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Appliances
ОглавлениеOrthodontic forces are obtained by deflection or torsion of flexible wires and cantilevers, and by activation of springs and elastics.
An important characteristic of the force systems generated by a cantilever or by well‐maintained up‐and‐down elastics is their high degree of constancy over time and deactivation (qualitative constancy).
In direct contrast, the force system generated by a straight‐wire appliance is only determined by the mutual relationship between the brackets and the wire [3]. Placing straight wires into badly placed brackets may or may not result in favourable tooth movement, depending on the geometric relationships between the brackets [11].
It will become apparent that these limitations in the straight‐wire approach can unmistakably influence orthodontic outcomes [3]. Using a so‐called customized straight‐wire approach with predetermined prescription brackets and utilizing robot‐formed wires cannot replace the manual skill of the orthodontist, neither can it render the biological and mechanical basis upon which the profession is built redundant [3, 4].
Ideal orthodontic care achieves individualized, predetermined treatment objectives. The selected course of action should address the patient’s problems and meet the individualized goals. These components imply that different patients require different treatments, which means that one appliance design (brackets prescription, archwire sequence, etc.) will not be capable of solving the problems of all patients [1–3].
In a continuous arch technique, where the number of variables is unknown or not measurable, the system becomes statically indeterminate and orthodontic prediction becomes impossible.
It is therefore clear that a purely straight‐wire approach cannot replace the custom‐made appliances needed to accomplish the specific goal of aligning an ectopic tooth efficiently.
The orthodontic tooth movement can generate bone and it is important to recognize that teeth can be moved ‘with bone’ or ‘through bone’. The tissue reaction that determines whether the movement is with bone or through bone depends on the stress/strain distribution in the periodontium surrounding the loaded teeth [3]. The displacement of teeth into edentulous areas or outside the initially given envelope without loss of attachment has demonstrated that teeth can be displaced with bone if the stress/strain distribution can be controlled [3].
No standard bracket design can deliver individualized treatment objectives. Only the orthodontist can control the specific characteristics of the force system to be used in treatment. The optimal alignment of ectopic teeth can only be resolved by the application of a custom‐made appliance, using a force system generated by wire bending [3].
Treatments should be performed with individualized appliances that adapt the force system to the patient and not the patient to the force system.