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CONCEPTS AND COMPONENTS OF REMOVABLE ORTHODONTIC APPLIANCES

Presented By:Dr. Chandrika Dubey

CONTENT
Introduction Development and History Scope of ROA Properties of Orthodontic wires Classification Indications Advantages Disadvantages Design Components Commonly Used Appliances Conclusion

INTRODUCTION
Removable appliance can be defined as an appliance one which can be removed by the patient for cleaning, but when in the mouth, is firmly attached to the anchor teeth, so that controlled pressure may be brought to bear on the teeth to be moved.

DEVELOPMENT OF REMOVABLE APPLIANCE


In united states, the original removable appliance were rather clumsy combination of vulcanite bases and precious metal or nickel-silver wires.

In early 1900s, George Crozat developed a removable appliance fabricated entirely of precious metal that consisted of an effective clasp for 1st molar teeth, heavy gold wire as framework and lighter gold finger springs to produce desired tooth movement
Its limitation is that it produces tipping of teeth

(Profitt 5th edition )


(Removable Orthodontic Appliance Graber Neumann)

Development continued in Europe despite their neglect in the United States. This was because
1. Angles dogmatic approach to occlusion, with its emphasis on precise positioning of each tooth, had less impact in Europe than in US 2. Social welfare system developed much more rapidly in Europe which tended to place emphasis on limited orthodontic t/t 3. Precious metal for fixed orthodontic appliance was less available in europe.
It was banned in nazi germany which forced german orthodontist to focus on removable appliance

(Proffit 5th edition) (Removable Orthodontic Appliance Graber Neumann)

In 1925 to 1965 era, american orthodontics was based almost exclusively on the use of fixed appliance While fixed appliance were essentially unknown in europe and all t/t were done with removable, not only for growth guidance but also for tooth movement of all types.

Proffit 5th edition (Removable Orthodontic Appliance Graber Neumann)

History
Invention of Vulcanite denture material Regulating devices Coffin Plate (1881) made out of piano wire N. W. Kingsley (1880) plate for jumping the bite Pierre Robin (1902) split plate with Screw J.H. Badock (1911) expansion plate with efficient screw
Next three decades these plates were eclipsed by E. H. Angles fixed appliances

History
C.F.L.Nord (1929) meeting of European Orthodontic Society, Heidelberg simple plate with screw for treatment of masses

M. Tischler (1936) Ninth International Dental


Congress, Vienna demonstrated sophisticated

active plates
A. M. Schwarz(1938) textbook entirely devoted to

treatment with plates

SCOPE OF REMOVABLE APPLIANCES


The use of removable appliances still varies widely between clinicians, but it is possible to achieve adequate occlusal improvement with these appliances, provided suitable cases are chosen. It is vital to emphasize that cases suitable for removable appliance treatment are those that require simple tipping movements only, and surprisingly few malocclusions will fall into this category.

PROPERTIES OF ORTHODONTIC WIRES


1) Esthetics 2) Stiffness 3) Strength 4) Range 5) Springback 6) Formability 7) Resiliency 8) Friction 9) Biohostability 10) Biocompatibility 11) Weldability Kusy, AO 1997

1) Esthetics:
desirable property -no compromise on mechanical properties composite wires

2) Stiffness/Load deflection rate:


Magnitude of force delivered by the appliance for a particular amount of deflection. LDR=Load/Deflection

F Edr4 d l3 l3 r4 E- Modulus of elasticity d- Deflection r- Radius l- Length


Doubling radius = Increases force 16 fold Doubling length = Reduces force 8 fold

L3 d

(2l)3 8d

1 d r4

1 16d (r/2)4

Low stiffness or LDR implies i. Low forces will be applied ii. Forces more constant as appliance deactivates iii. Greater ease &x accuracy in applying a given force -For active components low LDR -For retentive components high LDR Variable Cross-section Orthodontics-Burstone Variable Modulus Orthodontics NiTi TMA ss wire

3) Strength:
Force required to activate an archwire to a specific distanceKusy

Shape and cross-section of wire have an effect 4) Range:


Distance to which an archwire bends elastically, before permanent deformation occurs- Proffit

5) Springback:
The extent to which the wire reverses its shape after permanent deformation.

