0-Atlas Dentaurum-The Ultimate Reference Work On Removable Appliances PDF

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o-atlas Dentaurum
0TU
U0T
The ultimate reference work on removable appliances
Atlas of orthodontic and orofacial

orthopedic technique
/http://dentalbooks-drbassam.blogspot.com
www.pdfree.blogspot.com
Foreword
Ursula Wirtz:
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The idea
to compile an atlas of orthodontic and orthopedic technique emerged after hearing
the same questions over and over from students, dental technicians from private practices and
technician students.
This widely illustrated atlas with short explanations will provide a quick help to technicians
and students during their practice. It provides guidelines for the construction of orthodontic
and orthopedic appliances and explains the techniques for bending wire more easily with the
use of pliers. It illustrates orthodontists the use of alternative appliances and serves as
instruction for patients.
In this atlas, the construction of removable and fixed orthodontic and orthopedic appliances is
described. But as the single appliances vary considerably depending on the region or
practitioner, this atlas should mainly be a stimulus to make the construction of orthodontic
appliances using wire, screws and acrylic as simple as possible.
Whether the desired treatment goal is always achieved with the orthodontic appliance
depends mainly on the treatment method and the corresponding treatment appliance. The
effectiveness of the active and passive plates depends on their adequate retention and support.
The competence and teamwork of the practitioner, technician and patient are necessary for the
treatment result and the effectiveness of an appliance.
Because the technician is responsible for the perfect execution of the appliance, it must be
designed and constructed with the greatest care. This is the only way to guarantee that an
appliance is accepted by the patient and is worn with pleasure.
The therapeutic grinding and activating of the appliances is not dealt with in this atlas since it
is the task of the practitioner and not of the technician.
Prof Dr. Dr. Diedrich:
The actual level of orthodontic technique is determined through an extensive spectrum of
removable and laboratory made fixed appliances with a wide therapeutic indication.
In past time, known and proven base appliances have undergone many modifications through
ideas and empirical understanding so that there are inexhaustible possibilities for the
individual appliance design.
Mrs. Ursula Wirtz, collaborator of many years standing in my clinic, has set herself the task
to show this variety of appliances in a color atlas.
This successful synoptic depiction starts with the detailed description of the passive and
active basic elements of removable appliances. Based on this, the construction of all common
plates, functional orthopedic appliances, and combined fixed / removable devices as well as
active and passive fixed special appliances is compared.
This atlas is outstanding for its competence, systematology, love for details and endeavors to
provide the reader with the actual available therapeutic range. The atlas is a treasure trove for
everyone, practitioner or specialist technician, who is connected to the discipline of
orthodontics and orofacial orthopedics.
I wish this work a wide acceptance.
Author
Dental Technician Ursula Wirtz

1967 - 1971
1972 - 1982
1982 - 1984 Since 1984
Dental Technician Apprenticeship, Nickel Dental Laboratory, Stolberg, Germany
KuAcrylic Re sto rati on s Technician (Orthodontics), Jacobs Laboratory, Wrselen, Germany
Technician at Graef Laboratory for Orthodontics, Wrselen, Germany
Technician for orthodontics at the Aachen University Clinic for Orthodontics (Principal: Prof. Dr. Dr.
P. Diedrich)
Key aspects of activity:
Publications:
As a speaker:
Lingual-technique, autonomous apparatus, development of innovative treatment appliances.
Quintessence Publishing: Quintessence Dental Technology Laboratory Fabrication of the pendulum
appliance, laboratory production of mandible fxed linguai bar apparatus.
Urban and Fischer Publishers: PDZ Orthodontics III Book contribution Orthodontie Technique
Dentaurum: o-atlas of orthodontie techniques
Courses and lectures for Dentaurum, the Gesellschaft fur Kieferorthopdische Zahntechnik e.V., and
for the Aachen Vocational School II. Further ducation in the pendulum appliance for Dentaurum since
2003
Acknowledgements
This atlas was created while working at the clinic of the University of Aachen.
Therefore, I want to express my special gratitude to Prof. Dr. med., Dr. med. dent. P.
Diedrich, chief of orthodontics of the clinic of the University of Aachen. He enabled
me to put my ideas into practice and supported me generously in all areas. Dr. W.
Bauer made the professional orthodontic corrections in many hours of her time.
Dr. T. Hetz translated this reference work into English and Spanish, so that it can be
understood "in the whole world".
Dr. G. Kinzinger collaborated mainly in the Pendulum appliances section.
The idea and title of this atlas resulted together with Prof. Dr. med., Dr. med. dent H.
Wehrbein.
Mrs. I. Sous worked tirelessly finding and correcting errors with a trained eye,
detailed the draft, supported me with ideas and valued advice and in this way
sacrificed many hours for me.
My husband Heinz supported me in every way, accepting restrictions of our free time
activities in common.
I owe them all a debt of gratitude.
I would like to thank the Dentaurum Company sincerely for our friendly and good
cooperation, as well as the extensive promotion which made possible the making of
this project.
Ursula Wirtz
2T
Content
Chapter
1
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Models, labial bows, appliance retaining elements, support elements
Chapter 2
Spring elements
Chapter 3
Shield elements, different orthodontic plates
Chapter 4
Double plates, bimaxillar appliances
Chapter 5
Bimaxillar appliances, activators, bionators, function regulator appliances
Chapter 6
Wire appliances, rapid palatal expansion (RPE) appliances
Chapter 7
Nance and pendulum appliance, space maintainer, cleft and stimulation plate
Chapter 8
Retention appliances, splints, snoring appliance
CHAPTRR 1
The ultimate reference work on

removable appliances
The dental models
Function: Basis for treatment planning Description: Plaster models are the most
important records for diagnosis, treatment planning and the working basis for
removable and fixed appliances in the laboratory
It does not matter if the models have round, square or

rubber form bases; they always have to be fixed in habitual
occlusion. In all procedures the general guidelines are: 1.
Midpalatal raphe 2. Tuber plane 3. Occlusal plane As study
models could be considered the presentation card of every
orthodontist, they should be prepared very accurately.
The midpalatal raphe (1) corresponds to the midsagittal

line. It should be right angled to the tuber plane (2) and the
model base should be trimmed parallel to the occlusal plane
(3). When putting the models on their heel or back surface
they should always stand in habitual occlusion. The lateral
surfaces can be trimmed in a round or square shape or be
cast in plastic forms.
After shaping the models, they are smoothed out with wet
sandpaper, all bubbles, positive or negative, have to be
removed and the surface is polished and sealed with talcum
powder, soap or shine liquid. This way models can be
stored dustfree for years.
The simple labial bow

U
Function: Additional retention

The labial bow is bent as usual. Then some zigzag
inflections must be bent into the incisal part of the
wire as retention means for the acrylic.
In order to scatter the acrylic better, it is useful to

frame the labial bow with wax. This wax frame should
be shaped in a dimension that later corresponds to the
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thickness
of the acrylic shield.
On this occasion attention, should be paid on the

counter bite. In order to avoid occlusal interferences,
occasionally, the labial bow has to be adapted deeper.
The acrylic covered labial bow

U
Function: Additional retention

The labial bow is bent as usual. Then some zigzag
inflections must be bent into the incisal part of the
wire as retention means for the acrylic.
In order to scatter the acrylic better, it is useful to

frame the labial bow with wax. This wax frame should
be shaped in a dimension that later corresponds to the
thickness of the acrylic shield.
On this occasion attention, should be paid on the

counter bite. In order to avoid occlusal interferences,
occasionally, the labial bow has to be adapted deeper
The labial bow with vertical M-loop

U
Function: Alignment of the canine, if it is labially positioned or

partially erupted
The M-loop moves the tooth primarily in a lingual
direction. Depending on the location of the centre part
of the loop, the tooth can also be rotated.
The loop should only lie on the most prominent part of

the crown, avoiding contact with the gingival tissue.
The tag, bent over from the labial to the lingual side
(transversal tag), should lie as close as possible to the
premolar if the gap distal of the canine is to be closed.
The labial bow with retractive canine loop

Function:
Alignment of labially rotated canines
To optimize the point of force application, the loop
should embrace the tooth surface as far as possible.
This loop can tip the canine distally as well as
lingually.
In order to avoid interference with the occlusion, the

labial bow and the transversal tag should not lie too
high. If the tooth should be moved distally, there has
to be some space between the distal surface of the
canine and the transversal tag.
If the loop is bent the other way around, the canine can
be moved mesially.
The labial bow with canine loop

U
Function: Stabilization of the incisor segment

The labial bow is led to the end of the canine gap and
there it is bent back 180. Then distal of the lateral
incisor it is bent into the transversal tag.
If the four incisors have to be stabilized, the

transversal tag should contact the lateral incisor.
Because of the loop design, the canine can not migrate
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during its eruption.
Because of the transversal tag distal of the lateral

incisor, this labial bow maintains open the space for
the canine.
The labial bow with Andresen loop

U
Function: Retrusion of the canines

The loop should embrace the canine completely but
should not contact the gingival tissue.
The transversal tag between the canine and the first

premolar should be placed in a way that the wire does
not hinder the alignment of the canine
The labial bow with Andresen loop plays a rather

subordinate role in orthodontics; it is often used in
technical school as a bending exercise.
The labial bow with intrusion hooks

U
Function: Vertical movement of incisors

The loops are bent as usual. The horizontal part of the
labial bow runs along the centre of the crown up to the
teeth which are to be moved. There, the wire is bent in
a right angle to form a loop over the incisors and
afterwards bent back to the normal course of the labial
bow.
The transversal tag is covered by a wax layer so that

the hooks can be activated.
The modified labial bow

U
Function:
Engagement of elastics and soldering of springs
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For the application of elastics, different hooks can be
attached by laser or conventional welding, or can also
be bent in. Force is applied on the anterior segment by
the elastics and consequently the incisors are tipped
lingually
Elastics can also be installed vertically. They allow the

extrusion of retained teeth. The elastics are engaged on
soldered or bent-in devices of the labial bow, on to a
bonded attachment on the tooth.
For tooth movements in different directions, springs

can be soldered on.
Two loops integrated into the labial bow allow the

engagement of vertical elastics to align incisors.
A hook is soldered on the loop of the labial bow to

engage vertical elastics for the alignment of canines.
Two hooks are soldered in opposite directions on the

labial bow to rotate an incisor with elastics.
The partial labial bow embraces only a section of

anterior teeth corresponding to the specific oral
circumstances
The individual labial bow is contoured along the

gingival margin contacting the anterior teeth cervically
and is led by a canine loop into the retention.
A labial bow bent circularly, combined with Adams

clasps and a base plate, to form a retainer involving the
whole arch.
The intermaxillary bow
Function:
Influence of the lower jaw in a posterior direction
In certain cases the labial bow of the upper jaw can be

extended to influence the lower jaw. Normally, the
horizontal part runs along the lower teeth in centric
occlusion. At canine level the wire is bent 90 forming
the loops and then is anchored in the upper jaw.
It is also possible to solder or laser a separately bent

intermaxillary bow onto a standard labial bow on the
upper jaw. It is important to remember that
conventional or laser weldable wire has to be used for
both bows.
A variation of the intermaxillary bow is a labial bow

with an additional helix in the loops in order to
increase the elasticity of the bow.
The triangular clasp

U
Function: Simple retention for removable appliances of all types
The horizontally lying triangle continues into a vertical

part, then into the transversal tag and finally ends in
the retention portion. In order to protect the cheek, the
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open part
of the triangle should face distally.
The tag should be bent exactly over the triangle to

avoid disturbing the occlusion.
If the triangular clasp is used as an additional retention

in the front, the transversal tag has to run over the
labial bow.
The triangular clasp according to Zimmer

U
Function: Simple hold for removable appliances of all types
The triangular clasp according to Zimmer varies in a

way that the triangle closes interdentally. The buccal
part is not bent over the triangle, but directly back into
the transversal tag.
The buccal component should not be overdimensioned in direction of the cheek. It is formed
directly into the transversal tag and then into the
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retention.
The transversal tag should be adjusted as deep as

possible into the interdental space so that the occlusion
is not disturbed.
The triangular clasp according to Trnkmann

U
Function: Simple retention for removable appliances
The triangular clasp is characterized by the fact that

the open part of the triangle is located buccally. This
open end has to be rounded off with a rubber polisher
so that the cheek is not injured by a sharp end of the
wire.
After unifying the triangle in the middle of the buccal

part, the wire is bent towards occlusal into the
transversal tag. The tag should be bent as close as
possible to the occlusal surface of the teeth to avoid
disturbing the counter jaw in occlusion.
This variation of the triangular clasp allows a good

activation
The double triangular clasp

U
Function: Retention for the first molar if the second molar is missing
The double triangular clasp consists of two triangles
which are interconnected as in the Adams clasp.
The triangles should be aligned to the occlusal plane in

order to make activation possible.
In the mixed dentition, this clasp is fitted appropriately

on the first permanent molar but it can also serve as a
retention element on other teeth.
The Adams clasp according to Adams
Function: Anchorage, usually used on molars

It consists of a horizontal part and two U-shaped loops
that merge from the transversal clasp parts to the
retention. The clinical crown determines the height of
the loops. These loops should have such height that the
horizontal part of the clasp runs 1 - 2 mm below the
cusps.
The bridge portion of the clasp should keep a distance

of approximately 1 mm to the buccal surface of the
tooth so that the clasp can be activated.
Seen from occlusal, the angle between the loops, the

bridge portion and the transversal part is
approximately 45. Therefore the loops find retention
in the undercuts of the crown in the transition from
buccal to interproximal.
The Adams clasp according to Tenti

U
Function: Improved retention in comparison to the original Adams clasp
Depending on the tooth width, a 9 cm long wire is

marked parting from the middle at precisely 3.5 mm to
the left and to the right so that a 7 mm long piece is
marked in the centre of the wire. This part forms the
buccal bridge portion between the two loops. The
square part of the angle wire bending pliers (for
example Dentaurum REF 004-139-00) is positioned
from the inside at the markings and the wire is bent
downward slightly over 90.
Now two marks are made on the vertical parts, each

0.3 mm from the buccal bridge portion including the
wire diameter. With the round tip of the pliers, the
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bent upward by 180 at the markings on both
sides.
Holding the pliers horizontally, the mesial loop is bent

75 to the bridge. The corresponding angles for the
distal loop are 60 for the upper and 55 for the lower
jaw.
The square part of the angle wire bending pliers (for

example Dentaurum REF 004-139-00) is positioned 2
mm mesially and distally of the curve of the loop and
the wire is bent lingually 90 to the axis of the loop.
According to the central groove, the transversal tag

can be bent gingivally in a V-shape to avoid occlusal
interferences.
A small V-shaped bend towards the gingival tissue at

the central groove of the molar can be adapted to
minimize occlusal interferences
Function: Verbesserter Halt gegenber der Adamsklammer nach C. P. Adams

At the level of the lingual cusps the wire is bent
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the square part of the angle wire bending pliers
(for example Dentaurum REF 004-139-00) 60
towards the gingival tissue. Now both wire ends run
parallel to the buccal axis of the loop.
According to the crown length, the wire is bent

afterwards 60 from the marginal gum. Now the wire
end runs parallel to the occlusal surface. Directly after
this bend, the tag is bent again gingivally, parallel to
the gingival tissue in a distance of 1 - 2 mm.
Afterwards, the two wire ends are bent to form the

retention.
Six modifications of the Adams clasp

U
Function: Anchorage of individually standing teeth and molars
Adams clasp with an S-shaped loop bent in a vertical

direction.
Adams clasp with horizontally proceeding U-loop.

