* Corresponding Author: Dr Ritu Duggal, rituduggal@rediffmail.com

The popularity and clinical uses of ceramic bracket is increasing in the contemporary orthodontics. This article provides the clinician an up-to-date knowledge on the physical properties and clinical characteristics of ceramic brackets. It critically discusses the various aspects of ceramic brackets with regards to the composition, types, base characteristic, physical properties, enamel and bracket fracture, frictional resistance, bond strength, debonding methods, bracket recycling and potential clinical problems and their managements.

Division of Biosurface Technology, Biomedical Technology Wing
Sree Chitra Tirunal Institute for Medical Sciences & Technology
Thiruvananthapuram 695012
sharmacp@sctimst.ac.in

Since their introduction to orthodontics in 1986, the Ceramic Brackets have become popular as esthetic appliances. The newer designs of ceramic brackets offer excellent optical properties and the promise of additional esthetic appeal without significant functional compromises. Ceramic brackets are durable, allow adequate force control over long treatment periods, and their risk for discoloration is minimal. The introduction of Ceramic brackets was a muchheralded development in the orthodontic treatment of adult patients. Their acceptance by these patients has been unprecedented in the practice of orthodontics and contributed significantly in the expansion and development of contemporary orthodontic therapeutic modalities. Apart from offering esthetics, ceramic brackets exhibit excellent biocompatibility. There has been much concern regarding the allergic and cytotoxic effects induced by constituents and the corrosion products of the stainless steel brackets. Nickel and Chromium are the most common causes of metalinduced allergic contact dermatitis in man. Nickel has recently been reported to be moderately cytotoxic. Hence the advantages offered by the Ceramic brackets namely excellent esthetics, biocompatibility, corrosion resistance, stability in the oral environment and non toxic nature has made them an integral part of the orthodontists’ armamentarium.

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Surgical Removal of a Pacemaker Lead Causing Infective Endocarditis: A Case Report

0.4-1.1% of patients having permanent pacemaker implantation suffer serious infections leading to endocarditis. Generally accepted mode of therapy in these group of patients is removal of the infected pacemaker and lead that has caused endocarditis and accomplishing long term antibiotic therapy and accompanied by implantation of a new pacemaker to another anatomic site. A 71 year old female had implantation of permenant pacemaker 8 years ago owing to total AV block which was tended to be removed 1 year ago. However the lead was left in place because of the dense adherences and another pacemaker was introduced through left subclavian vein. Patient then addmited with signs and complaints of infection. Although the newly implanted pacemaker and lead was removed with suspected infection and ampiric antibiotherapy was initiated, clinical signs continued and ecocardiography revealed vegetation on the previously implanted lead. Surgical extraction of the lead was planned and preoperative angiography showed aterosclerotic leison in the circumflex artery. İnfected lead was extracted by the use of cardiopulmonary bypass through right atriotomy incision with concommitant bypass and implantation of epicardial DDD-R pacemaker. Postoperative period was uneventful and patient was discharged on 15th postoperative day without signs of infection.The pacemaker system must be removed in cases of endocarditis owing to the infected pacemaker lead. Simple transvenous extraction has to be avioded especially when the tip of the lead is infected. This method prevents the risk of pulmonary embolisation associated with vegetation and mechanic injury to the tricuspid valve and right ventricule.