Wire can be activated to a large extent hence fewer activations will be needed

6) Formability:
Ability to bend wire in desired configuration.

7) Resiliency:
Amount of energy stored in a body.

8)

Friction:
While closing spaces in continuous archwire technique, involves relative motion of bracket over wire.

Excess friction- loss of anchor - binding Least amount of friction desired 9)

Biohostability:
Ability of a wire to accumulate, or be a site of accumulation of bacteria, spores or viruses

10) Biocompatibility:
Resistance to corrosion and tissue tolerance to elements in the wire.

11) Weldability:
Ease by which a wire can be joined to other metals by actually melting the 2 metals in the area of the bond

ACTION OF REMOVABLE APPLIANCE


SPONTANEOUS MOVEMENT
Where extractions are carried out as part of t/t, the relief of crowding may allow neighboring teeth to upright to upright towards extraction site ERUPTION GUIDANCE
As space maintainers

UPRIGHTING
When crowding is relieved, a tooth may upright by movement of crown towards extraction space

LABIO-LINGUAL MOVEMENT MESIAL MIGRATION

Removable Orthodontic Appliance - Isaacson

ACTIVE MOVEMENTS
TIPPING
Mesiodistal Tipping Buccolingual tipping

ROTATIONS AND CONTROLLED APICAL MOVEMENTS OCCLUSAL MOVEMENT INTRUSION

Removable Orthodontic Appliance - Isaacson

WHY REMOVABLE APPLIANCE HAVE LIMITED USE IN LOWER ARCH


Patients find the bulk unsatisfactory Retention is less satisfactory Considerably reduced area available for active component (it is not possible to construct springs with long range of action)

Removable Orthodontic Appliance - Isaacson

CLASSIFICATION

Types of Removable Appliances


According to Moyers
Loose fit imprecisely and alter neuromuscular function Attached maintain fixed relationship with dentition

Active appliances Passive appliances

Active Appliances
Extra oral traction devices
Head gears Facemasks Chin cup

Lip Bumpers (Plumpers) Active plates


Schwartz appliance Sapce regaining appliances Anterior Spring Aligners (Barrer Appliance)

Crozat appliance Vaccum formed Appliances ( Invisibles)

Passive appliances
Used to To maintain the status quo within the dentition To disocclude the dentitions during orthodontic treatment To disclude the teeth prior to registration of bite relationships As adjuncts to treatment of temporomandibular dysfunction

Passive appliances
Bite planes Occlusal Splints Multiple Space maintainers Retainers

ACTIVE PLATE
The removable appliance used at present were developed before world war II During that time, there were two distinctive devices
ACTIVE PLATE
Uses force from within the appliance

ACTIVATOR
Uses muscular force

THE ACTIVE PLATE CONTAINS


Baseplate Clasps Active elements
Labial wire Springs Screws Elastics

(Removable Orthodontic Appliance Graber Neumann)

Appliance can be
Active (appliance which applies force on the teeth)
Passive

(appliance which does not applies force on the teeth)

According to skeletal or dental changes


Orthopaedic Changes. Orthodontic Changes

Appliances classified according to the movement of teeth


Labiolingual and buccolingual movement of teeth Mesiodistal movement of teeth Rotation and root movement Expansion and contraction Intermaxillary and extra oral traction Functional appliances

Removable Orthodontic Appliance - Isaacson

Indications
Minor tooth movement technique may be considered
Malposition limited to relatively few teeth Desired movement not more than few mm Adequate space between adjacent teeth to permit entry of teeth to be moved Allowable axial inclination corrected by tipping forces Diastima closure Crossbite correction Anterior crowding

Closing of spaces Uprighting of teeth Migration of mandibular incisors

Retention after corrected malocclusion

To gain space

Preventive and interceptive orthodontics

ADVANTAGES
Patients maintain good oral hygiene

DISADVANTAGES
Patient co-operation is vitally important

Easy to clean
Tipping type of tooth movement is carried easily Less chair side time Lesser forces are used, than those needed for bodily tooth movement Can be used by general dental practitioner who have received adequate training Relative less expensive