Adams clasp with only one mesial loop because of

unfavorable gingival architecture on the last molar
If the Adams clasp should serve as a retention element

for two teeth, a V-shaped bend between both teeth is
appropriate.
An Adams clasp, also embracing two separated teeth.

The clasp is activated contracting the centered U-loop.
Another variation is the Adams clasp over two teeth

with a centered arrow for additional hold.
The Adams clasp with anchorage for extraoral traction
Function: Anchorage for headgear

The Adams clasp is bent over two teeth. In the centre,

exactly between both teeth, the wire is bent into a coil
in order to anchor the extraoral traction.
The bridge portion with the coil should not contact the
teeth and should match the height of the coil on the
opposite side. This way, the headgear can be inserted
without any problems into the Adams clasps.
As shown here, in an upper twin block appliance the

labial bow can be laid under the Adams clasp
The Adams delta clasp

U
Function: Good retention if the Adams clasp is the only retentive component (in an
incomplete tooth row)
The Adams delta clasp is the combination of an

Adams clasp and a triangular clasp.
The centrally localized triangle offers additional

retention.
Both loops are bent in the same way as in the simple

Adams clasp
The arrowhead clasp

U
Function:
Anchorage for removable appliances in the deciduous, mixed

and especially in the permanent dentition
To achieve optimal hold, the arrows have to be

adapted to the anatomical details.
The arrowhead is bent downward with the arrowbending pliers and laid horizontally into the interdental
area.
If the contiguous teeth have not erupted yet, it can be

bent with one arrow and the sides fit tightly mesially
and distally as shown here.
The modified arrowhead clasp

U
Function: Anchorage for removable appliances in the deciduous, mixed and

especially in the permanent dentition
An arrowhead clasp bent with two arrows in which its
mesial tag can be used with an additional bend for the
movement of canines.
To avoid occlusal interference, the mesial end can be

bent in a retrograde way.
Forming an additional loop on the distal tag, a

buccally positioned tooth can be aligned into the tooth
row.
The eyelet clasp according to Groth

U
Function: Retention for removable appliances in the deciduous dentition

First, a V-shaped loop is bent which adjusts
interdentally between the two anchor teeth.
Then the clasp leads loop shaped towards occlusal.
and is continued into the retention.
The eyelet clasp according to Stahl
Function:
Retention in the deciduous and mixed dentition
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The size of the eyelet depends on the width of the
interdental area of both anchor teeth.
In the upper jaw, the vertical part of the clasp which

continues into the transversal tag should be long
enough to allow a good activation.
For the eyelet clasp in the lower jaw, one has to pay
attention to avoid causing any interference with the
buccal cusps of the upper jaw. Therefore, a small bent
has to be made into the ascending part of the clasp.
The double eyelet clasp

U
Function:
Anchorage of one or more teeth in removable appliancesa
The eyelets are bent lying in the cervical area of the

tooth and can be activated with movements towards
lingual.
The eyelets are to be located in the undercut area.

Image of a completed appliance with a continuous

eyelet clasp over several teeth.
The universal clasp

U
Function: Retention of removable appliances with incompletely erupted molars

The universal clasp is a retaining element which can
be activated for better hold with a loop.
The eyelets, mesial and distal of the tooth, have to fit

preferably close to the gingiva. As the eruption
continues, the undercut areas of the tooth will expose.
Then the fit of the clasp can be optimized activating
the loop.
In order to avoid irritation the loop should not touch

the gingival tissue.
The ball clasp

U
Function: Anchorage of removable appliances, frequently applied on incisors and

small posterior teeth
The ball clasp can be bent in different manners under
the condition that the ball is always inserted gingivally
in the interdental area.
Its application is normally with short clinical crowns

or with teeth that dont have retentive undercuts (for
example lower incisors).
It should lie in the interdental area, gingival of the

contact point. For this, it is necessary to slightly carve
the papila.
The Lorenz spring
unction:
Especially strong anchorage of removable appliances
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The plaster casts are carved interdentally on the oral
and buccal side so that the holding springs can be
inserted deep into the retentive area. The first and
lower part of the spring is bent from labial to occlusal
and then towards lingual into the retention.
The second and upper part of the spring is bent from

lingual to occlusal above the contact points into the
undercut beside the first part. On the occlusal surface,
the wire is bent 180 and then back on the other side of
the first part in order to be bent into the retention.
Because the Lorenz spring consists of two separately

bent parts, it can reach far into the undercuts and is
therefore a very strong retaining element
The occlusal rest

U
Function: Stabilization of lower appliances against vertical forces

Without the use of occlusal rests, appliances could
sink into the floor of the mouth because of blocking
out the undercuts. The occlusal rest is laid into the
lingual groove of the molar and should not interfere
with the occlusion.
One can bend the occlusal rest to an eyelet.

or can leave it ending in a simple wire.
The incisal rest

U
Function: Stabilization of removable appliances
If vertical support is needed in the front, teeth can be

held by short wires with an eyelet bent over the incisal
edge.
A wax layer should be applied to the upper third of the

incisors before the polymerization of the base plate.
Therefore it is possible to activate the incisal rests for
intrusion of the teeth.
The incisal rests fixed in this manner prevent tipping

of the incisors and tilting of the appliance.
CHAPTRR 2
Spring E lements
The active circumferential

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U
clasp
Function: Mesial or distal tooth movement

It is bent exactly like a normal circumferential clasp
used in general dental technique; the only difference is
the free end which is bent into a small loop so that it
can be introduced into the area of the papilla.
As clinical crowns in adolescents are mostly short, the

clasp should lie at the gingival margin on the buccal
side in order to give enough retention to the appliance.
If the circumferential clasp is to be activated, the

active part has to be waxed out before the retention.
The circumferential clasp for a first molar is usually

placed from distal; hereby, the final loop is bent
mostly in a vertical direction.
Equally, the final loop can be bent in a horizontal

direction. On this occasion the loop reaches deep into
the interdental area at the cervical margin.
When the first molar is banded, the circumferential

clasp can be anchored between the tubes of the band.
The canine retracting spring

U
Function:
Alignment of teeth into the arch
It attacks the tooth from buccal. The resilient part of
the retracting spring is bent U-shaped and at the end
continued into the transversal tag which prevents the
posterior teeth to migrate mesially. The transversal tag
continues into the retention.
The transversal tag should lie as close as possible to

the bicuspid and should not project too far buccally in
order to allow enough space for the transversal tag of
the labial bow and to avoid disturbing the occlusion.
The loop has to be designed to neither contact the

gingival tissue nor disturb the labial bow which
afterwards is laid over it.
Modifications of the canine retracting spring

U
Function:
Alignment of canines into the arch
First, the loop at the canine is bent, and afterwards the

space maintaining part which simultaneously serves as
a distal guiding rail for the canine.
The canine retracting spring can also be bent V-shaped

and with a helix.
If the wire for the V-shaped helical spring is bent over

a greater distance, the space maintaining part can be
extended (analogous to the spring on the top of this
side) as a guiding rail.
Canine retracting spring with a long cantilever and

helix. The end of the loop is bent overlying the
cantilever into the transversal tag as a guide to hold the
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in proper position.
In smaller gaps, the retracting spring can be bent oval

shaped and led back exactly over the starting point into
the acrylic.
Usually the retracting spring is anchored in the base

plate. However it can also be soldered directly onto the
labial bow.
The helical finger spring

U
Function: Mesial or distal movement of single teeth

The finger spring is placed in the interdental area of
the teeth with a small loop.
The helix is positioned directly under the tooth crown

and covered with wax together with the active portion.
The helix lies always opposite to the direction to

which the tooth should be moved (safety pin
principle). View of the lower side of the mandibular
plate
The finger spring

U
Function: Tooth movement in sagittal and transversal direction
The spring contacts the tooth being moved

interdentally and therefore, is also called interdental
spring, intermediate spring, mesial or distal spring.
The entire resilient portion of the spring is covered

with wax in order to make activation possible. The
whole active portion, as well as the retention, should
maintain a distance of approximately 1 mm to the
gingival tissue.
When the spring is covered properly with wax and the

appliance is finished there is enough free play to
activate the spring.
The protrusion spring

U
Function: Movement of a single tooth or entire tooth groups

The free end protrusion spring for single tooth
movement (0.5 mm spring hard) is exactly as wide as
the tooth being moved. It is fixed with wax as deep as
possible at the tooth crown, so that the tooth tips as
less as possible.
The active portion is bent flat in a right angle to the

tooth axis and is completely covered with wax before
sprinkling the acrylic. The retention is bent according
to the anatomy of the upper jaw in a distance of 1 mm.
Because of the wax cover, the active portion remains

freely movable for activation.
The free end protrusion spring with retaining

function
U
Function: Protrusion of teeth with simultaneous retaining function and

diastema closing
The multifunctional protrusion spring serves as a
retaining element because of the bent over of the free
end; through corresponding activation it can also
function as a mesial spring.
Accordingly, the parts being activated have to be

covered with wax to make activation possible.
In this example only the retention is anchored in the

acrylic. The remaining parts of the spring are freely
movable for activation.
The free end protrusion spring with mesial arm
Function:
Combined labial and mesial movement
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This versatile protrusion spring can be applied both in
the front, for single tooth movements, and in the
posterior section. Here, it is recommended to use
larger wires. The spring can move the tooth labially
and simultaneously mesially or distally. The end of the
spring is bent into a small loop as usual. The
protrusion spring comprises the entire tooth width.
Correction of rotation is possible if the tooth is only
comprised part wisely.
To make activation possible, the resilient portion is
covered with wax as usual.
The finished spring consists of a mesial arm which

embraces the tooth being moved extensively and a
protrusive portion. As far as the retention, the spring
lies exposed over the acrylic.
The double loop spring

U
Function: Protrusion
The spring consists of two loops which run parallel to
the occlusal plane.
It is fixed in the lower third of the clinical crown and

is covered with wax.
he spring does not finish in a free end, instead, both

wire ends are anchored in the acrylic; therefore the
spring is less resilient.
The double helical spring

U
Function: Maximizing the elasticity of the protrusion spring

First, a small loop is bent which contacts distally on
the tooth in order to prevent a distal migration; then
two helixes are bent opposite and horizontally to the
occlusal plane.
The spring is prepared in such a way that the entire

active part is covered with wax.
Only the retention is anchored in the acrylic, the

remaining part is freely movable and through the wax
cover easily accessible.
The helical protrusion spring for the anterior

segment
Function: Protrusion of the entire anterior segment

The loops are bent opposite and horizontally to the
incisal plane over the entire width of the anterior
segment. The retention tags are parallel to the palatal
gingival tissue.
The active portion should be blocked out completely

with wax so that the spring can be activated easily.
The retention has to be anchored properly in the

acrylic to be able to resist the high strain.
The closed protrusion spring for incisors

U
Function: Alignment of the dental arch

The closed protrusion spring can be used in
conjunction with the labial bow to align the dental
arch. This spring is bent lying on the most prominent
parts of the lingual tooth arch.
It proceeds horizontally to the occlusal surface and is

covered with wax in the usual manner.
Both retention tags are anchored in the acrylic base,

the rest of the spring lies free for activation.
The buccal box spring

U
Function: Oral movement of buccally standing single teeth, preferably

in the activator
The buccal box spring emerges out of the interocclusal
acrylic in a distance of approximately 1 - 2 mm to the
tooth being moved; it encloses the tooth lying buccally
at the gingival margin.
In order to create a counter base, the activators whole

interocclusal acrylic is preserved. The area where the
teeth are being moved is excluded. This area has to be
covered with wax during the preparation; therefore,
the activator is stable guaranteeing the proper function
of the spring.
The acrylic of the activator has to be removed in such

a way that the tooth is not hindered in its movement.
The buccal box spring is mainly used in activators.
The paddle spring

U
Function:
Protrusion of incisors with triangular shaped palatal surfaces
The paddle spring has a wider base in comparison to

the lingual protrusion spring. The spring should lie as
extensive and precise as possible on the lingual
surface.
The active part has to be covered with wax and both

ends of the wire have to be anchored in the acrylic
base.
It can also be used for buccal movement of posterior

teeth.
The paddle spring over several teeth
Function:
Buccal movement of several teeth
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A paddle spring over several teeth is often used in the

making of bionators for the anterior and also for the
posterior areas.
As with all other springs, after its bending it is covered

with wax to allow space for its activation.
In the posterior area, the paddle spring is frequently

bent using larger wire than in the front.
The intrusion hook

U
Function: Intrusion of single anterior teeth

The wire for the intrusion hook is bent in the centre by
180 so it is led double from labial across the incisal
edge towards lingual. If the appliance design includes
protrusion springs, the intrusion hooks have to be
adapted.
The entire spring area has to be covered with wax and

the screw has to be fixed before finishing the
appliance.
In the finished appliance, the springs and the intrusion

hooks have to lie freely so that they can be activated
without any effort.
The sheet spring

U
Function: Protrusion of single teeth

First, according to the mesiodistal diameter of the
tooth the matching sheet spring is chosen. Then
depending on the crown length the spring is bent
together in an S-shape.
The retention portion is carved with a disc; the active

portion is covered with wax.
The sheet spring has to emerge sufficiently out of the

acrylic to allow enough free play for its activation.
The beam spring

U
Function: Buccal movement of bicuspids and molars

The spring is placed underneath the equator at the
lingual/palatal surface of the tooth being moved. The
cantilever proceeds straight (like a beam) and is then
bent into the retention. The spring presents advantages
in restricted areas, for example in steep palates.
The beam shaped cantilever of the spring is covered

with wax in such a way that the spring is freely
movable in direction of the base plate. For space
opening additional C-clamps and expansion screws are
used.
The space opening and spring activation take place

simultaneously.
The buccal spring
Function:
Uprighting of lingually tipped teeth
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The spring has a loop that is directed distally, this
means the open side shows towards mesial.
After the loop, the spring is bent approximately 3 - 4

mm downwards and then turned again upwards 180
to finish into the retention.
For achieving an optimal effect with this spring, the

wire portion contacting the tooth should be positioned
under the equator of the tooth.
The buccal spring according to Schneemann

U
Function: Lingual or palatal movement of two teeth

The buccal spring is bent out of one piece of wire
embracing two teeth. Both teeth are moved
simultaneously. The spring has only one retention
portion.
In order to make the oral movement of those teeth

possible, they are covered with wax on their lingual or
palatal surface, or the according acrylic on the base
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plate isODONTOLOGICA
removed.
The buccal spring lies close to the teeth, so that the

wire end which lies in the centre does not irritate the
cheek tissue.
The pressure spring

U
Function: Oral movement of bicuspids and molars

The pressure spring, which attacks from buccal and
resembles the Bonyhard clasp, is predominantly used
on bicuspids but can also be applied on molars as
shown here.
The bridge portion that leads to the retention should be

bent in such a way that the tooth is not disturbed in its
oral movement.
The exposed loop makes activation easy.

