Introduction
In orthodontics, the terms ‘instrument’ and ‘equipment’ are often used interchangeably. However, there is a distinction between the two. An instrument is a precision tool used for specific tasks such as cutting ligatures or trimming models. On the other hand, equipment in orthodontics refers to big tools and machinery used in a laboratory or clinic, such as dental chairs, spot welders and polishing lathes.
Instrument specific to orthodontic use
An orthodontist must properly understand each instrument’s working principles and indications for specific use. The appropriate selection of instruments is of utmost importance for any medical procedure, including orthodontic treatment.
Most orthodontic instruments are composed of stainless steel, a material that offers the advantage of corrosion resistance. These instruments are designed with an ergonomic shape and screw joint to meet the specific needs of orthodontic procedures. Gold brazing of stainless-steel instruments can prolong their lifespan and usefulness. The tools are designed without sharp ends, sporting round tips for patient comfort and safety and serrations on the working ends for improved grip. The cutting edges of the instruments are made of either stainless steel or tungsten carbide (TC). The tungsten carbide tips have a few advantages over stainless steel, such as improved hardness and durability, but they are more brittle. TC-coated instruments also offer:
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Durability.
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Precise cutting performance.
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Sharp cutting edge.
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Three times stiffer than stainless steel.
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Denser than steel, hence resistant to scratches.
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The cutting edge maintains sharpness and alignment.
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The TC-coated tips are brittle and hence, more prone to fracture. The TC instruments should be handled with extra care.
Instruments for banding
The orthodontic band cemented to the tooth is a practical means of obtaining an attachment like tube or a bracket. Banding in contemporary clinical orthodontics has specific indications. These are:
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Teeth that will receive substantial forces against the attachments, for example, the upper first molar in the case of headgear therapy and loop mechanics.
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Teeth that need both labial and lingual attachments.
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Teeth with shorter clinical crowns.
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Tooth surfaces incompatible with strong bonding, such as amalgam restorations, porcelain veneers and enamel fluorosis.
Banding of the teeth is the first clinical step in starting orthodontic treatment. It includes the placement of separators, followed by band pinching and cementation of a pinched or prefabricated band. Separators are placed 24–48 h in advance of banding appointment. Orthodontic instruments and armamentarium required for banding tray set-up are presented in Table 43.1 . Salient features and functions of the most used banding instruments are as follows:
TABLE 43.1
Instruments and armamentarium for orthodontic tray set-up for banding
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Separators placing pliers
It is a single-ended instrument with a barrel-shaped angled beak and a handle. The handle is adapted for a palm grasp. The barrel-shaped tip prevents the module from slipping, reducing the risk for tissue damage. Pliers expand elastic separators before positioning them interdentally. Due to the angled beak, it is easy to position the separator in both the anterior and posterior regions. The separator placing pliers are used to place elastic separators in the interproximal area, both gingival and occlusal to the proximal contact ( Fig. 43.1 ).
Photographs showing separators placing plier:
(A) Separator placing plier; (B) Elastic separator and barrel-shaped tip (C) Stretched elastic separator.
Source: (A) https://surtex-instruments.com/product/force-module-separating-plier/ ; (B, C) https://www.hufriedygroup.com/en/pliers/force-module-separating-pliers
Band crimping (pinchable) pliers ( Fig. 43.2 )
Band crimping pliers are available individually for the right and left sides for maxillary and mandibular buccal teeth. It has a band clamping portion and a handle. Each of the band clamping portions has an elevated surface and depression. The purpose of the high edge is to provide friction contact with the portion of the band strip to prevent it from slipping. It is used for preparing the molar band. With availability of preformed bands, band formation in clinical practice is no more in use.
Photograph showing a band pinchable plier.
(A) The right and left band pinchable pliers and (B) working end.
Source: https://www.libraltraders.com/shree-pedo-band-forming-plier-right-left-shp43.html
Double beak pliers ( Fig. 43.3 )
These are available separately for anterior and posterior band fabrication. Double-beak pliers were used for forming bands directly in the mouth and were of immense importance before bonding was established as a routine clinical practice.
Photograph showing double beak pliers used for pinching anterior bands.
Band (crown) contouring pliers ( Fig. 43.4 A)
It is single-ended pliers with two beaks on one end and a handle on the other end. One beak is concave, while the other is convex (ball shaped), allowing the contouring of bands. The ball-shaped beak of the pliers is placed on the bands inside surface, and hand pressure is used to improve the contour before the final placement of the molar band. It can be used to re-contour band edges that sometimes get distorted during band placement. These pliers are ideal for contouring and adapting the orthodontic band to tooth anatomy.
Photograph showing band (crown) contouring pliers.
Source: http://www.hu-friedy.com/products/crown-and-band-contouring-pliers.html
Another variation of the band-contouring pliers is band (crown) crimping pliers ( Fig. 43.4B ). It is used to contour the gingival surface of the preformed bands to provide better adaptation to tooth anatomy.
Photograph showing band (crown) crimping plier.
Source: http://www.hu-friedy.com/products/crown-and-band-contouring-pliers.html
Mershon band pusher ( Fig. 43.5 )
It is a single-ended instrument with a rectangular (or square) working end/tip on one end and a cylindrical hollow handle on another. Its rectangular tip with a serrated surface is meant to transfer force to push bands slip through contact points. The edge of the rectangular pad is serrated to facilitate grip. Its cylindrical hollow handle allows it to keep it light for better operator grasp. It aids in the placement and seating of orthodontic bands. It is used to push the band to the seat or to adapt it precisely to the contour of the teeth. It can also be used to modify the coronal margins of the band to adapt the marginal ridges.