Whenever multiple tooth movements are to be carried out, it should be done at a time.
Treatment duration is prolonged in case of severe malocclusion Multiple rotations are difficult to treat using removable appliances. Requiring extraction, it is very difficult to close residual space by forward movement of posterior teeth. Appliances are removable, there is a greater chance of patient misplacing or damaging them. Patients should exhibit enough skill to remove and replace the appliance without distorting them. They cannot be used to treat severe cases of Class II and Class III malocclusions with unfavorable growth pattern.

Can be removed -for cleaning of teeth & appliance -if in pain -on socially sensitive occasion

Components of removable appliances

Retentive Components Baseplate Active components

Retention
They are components that help in keeping the appliance in place and resist displacement of the appliance.
Retention is accomplished by clasps made of stainless steel wire. Other material such as platinised gold wire, have superseded by the former materials which has the advantage of far greater strength and equal resistance to corrosion. There clasps must be made in such a way that the active portion lies gingival to the greatest diameter of the tooth and so can be bent inwards to clasp the tooth and retain the appliance against strong displacing forces.

CLASPS
Can be defined as a component of ROA that retains and stabilizes an orthodontic appliance in oral cavity by contacting the surfaces of the tooth or by engaging interproximal embrasures

Requirements of an ideal clasp


It should offer adequate retention It should permit usage in both fully erupted as well as partially erupted teeth. It should offer adequate retention even in the presence of shallow undercuts. They should not by themselves apply any active force that would bring about undesirable tooth movements of the anchorage teeth. It should be easy to fabricate. It should not impinge on the soft tissues. It should not interfere with normal occlusion.

Mode of action of clasps


There are 2 types of undercuts
Buccal and lingual cervical undercuts Mesial and distal proximal undercuts

Buccal and lingual cervical undercuts


The buccal and lingual surfaces of molars have a distinct undercuts at the cervical margin. This can be seen from the mesial aspects of a molar. Eg: Circumferential clasps, south end claps

Mesial and distal proximal undercuts


The molars are widest mesio-distally at the contact point and gradually taper towards the cervical margin. These surfaces sloping from the mesial and distal contact areas towards the neck of the teeth are called the mesial and distal proximal undercuts. Eg: Adams clasp, Crozat clasp

Classification of clasps
Free ended clasp
(One end embedded in the acrylic portion and free end on the tooth surface.) Eg:
Circumferential clasp Duyzing clasp Crozat clasp Triangular clasp Ball end clasp Hand wrought roach clasp Arrow pin clasp

Continuous or looped clasps


(Both ends are embedded in the acrylic portion or base plate)
Eg:
Molar clasp Visick clasp Arrowhead clasp Adams clasp Eyelet clasp South end clasp

Circumferential Clasp
ALSO CALLED C-clasp three quarter clasp INDICATIONS for the retention on premolars and molars WIRE USED 0.9mm DISADVANTAGES
Cannot be used on deciduous teeth as there is no infrabulge area Cant be used on partially erupted teeth Can only be used on post. Teeth Clasp is rigit as it is made of thicker wire Difficult to adjust, gets distorted easily Tends to create space b/w teeth by wedging action as it is made of thicker wire Can not be repaired if broken

ADJUSTMENT clasp is adjusted by holding it at the contact point and bending it towards the tooth (Removable orthodontic appliance MS Rani 2nd Edition)

Jacksons Clasp
ALSO CALLED full clasp U-Clasp INDICATIONS retention on premolars and molars WIRE USED 0.9mm DESIGN Engages both buccocervical undercuts ADVANTAGES Simple design Offers adequate retention DISADVANTAGES Inadequate retention in partially erupted teeth similar to C clasp ADJUSTMENT bending the clasp towards tooth by holding it at the contact point

(Removable orthodontic appliance MS Rani 2nd Edition)

Adams Clasp
ALSO CALLED
liverpool clasp universal clasp Modified arrowhead clasp

INDICATIONS
retention on molars, premolars and anteriors

WIRE USED
0.7 mm for posteriors 0.6 mm for anterior

DESIGN
Parts Bridge Arrowhead Retentive arms Clasps act by engaging certain constricted areas of the teeth that are called undercuts. When clasps are fabricated, the wire is made to engage these undercuts. So, their displacement is prevented.