The T-loop spring

U
Function: Lingual or palatal movement of posterior teeth

The spring is bent in the same way as the T-loop in the
fixed appliance technique. Both ends of the wire are
narrowly adjusted to the contour of the teeth being
moved and then bent into the retention.
The base plate is either covered with wax or trimmed

free in the direction of the movement.
The T-loop is activated narrowing both T-loop tags

and bending the T towards lingual.
The lingual or palatal spring
Function:
Lingual or palatal movement in the posterior area
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The tip of the clasp is bent over and the tooth is
completely embraced from buccal. The activation
loops are bent in an S-shape in a distance of 2 mm to
the lingual or palatal area of the tooth crown.
This active portion has to be covered with wax as

usual. In this case, the lingual or palatal surface of the
tooth should also be covered with wax so that the
acrylic does not lie directly on the tooth and its oral
movement is not hindered.
The retention should be anchored sufficiently in the

acrylic so that the spring is not torn off because of the
resulting forces.
The oral spring

U
Function: Lingual or palatal movement of buccally erupted teeth

The tooth is embraced with a precisely adapted one
armed clasp. After crossing the contact point, the wire
continues 5 to 7 mm horizontally to the occlusal plane
and straight towards oral, and is then bent in a right
angle into the retention.
The active portion of the clasp is covered with wax on

the lingual side in order to avoid damaging the wire
while trimming the base plate.
With the oral spring, not only the tooth crown can be
tipped lingually, also alveolar remodeling takes place
in oral direction as a result of the bone remodeling
during tooth movement.
The crossed over mesial springs

U
Function: Diastema or space closure at incisors

The endings of the clasps are bent into small loops; the
palatal portions of the clasp are bent parallel over each
other.
The entire clasps are covered with wax as far as their

retention portions.
The springs can only be applied in combination with a

transversal screw. Through the opening of the screw
both spring parts are pulled together.
The closed intermediate spring with loop

U
Function:
Diastema closure
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Here, the closed intermediate spring has a loop on the
labial side. Through activating the loop (see below) the
central incisors can be moved together in an optimal
way.
On the palatal side, the wire ends cross over so that the
centered lying screw which expands the upper jaw in a
transverse direction pulls together the springs
simultaneously and therefore moves both teeth
together. Both clasps have to be covered with wax as
far as their retention.
This way, the spring anchored in the acrylic base can

be activated properly. The consistent mesial pressure
from labial and palatal sides moves both teeth towards
one another guided by the acrylic.
CHAPTRR 3
Shields elements, different

orthodontie plates
The tongue guard
Elements:
The tongue guard runs inside along the tooth rows in the
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ODONTOLOGICA
area of the open bite.
Function: Abhalten der Zunge von den Frontzhnen
Description: manderfrmig gebogenes Gitter
Das Zungengitter verluft innerhalb der Zahnreihen im

Bereich des offenen Bisses.
It consists of multiple loops which are bent in a

distance of 3 to 4 mm and shield the open area of the
bite from the tongue.
The tongue guard is often combined with an oral

screen, but can also be integrated into an active plate.
The lip activator according to Dass

U
Elements: Stimulation spring 1.2 mm spring hard

Function: Closing stimulation of the lips
Description: Appliance which follows the safety pin principle and
represents exercise for the lips
The spring, which also serves as a grip, is bent once

around the loop forming pliers. The following zigzag
bent is used for activation if the tension decreases. The
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retention
works simultaneously as reinforcement for
the acrylic shield.
The wire end and the retention are underlaid with a

wax plate and framed with a wax stripe.
The acrylic shield is finished concave to the labial

surface, corresponding with the shape of the lip.
The lip bumper

U
Elements:
Lip bumper 1.0 mm spring hard
Function:
Separating the lip from the incisors
Description: A bow in the shape of the arch with zigzag bents for
retention of the lip pads
The lip bumper, which in this example is made
individually, is anchored in the buccal tubes of the
molar bands.
In order to have the lip pads in a certain distance from

the gingival tissue, the bent lip bumper wire is
underlaid with wax. The distance between the wire and
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the waxODONTOLOGICA
layer is about 1 mm.
When the finished lip bumper is in place, the distance

from the gingival tissue should be 1 - 3 mm.
Lip pads with an engaged labial bow

U
Elements:
Function:
Description:
Modified wire of the lip pads, engaged labial bow 0.7 mm spring hard
Protection from the upper lip (combination with the engaged labial bow)
The lip pads wire contains a closed loop in order to be able to engage the
labial bow
In this case of special lip pads, the wire between the

canine and the bicuspid is bent into a loop to allow the
engagement of the labial bow.
The area in which the lip pads should keep away the
lip has to be underlaid with wax.
Depending on the desired function, the labial bow can

be either engaged or not.
The inclined plane

U
Elements:
Function:
Description:
Simple retention elements and labial bow 0.7 mm spring hard

Movement of single teeth or tooth groups
Simple appliance for the correction of the position of single teeth
or tooth groups in anterior cross-bites and for the anterior
movement of the mandible
For the inclined plane, simple retention elements and a

labial bow are bent. Special care should be taken with
the retention elements to guarantee a good anchorage
because of the load.
For the making of a fixed inclined plane, first the

retentive parts of the teeth have to be blocked out with
wax and the model has to be articulated in reference to
the construction bite.
The inclined plane in the anterior area of a maxillary

plate can be used to move the mandibular teeth
forward, or to advance the mandible from a distal bite
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ODONTOLOGICA
into a neutral
occlusion.
The active plate

U
Elements:
Function:
Description:
According to the planned design

Different purposes, depending on the design
In combination with resilient wire elements and pressure or
traction screws, active plates can serve many different purposes
For the making of an active plate the models are

prepared in such a way that all blisters have to be
eliminated and the undergoing parts have to be
covered with wax. The chosen clasps are bent
according to the planned design, the active parts are
covered with wax and the screws are positioned on the
model.
The prepared model can be watered. The model should

not to be isolated if the plaster is not synthetic. The
acrylic can be scattered on and can be polymerized in
the pressure vessel for around 10 minutes.
Afterwards, the plate is detailed, the screw sections are

sawed and the active elements are uncovered. The
basis plate is only polished on the upper side. On the
lower side, only coarse details have to be eliminated.
Otherwise, the lower side remains untreated in order to
adjust as precise as possible onto the model.
The Cetlin appliance

U
Elements:
Function:
Description:
Distal spring 0.7 mm spring hard, modified labial bow 17 x 24

rectangular stainless steel wire
Distal movement of the last molars using a headgear
Simple plate to move the last molars distally with fixed bands for
extra oral traction
The labial bow is only laid over the four incisors and
an acrylic shield is adapted. Adams clasps are bent
over the first bicuspids. In order to adjust the distal
springs between the bicuspid and the molar, the plaster
model has to be slightly erased in this area.
The springs and the acrylic shield are blocked out with
wax and covered with acrylic.
The distal limit of the acrylic base

reaches the A-line. The acrylic does
not contact the last molars. Therefore
they can be banded without any
problems and the teeth can glide
distally along the acrylic.
Upper and lower plate with pressure-traction

screw according to Heller
U
Elements:
Function:
Description:

Movement of single teeth mesially or distally
This screw moves single teeth in anterior-posterior direction
using the anchorage of all other teeth which are not to be moved
While designing and bending the elements, one has to

pay attention in order that the retentions of the clasps
do not reach into the sawing area.
The acrylic base has to be sawed or grinded free in all

the extension of the gap. The acrylic underneath the
screw can continue in order to make the appliance
more stable.
A view of the plate with a completely open screw: The

Adams clasps for the bicuspids which are to be moved
lie on the distal end of the gap.
Appliance with open screw
Elements:
Function:
Description:

Gap closure
The screw creates a continuous force used for gap closure
The open screw is available in different sizes

depending on the size of the gap. The retention should
be bent again in such a way that it does not invade the
later sawing area.
n the area of the gap, the acrylic edges are grinded off
parallel so that the screw can be closed without any
obstacles.
When the screw is totally closed and a gap remains

between the teeth, one can proceed gradually; after a
new impression, the plate is changed inserting a new
screw in order to close the gap completely.
The gap closing plate with diastema screw

U
Elements:
Function:
Description:

Gap or diastema closing with a screw
This is about a sturdy screw with activation extensions which are
added to close a gap or a diastema
The elements are bent according to the planned design.

The diastema screw is centered with its plastic holder
in the middle of the arch. The activation extensions are
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adaptedODONTOLOGICA
on the distal surface of the tooth and are
eventually shortened.
In the area of activation the extensions have to be

covered with wax.
After scattering, finishing and polishing the appliance

the proper function of the screw has to be proved.
The active plate with rotation screw

U
Elements:
Function:
Description:

Rotation of single teeth through pressure or tension
The screw has two extensions with which the tooth is pushed on
one side and on the other, pulled into the right position
After bending and fixing all clasps and holding

elements the screw is adapted. It has a pressure and a
tension extension. First, the pressure extension is
adapted on the tooth; then the tension extension is
screwed back in order to create a free space in the
acrylic for the later activation.
The whole length of the extensions and the slots of the

screw are covered with wax.
The active plate is covered with acrylic and finished.

At this moment of the making, the retention of the
tension extension still lies inside the acrylic. For the
insertion of the plate, the tension extension is screwed
back the estimated amount and is adapted to the tooth
contour.
Plate or appliance with piston spring screw

U
Elements:
Function:
Description:

Single tooth movement in labial direction
The punctual contact point of this screw moves the tooth around
its axis
The assembly screw is first screwed into the prepared

nut until the tip exposes 0.5 mm. On the point of force
application on the tooth, a drop of wax is placed. The
screw and the nut have to be heated slightly, pressed
onto the wax and positioned in the desired direction.
The acrylic is scattered as usual. Before finishing the

appliance, the assembly screw is unscrewed. Possible
acrylic or polishing residues are removed and the
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piston spring screw is screwed in. The resilient
pin of the screw should only emerge slightly out of the
nut.
The piston spring screw is activated with a small

screwdriver. There are three different screw lengths
(4/6/8 mm) therefore a labial movement up to 7 mm
can be achieved.
The lever activating screw

U
Elements:
Function:
Description:

Labial inclination of lingually inclined molars or molar rotation
Lingually inclined teeth are gradually set upright with this screw
The screw consists of a base plate and a pan lever on

which a small movable pan plate is fixed. The pan
lever is connected to a hinge joint with a spring for a
firm adjustment. The small pan plate has to be
adjusted on the tooth to be moved and has to be
covered with wax together with the hinge joint, the
spring and the activation screw.
If the inclination of the tooth is severe, the point of

application of the pan plate does not have to lie under
the biggest circumference of the tooth in order to avoid
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ODONTOLOGICA
interferences
when inserting the appliance. In
combination with a labial spring, the lever pan screw
can also be used to rotate a molar.
The activation screw changes the position of the pan

lever and moves the distal part of the molar labially. A
labial spring which can be soldered on the Adams
clasp serves as counterpart for the rotation and exerts
pressure towards lingual on the mesial part of the
molar. This force couple results in a rotational
movement of the molar.
Appliance with Bertoni screw (Y-plate)

U
Elements:
Function:
Description:

Simultaneous transversal and anterior-posterior expansion of
the arch
The three dimensional screw allows a combination of transversal
and anterior-posterior expansion of the arch
During the construction of the appliance, it is

important to observe that the retentions do not lie in
the area of the sawing traces.
The three dimensional screw allows a transversal

expansion of the arch with simultaneous protrusion of
the incisors. The screw has to be adapted in such a
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ODONTOLOGICA
way that
it allows an independent activation of all
plate sections.
The saw-tracing of the finished appliance forms a Yshape. The retentions of the wire elements lie in the
corresponding section according to their function. This
way, they can maintain their function even after a
strong activation. The Y-plate is often used for
anterior-posterior expansion in order to gain space for
the alignment of upper canines.
Plate with three dimensional, multisectional

screw according to Beutelspacher
U
Elements:
Function:
Description:

Combined transversal and anterior-posterior expansion of the
mandible
Combined transversal expansion of the lower arch analogous to
the Bertoni screw in the upper arch
After designing the appliance, the wire elements are

bent and covered with wax. The retentions have to lie
in such a way that they do not hinder the later sawing.
In order to define the direction of the protrusion force,
the protrusion springs have to be adjusted horizontally
and vertically before fixing the screw onto the model.
After the polymerization of the acrylic, the mounting

of the screws is removed and the appliance is finished.
Afterwards, the sawing is performed.
The function of the multisectional screw according to

Beutelspacher is analogous to the function of the
Bertoni screw in the maxilla.
The fan type expansion plate with different

screws and applications
U
Elements:
Function:
Description:

Enhanced expansion in specific areas
Enhanced expansion in the maxilla: 1. Anterior expansion, 2.
Posterior expansion, 3. Eccentric expansion
The fan type expansion screw exists in two designs:

As a one piece or two piece expansion screw. Both
have the same function, to expand the anterior or
posterior region fan shaped. The two piece expansion
screw has the advantage that through the separate
fixation of the screw and hinge, the lever is longer so
that the fan type expansion is enhanced.
1. Anterior expansion
Fan type expansion plate with divided screw The
divided screw is smaller and is therefore favored in
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narrowODONTOLOGICA
jaws. This way, there is more space for the
retentions of the wire elements. The separate joint that
forms part of the hinge has to be covered with wax.
2T
2T
The finished appliance shows that the hinge which lies

on the dorsal end of the plate is not covered with
acrylic. The appliance has to be extended notoriously
further into the palate than a simple split plate. It
should not stand out over the A-line.
The appliance can be expanded like a fan after its

sawing. To assure an opening without interference the
hinge should lie uncovered on the posterior limit of the
plate.
Fan type split plate with fan type expansion screw

in one piece
In the same way as in the two piece screw, the hinge of
the one piece screw has to be covered with wax.
The finished appliance is also sawed, and the hinge

has to be cleared of wax and acrylic residues. The fan
type plate is often used for expansion in patients with
lip and palate cleft.
The top view of an activated fan type split plate with

one piece screw.
2. Posterior expansion
Fan type plate with reverse built-in, divided screw The
screw can also be adapted in the opposite direction;
then its function is the posterior expansion of the
maxilla.
The hinge is covered with wax as usual and the sawing

cut is widened wedge shaped from the hinge to the
front
.
The activated screw shows that the wedge shaped cut
is closed in the anterior region. If the wedge shaped
cut is insufficient for the planned expansion, it can be
cut wider.
3. Eccentric expansion
Fan type appliance with one piece screw for eccentric
expansion An eccentric expansion is achieved by the
oblique fixation of the screw. The screw is built in as
usual, then it is covered with wax and the plate is
sawed.
2T
2T
Because of the oblique position of the screw, the

activation results in an eccentric rotation of the arch.
This way, space can be gained in specific parts of the
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arch, asODONTOLOGICA
in this example, in the area of the lip and
palatal cleft.
The Mandibular plate with bow screw according

to Mller
U
Elements:
Function:
Description:

Expansion in the anterior arch section
The anterior arch section is expanded wider, analogous to the
fan type screw in the upper arch
The wire elements are bent according to the design.

