

MIC 0.65 1.3 micro gm/cm
2
/day
Mc Neill C J et al. AJODO 2001

Flouride delivery tried with bonding materials
Maximum release over the first 2 days only







Flouride coatings on orthodontic wire for
controlled release of flourine ion - Su-Hee-
Lee et. al. Wiley Interscience 2005
Aim
To develop a new method of releasing fluorine in a
controlled manner using coating on Ti based metals
Materials & methods
Thin films of 2 fluoride compounds namely CaF
2
&
MgF
2
were tested by coating on Ti plates (10x10mm
& 2mm thick) by E-Beam evaporation method.
Samples stored in 10ml TT of deionised water &
flourine release evaluated using Ion
chromatography.
Results
Fluorine was released rapidly in case of
MgF
2
samples both after heat Rx as well as
in as deposited state
Results
CaF
2
showed a linear release both in the as
deposited stage as well as after heat Rx
1.58-1.67g/cm
2
/day(0.65-1.63g/cm
2
/day)
Results
Biological considerations
Conclusion
Based on these findings the fluoride coatings
used in this study particularly CaF
2
are
strongly recommended for use in orthodontic
wires.
Invisalign

Is Invisalign really new?
Kesling(AJO1945)-showed tooth movement as a
series of planned individual setup models for use
with positioners
Nahoum(NYSDJ 1964)-vacuum formed dental
contour appliance
Pontiz(AJO1971)-thin overlay appliances for staged
Rx.
McNamara(JCO1985),Sheridan(JCO1993),Rinchuse
(JCO1997),Lindauer & Schoff (JCO1998)
Invisalign

What is New?
Laser scanning that creates accurate 3D
surface map of the teeth
Software to simulate tooth movement
Computer controlled fabrication
(stereolithography) of accurate models that
reflect virtual stages of Rx
Invisalign

Invisalign

How is Invisalign used by the patient?
Each set of aligners are worn for 2 weeks
Only removed for eating, tooth-brushing &
flossing
Aligners are kept clean by soaking in 4 drops
of sodium hypocloride(Clorox

) water.

The Invisalign system in adult
orthodontics:Mild crowding & space closure
cases Boyd et. al. JCO Apr 2000

4 Case reports
2 Spacing
2 mild crowding

The Invisalign system in adult
orthodontics:Mild crowding & space closure
cases Boyd et. al. JCO Apr 2000
The Invisalign system in adult
orthodontics:Mild crowding & space closure
cases Boyd et. al. JCO Apr 2000
The Invisalign system in adult
orthodontics:Mild crowding & space closure
cases Boyd et. al. JCO Apr 2000
The Invisalign system in adult
orthodontics:Mild crowding & space closure
cases Boyd et. al. JCO Apr 2000
The never ending search for Eldorado
continues.
References
Phillips science of dental materials
Kenneth J. Anusavice; 10
th
Edition,2001,W.B
Saunders Company:274

Shear bond strength of calcium phosphate
ceramic brackets to enamel Daijiro
Meguro, Tohru Hayakawa, Mayuko
Kawasaki, Kazutaka Kasai; Angle
Orthodontist 2006;76#2:301-305
References
Orthodontic biomaterials:From the past to the
present Robert P Kusy;AO 2002;72:501-12
Optiflex archwire treatment of a skeletal class III
openbite Talass MF;JCO1992;26:245-52
Fiber reinforced composites in orthodontics
Burstone & Kulhberg;JCO 2000;34:271-79
Fabrication of a new composite orthodontic archwire
& validation by a bridging micromechanics model
Zheng-Ming Huang et. al.;Biomaterials
2003;24:2941-53
References
Evaluation of Zirconia brackets Keith, Kusy
& Whitley; AJODO 1994;Dec:605-614
SBS,bond failure & SEM analysis of a new
flowable composite for orthodontic use-
Michele DAttilio et. al;AO 2005;75:410-415
A new one step dental flowable composite
for orthodontic use: An In Vitro bond strength
study- Simona Tecco et. al:AO2005;75:672-
677


References
The use of ormocer as an alternative
material for bonding orthodontic brackets
Ajlouni,Bishara et. al.;AO 2004;75:106-08
Effect of Antibacterial monomer containing
adhesive on SBS of orthodontic brackets
Bishara et. al.;AO 2005;75:397-99
SBS of orthodontic brackets with newly
developed antibacterial self etch adhesive
Neslihan et. al;AO 2005;75:843-48
References
http://www.google.co.in
http://pubmed.com
http://www.bedfordplastics.com/aboutfrp.htm
http://www.freepatentsonline.com
http://www.bioeng.nus.edu.sg
http://www.stormingmedia.us
http://www.forestadent.co.uk
http://www.interscience.wiley.com
http://www.invisalign.com
http://www.orthoclear.com
http://www.isc.fraunhofer.de
http://www.bosworth.com
http://www.rms-fondation.ch
http://www.gestenco.com