ADVANTAGES
Small, neat, unobtrusive, occupies minimum space Rigid, offers excellent retention Used on any tooth in the arch If broken can be repaired by soldering Permits modifications in design

DISADVANTAGES
Extensive wire bending incorporates stresses in the wire

Modifications
Adams clasp with single arrowhead
in partially erupted teeth

Adams clasp with J hook


A hook can be soldered on to the bridge of the Adams clasp. This hook also helps in engaging elastics.

Adams clasp with helix


A helix can be incorporated into the bridge of Adams clasp. This helps in engaging elastics.

Adams clasp with additional arrowhead


Adams clasp can be constructed with an additional arrowhead. The additional arrowhead engages the proximal undercut of the adjacent tooth & is soldered on to the bride of Adams. This type offers additional retention.

Adams clasp with soldered buccal tube


A buccal tube can be soldered on the bridge of the Adams clasp. This modification permits use of extra oral anchorage using face bow headgear assembl

Adams clasp with distal extension


The Adams clasp can be modified so that the distal arrowhead has a small extension in corporate distally. The distal extension helps in engaging elastics.

Double clasp on maxillary central incisors


Adams clasp can be fabricated on the incisors & premolars when retention in those areas is required. They can be constructed to span a single tooth or two teeth. (Removable orthodontic appliance MS Rani 2nd Edition) (Removable orthodontic appliance Isaacson)

Schwarz Clasp
ADVANTAGES
Can be used in deciduous or permanent teeth Arrowheads can be adjusted medially or distally Allows partially erupted teeth to erupt in position

DISADVANTAGES
Skill to fabricate Can be used only on posterior teeth Requires special plier

ADJUSTMENT
Arrowhead bent towards papilla to engage undercuts (Removable orthodontic appliance MS Rani 2nd Edition)

Duyzings Clasp
INDICATIONS used to engage buccal undercuts of molars WIRE USED 0.7 mm ADVANTAGES one half of the clasp can be used if requires DISADVANTAGES easy displacement
ADJUSTMENT Bending towards the tooth or undercut area

(Removable orthodontic appliance MS Rani 2nd Edition) (Orthodontic Removable Appliance - Lokhare)

Eyelet Clasp
WIRE USED 0.7 mm DESIGN
similar to triangular clasp used as single eyelet or multiple eyelet clasp eyelets placed in embrasures

ADVANTAGES
No sharp bends, breakage unlikely Does not interfere with eruption of teeth

DISADVANTAGES
On single tooth does not have firm grip

ADJUSTMENT
Bending eyelet interdentally towards the tooth

(Removable orthodontic appliance MS Rani 2nd Edition)

Delta Clasp (william J Clark)


WIRE USED 0.7 mm DESIGN similar to adams clasp in principle ADVANTAGES does not open with repeated insertion and removal maintains shape better requires less adjustment less prone to breakage ADJUSTMENT
hold retentive loop and twist inwards or,
bending towards interdental undercut as it emerges from acrylic (Removable orthodontic appliance MS Rani 2nd Edition)

Southend Clasp
INDICATIONS retention on anteriors WIRE USED 0.7mm ADVANTAGES
Esthetically more pleasing simple design less obstructive as compared to double clasp

ADJUSTMENT adjusted by readapting it into the interdental area

(Removable orthodontic appliance MS Rani 2nd Edition)

BASEPLATE
Base plate is to incorporate all these components together into a single unit.