The retentions of the clasps should not disturb the area
of the screw. Then the screw is fixed on the model.
The mandibular bow screw is adjusted in the same

way as a transversal expansion screw into the plate.
After finishing and polishing, the appliance is sawed.
The opened bow screw expands the mandible almost

fan shaped.
Labial spring bow plate according to Bandulet

U
Elements:
Function:
Description:
Adams clasp 0.7 mm hard, labial arch 0.7 mm spring hard

Alignment of the incisors
The incisors are aligned with a set-up which is transferred
with an acrylic covered labial arch
A slight anterior crowding or wrong position of the

incisors can be compensated with a set-up from canine
to canine. The plaster model has to be duplicated for
the making of the appliance.
Adams clasps with soldered tubes are used as retention

elements. The distal part of the labial arch, which is
covered with acrylic in the anterior region, is inserted
into the molar tubes which serve as guide rails.
Both sides of the labial bow have small loops distal of

the incisor coverage. From these loops, elastic springs
are attached to the distal endings of the labial bow that
slide out of the molar tube. This way, a continuous
pressure is applied on the incisors which results in
their alignment according to the set-up.
The Roberts retractor

U
Elements:
Function:
Description:
Labial arch 0.6 mm spring hard, Adams clasp 0.7 mm hard

Retraction of the incisors
Simple appliance for the retraction of incisors
The special part of this appliance is the labial arch. To

enhance the transversal mesial tags of the labial arch,
small tubes or the needle of a syringe of corresponding
size are pulled over the wire. This way the thinner
active part of the labial arch, with additional loops in
the U-loops, can serve specifically as an active
element.
If the labial arch is bent almost completely only resting

the retentions, the tubes are pulled over the wire, and
with the enforcement in place, the retentions are bent.
The tubes start from the loop to the beginning of the
retention.
The transversal screw activates the labial bow

automatically.
The double bite jumping plate (VSD, VD-plate)

U

Elements:
Function:
Protrusive movement of the mandible
Description:
The incline of the upper guards contacts the inclined plateau of the lower
plate and results in a protrusion of the mandible
The double bite jumping plate with preformed guards

and integrated screws in the upper and lower jaw
The result of the incline of the upper guards contacting the
inclined plateau of the lower plate is a protrusion of the
mandible. The models are mounted in the fixator according
to a construction bite and the retention elements are bent
according to the design. The mandibular plate is totally
finished. The acrylic plateau in the incisor area is designed
1 mm over the incisal edges. Following the plateau an
inclined plane of 60 in relation to the occlusal plane is
added as a gliding surface for the guards.
Preformed mandibular expansion screws for double

plates can be used when screws are integrated into the
double plates. The screw with holder and mounting
pattern for the adjustment of the incline is adapted on
the lower plaster model, then the acrylic is added and
the appliance is finished.
First, the plateau of the finished mandibular plate is

covered with a very thin layer of wax and then, the
preformed maxillary expansion screw with guards is
fixed. After that, the acrylic is scattered on the
maxillary plate and both parts of the fixator are set
together carefully. Acrylic can be added to the
maxillary plate if the expansion screw is not covered
adequately.
Modifications of the bite jumping guards
Individually bent guards (1.2 mm spring hard):

In this case, two wire loops are added into the maxillary
plate. While polishing the maxillary plate one has to pay
attention not to damage the upper plateau. It is only sanded
down and polished. Following these precautions, the
contact of the upper and lower plateau is flat and extensive.
This is important to distribute the pressure evenly over the
appliance and therefore avoid overloading and breaking of
the guards.
Bite jumping handle (1.2 mm spring hard):

If the double plates do not include an expansion screw,
a one piece protrusion wire can be added. In this case,
the width of the wire should correspond to the width of
the inclined plane on the lower plate. In this variation,
the wire should not extend lingually over the
mandibular plate.
Lateral guiding spurs (Mller spurs):

The guiding spurs can also be applied in the posterior
region. For example, when the lingual area is reduced,
these prefabricated Mller spurs can be a good
solution. Again, the mandibular plate is finished first
including guide planes in the area of the first molars.
In models of Angle class II patients, these surfaces
show towards dorsal. The models have to be mounted
in the fixator as mentioned before with a construction
bite.
The double bite jumping plate system according

to Schaneng
U
A complete fitting set for the double bite jumping plate

system according to Schaneng consists of: 3 expansion
screws with bridge, 1 adapter (small), 1 adapter (large), 1
mounting pattern and user instructions.
The elements are bent according to the design. After fixing

the mandibular screw, the mounting pattern is held
parallel to the occlusal plane over the mandibular model.
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ODONTOLOGICA
Here, the
holder lies between the guiding surfaces of the
pattern and these have to adapt closely to the body of the
screw. The plastic adapter is fixed over the guiding surface
onto the holder of the screw.
The mounting pattern is removed. The gap that results

between the body of the screw and the adapter is the
space for the acrylic inclined plane. This inclined plane will
always be of 60 because of the mounting pattern. This
way the mandibular plate can be prepared, hydrated and
scattered.
The inclined plane of the mandibular plate which resulted

from the use of the mounting pattern is slightly sanded
and polished.
Before fixing the guards, the loops have to be covered with

wax in order to maintain their elasticity.
The finished lower plate is isolated with a very thin wax

layer. The combination of guards and expansion screw is
fixed onto the inclined plane.
When closing the fixator the screw should be close to the

palate without contacting it. After this, the acrylic can be
applied on the maxillary model.
During the finishing the loops have to be uncovered

without grinding them. When the transversal screw is
expanded widely, tension can be produced on the guards.
These can be neutralized by simply bending open the 1.2
mm strong M-loop.
The exact following of the construction principles and the

correct adjustment of the angles are the conditions for a
proper elastic bite jumping double plate.
The class III double plate (RD-plate)

U
Elements:
Function:
Description:
Clasps according to the planned design, Mller thorns (preformed

elements)
Retrusive movement of the mandible
Mller thorns are built in reversed (exchanging left and right)
In appliances of patients which present a class III, the

surfaces on which the thorns glide along are directed
mesially. Again, the mandibular plate is finished and
polished first.
The thorns are fixed with wax as mentioned before onto the
lower plate. The finished mandibular plate is covered with
wax to avoid sticking on the maxillary plate. Now acrylic
can be applied
on the upper plate and the fixator has to be
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ODONTOLOGICA
closed while the acrylic is not yet polymerized.
View of both finished and polished appliances.
The RD-plate with screw according to Sander

U
Elements:
Function:
Description:
Bending of the clasps according to the planned design

Retrusive movement of the mandible
The activation of the screws results in a retrusive movement of the
mandible
After bending the elements, the screws are fixed on the

lower model, the acrylic is scattered and the appliance is
finished.
The mounting templates have to be adapted onto the screw

holder and for the maxillary appliance the guards are fixed.
The activation of the screws produces a retrusive

movement onto the mandible.
CHAPTRR 4
Double plates, bimaxillar appliances
The Roberts
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ODONTOLOGICA
U
Elements:
Function:
Description:
retractor as bite jumping appliance

U
Labial bow 0.6 mm spring hard, Adams clasp 0.7 mm hard

Mandibular advancement
The addition of an inclined plane into the acrylic base results in a
mandibular advancement
The maxillary elements are fixed as

usual. A transversal split screw can be
added into the dorsal part of the acrylic
base if desired.
The acrylic base of the upper plate is

extended into the lower jaw. The base
plate is designed as an inclined plane.
The lower inclined plane lies behind
the mandibular incisors and causes the
advancement of the entire mandible.
The bimaxillar effectiveness can be

appreciated in a lateral view:
- Retrusion of the upper incisors
because of the labial arch
- Advancement of the mandible
because of the inclined plane.
ODONTOLOGICA
The double
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U
Elements:
Function:
Description:
plate according to Planas

U
Labial bow 0.7 mm spring hard, circular clasp 0.7 mm spring

hard, thorns 0.7 mm spring hard
Increase of the vertical dimension
This double plate appliance serves to increase the vertical
dimension
This double plate appliance can also be

used without clasps. In the upper jaw,
only a labial bow and two continuous
clasps are attached. The lower plate is
stabilized through thorns between the
canines and the lateral incisors and
other thorns distal of the first molar.
Both plates can be modified using

transversal screws. The lower plate has
two horizontally laying bite blocks
which are located in the lingual molar
area. The upper plate has the same bite
blocks which in height are adapted in
relation to the lower ones in such a
way that they adapt exactly and
produce a vertical opening.
With this double plate appliance it is

very important to achieve a good
fitting of the bite blocks. They have to
be designed quite delicately in order to
avoid restricting the lingual area and to
hinder the pronunciation as less as
possible.
ODONTOLOGICA
The Berlin reactivator
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U
Elements:
Function:
Description:
Connecting wire for the lingual shield 1.2 mm spring hard, labial bow 0.8
mm spring hard, ball clasp, headgear hook 0.8 mm hard
Combined with a headgear the upper jaw is restricted in its growth
Ball clasps are used in the buccal area. The wire diameter
can vary according to the tooth dimension. The retentions
have to be designed according to the reduced base plate.
The hooks for the extraoral traction are located between the
upper lateral incisor and the canine.
The lingual shield is positioned along the inner alveolar

curve and reaches into the area of the first premolar. The
support wire of the lingual shield is fixed firmly into the
upper plate. The reactivation of this appliance occurs by
activating the wire which emerges out of the upper base
plate towards the front.
The upper base plate reaches slightly under the gingival

margin in the posterior region. In the anterior region, the
incisors are not covered on the palatal side, they rest with
their incisal edge on a plateau which simultaneously
supports the lower incisors. The plateau covers all teeth.
For this appliance a construction bite is needed.
The bimaxillar prognathism upper plate

according to Buo
U
Elements:
Function:
Description:
Anterior intermaxillary bow 0.8 mm spring hard, labial pads 0.8 mm spring
hard
Treatment of mandibular prognathism in the mixed dentition
Bimaxillar appliance with a strong lingual shield which can be used in the
mixed dentition
The upper plate is anchored with simple retention thorns.

Loops are bent on both sides of the intermaxillary bow. The
part which lies on the lower incisors is covered with a
spring and
a plastic tube. The labial pads are similar to
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ODONTOLOGICA
those of Frnkels function regulator although in the centre
they are not connected
.
The upper plate is furnished with a strong acrylic lingual
shield. This acrylic shield should not touch the mandible.
Therefore the models are covered with wax in the area of
the lower teeth and of the lingual shield. Through this free
space to the lingual shield and the intermaxillary bow, the
mandible is supposed to be restricted or even moved
backwards.
In order to distract the tongue from the incisors, this
bimaxillar prognathism plate also includes a Coffin spring.
The bi-block appliance according to Chateau

U
Elements:
Function:
Description:
Labial bow 0.7 mm spring hard, arrow clasps 0.7 mm spring

hard, lingual bow 0.7 mm spring hard
Forward positioning of the lower jaw into a neutral position
The mandible is positioned forward through the removable
lingual bow
This appliance only consists of an upper plate with a

removable lingual bow to enhance the forward positioning
of the lower jaw. The wire elements are bent and the tubes
are incorporated into the upper base plate. For the
positioning of the mandible the wire is put into the tubes
and is fixed with wax to the molars. The opening of the
tubes should be covered with wax before adding the acrylic.
After the polymerization, the lingual bow is removed from

the tube to finish the plate. The opening of the tube should
be slightly inclined backwards on the surface of the upper
plate inODONTOLOGICA
order to allow a safe anchorage of the labial bow
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and to prevent a sharp transition to the acrylic base.
After polishing the upper plate, the lingual bow is fit to the
lower jaw and its proper anchorage is assured. The lingual
bow should contact the cervical third (of the crowns) of the
lower incisors and premolars.
The Bimler appliance type A

U
Elements:
Function:
Description:
Labial bow 0.9 mm spring hard, Coffin spring 0.9 mm spring hard, labiolingual bow 0.9 mm spring hard, anterior spring 0.8 mm spring hard
Treatment of protruded incisors
The appliance is a delicate functional appliance with a low acrylic share
The labial bow is bent contacting closely the upper incisors.

