Fixed treatment with brackets, bands and arches 

The fixed treatment with brackets, bands and arches is the “royal discipline” of orthodontics.
If teeth have to be moved physically, a fixed brace (bracket appliance) is indispensable, because only brackets can move the teeth into all three spatial directions and therefore treat all kinds of teeth misalignments.
The so-called brackets fix the archwire in place. In most modern brackets, the information on how the teeth are to be moved is already programmed into the appliance. The force transferred via the archwire then moves the teeth.
In the past, elastic ligatures affixed the archwire to the brackets. This had the disadvantage that plaque would gather on the ligatures, making oral hygiene more difficult. With self-ligating brackets, as used in our practice, these small elastics are no longer needed, making oral hygiene much easier.
Besides, moving the teeth required considerable force, but much of it was lost through friction between the arch and the brackets. By using the free-flowing bracket-arch-system, no force is lost through friction and we can undertake treatment with much lighter force, which is also far more friendly on the tissue.

---

The Damon system (self-ligating, frictionless)

---

Speed (self-ligating)

---

Aesthetically tasteful ceramic brackets are transparent and less conspicuous than metal-brackets.

QuicKlear Bracket® (self-ligating ceramic brackets)

---

For patients who do not want their brackets to be noticed, it is also possible to attach a fixed brace to the inner sides of the teeth. These so-called lingual brackets (also see “lingual technology”) are invisible from the outside.

 Königsteiner Hybridtechnik® 

Up to now, patients with a deep bite requiring fixed braces in the upper and lower jaw, frequently encountered the problem of the upper teeth biting down onto the lower brackets, causing them to break and ultimately delaying treatment. To avoid this, one either had to cap the lower molars with cement, or glue so-called bite turbos behind the front teeth. However, both scenarios made chewing more difficult, rendering it a less than perfect solution.
Through the advancement of lingual treatment, initially developed for aesthetic reasons, we were able to find a much more comfortable solution for the patient. We now bond the lower jaw brackets to the inner side of the teeth. Not only does this look better, it also improves the quality of life by avoiding cement caps and bite turbos. The insides of the teeth are also less prone to de-mineralisation because of the self-cleansing attributes of saliva.
For children that play wind instruments (in particular, flute or trumpet), it is far more pleasant if the brackets in the lower jaw affix to the insides of the teeth.

Dental health

To avoid damage (e.g. plaque) on the teeth, we bond the brackets onto the teeth with fluoride-releasing glue. This hardens the enamel much like fluoride-enriched toothpaste would do. However, a conscientious oral hygiene during treatment with a fixed appliance is vital. Food remnants get easily stuck around the brackets and can pose danger to the tooth if not removed thoroughly.

If we use a fixed brace (brackets), we give our patients an oral hygiene starter-kit that includes all the brushes required for dental care. We also explain how to look after teeth with brackets and keep them flawless.
After that we arrange for two appointments in our ‘cleaning school’. First, the teeth are coloured blue to expose and make visible any weaknesses. In a second appointment, we check again whether the patient is able to clean the teeth perfectly despite the fixed brackets.

Depending on demand and requirement, we use a diverse range of fixed appliances. For example, if the patient still has a number of milk teeth, we are careful to limit treatment to just a few teeth. The required treatment period lasts for about 6 months, and a complete treatment of all teeth takes about 1 to 1.5 years.

 Lingual treatment technique ("braces on the inside") 

One talks of lingual technique, when the brackets of a fixed brace are attached to the inner side of the teeth.

The advantage of the lingual technique is that the teeth can be moved in all dimensions and, because the brackets are invisible from the outside, they meet the highest aesthetic requirements. So, if you are in a meeting, nobody will notice you are wearing braces. The inner side of your teeth is also more resistant to de-mineralisation, due to the self-cleaning attributes of saliva. Lingual brackets are either universal miniature brackets e.g. 2D, or can be custom-made for the patient, e.g. Incognito bracket.

---

2D-lingual bracket

The 2D-lingual bracket is extremely flat and with its specially rounded edges, the patient hardly feels it. We predominantly use this bracket in the lower jaw. In patients with a deep bite position, it has the advantage of not having to block the bite in order to position the brackets from the outside.

---

Incognito

The Incognito bracket differs from conventional appliances, in terms of conception as well as manufacture. The computer-designed brackets are tailor-made for each patient and manufactured in a complex production process (Rapid-prototype-process), ensuring an optimum fit in the patient’s mouth.

Making the brackets requires a highly skilled procedure and takes place in a specially equipped laboratory.

First, we consult with you to put together a treatment plan. Then we make exact silicon impressions of your upper and lower jaw. These are send to the specialist laboratory of the German company ‘TOP-Service for lingual technology’ in Bad Essen, where the brackets and arches are measured and designed with computer-driven CAD/CAM technology. The individual brackets are made from anti-allergic materials with a high gold content, and the archwires (orthodontic components connecting the brackets and thus teeth in order to move them) are precision-bend using a machine solely developed for this process. The result is a tailor-made bracket system. The appliance is then send back to us, and we can start the treatment. Using the so-called “indirect bonding technique” (glue tracks on the teeth), we fit the brackets in one treatment session.
With Incognitos, teeth movement and treatment results can be predicted even more accurately than with universal brackets.
Compared to conventional lingual brackets, higher patient comfort is ensured through:
1. a flat bracket design (noticeably smaller brackets than conventional systems),
2. an enlarged bracket to tooth bonding surface, and
3. the optimal positioning of the bracket, thanks to its computer-design.

As the brackets are made with a high gold content alloy, they offer a sensible alternative for patients with allergic reactions to nickel.

 Anchor pins 

Anchor pins are tiny titanium screws that, following a local anaesthetic, are inserted between the roots of the tooth i.e. into the palate.
Anchor pins serve as external anchoring points and enable a fast and precise treatment with less undesired side-effects than the conventional treatment.
Every movement of the tooth requires an anchoring point to make movement possible in the first place. Conventional treatment methods use other teeth as a fulcrum for this movement. In most cases this not only brings about the desired movement of the treated tooth but also an undesired migration of the other teeth. Using the anchor pins as a “neutral anchorage” helps to avoid these side-effects. Only the desired tooth is moved into the desired direction. On completion of treatment, the titanium screw are simply removed.

Examples of application:

 Königsteiner Intrusion® 

The missing overlap between the upper and lower front teeth’s incisal edges is described as a frontal open bite. This malocclusion of the jaw and/or the teeth needs to be treated urgently, because not only does it affect the aesthetic appearance of a patient, it also reduces his or her ability to masticate. (Julien et al, 1996). Pronounced open bites can cause lisping and other speech impediments (Proffit, 1993).
To treat an open bite in a patient’s permanent dentition, we use the Königsteiner intrusion® mechanism in our therapy. This treatment technique – further advanced by us, will move the upper molars inwards and, due to the geometry of the jaw, leads to a positive forward movement of the lower jaw, bringing about the closure of an open bite.
To achieve this, we insert an anchor pin into each palate at the level of the first large molars (also see “anchor pins”). A transpalatal arch (also see “transpalatal arch”) is fastened to the large molars, and using elastic chains running from the molar to the anchor pin, the molars can now be moved inwards and the bite will gradually close.

---