Functions
Unit of all at components both active and retentive components. Helps in anchoring the appliance in place. It provides support for the wire components Distributing the forces over a larger area. Bite planes can be incorporated into plate

Requirements and choice of material for base plate preparation


Readily cleanable by the patient and remain clean in the mouth. Should be strong. Sufficiently hard to resist the abrasion. The material must resist attack by the oral fluids and it should be of such a colour that food debris is readily visible on it. It should readily represent the pressure points.

Limitation to Base Plate


Knife edge should not be attempted Not be horseshoe shaped because it is not stronger and it can be warped. No posterior seal is necessary (it makes palatal sore and difficult to clean).

Extension of the Base Plate


Maxillary Base Plate
Usually covers the entire palate till the distal on the last molar.

Mandibular base plate


Is usually shallow to avoid irritation to the lingual sulcus. To compensate for this it should be made thicker to increase the strength.

Usually made of Acrylic As thin as possible(1-2mm) Closely adapted Extend as far as necessary to obtain anchorage Lower baseplate- U shaped, relatively thicker Shallow lingual sulcus reinforced with ss wire or bar

BITEPLANE

Anterior Posterior

Upper Lower

Parallel to occ plane Inclined to occ plane

Anterior biteplane
Platform behind upper incisor teeth Height enough to separate posterior teeth by 1.5-2mm Reduce overbite of anterior teeth opening the bite Height of plane gradually increased Proclination of upper incisors

Sved Biteplane
Introduced by Sved in 1944 Covers incisal edges of upper anteriors Pressure transmitted axially Retention questionable Ideal in growing individuals

Posterior Biteplane

displacing activity of mandible unilateral posterior crossbite wide enough to contact buccal & palatal cusps occlusion disengaged equal on both sides after correction appliance acts as retainer

Lower Inclined Plane


Catlan more than 200 yrs ago Anterior crossbite 45 degrees to occ plane Upper incisors guided into correct position labially indicated when incisors are in early stage of eruption If used for more than 6wksanterior open bite results May need frequent cementation

Pre-treatment

Post-treatment

In-vivo evaluation of the bacterial contamination and disinfection of acrylic baseplates of removable orthodontic appliances
INTRODUCTION
This randomized clinical trial assessed, by using microbial culture and scanning electron microscopy (SEM), the contamination by mutans streptococci (MS) colonies/biofilms on acrylic baseplates and evaluated the efficacy of antimicrobial sprays (Periogard, Cepacol and sterile tap water [control]) on their disinfection.

Fernanda Campos Rosetti Lessa,a Carla Enoki,a Izabel Yoko Ito,b Gisele Faria,c Mirian Aiko Nakane Matsumoto,d and Paulo Nelson-Filhoe (Am J Orthod Dentofacial Orthop 2007;131:705.e11-705.e17)

METHOD
Seventeen children were randomly enrolled in a 3-stage changeover system with a 1-week interval between each stage. All solutions were used in all stages by a different group of children. The acrylic baseplates were worn full time except at meals. At the end of each week of the trial, the baseplates were submitted to a randomized disinfection protocol and were sent for microbiologic analysis. New baseplates were constructed, and the same sequence of procedures was repeated 2 more times. Acrylic baseplates representing each test solution were examined by SEM.

CONCLUSIONS
In this study, acrylic baseplates of removable orth- odontic appliances worn by children were contaminated by MS colonies/biofilms in all cases after 1 week. Although Cepacol had better results than sterile tap water (control), Periogard showed significantly greater efficacy in reducing MS colonies/biofilms on acrylic surfaces and can be recommended for disinfection of removable orthodontic appliances.

Active components
Labial bow Springs

BOWS
Labial bow is that component if ROA which helps in retracting and retaining the anterior teeth and also contribute for retention of appliance

LABIAL BOWS
May have 2 functions 1) Serve as active element for movement of teeth 2) Hold the plate in place & retain the teeth

Labial Bow with U loop


INDICATIONS retention of anterior teeth retraction in case of minor overjet WIRE USED 0.7 mm wire ADVANTAGES can be fabricated easily can correct minor discrepancy in overjet easy to adjust CONTRAINDICATION In case of severe proclination of incisor because bow portion has a tendency to slip gingivally when activated causing insufficient activation ADJUSTMENT
Compressing of U loop Displaces palatally by only 1mm (Removable orthodontic appliance MS Rani 2nd Edition)

Long Labial Bow


INDICATIONS
Minor anterior space closure Minor overjet reduction Closure of space distal to canine Guidance of canine during canine retraction. Also is used for retention.