On the height of the second premolars, the wire is bent
backwards by 180 and passed between the canines and
first premolars into the retention. The anterior springs lie on
the most prominent parts of the incisors. The Coffin spring
is bent closed distally.
While bending the lower labio-lingual bow the wire is

positioned in the centre of the incisors. From there, it is
bent towards occlusal and then in height of the first
premolar
is guided back to the canine. After this, it is bent
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ODONTOLOGICA
by 180 back to the molar and from there arched into the
upper jaw for retention.
In the lower jaw, the anterior spring is closed cervically and

is anchored with its retention labially in the acrylic shield of
the labio-lingual bow.
In the upper jaw the side wings, and in the lower jaw the
labial shield are limited with wax.
The acrylic base of the finished appliance is very small and

therefore it has to be polished carefully. The whole
appliance should be preferably worked on with a manual
motor and not with the lathe.
To reduce the force application the anterior springs are

upholstered with plastic tubes.
The Bimler appliance type B

U
Elements:
Function:
Description:
Anterior spring 0.8 mm spring hard, expansion bow 0.9 mm

spring hard, retention thorn 0.8 mm spring hard, labio-lingual
bow 0.9 mm spring hard, anterior loop 0.8 mm spring hard
Base appliance type B for the treatment of retruded central
incisors
The appliance consists of a rigid upper base plate, combined
with an expansion screw
The expansion bow for the retruded central incisors lies

horizontally on the palatal surface similar to a common
protrusion spring. From there, the wire is bent between the
canine and the first premolar over to the buccal side
embracing the first premolar. Then the wire is bent between
the first and second premolar back to the palatal area into
the lateral acrylic shields.
Anterior springs are added to correct the protruded lateral

incisors. On the buccal side a loop is bent between the
lateral incisor and the canine and wire ends are bent over.
In the lower jaw the labio-lingual bow and the anterior

springs are bent in the same way as in the type A. A
retention thorn is fit on the mesial side of the molars and its
retention is anchored in the upper acrylic base plate.
The transversal screw is fixed before adding wax and

then the wax collar for the incisor shield in the lower
jaw is added.
The design of the upper base plate is delicate. In the lower

jaw the anterior spring and the labio-lingual bow are
anchored in the incisor shield.
After finishing the appliance, the anterior springs are

covered with plastic tubes.
The Bimler appliance type C

U
Elements:
Function:
Description:
Intermaxillary bow 0.9 mm spring hard, anterior spring 0.8 mm

spring hard, Coffin spring 0.9 mm spring hard, occlusal rest 0.8
mm spring hard, mandibular bow 0.9 mm spring hard,
mandibular connection bow 0.9 mm spring hard
Base appliance type C for the treatment of prognathism with
anterior cross-bite
An elastic appliance with intermaxillary bow and lingual pads
The upper intermaxillary bow is bent contacting the lower

incisors and in distance to the upper U-loops. The Coffin
spring is closed distally. The anterior spring is bent
contacting on the most prominent parts. The occlusal rests
have to be horizontal to the occlusal surfaces.
In the lower jaw, the lingual bows are led from the
mesial edge of the canine distally, then buccally
between the canine and the first premolar. On the
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buccal ODONTOLOGICA
side the wire is bent into a mesial loop and then
back distally. Now the wire is led between the first and
second premolar over to the oral side again. After a
loop formed indentation towards anterior, the lingual
bow moves over to the acrylic base plate of the upper
jaw.
Both lingual bows are joined through a connecting
wire with three zigzag bents into the lingual acrylic
pads.
In the upper jaw, the lateral acrylic shields are limited

with wax stripes. In the lower jaw, small acrylic
shields are made in the canine and premolar area in
order to anchor the connecting wire.
The finished appliance is a delicate design and has

therefore to be handled with caution during polishing
and finishing procedures.
After completely finishing the appliance, the occlusal

rests are covered with plastic tubes in order to make
the vertical opening more elastic. In the upper jaw, the
anterior spring can also be covered with a plastic tube.
The twin block appliance

U

Elements:
Labial bow 0.8 mm spring hard, Adams clasp with spring for extraoral
traction 0.8 mm spring hard, ball clasp 1.0 mm spring hard, Adams clasp
0.7 mm hard
Function:
Correction of mandibular retrognathism
Description:
The mandibular position is determined with a construction bite and is fixed
through inclined bite planes
In the upper plate the labial bow is passed between the

second premolar and the first molar into the acrylic base.
The Adams clasp is bent over two teeth, including a spring
in the centre to anchor the headgear. The lower plate only
includes ball clasps in the anterior region and Adams clasps
in the posterior region.
First, the lower plate is finished. It includes a small bite

block in the premolar area which is sloped distally. In the
upper plate the bite block is sloped in the opposite direction
and therefore fits exactly onto its counterpart.
Through these two inclined planes the occlusion is fixed

and the mandible is determined in its position.
The double plate with intermaxillary elastics

according to Neuner
U
Elements:
Function:
Description:
Arrow clasp 0.7 mm spring hard, thorns for elastics 1.0 mm

hard, labial bow 1.0 mm spring hard, occlusal rest 1.0 mm hard
Retrusion of the mandible and anterior movement of the upper
jaw
Elastics are engaged in soldered ball hooks in order to adjust the
occlusion
Arrow clasps and two hooks for the engagement of elastics

are incorporated into the upper plate. Occlusal rests are bent
over the lower molars. The counter hooks in the lower jaw
for the intermaxillary elastics are soldered on the labial bow
which afterwards is covered with acrylic.
For the lingual shield, the interdental areas have to be

erased to guarantee a firm adjustment especially while
opening. The limits of the acrylic cover are slightly
underneath the incisal edge and over the point of the
papilla.
Ideally, the position of the hooks on both plates has to

allow a horizontal course of the engaged elastics. This way
the vertical force component can be minimized.
The bimaxillar appliance according to Sevinc

U

Elements:
Guiding bow 1.2 mm spring hard, labial bow 0.7 mm spring hard,
connecting wires 0.7 mm hard
Function:
Alteration of the position of the upper jaw in relation to the cranial base
Description:
By the application of force onto single teeth, tooth groups or the tooth rows,
alveolar tooth movements are induced and the position of the upper jaw in
relation to the cranial base is altered
The upper plate is finished according to its design. All

different screws can be incorporated: for example the fan
type expansion screw, multi sector screws, screws
according to Bertoni or Beutelbacher, or simple transversal
screws as well as all different sorts of springs. The
connecting wires for the buccal pads are bent in a slight
distance from the gingival tissue and are then fixed.
The three dimensional screw allows a transversal expansion

of the arch with simultaneous protrusion of the incisors.
The screw has to be adapted in such a way that it allows an
independent activation of all plate sections.
First, the upper plate is finished with its buccal pads which
serve to control the buccinator muscle and if needed, keep
its effect from the alveolar bone. After its polishing, the
upper plate is grinded free for the retention tags of the
lower spring bows in order to connect the lower and the
upper plate.
The tongue pad with its guiding wires is finished

separately. In this case, anterior springs for an incisor
correction were added. The spring bows with its
retentions are bent without tension into the upper plate.
The lingual pad located in the anterior region allows a

reduction or increase of the vertical effects. Similarly,
a retrusion of the whole mandible can be achieved by
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ODONTOLOGICA
an activation
of the spring bow.
A finished bimaxillar appliance consists of the upper

base plate and the integrated guiding bow with its
tongue pad.
The buccal double plate according to Bierschenk

U
Elements:
Function:
Description:
Adams clasps 0.7 mm hard, helical protrusion spring for the

anterior segment 0.5 mm spring hard, canine retracting spring
0.8 mm spring hard, incisal spring 0.5 mm spring hard, guiding
thorns 1.2 mm spring hard
Treatment of mandibular retrognathism using an upper
expansion plate and a lower buccal plate
This combination of an upper and lower plate with guiding
thorns and notch in the bite blocks is very pleasant for the
tongue
The models are mounted with a construction bite in a

fixator. A vertical opening of approximately 5 mm is
necessary to integrate the inclined planes into the
posterior bite blocks. The elements are bent according
to the planned design. It is important to remember that
the retention tags of the lower plate have to be located
on the buccal or labial side because this is where the
acrylic will be added.
On each side the upper plate has posterior bite blocks. In

the area of the second premolars these smooth bite blocks
are grinded to form inclined planes of 45. When closing,
the guiding
thorn of the lower plate is driven into these
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ODONTOLOGICA
inclined planes and therefore guided into the desired
occlusion.
In the anterior region, the lower buccal plate is supported

with incisal rests; an expansion screw can also be added. In
a vertical plane, the guiding thorns have to emerge slightly
in order to slide into the inclined planes of the upper bite
blocks.
The rilinator
U
Elements:
Function:
Description:
Adams clasps 0.7 mm hard, inner pressure bows 0.5 mm spring

hard, labial bows 0.8 mm spring hard
Pressure is exerted on the jaws while opening and swallowing
Smooth occlusal covers towards both teeth and the occlusal
plane are the distinct feature of this appliance
The wire elements are bent and fixed with wax onto the
model. When the treatment goal is bite closure, the acrylic
occlusal surfaces are replaced with occlusal springs. The
inner pressure bow and the labial bows are used to align the
incisors.
For the making of the acrylic surfaces, the occlusal surfaces

of the posterior teeth are covered with wax up to the
cuspids. Wax is also added on the lingual surfaces in a right
angle so that the acrylic contacts only the tips of the
cuspids, and on the lingual side, the crowns of the molars
should only contact the acrylic from the equator on to the
beginning of the gingival tissue.
The special features of the rilinator are the lateral occlusal

covers. The posterior teeth can be maintained in their
vertical position, they can erupt grinding the acrylic or
being intruded
using occlusal springs. In this occlusal view,
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ODONTOLOGICA
one can confirm that the planes are grinded completely
smooth and that they fit perfectly onto one another. When
expanding, the occlusal planes have to glide over each
other.
The rilinator with Jasper Jumper

U
Elements:
Function:
Description:
Labial bow 0.7 mm spring hard, Adams clasps 0.7 mm hard,

protrusion springs 0.5 mm spring hard
Fast conversion from an Angle class II-1 to class I
Instead of the VSD-planes, in this case, the Jasper Jumper
produces the advance
As in the base appliance, labial bows, protrusion springs

and Adams clasps are fixed on the model. For this
appliance headgear tubes have to be soldered onto the
Adams clasps, otherwise, presoldered tubes with wire can
be used. The bow for the Jasper Jumper is fixed directly
with one or several pearls into the lower plate.
For the occlusal covers in the posterior region, the occlusal

surfaces of the premolars and molars are grasped in acrylic.
The clinical crowns of the first molars are covered with
wax, so that only the tips of the cuspids contact the acrylic.
The acrylic has to be finished and polished smoothly in

order to guarantee a firm contact and to increase the vertical
dimension evenly.
The Bass appliance

U
Elements:
Function:
Description:
Adams clasps 0.7 mm hard, torque springs 0.6 mm spring hard,

lingual pads 1.2 mm spring hard, vestibular shields 1.0 mm
spring hard, labial pads 1.0 mm spring hard
Growth stimulation due to the vestibular shields
First, the Adams clasps are bent over the molars and the
first or second premolars (or second deciduous molars).
Before bending the torque spring for the incisors, wax has
to be added on the palatal side of the incisors 2 mm from
the incisal edge up to covering 5 mm of the gingival
margin. This way, an acrylic step can be designed behind
the central incisors. The torque spring is bent carefully over
the round edge of the pliers in order to reduce the risk of
breakage and is then fixed onto the model.
The tubes have to be sealed with wax on both ends before
fixing them onto the model. After placing the screw onto
the model, the acrylic can be added including the occlusal
planes. The posterior part of the plate should be designed as
delicate as possible. The tubes have to be covered with
acrylic as far to guarantee enough retention for the shields
with labial pads. In addition to the setting in the acrylic
base, it is recommended to solder the tubes onto the Adams
clasps.
The finished plate is set onto the model and then the wax
layer is added for the vestibular shields and labial pads. The
retention tags for the vestibular shields are bent
individually. An alternative is to use preformed vestibular
shields. In order to insert the labial pads into the vestibular
shields, a tube is soldered onto the individually bent
retention tags. This tube is inserted into the labial pad.
Vestibular shields and labial pads can only be finished after

covering the tubes with the inserted wires with a thin wax
layer. A penetration of the acrylic into the tubes should be
avoided.
The anterior tube on the palatal side of the plate is used as

opening for the labial pads. Both models are put together in
the fixator in order to centre the lingual pads 4 to 5 mm
underneath
the gingival margin of the lower premolars; the
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ODONTOLOGICA
retention tags are bent according to the situation.
The finished Bass appliance can be up up-fitted to allow the

patient to get used to the appliance gradually.
The Hansa plate according to Hasund

U
Elements:
Function:
Description:
Closed torque spring 0.7 mm spring hard, upper connecting bow

1.0 mm hard, Adams clasp 0.6 and 0.7 mm spring hard
Treatment of Angle class II-1 malocclusions
In this functional orthopedic appliance special springs connect
the upper plate to the lower plate
The closed torque spring which serves to receive the Jhooks is located with loops distally of 11 and 21, the
connecting bow is located directly behind. The Adams
clasps over 54 and 64 are bent of 0.6 mm spring hard wire,
the Adams clasps over 55 and 65, and also over 16 and 26,
are bent of 0.7 mm spring hard wire. The buccal tubes are
placed on the second deciduous molars or on the second
premolars. The split fan type expansion screw is built in
without its joint.
In the mandible, the reduced lower plate is connected with
the upper jaw through a labial shield and a pair of
especially designed spring bows for this plate. With this
spring bow, the mesial retention tag is anchored in the
lower plate; the distal tag is anchored into the lateral bite
block in height of the occlusal plane. The pair of spring
bows should not contact the gingival tissue or teeth.
When all wire elements are bent, the wax layer for the
reduced lower plate is added. A slim wax stripe limits the
free part of the palate and simultaneously blocks out the
connecting
bow.
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ODONTOLOGICA
It is advisable to add a wax frame in order to manufacture

easier the upper reduced plate. For this purpose, a narrow
wax stripe is fixed on the labial side of the upper tooth row.
The thickness of this wax stripe is of approximately two
wax plates. Finally, to make the application of the acrylic
easier, a wax frame is fixed around the previous wax layer.
The buccal tubes are also sealed with wax. Prepared this
way, the acrylic can be added on the upper plate and it can
be finished.
The lower lip shield is bent in average with 6 loops; the
retention tag is passed between the canine and the first
premolar, or the first deciduous molar, into the lower
acrylic base ideally with a mesial direction. The retention
tags of the spring bows are bent distally. The retention for
the lower jaw lies lingually underneath the tooth row. The
other retention, which is anchored in the upper plate, is
positioned in height of the lateral bite blocks parallel to the
occlusal plane.
The wax lining of the lower model covers the cuspids of the
posterior teeth in such a way that the compensation curve is
maintained. In the anterior region, the wax is added in the
same manner as in the posterior region so that there is no
transition between them. Now acrylic can be added
separately on the lower plate and it can be finished.
The upper plate is finished first. The lateral and anterior

bite planes should have even contact with small
impressions for the lower teeth; the torque springs should
lie free and the buccal tubes should extend over the lateral
bite planes. The connecting bow has to lie free in such a
way that it can be activated parallel to the screw. The bite
plane should embrace the teeth as far as possible although
the Adams clasps should lie free.
The lower plate is also finished separately. The base plate

ends on the level of the 2nd. deciduous molar or distally of
the 2nd. premolar. In the incisal or lingual area the plate has
to be shortened
in order avoid interfering with the height
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ODONTOLOGICA
determined by the construction bite. This way, the
separately finished appliances can be polished without
problems.
The finished plates are positioned onto the models to mark

the spots where the retentions of the spring bows are
anchored into the upper plate. The retentions are integrated
into the acrylic of the lateral bite blocks parallel to the
occlusal plane. The superfluous acrylic is grinded and
polished. In the area of the loops a small groove is milled to
make the insertion of the headgear easier. If necessary, the
buccal tubes have to be grinded free minimally.
The selective orthopedic double plate according

to Marillo
U
Elements:
Function:
Description:
Labial bow 0.7 mm spring hard, expansion spring 0.9 - 1.0 mm

spring hard, protrusion spring 0.5 mm spring hard, posterior
wire loops 1.0 - 1.2 mm spring hard, occlusal rests 0.8 mm
spring hard
Three dimensional double plate being activated through wire
loops and springs
The design of the double plate is more delicate with wire loops
and springs as with screws
The labial bow is laid between the 1st. and 2nd. premolar
into the acrylic base. Depending on the planned design,
protrusion springs and the occlusal rests can be included in
the lower plate. The expansion springs for the upper and
lower jaw are fixed onto the model in such a way that the
active parts are covered with wax and only the retentions lie
free.
To increase the support, small acrylic pillars are added in

the canine region.
In the molar area, the support is given through the posterior

loops. Through the activation of these loops the correction
of the occlusion can be achieved in an anterior-posterior
and vertical plane. The posterior wire loops are not
integrated into the plates until the end.
The double plate with distal spring loops

according to Schwarz
U
Elements:
Function:
Description:
Labial bow 0.7 mm spring hard, spring loops 1.2 mm spring

hard
Treatment of anterior cross bites
With the distal spring loops the double plate can be reactivated
As wire elements, only simple labial bows are bent. The

retentive parts have to be blocked out with wax and the
extension of the plate is also limited with wax.
The models are mounted into the fixator with the

construction bite. The spring loops can then be fixed with
acrylic into the polished plates.
In order to be able to activate the springs better, they are

extended minimally over the base plate.
The LS-Duobloc according to Leger/Soerensen