Photograph showing Mershon band pusher.
Source: © Dentaurum GmbH & Co. KG
Band seater (bite stick) ( Fig. 43.6 )
The band seater has a triangular/square bite pad with a soft metal pad/tip embedded in a plastic or wooden handle. The edge of the biting pad is serrated to facilitate grip over the band. The band seater is used for much the same purpose as the band pusher. However, instead of finger and hand pressure by the operator, the patient is asked to bite hard on band seater to transfer seating force.
Photograph showing band seater (bite stick).
Band plugger (director or pusher) with scaler ( Fig. 43.7 )
It is a double-ended instrument with a band pusher or plugger on one end and a scaler on another end. Historically, Mitchell’s trimmer was intended to be used for trimming the cementoenamel junction with the spoon-like end of the instrument after a tooth had been prepared for a crown. Its use in orthodontics includes removing excess cement after placement of orthodontic bands. It can also be used after debonding brackets in the removal of excess cement with a conventional handpiece and a debonding bur. While one end is used for seating or placing orthodontic bands during the try-in and cementing phases, another sharp scaler, like the head, removes excess material after cementation or bonding of bands.
Band plugger (director or pusher on one end and cement removing scaler on another end) with scaler.
Source: https://www.hufriedygroup.com/en/orthodontic-hand-instruments/band-pusher-scaler
Instruments for bonding
Precise bonding is critical to the final tooth alignment and positioning at the completion of orthodontic treatment. Accurate placement of pre-adjusted appliances decreases the need for finishing bends and reduces unnecessary tooth movement. Bonding involves four basic steps, namely cleaning, enamel conditioning, sealing and bonding. Proper use of instruments and armamentarium for each step is especially important for a successful bonding procedure. Orthodontic instruments and armamentarium required for bonding tray set-up have been presented in Table 43.2 . Salient features and functions of the most used bonding instruments are as follows:
TABLE 43.2
Instruments and armamentarium for orthodontic tray set-up for bonding
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Boone gauge ( Fig. 43.8 )
It is the most frequently used bracket positioning aid. It has a flat surface and fixed metal pin with or without lead pencil lids.
Photograph showing Boone gauge.
Source: https://www.orthotechnology.com/shop/instruments/boone-gauge-stainless-steel
The occlusal-gingival placement of the bracket is marked with this instrument. A flat surface rests on the incisal/occlusal surface of a tooth, and fixed metal pin scribes mark for bracket heights of 3.5, 4, 4.5 and 5 mm. While marking in the incisal region, the marker should be perpendicular to the labial surface, and in the canine, premolar and molar regions, it should be parallel to the occlusal surface.
McLaughlin, Bennett, Trevisi (MBT) bracket positioning gauge ( Fig. 43.9 )
Bracket positioning gauge is made up of aluminium (or stainless steel). It has a flat surface and fixed metal blade. This device simplifies the seating of the bracket on the teeth at the correct height from the incisal edge. It accurately measures the height of the bracket placement from the incisal edge at 2, 2.5, 3, 3.5, 4, 4.5, 5 and 5.5 mm.
Photograph showing bracket positioning gauge (MBT gauge).
Direct bond bracket tweezers ( Fig. 43.10 )
It is a single-ended instrument with two flat beaks on one end and handles on the other end. Flat beaks are with serration to securely hold the single bracket when placed onto the tooth during direct bonding. Applying pressure on the handle opens the working end, and releasing closes the working end to grasp the bracket securely.
Photograph showing direct bond bracket tweezer.
Source: http://www.hu-friedy.com/products/slim-direct-bond-bracket-tweezers.html
Bonding accessories
The orthodontic office must be equipped with cheek retractors ( Fig. 43.11 A) of both paediatric and adult sizes. A cheek retractor with tongue guard and suction attachment (Nola dry field system) is an excellent system for maintaining an isolated field during bonding ( Fig. 43.11 ). Dental photographic mirrors, both adult and paediatric sizes and tongue separator/tongue guards ( Fig. 43.12 ) are essentials in day-to-day practice.
Photograph showing (A) cheek retractor. (B) All-in-one device for isolation during orthodontic bonding: Nola dry field contains cheek retractors, tongue guard and inbuilt suction holes and connectors. (C) Nola dry field system in mouth
Source: (B) https://www.osecompany.com/products/nola-full-arch-dry-field-system/
Photograph showing tongue separator/tongue guard.
Source: https://www.dentalbasket.in/ortho-technology-ortho-tongue-guard-shield
Instruments for wire bending and manipulation
Wire cutting, clasp forming, arch forming, loop forming instruments used for the manipulation of wires have been presented in Table 43.3 . Brief descriptions of instruments used for wire bending are as follows:
TABLE 43.3
Commonly used instruments for wire bending and manipulation
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Arch forming instruments
Bird beak pliers ( Fig. 43.13 ): Bird beak pliers (# 139 wire bending pliers) is a single-ended plier with two beaks at one end (pyramidal and cone-shaped beaks) and a handle on another end. Bird beak pliers are the most versatile pliers in orthodontics. The bird beak pliers are used to bend a variety of arch wires up to 0.030 inches. It is utilized to place various horizontal, vertical and loop bends. The pyramidal beak is used to place a sharp bend in the arch wire, whereas loops and more gradual bends are placed with the cone-shaped beak.