WIRE USED 0.7mm ADVANTAGES Used to close space between canine and premolar can control the canine ADJUSTMENT Closing the U loops so that horizontal arm is displaced palatally by 1 mm each time it is activated

(Removable orthodontic appliance MS Rani 2nd Edition)

Split Labial Bow


INDICATIONS
Anterior retraction Correction of midline diastema

ADVANTAGES flexibility is more DISADVANTAGES flattening of arch results in cases where it is not required ADJUSTMENT closing the U loops so that the arch form is maintained

(Removable orthodontic appliance MS Rani 2nd Edition)

Labial Bow with Reverse Loop


INDICATIONS
can be used to retain anterior teeth after active treatment is completed. Controls the canine.

WIRE USED 0.7 mm ADVANTAGES prevents buccal drift of canine during retraction of anteriors ADJUSTMENT Done in 2 stages 1) Vertical loop opened by compressing with plier 2) This lowers the bow in incisor region compensating bends at the base of the loop

(Removable orthodontic appliance MS Rani 2nd Edition)

Mills Bow
ALSO CALLED extended labial bow INDICATIONS in severe protrusion of teeth alignment of irregular incisors WIRE USED 0.7mm ADVANTAGES more flexible because of extensive loops lighter force long range of action DISADVANTAGES bulky less comfortable cannot be adjusted precisely ADJUSTMENT
(Removable orthodontic appliance MS Rani 2nd Edition)

High Labial Bow with Apron Spring


INDICATIONS
t s useful in retracting the teeth with severe proclination of the teeth. It can be used to correct single tooth malposition.

WIRE USED 0.9 mm/1 mm 0.4 mm ADVANTAGES does not slip over the inclined planes of teeth lighter forces long range of action single tooth malposition can be corrected DISADVANTAGES not well tolerated by patients time consuming can not be used in lower arch Cannot be used in patients with shallow sulcus ADJUSTMENT apron spring is bent towards the teeth for activation
(Removable orthodontic appliance MS Rani 2nd Edition)

Roberts Retractor
INDICATIONS correction of severe protrusion of teeth WIRE USED 0.5 mm ADVANTAGES does not slip over inclined plane light force is applied range of action is more as more length of wire is incorporated
DISADVANTAGES uncomfortable cannot be given on lower arch as sulcus is shallow ADJUSTMENT placing a bend in vertical limb of wire where it emerges from coil so that the wire is displaced palatally
(Removable orthodontic appliance MS Rani 2nd Edition)

Fitted Labial Bow


INDICATIONS used for retention WIRE USED 0.7 mm ADVANTAGES for retention canine is controlled DISADVANTAGES time consuming

(Removable orthodontic appliance MS Rani 2nd Edition)

Beggs Retention Bow


ALSO CALLED wrap-around retainer INDICATIONS retention purpose WIRE USED 0.7 mm ADVANTAGES allows settling of occlusion at the end of active phase of ortho t/t no crossover wire DISADVANTAGES If not constructed well retention may not be good

(Removable orthodontic appliance MS Rani 2nd Edition)

SPRINGS
Springs are active component of removable orthodontic appliances that are used to effect various tooth movements

Ideal requisites of a spring


Simple to design Less likely to be distorted by the patient Easier to adjust Less likely to produce unintended tooth movements Easy to clean It should remain active over a long period of time

Factors to be considered in designing a spring


The connection between the length, thickness and amount of deflection of a commonly used spring of round cross section expressed by the formula.

D PL3

T4
D = Amount of deflection P = Amount of pressure L = Length of the spring T = Thickness of the wire

DIAMETER Force directly proportional to diameter diameter = Force = flexibility LENGTH Length = force = flexibility FORCE Force depends upon the number of teeth to be moved DIRECTION Direction is determined by point of contact b/w spring and teeth

Simple rules for guidance in the design of these springs.