U
Elements:
Function:
Description:
Labial bow 0.8 mm spring hard, labial bow with pads 0.8 mm
spring hard
Treatment of Angle class III patients
A bimaxillar appliance which can retrude the mandible by
activation of the screw
For the correct installation of the LS-Duobloc spring, the

complete installation kit is needed which consists of an
occluding pattern (A), a dividing metal sheet (B) and a
mounting pattern (C).
The occluding pattern (A) which is used for the

construction bite indicates the horizontal dividing line of
the bimaxillar appliance. The acrylic bases are only
connected through the installation of both screws on the
right and left side. The models are mounted into the fixator
in such a way that the mounting pattern and the fixator do
not hinder each other.
After bending the labial bow in the lower jaw and the labial
bow with integrated pads in the upper jaw, the acrylic can
be added.
For this purpose, the fixator is divided and a wax

embankment is added around the upper and lower model. In
the upper jaw the acrylic covers the anterior third of the
palate. The dividing metal sheet (B) with a Vaseline layer is
adapted onto the lower model and the fixator is closed until
its closing limit. After the polymerization of the acrylic, the
metal sheet is removed and the plates are finished.
In order to integrate the screws, the plates are grinded, box

shaped, on the right and left side. The position of the screws
is determined by the mounting pattern (C) and eventually
the acrylic has to be grinded slightly more. When the
screws adapt well into the grinded boxes, the screws are
covered with wax except for their retentions. The screws
are fixed in the mounting pattern and the free part of the
holding slot is also covered with wax.
he screws have to be proved for their parallelism and the

proximity to the dental arch and after that, the screws with
the mounting pattern can be polymerized into the acrylic.
The mounting pattern is removed from the mounted LSDuobloc screws, the screw slot is liberated of its wax and
the appliance is finished
The application field of the LS-Duobloc screw

U

In case of a mesial relation of the molars and incisors the
type I appliance is used.
In case of a neutral occlusion in the molar region and an

anterior cross-bite, the type II appliance is recommended.
In an asymmetric combination on the right and left side of

the mentioned malocclusions, the type III appliance is
indicated.
CHAPTRR 5
Bimaxillar appliances, activators,

bionators, function regulator appliances
The activator

Elements:
Labial bow and retention thorns 0.8 mm spring hard
Function:
Mandibular advancement and opening of the vertical dimension
Description:
By this passive and loose appliance functional stimuli are transmitted to the
bone tissue via muscle activity for example during swallowing
The classical activator according to Andresen and Hupl is

still one of the main appliances for changing the position of
the mandible and for the opening of the vertical dimension.
It can also be used for the lateral side shifting of the lower
jaw. This appliance, originally called Monobloc, does not
have any elements that can be activated and is designed as
delicate as possible. The retention thorns only anchor the
molars maximally, not the appliance, whose ideal function
is as an exercise device.
Labial bows and retention thorns are fixed with wax onto
the model. For the acrylic base, the model can be blocked
out additionally in order to accelerate the grinding and
finishing. After the models are prepared this way and
hydrated, acrylic can be added on each one individually and
before its polymerization, they are set together in the
fixator. The transitions are smoothed with additional
acrylic.
This base appliance can include interocclusal acrylic, or it
can be grinded free in order to achieve a passive opening of
the vertical dimension. With the inclusion of a screw an
additional transversal expansion is possible.
The Herren activator

U
Elements:
Function:
Description:
Labial bow 0.8 mm spring hard, retention thorns 0.8 mm spring

hardLabialbogen 0,8 mm fh,Haltedorne 0,8 mm fh
Modification of the muscular effect through an over dimensional opening
of the occlusion
The over dimensional vertical opening of the occlusion, which is intended
to alter the muscular activity, is characteristic for this appliance
The Herren activator differs from the classic activator only

in the high vertical opening. The elements are bent as in the
traditional activator and a wax collar is fixed for the
limitation
of the acrylic.
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ODONTOLOGICA
The vertical opening for the Herren activator is 8 to 10 mm,

determined by the construction bite and then set in the
fixator.
The design of the appliance of the finished activator does

not differ from the classic activator.
The propulsor according to Mhlemann/Hotz

U
Elements:
Function:
Description:
None
Treatment of maxillary dentoalveolar protrusions in the mixed
dentition
Bimaxillar appliance without wire elements
The models are located in the fixator according to the

construction bite. It is important to observe that the fixator
does not hinder the application of the acrylic.
When the retentive parts are blocked out, the models are
covered with wax for the acrylic base. In the upper jaw the
complete labial surface is covered with acrylic, in the lower
jaw theODONTOLOGICA
lingual surface. The connection of the upper buccal
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shield to the lower lingual shield serves also as occlusal
support and stabilizer for the appliance. The lower incisal
edges are also mounted into acrylic in order to prevent the
lower incisors from tipping.
In the posterior area the interocclusal acrylic is removed in
order to allow the premolars to erupt.
The headgear activator according to van Beek

U
Elements:
Function:
Description:
Headgear 1.2 mm spring hard

Treatment of malocclusions class II-1
This headgear activator achieves the mandibular position through the
lingual wings of its lower base
The models are set into the fixator by a construction bite

with a vertical opening of approximately 10 mm. Between
the central and lateral incisors the short and strong outer
bows are set into the acrylic of the activator. The lower
incisors are grasped labially 2 mm in acrylic in order to
avoid their protrusion. The lingual surfaces remain free.
The upper incisors are also grasped in acrylic. The position
of the mandible is achieved through the long lingual wings
of the lower base.
The upper base plate is kept small. The palatal area of the
upper anterior teeth is blocked out with wax in order to
allow a retrusion. The lateral bite plane reaches to the
centre of the occlusal surfaces. In the premolar region, the
lower base is extended as far as possible downwards.
In combination with a high pull headgear, this appliance

with bite block can be used to intrude the upper teeth.
The activator according to Pfeiffer and Grobety

U

Elements:
Modified labial bow with soldered triangular clasp 0.8 mm spring hard
Function:
Retraction of the upper jaw with simultaneous distal movement of the
upper teeth
Description:
Retraction of the upper jaw, and under influence of the masticatory
muscles, mesial movement of the lower teeth with simultaneous distal
movement of the upper teeth; the headgear is only used combined with the
fixator
The impressions are filled with the bands in order to be able

to adapt the finished appliance better. In the original
appliance only a modified labial bow with a soldered
triangular clasp is bent
The canine loops of the labial arch are placed as usual in

the canine area. Then the wire is bent distally and between
the first and second premolar it is bent into the retention.
The screw is fixed in the upper jaw and the base plate is
limited with wax stripes.
The activator additionally consists of lateral bite blocks and

an incisal cap in the lower anterior region.
The lower impression has to depict the lingual area very

well in order to extend the lower lingual wings as far as
possible into the sublingual area.
The lower wings of the activator should be very

pronounced on the lingual side favoring the activity of the
masticatory muscles.
This is a lateral view of the activator with its

pronounced lower wings.
The Functionator according to Eschler

U
Elements:
Function:
Description:
Labial wire 0.8 mm spring hard, triangular clasp 0.7 mm spring hard,
Adams clasp 0.7 mm hard
Treatment of class II-1 or class III
Depending on the position of the labial wire, the upper front can be
retruded (class II treatment) or the lower front can be moved lingually
(class III treatment)
Class II-1 treatment: When the labial wire adapts on the

upper front teeth, from the mesial third of 13 to the mesial
third of 23, then it is bent with distance to the lower incisor
area. This way, the upper front teeth which are blocked out
with wax can be moved orally and the lower lip can be
maintained off the lower incisors.
Class III Treatment: When the labial wire adapts on the

lower front teeth, from the mesial third of 33 to the mesial
third of 43, then it is bent with distance to the upper incisor
area. This way, the lower front teeth which are blocked out
with wax can be retruded and the upper lip can be
maintained off the upper incisors.
A screw can be added to the appliance. For a desired

anterior-posterior correction an inclined anterior plane can
be integrated in addition to the bite block.
The activator with spring bows according to

Schwarz
U
Elements:
Function:
Description:
Labial bow 0.8 mm spring hard, spring bow 1.2 mm spring hard
Activation through muscle function
Through the spring bows, which can be activated horizontally or
vertically, the muscle activity is stimulated
The base appliance only contains few elements, but can be

replenished in any way. A labial bow is bent for each upper
and lower jaw and the single plates are finished with plane
lateral bite blocks.
The polished and finished plates are set onto the models
which were articulated according to the construction bite.
Now the unifying spring bows can be bent and be added
into the acrylic of the single plates of the activator. These
spring bows are supposed to enhance muscle activity.
The spring bows reach distally over the base plate for a
proper activation. Different directions for their activation
are possible (horizontal, vertical).
The open bite activator with tongue crib

U
Elements:
Function:
Description:
Labial bow 0.8 mm spring hard, Coffin spring 1.2 mm spring

hard, tongue crib 1.0 mm spring hard, mandibular connection
bow 1.0 mm spring hard
Intrusion of the posterior teeth, extrusion of the incisors and
simultaneous protection of the tongue
The tongue is kept from the teeth because of the tongue loop
which follows the curve of the dental arch
The models are set into the fixator with the construction
bite and the vertical opening is determined. The labial bows
are bent as usual. The connecting bow in the lower jaw and
the Coffin spring in the upper jaw are fixed each 1 mm
from the gingival tissue. The divided tongue crib is fixed
parallel to the lingual or palatal area of the incisors.
The tongue crib consists of two divided loops. For the first
half, the wire is bent back 180 in the middle. The
separation of the parallel wires corresponds to half of the
area to be closed off. The loop is bent according to the
curvature of the anterior segment. Both wire ends are bent
over for retention and are anchored in the lateral part of the
activator. The second half is bent like a mirror image and is
set on the other side.
The acrylic body of the open activator is designed quite
delicately. The anterior open base and the adapted tongue
crib make this a well accepted appliance by patients.
The SKEL activator according to Ruhland type II-1

U

Elements:
For class II-1 II-2: Labial arch 0.9 mm spring hard, Coffin spring 0.9
mm spring hard, occlusal molar rests 0.8 mm spring hard, occlusal rests
canine 0.7 mm spring hard, protrusion spring 0.7 mm spring hard For
class III: Labial arch 0.9 mm spring hard, Coffin spring 1.1 mm spring
hard, lingual bow 0.9 mm spring hard, connection spring 0.9 mm spring
hard
Function:
A reduced elastic activator with different tasks for class II-1, II-2 and III
Description:
A reduced elastic activator
Type II-1
In the upper as well as in the lower jaw, the labial bows are
set into the acrylic between the 1st and 2nd premolar. The
distally closed Coffin spring is located in the molar region.
The lower incisors area is shaped with protrusion springs.
The canines in the upper jaw are held with C-clasps.
2T
2T
The acrylic base is reduced in its anterior part and has no

interocclusal acrylic. The delicate design of the acrylic and
the relative thin wire elements make this appliance very
flexible.
Altogether the acrylic body is kept small.
The SKEL activator according to Ruhland type II-2

U
Elements:
Function:
Description:
For class II-1 II-2: Labial arch 0.9 mm spring hard, Coffin
spring 0.9 mm spring hard, occlusal molar rests 0.8 mm spring
hard, occlusal rests canine 0.7 mm spring hard, protrusion
spring 0.7 mm spring hard For class III: Labial arch 0.9 mm
spring hard, Coffin spring 1.1 mm spring hard, lingual bow 0.9
mm spring hard, connection spring 0.9 mm spring hard
A reduced elastic activator with different tasks for class II-1, II-2
and III
Type II-2
The upper and lower front region is developed using
protrusion springs. The labial arch passes between the 1st
and 2nd premolar into the acrylic. The first molars are
maintained by thorns. The Coffin spring is positioned in the
same way as in type II-1.
2T
2T
The acrylic base is the same as in type II-1. From the mesial
part of the canines to the distal end of the molars both
acrylic parts of the upper and lower jaw are connected
.
The making of this appliance corresponds mainly to the one
of type II-1, it differs only in the protrusion springs in the
upper jaw and the lacking of the occlusal rests for the
canines.
The SKEL activator according to Ruhland type III-a

U

Elements:
hard
Function:
Description:
Type III-a
The appliance for class III is horizontally divided. Two
distal spring bows connect the upper and lower part.
2T
2T
The elements in the lower jaw are two holding thorns and a
connecting bow. The upper jaw consists of protrusion
springs, an intermaxillary bow and a Coffin spring. First,
both parts, upper and lower, are finished separately.
Interocclusal acrylic is not necessary. With a construction
bite, the upper and lower parts are connected in the
articulator through spring bows in the distal part of the
plates.
Through activation of the intermaxillary bow and both
spring bows the lower jaw is retruded.
ODONTOLOGICA
The SKEL activator according to Ruhland type III-b
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U
Elements:
Function:
Description:
hard
Type III-b
In the lower part, the same type can be replenished with a
tongue crib which simultaneously serves as a connecting
bow. Support thorns can also be placed before the molars if
needed.
2T
2T
The appliance is also divided horizontally and is activated

through the far distally fixed spring bows. The tongue crib
prevents a negative influence of the tongue. The
intermaxillary bow makes a distal movement of the
mandible possible
.
View of the finished appliance type III b.
The SKEL activator according to Ruhland type III-c

U
Elements:
Function:
Description:
For class II-1 II-2: Labial arch 0.9 mm spring hard, Coffin
spring 0.9 mm spring hard, occlusal molar rests 0.8 mm spring
hard, occlusal rests canine 0.7 mm spring hard, protrusion
spring 0.7 mm spring hard For class III: Labial arch 0.9 mm
spring hard, Coffin spring 1.1 mm spring hard, lingual bow 0.9
mm spring hard, connection spring 0.9 mm spring hard
A reduced elastic activator with different tasks for class II-1, II-2
and III
Type III-c
Instead of the spring bows between the upper and lower
jaw, a prognathism screw (LS-Duobloc- Screw) was
installed. Through this screw a more uniform distal
activation of the lower part is possible.
2T
2T
The acrylic is added in one process by means of a dividing

metal plate. In order to install the prognathism screw
parallel, a metal pattern is needed for their installation.
The SKEL activator type III-c according to Ruhland works

through the bilateral activation of the lower screws which
move the base of the lower jaw distally against the base of
the upper jaw.
The elastic open activator according to Klammt

(EOA)
U
Elements:
Function:
Description:
Palatal bow 1.2 mm spring hard, labial bow 0.9 mm hard

Alignment of the anterior teeth
Open activator with wide space for the tongue
The labial bows lie parallel to each other and are bent
buccally of the first molars into a loop. From there, they are
guided back mesially of the canines from where they are
bent palatal or lingual into the retention. The palatal bow is
bent similar to a Coffin spring and connects the acrylic
parts.
For an ergonomic finish and material saving, the models are

blocked out with wax. Under the palatal bow, a wax spacer
is placed to ensure adequate clearance for tissue comfort.
The acrylic shares lay orally from the canines to the last
molars forming a small band contacting teeth and gingiva.
The occlusal surfaces are not covered with acrylic and a
vertical support by the acrylic is left only in the canine area.
The rigid open activator (SOA)

U
Elements:
Function:
Description:
Connecting bow 1.5 mm hard, labial bow 0.9 mm hard,

supporting thorns 0.8 mm spring hard, protrusion spring 0.7 mm
spring hard
Alignment of the anterior teeth
Delicate activator with wide space for the tongue
For the SOA the elements are bent according to the planned
design and are fixed with wax. The rigid connecting bow is
underlaid with tin foil before its fixation in the area of the
first molars of the upper jaw to guarantee an even distance
from the palatal gingival tissue.
The acrylic base is designed as in the EOA, as delicate as

possible with interocclusal acrylic. The rigid connecting
bow gives the body of the appliance certain stability.
Because of the rigid connecting bow, with this appliance

expansion of the jaws is not possible
Modifications of the EOA and the SOA
Instead of the palatal bow, an expansion screw can be

incorporated and in the anterior region paired guiding wires
can be added.
If the canines should be influenced separately (in this

example an EOA), an additional M or U-loop can be bent
into the labial wire. In order to distract the tongue from the
incisors the Coffin spring can be replenished with a small
movable plastic pearl.
With corresponding carving of the models (in this example

an EOA), labial shields or pads can be added for functional
enhancement.
The spring activator according to Sander

U
Elements:
Function:
Description:
Labial bow 0.8 mm spring hard, protrusion loop 0.8 mm spring hard,
triangular clasps 0.7 mm spring hard, Adams clasps 0.7 mm hard, palatal
bow 3.0 x 1.5 mm half round steel wire, a special spring system according
to Sander: 1.0-1.1 mm spring hard wire with simple or triple loop
Treatment of skeletal open bites and rehabilitation after TMJ injuries
Special springs of 1.0-1.1 mm spring hard wire are located lateral in this
appliance and therefore do not hinder the tongue
For the making of the spring activator the models are set in
the fixator. As the acrylic base of the upper jaw is reduced,
the retentions have to be bent according to this situation
being anchored into this acrylic segment. The highest part
of the palate is covered with a tin foil which is 1 - 1.5 mm
thick to guarantee an even distance of the palatal bow and
to avoid pressure areas. The finished elements are fixed
onto the model, acrylic is added and the plate is finished.
The base of the upper plate should extend palatally as much

as to guarantee sufficient retention and stability for the
special spring. The upper plate is finished and polished
completely
in order to allow an even adjustment of the
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ODONTOLOGICA
upper and lower bite blocks. Isolated with a thick wax
layer, the upper bite block can be set onto the polymerizing
lower plate. Another option is to separate both plates with a
metal plate
Special attention should be paid to the fact that the labial

bow with its occlusal parts does not lie over the occlusal
plane. While occluding firmly with the spring activator
there should not be any interfering contacts in the anterior
area. The widths of the lateral bite blocks have to be
adapted orally so that the spring bow can glide past the
acrylic to connect the upper with the lower jaw.
Because of the extremely high load on the wire, the springs

should be made out of 1.1 mm wire. The decision on
whether to incorporate one or three loops into the spring
design depends on the oral space availability. The loops
have to be bent in such a way that while closing the wire is
pushed into the loop, which means it is activated (safety pin
principle). The length of the spring can be calculated
reaching from the last molar approximately to the first
premolar or canine.
After polishing both individually made plates and the bite
blocks lay even on each other, the height has to be checked
in the fixator according to the construction bite. The
retentions of the springs have to be anchored as far as
possible into the distal area of the acrylic segments. The
springs should be incorporated into the plate without strain.
Instead of the palatal bow, the spring activator can also be

fitted with a transversal expansion screw or headgear tubes.
If the headgear tubes are incorporated in the area of the first
premolars the triangular clasps cease to apply.
The divided activator with screw for the upper jaw

U

Elements:
Labial bow and retention thorns 0.8 mm spring hard
Function:
Separate expansion of the maxilla
Description:
In this horizontally divided bimaxillar appliance, the upper expansion
screw is anchored in the lower jawin diesem horizontal geteilten
bimaxillren Gert ist die Oberkiefer- Dehnschraube im Unterkiefer
verankert
The elements are bent following the design, in this case,

additionally with two protrusion springs. The extension of
the acrylic base is limited with wax. In this horizontally
divided appliance, after bending the elements, the lower
jaw is finished separately and polished.
In the interocclusal area, the upper and lower bite blocks of

the divided activator show a separation of almost one
millimeter. That is the reason why this area is covered with
wax to this height.
In the upper jaw, the screw is centered and fixed with wax
so that the retentions of the screw stick out into the lower
jaw. Therefore, in the anterior region, two notches have to
be grinded into the lower base plate. The fixator should be
able to open and close without interference. The area of
retention in the lower jaw is blocked out with wax.
Now acrylic is added on the upper jaw. While the acrylic is

still malleable the fixator is closed. The wax layer in the
retention area of the screw prevents the union of the upper
and lower plate. This way the upper plate can be sawed,
finished and polished separately.
After this, both separately produced plates are unified to

one appliance. For this purpose, the division and the
interocclusal area close to the screw are covered with wax.
Now theODONTOLOGICA
retentions of the screw are polymerized into the
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lower plate and therefore both plates are unified to one
bimaxillar appliance.
The upper part of this activator can be expanded without

the lower jaw.
The Prognathism activator according to

Wunderer with screw according to Weise
U
Elements:
Function:
Description:
Labial bow 0.8 mm spring hard, retention thorns 0.8 mm spring hard
Continuous retropositioning of the mandible with simultaneous
advancement of the upper jaw
In this horizontally divided activator, through the effect of the screw
according to Weise a continuous retropositioning of the mandible and a
simultaneous advancement of the upper jaw are strived for
The body of the Weise screw unifies the upper plate with
the lower plate through a strong U-shaped bow. Only the
retention part of the screw is grasped in the acrylic. The
bow extends orally over the acrylic base. The sagittal
divided screw lets the upper plate glide over the lower plate
The labial bow for the upper jaw normally does not contact
the incisors while in the lower jaw it contacts the incisors
passively. The retention thorns are bent as usual. The parts
of the upper
and lower jaw are finished and polished
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ODONTOLOGICA
separately. It is important that the occlusal and interdental
tooth surfaces are grasped with acrylic.
The prognathism screw according to Weise is polymerized

into the lower plate in such a way that it does not hinder the
upper jaw in its occlusion also verifying that the body of the
screw is parallel to the occlusal plane. The retention part of
the screw has to be well covered with acrylic. The bite
block of the lower plate can be covered with an even layer
of wax in order to avoid a later division of the activator.
After this preparation of the lower base plate, acrylic can be
added on the upper part of the activator.
The connecting bow from the upper to the lower part and
the part of the body of the screw that extends orally are not
covered with acrylic, only the retentions of the screw
.
In the finished activator, in the upper part of the base plate a
small opening can be grinded from the palatal side in order
to activate the screw. Nevertheless the screw can also be
activated from the oral side with a screwdriver.
The finished acrylic base has to be designed as delicately as

possible. Through the continuous activation of the sagittal
screw spindle a retropositioning of the lower jaw and an
advancement of the upper jaw are possible.
The U-bow activator according to Karwetzky

U

Elements:
U-bow 1.2 mm spring hard, labial bow 0.8 mm spring hard
Function:
Movement of the mandible in different directions, according to the specific
type (type I-III)
Description:
Through the addition of different U-bows into the elastic activator, different
directions of mandibular movement are possibl
For the U-bow activator separate upper and lower plates

with even grinded bite blocks and other elements
(depending on the planed design) are made. If screws are
added into the plates, they only have effect on that specific
jaw.
Type I distal activator Through both U-loops, which are

anchored into the acrylic in the region of the first molars,
both plates are joined to a bimaxillar appliance. The long
arm of the U-bow is always fixed into the lower jaw, the
short arm into the upper jaw. In this type I distal activator
the arms of the U-bow point anteriorly.
Type II prognathism activator In type II both anchored arms

of the U-bow are directed posteriorly. The long arms are
situated in the lower plate as seen here
.
Type III-a
Pan activator In this type III-a two different bows are built
in. On the right side, the upper short arm shows distally, on
the left side, the short upper arm shows mesially. When
activating the U-loops a panning movement to the right is
produced.
Type III-b Pan activator

In the type III-b the U-bows are incorporated opposite as in
type III-a. On the right side, the short upper arm shows
mesially,
on the left side the short upper arm shows distally.
PDFREE COMUNIDAD
ODONTOLOGICA
This way, when activating, a panning movement to the left
is the result.
This draft shows a schematic representation of the U-loops

of the different activator types and the movement which is
produced by their activation (draft according to the tooth
scheme).
The Teuscher activator

U
Elements:
Function:
Description:
Headgear tubes, torque springs 0.5 mm spring hard, Coffin spring 1.2 mm
spring hard
Inhibition of the development of the upper jaw with simultaneous
mandibular advancement
This headgear activator hinders the development of the upper jaw with
simultaneous advancement of the mandible
Base appliance with four torque springs

The torque springs only contact the upper incisors in one
point shortly underneath the gingival margin. It is bent
away slightly to avoid contact with the rest of the clinical
crown. The retention is in the interocclusal area.
The headgear tubes lie between both tooth rows in the area
of the deciduous molars. The interocclusal area should be
high enough to allow a good anchorage of the retentions of
the headgear tubes in the acrylic. It should also be checked
from the occlusal point of view if they lie parallel to be able
to insert the inner bow without any problems.
The acrylic base has to cover one third of the lower

incisors, and the upper incisors should be covered on the
palatal side up to one half and on the labial side, only to the
incisal edge.
PDFREE COMUNIDAD
ODONTOLOGICA
Modifications of the Teuscher activator

U
a) Torque springs on the central incisors

The Teuscher activator allows the design of torque springs
on the central incisors in combination with protrusion
springs for labial movement on the lateral incisors.
2T
2T
b) Sheet springs and labial bow

The same effect can be achieved with sheet springs and a
labial bow that should contact the most prominent teeth.
2T
2T
c) Labial pads
On the Teuscher activator, lip pads for the development of
the lower jaw can be attached as in the function regulator
according to Frnkel. Therefore the limit of the vestibule
has to be erased before making the appliance.
2T
2T
d) Lip bumper
Also, a lip bumper can be attached directly to the appliance
in order to support a protrusion of the lower incisors. It has
to be positioned in height of the gingival margin in front of
the lower incisors in a distance of approximately 1 mm.
2T
2T
e) Expansion screw
Another variation for the expansion of both jaws: an
expansion screw between the upper and lower jaw.
2T
2T
f) Combination with fixed appliances

If the Teuscher activator is used in combination with a
transpalatal arch and upper molar bands, the activator has to
be liberated in the area of the molar tubes and the palate.
2T
2T
The Harvold-Woodside activator for class II-1

U
Elements:
Function:
Description:
Labial bow 0.9 mm spring hard, distalizing springs 0.9 mm spring hard
Functional change of the occlusal plane in a malocclusion class II-1
A vertical opening of up to 20 mm is necessary for this activator; the
smooth lateral bite plane maintains the upper incisors and the lower are
grinded
In this class II-1 activator the labial bow is bent contacting

up to the canines, from there it is bent similar as the
buccinator loop to shield the cheek and is then bent through
a U-loop again towards the front; the retention finishes in
the area of the interocclusal opening. The distalizing
springs consist of a big loop in the molar region and have a
distal cantilever mesial of the first molars and its retention
in the incisal area
The coverage with wax should be done carefully. The

characterizing feature of this appliance is the large vertical
opening in the buccal sections which is determined by a
construction
bite. In order to guide the anterior movement
PDFREE COMUNIDAD
ODONTOLOGICA
in the posterior region, a thin wax plane is added in the
upper jaw and a high wax plane, higher than half of the
vertical opening, is added in the lower jaw; the main
purpose is to create plane surfaces for the acrylic platforms.
If the fixator is closed the separation between both wax
planes in the buccal area should be of approximately one
millimeter, so that the lateral bite plane presents enough
stability.
On the models the extension of the acrylic shield over the

whole incisal area in the upper and lower jaw should be
limited with a wax frame. The retention of the labial bow
lies in the interocclusal acrylic right behind the upper
incisors. The models prepared this way can be covered with
acrylic and put into the pressure vessel for its
polymerization.
In the finished appliance, for their proper activation, only

the retention of the distalizing springs is covered with
acrylic. The labial bow only contacts the upper incisors.
The distal limitation of the appliance is the A-line.
The labial shield covers the incisors over one third of their
clinical crown. The lateral bite planes have no contact at all
with the posterior teeth in order to achieve the desired
vertical eruption.
The Harvold-Woodside activator for class III

U

Elements:
Labial bow 0.9 mm spring hard, distalizing spring 0.9 mm spring hard
Function:
Therapy of a class III malocclusion
Description:
The class III activator should not hinder the buccal segments in their
vertical eruption
In this class III activator, the labial bow in the lower jaw is
bent as an intermaxillary bow; its task in the upper jaw is to
shield off the lips through loops bent as labial pads. The
retention lies as in the class II appliance, in the anterior area
of the vertical opening. Also, the distalizing spring is bent
with a big loop in the molar region. Although in this
appliance the distal cantilevers are located behind the first
molars, the retention ends in the anterior palatal area.
As before, the wax coverage is very important. The big
vertical opening corresponds to the one in type-II. In this
case, a wax plane that reaches over the half of the vertical
opening is added onto the upper jaw. In the lower jaw, the
posterior teeth are slightly covered with wax and in the
incisal area, from canine to canine, the wax is concavely
shaped; the loop and the distal cantilever of the distalizing
spring are also covered with wax.
For its proper stability, the acrylic in the interocclusal area
should show a thickness of one millimeter.
The acrylic shield of this appliance only covers the lower

incisal area and is correspondingly framed with a wax
limitation. Despite its location, a sufficient anchorage has to
be guaranteed for the retention of the labial bow. Before
adding the acrylic both models have to be hydrated.
In this class III appliance, the distal limitation is also

marked by the A-line. Once again, only the retention of the
distalizing springs is grasped in acrylic. In the upper jaw,
the labial
bow does not contact but shields off the lip
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The upper teeth only contact the acrylic shield. The acrylic
can be trimmed and shaped individually by the orthodontist.
The lateral bite plane allows more vertical eruption for the
upper posterior teeth.
The bionator according to Balters