The direction of tooth movement depends on the point at which the spring makes contact with it.

The arm of the spring is virtually rigid and the coil may be regarded as the center from which the arm pivots. Movement of the arm will always be radial and movement of any point on it will be part of a curve with its center at the coil. Further away from the coil this path is nearer to a straight line. Nearer to the coil it will be a tight curve.

If the tooth to be moved needs to travel in a straight line a long arm will be needed; if in a curve a very short arm. A long range of action is allowed by a long arm, a short range of action by a short arm.

Wherever possible the arm should be kept straight so that its path can more accurately be assessed. On occasions a kink may be necessary to avoid interference from another tooth

A simple formula may be used to find the position in which the coil should be placed. A line drawn joining the present position and desired position of the tooth. A perpendicular bisector is drawn to this line. The coil may be placed anywhere along this line, usually as far away as possible. The limiting factor is usually the presence of the other teeth.

Classification of Springs
I.

Based on direction of tooth movement


1. Springs for mesio-distal tooth movement

2. Spring for labio-lingual tooth movement


3. Springs for expansion of arches

II. Based on nature of support 1. Self supported springs 2. Guided springs 3. Auxiliary springs
III. Based on presence of loop or helix

Single Cantilever Spring


INDICATIONS mesial or distal movement of teeth closure of midline diastema WIRE USED 0.5 mm DISADVANTAGES can be used only in those teeth which are in proper alignment bucco-lingually along the arch ADJUSTMENT opening the helix 3mm 0.5mm wire 1.5mm 0.6mm wire
(Removable orthodontic appliance MS Rani 2nd Edition)

Double Cantilever Spring


ALSO CALLED Z-spring INDICATIONS correction of minor rotation labiolingual movement of teeth WIRE USED 0.6 mm DISADVANTAGES If not perpendicular to palatial surface of teeth, it tends to intrude ADJUSTMENT rotation correction opening the upper helix 2-3mm labiolingual movement opening both the helix 2-3mm
(Removable orthodontic appliance MS Rani 2nd Edition)

teeth

T Spring
WIRE USED 0.6 mm INDICATIONS buccal movement of posterior teeth ADJUSTMENT vertical arm of T spring should be bent to displace horizontal arm toward the tooth
*not used for anterior coz if it is applied to a sloping surface, vertical component will be larger and labial component smaller ; this reduces the efficiency and tooth may intrude
(Removable orthodontic appliance MS Rani 2nd Edition) (Removable Orthodontic Appliance Isaacson)

Coffin Spring (Walter Coffin)


INDICATIONS expansion of dental arch Transverse arch expansion Unilateral crossbite with lateral mandibular displacement WIRE USED 1.25 mm ADVANTAGES economic easy to clean differential expansion can be obtained in PM and Molar DISADVANTAGES tends to be unstable easy to overactivate ADJUSTMENT expand the spring so that two halves of the appliance move

apart

(Removable orthodontic appliance MS Rani 2nd Edition)

Activation

CANINE RETRACTORS
springs that are used to move canine in distal direction

CLASSIFICATION Based on location buccal Palatal


Based on presence of helix or loop

Helical
looped Based on mode of action

push type pull type

Buccal Self Supported Canine Retractor


INDICATIONS where canine is placed labially or high in the sulcus when both distal and palatal movement is required WIRE USED 0.7 mm for self supporting 0.5 mm for supporting type
DISADVANTAGES can not be used in lower arch due to shallow sulcus uncomfortable to patient flexibility is compromised ADJUSTMENT free end is cut short by 1mm and is re-adapted to engage the mesial side of canine or by closing the coil by 1mm
(Removable orthodontic appliance MS Rani 2nd Edition)

Supported Buccal Canine Retractor


INDICATIONS where canine is placed labially or high in the sulcus when both distal and palatal movement is required WIRE USED 0.5mm supported in tubing ADJUSTMENT activated by closing the coil by 2mm

(Removable orthodontic appliance MS Rani 2nd Edition)

Reverse Loop Canine Retractor


INDICATIONS canine is placed in the line of arch and has to be just distalized WIRE USED 0.6mm ADVANTAGES can be used in shallow sulcus ADJUSTMENT coil is opened for activation 1 mm of free end of active arm is cut and re-adapted

(Removable orthodontic appliance MS Rani 2nd Edition)

U Loop Buccal Canine Retractor


INDICATIONS where functional depth of sulcus is less when canines are placed bucally WIRE USED 0.6mm ADVANTAGES can be used in shallow sulcus DISADVANTAGES requires frequent adjustment ADJUSTMENT free end is cut by 1mm and re-adapted

(Removable orthodontic appliance MS Rani 2nd Edition)

Palatal Canine Retractor


INDICATIONS palatally placed canine requires distal and buccal movement WIRE USED 0.6mm DISADVANTAGES uncomfortable to patient easily distorts ADJUSTMENT coil is opened by 2-3mm at the point where active arm emerges from the coil
(Removable orthodontic appliance MS Rani 2nd Edition)

BOXING AND GUARDING


Boxing is done prior to acrylisation of base by covering the spring by modeling wax
PROCEDURE OF BOXING Fabricated spring is positioned on the cast Active arm, coil and path traversed by active arm is covered by modeling wax Waxing should be of sufficient thickness just to cover spring completely After acrylization, the wax is flushed out in dewaxing unit or with hot water

Instruction to the patient


It is one of the most important aspects of ensuring success with removable appliances that the patient and the parent should be adequately counseled. With the aid of a mirror the patient should be shown how to remove and insert the appliance The instruction to wear the appliance for 24 hours per day is then given, apart from removal for cleaning after meals Well constructed appliances do not interfere with eating normal food or with speech, and patients should be assured that within a few days they will find no difficulty with eating and speaking.

A high standard of oral hygiene should be insisted on to avoid the possibility of enamel decalcification or gingival inflammation. Removable appliances should be taken out and brushed with soap and water and the mouth cleaned after every meal Diet should be that required for good general health and hard and sticky foods and sweets avoided completely. Patients must be told quite clearly that if an appliances is causing pain or discomfort, they should attend the clinic at once and preferably not remove the appliance as it will then be possible to see what is causing the pain and take appropriate action.

Microsensor removable

technology to help appliance

monitor wear

Marc Bernard Ackerman,a Morgan Stuart McRae,b and William H. Longleyc Jacksonville, Fla (Am J Orthod Dentofacial Orthop 2009;135:549-51)

Retention is routinely prescribed after orthodontic treatment to prevent relapse. Orthodontists often notice a discrepancy between what a patient reports about retainer wear and what a clinical examination shows. Smart Retainer environmental microsensor that can be easily incorporated into many types of removable orthodontic appliances to monitor compliance. USB-powered Smart Reader uses wireless technology to download information about actual usage from the Smart Retainer. The information is decrypted and analyzed, and can be shown to the patient in easy-to-understand charts.

CONCLUSION
Removable appliances have many advantages, they exert minimal interference with dentoalveolar growth, and are particularly useful for treatment during the developing stages of the dentition. Removable appliance treatment, taking place at earlier ages, is attractive as it offers early completion dates and little inconvenience during socially and educationally busy years for the growing child. The success of removable appliances depends on good design and attention to detail. Collaboration between the user of an appliance (the orthodontist) and the producer (the technician) must be close. Removable appliances must be well designed and accurately constructed to the specification of the orthodontist who, if necessary, must be able to construct an appliance himself exactly as he wants it.

References
Orthodontic treatment with removable appliancesW. W.J.B. Houston, K.G. Issacson The Design, construction and use or Removable Orthodontic Appliances C. Philip Adams Removable Orthodontic Appliances- T.M. Graber, Bedrich Neumann Orthodontics Principles and Practice- T.M. Graber Contemporary Orthodontics- Proffit

References
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