U
Elements:
Function:
Description:
Buccinator loop 0.9 mm spring hard, Coffin spring 1.2 mm

spring hard
Influence on the lip and tongue function
A reduced activator with special influence on the function of the
lips and tongue
The three basic types of the bionator:

1) In the base appliance, the labial part of the wire of the
buccinator loop runs along the incisal third of the anterior
teeth up to the centre of the canine. From there the wire is
bent diagonal downwards and then in a distance of 2 mm
from the posterior teeth, it is led distally as a buccinator
loop up to the mesial cusp of the first molar. From this
point on, it is bent back along the upper teeth. The distance
between the two wires of the buccinator loop should not
exceed 1 cm in order to shield off and avoid the
interposition of the cheek.
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The Coffin spring is bent distally closed. The appliance can

be designed with an acrylic overhang for the lower incisors.
The bionator is a rigid appliance with a delicate design of

its acrylic base. The position of the tongue is influenced by
the Coffin spring.
2) The shield appliance has a similar labial bow as the base

appliance. Because of the open bite, for example in patients
with tongue dysfunction, the labial wire is located in the
middle between the upper and lower incisors. This bow
hinders the introduction of the lower lip between the arches.
The acrylic base of the shield appliance is closed in the

front but it should not contact the incisors or the
dentoalveolar margin so that the open bite can close. This
area can be blocked out with wax before the application of
the acrylic, or be trimmed free after its finishing.
3) In the reverse appliance, the labial bow only contacts the

lower front teeth; it is then led distally up to the centre of
the first molars and from there, back over the upper molars.
Between the canines and the first premolars in the upper
jaw the labial bow is bent orally into the retention. The
shape of the Coffin spring is opposite to the shape in the
base and shield appliance.
In the anterior region the acrylic base of the reverse

appliance is vertically elongated in order to influence the
upper incisors labially, as with an inclined plane. This bite
plane serves
as protrusion element for the maxillary
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anterior teeth.
Modifications of the bionator

a) Headgear tubes:
The appliance can be used with extraoral traction for the
upper jaw including HG-tubes in height of the second
deciduous molars or the second premolars. A precondition
is a sufficient vertical opening which should be considered
during the realization of the construction bite. The HGtubes
can be integrated into the interocclusal acrylic during its
polymerization or they can be incorporated afterwards.
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b) High labial bow:

If the patient has problems maintaining the appliance in
position while speaking or even in its rest position, a high
labial bow can be added onto the labial arch. For the
soldering it is recommended to cover the acrylic with heat
protection paste. The high labial bow is bent depending on
the modification high into the vestibule and soldered onto
the buccinator loop.
c) Lateral shields:
If the vertical opening is wide, the buccinator loops can
present a longer distance than 1 cm. In order to avoid the
interposition of the cheek, the loops are covered with
acrylic. Before this, it is important to underlay this area
with wax to guarantee a sufficient distance from the lateral
shields to the teeth in order to allow a transversal
expansion.
d) Labial pads in the upper jaw:
It is also possible to add labial pads in the upper jaw, here
in a reverse appliance. These pads or shields are made
following the same principles as in the making of the
function regulator according to Frnkel.
e) Labial pads in the lower jaw:

To achieve an anterior-posterior development, the labial
pads can also be incorporated in the mandible.
The kybernator
U
Elements:
Function:
Description:
Coffin spring 1.2 mm spring hard, labial bow and retention thorns 0.8 mm
spring hard
Setting of a neutral occlusion
Setting of a neutral occlusion with simultaneous elimination of an
increased overjet and overbite
The kybernator differs from the bionator mainly through its

labial bow. The design can incorporate a labial bow in the
upper jaw and an acrylic overhang in the lower jaw.
It is also possible to add two labial bows, retention thorns

and if necessary, all kinds of springs. The Coffin spring
ends in the molar area.
Whether the lateral bite plane contains interdigitations, or if

it is plain, or is removed totally, has to be decided
depending on each patient.
The bite restrainer according to van Thiel

Elements:
Arrow clasps 0.7 mm spring hard, labial bow 0.8 mm spring hard
Function:
Retrusion of the front
Description:
The special construction of the labial bow retrudes extremely protruded
incisors
This appliance contains retention elements in the mandible,

in this example arrow clasps. A labial bow is added both in
the upper and lower jaw.
The appliance base is made according to the design of the

bionator base appliance.
Additionally, transversal or segmental screws can be added

to this appliance.
The function regulator appliance according to

Frnkel (FR I to FR IV)
U
Elements:
Function:
Description:
Depending on the appliance

Correction of functional disorders
These bimaxillar appliances have to be seen as functional
orthopedic exercise devices with labial and buccal shields
General prerequisites for the FR I - IV

The buccal vestibule has to be measured intraorally in order
to be able to carve the upper model for the labial pads and
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ODONTOLOGICA
vestibular
shields. Normally the orthodontist should carve
the model himself during the appointment. If not, he has to
give the technician exact measurements which have to be
transported onto the model.
The thickness of the wax relief is measured with a probing

instrument, and should be 3 mm in the area of the teeth and
2.5 mm in the vestibular sulcus. The wax relief has to be
done with the greatest care because only then a correct
adjustment of the appliance and an expansion of the
dentoalveolar ridge are guaranteed.
Function: FR I
The function regulator type I is planed for the transversal
and sagittal compression of an Angle class I and II and for a
slight developmental inhibition of the apical base. It is also
used in the class II-1 without an increased overbite and
without a notorious mesial migration of the lateral
segments. Components: 2 vestibular shields, 2 lower labial
pads, 1 lingual shield with lingual bow, 1 palatal wire with
occlusal rests, 2 canine loops in the upper jaw and the
support or connecting wires of the pads and shields.
In the FR I the wire diameter for the labial bow in the upper
jaw is 0.9 mm. The canine loop (wire diameter 0.9 mm)
starts in the distobuccal aspect of the canine, it is bent
completely around the canine and ends buccally in the
lateral shield between the canine and the first premolar. The
palatal wire with rest is bent out of 1.0 mm wire
In the lower jaw, the support wires between the labial pads
and the vestibular shields as well as the connecting wire for
the pads are 0.9 mm strong.
The connecting wire between the vestibular shield and the

lingual shield is bent out of 1.0 mm wire. The lingual bows
and the stiffening wire are bent out of 0.8 mm wire in this
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example.
The lingual shield of the FR I is designed in such a way that

the lingual bows lie free and only the stiffening bow and the
connecting wires are grasped with an acrylic pad.
The acrylic shields and the pads have a thickness of

approximately 2.0 mm. The length of the vestibular shields
has to correspond to the extension of the carvings.
type FR II has its application in the class I with retrusion of

the incisors and increased overbite, in the class II-1 with
extreme protrusion of the upper incisors and increased
overbite as in the class II-2.
Components:
The FR II consists of 2 vestibular shields and 2 lower labial
pads, the lingual shield and the palatal wire. It differs from
the FR I only in the modified canine extensions in the upper
jaw and the protrusion bow.
Function: FR II
The function regulator
For the protrusion bow or upper lingual wire the model has
to be carved deeply between the canine and the first
premolar. The other elements are bent according to the FR
I.
Only the canine extension is bent in a different way as in

the FR I. It runs along with a parallel bent wire over the
labial surface of the canine and then is bent upwards to
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finish with
its retention in the vestibular shields.
To activate the anterior segment of the vestibular shield and

the connected lingual shield, the vestibular shield has to be
sawed open and the vertical sawing line widened with a
wax knife.
The lingual shield and the protrusion bow should not hinder
each other.
Function: FR III
The function regulator type III is designed for malocclusion
class III, especially for patients with a notorious mandibular
prognathism in combination with a midfacial insufficiency.
Components:
2 vestibular shields, 2 upper labial pads, 1 protrusion bow,
1 lower labial bow and occlusal rests.
For the FR III the wax relief on the model has a different
shape. The model has to be carved more than usual in the
area of the upper lip pads. The wax relief is only added onto
the upper model as in the area of the upper lip pads.
Additionally, with a thin drill, a groove is grinded into the
lower front in height of the gingival papilla in order to
guarantee a tight fit of the lower labial bow onto the teeth.
The wire elements for the FR III: lower labial bow, 2

occlusal rests on the last lower molars, 1 protrusion bow or
upper lingual wire in the upper jaw as well as the support
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wires for
the lip pads and vestibular shields. If necessary,
occlusal rests can also be added in the upper jaw.
In the mandible, the vestibular shields fit closely opposite

to the upper jaw. When all the wire elements are bent,
acrylic is added and the appliance is finished.
Function: FR IV
The function regulator type IV is used in class I patients
with skeletal open bite, especially as early treatment in the
first mixed dentition. Another application area is the
bialveolar protrusion in the mixed dentition. In these
patients a labial bow is added in the mandible.
Components:
2 lower labial pads, 2 vestibular shields, protrusion bow,
occlusal rests and palatal wire.
The wax layer of the FR IV is designed as in the FR I and
FR II. The occlusal rests can be designed individually
respecting their form and location; they should avoid
interfering with the distal traslation of the FR IV.
Interdental erasements and rests of the lateral shields have
to be avoided.
The elements in the upper jaw are: 1 labial bow, 2 occlusal

rests led on the first molars from distal, 2 occlusal rests on
the first premolars and 1 palatal bow that runs behind the
first molar. In the lower jaw, the connecting wires and the
rests on the first molars are bent.
In the FR IV the occlusal rests and the labial pads contact

the model in contrast to both lateral shields.
Function regulator with integrated screw In all Frnkel

appliances the vestibular shields can be replenished with
screws. This allows a posterior activation of the lip pads if
necessary. The wire elements are bent following the
planned design and the screw is fixed onto the wax relief.
Acrylic is added on the function regulator, in this case, a FR

II; it is finished exactly as usual and then the sawing cut is
realized.
When the pads shall shield the lip further off, both screws
are activated parallel.
CHAPTRR 6
Wire appliances, rapid palatal expansion

(RPE) appliances
The Crozat appliance

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Elements:
Function:
Description:
Crib (Jackson clasp) 0.7 mm, crescent (retention thorn) 0.8 mm, occlusal
rest 1.0 mm, lingual arm 1.0 mm, body wire 1.2 mm, buccal extension 1.3
mm, elastic hooks 1.0 mm, cuspid hooks 0.8 mm, distal extensions 0.8 mm,
precurved auxiliaries 0.8 mm, basic high labial arches 1.3 mm, pins, putters
0.7-0.8 mm, elastic hooks 0.8 mm
The Crozat appliance can perform all functions of an active plate
In this appliance, the wire elements are not anchored in an acrylic base,
but lasered or soldered together
The treatment sequence of Crozat appliances takes

place in three phases: In the first phase, using the basic
appliance, expansion of the molars and premolars is
induced and also derotation of the first molars if
necessary.
In the second phase, canines and second molars are

aligned or rotated. Therefore the basic appliance has to
be adapted passively on the cast and then the
corresponding springs are soldered on.
In the third phase the following tasks are achieved:

Movement of single teeth or tooth segments
towards buccal palatal, mesial or distal, extrusion
or intrusion of teeth, rotations of incisors or
premolars and transverse expansion in case of
relapse.
The retention period starts after the third phase.
The preparation of the cast

First, the buccal equator of the teeth is determined with
a parallelometer in order to indicate the position of the
horizontal
buccal part of the clasp. The gingival
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triangles, mesially and distally of the molar, are
removed from the plaster cast. The erasing has to be
done parallel to the occlusal plane. It is important not to
erase too deep, so that once inserted, the crescent does
not crush the papilla. A careful erasement guarantees a
good support even when a stronger strain is applied. If
necessary, the cast is now duplicated to make a
soldering cast.
The crib
The crib is the most important clasp of the entire
appliance, and therefore, has to be adapted very
precisely to the shape of the tooth. It fits tightly on the
first molar and has to grasp the tooth interproximally in
such a way that even its rotation is possible. The
horizontal buccal part of the clasp lies over the equator,
underneath has to be enough distance to the gingival
margin in the buccal area for the crescent.
The crescent
In the interdental space on the buccal side of the first molar,
small holes are made with a 0.8 mm drill into the mesial and
distal area of the cast. These holes allow a better fitting of the
crescents onto the soldering cast. The curve of the crescent
has to lie mesio-distally, exactly onto the buccal contour of
the molar and the extremes have to lie in the holes. For the
later soldering the crescent on the buccal side has to lie
exactly along the crib. After the laser or conventional
soldering, the crescent has to be shortened according to the
holes drilled.
To achieve a stable soldering surface as well as a

smooth and clean inner side of the appliance a thin
metal band is pushed behind the crib and crescent. For
this purpose, thin band material such as the one used in
banding technique for the anterior teeth is employed.
The unpolished side of the band shows outwards. This
small piece of band is pushed along the buccal surface
of the molar behind the clasps.
The occlusal rest

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occlusal rest adapts onto the palatal groove
and the occlusal surface of the same molar (with
the clasp). To avoid occlusal interferences, the rest
has to end shortly before the central fossa. After
the soldering, a corresponding shortening is
possible.
In the upper jaw

The body wire
First, the U or W-loop is adapted onto the model.
The palatal rest has to be bent slightly inwards
according to the shape of the palate. The endings
of the palatal rest lie along the horizontal parts of
the crib. It is important to keep an even distance of
1 mm to the gingival tissue.
The lingualarm
Continuing exactly with the occlusal rest, the
lingualarm is bent adapting up to the first
premolar. The bent between the first molar and the
second premolar has to be located in the interdental
space, the rest of the entire arm can either contact
in one point or can be curved and also reach into
the interproximal area.
The buccal extensions

It is fixed buccally on the center of the first molar.
Later on, it can serve for the buccal expansion of
the appliance (e.g. high labial arch), without
compromising the solder union of the crib or
crescent. The buccal extension simultaneously
makes the removing of the appliance easier for the
patient without deforming the crib. The end of the
wire is bent concavely to ensure a sufficient
distance to the gingiva. The wire is bent in a 90
degree angle. The length of the bow should not
exceed 12 mm.
In the lower jaw

The body wire
When
the crib and crescent for the lower jaw are
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finished, the lingual arch can first be adapted
manually into U-shape in the approximate size of
the sublingual space. In the centre of both molars a
right angle is bent towards occlusal and in height
of the crescent, another bend is made mesially. The
wire has to have an even distance to the cast and
assure symmetry in the horizontal plane.
The remaining elements are bent according to

those in the upper jaw. Concerning the lingual arm
and the palatal arm, it is important that the bent
between the first molar and the second premolar
reaches into the interproximal space. When the
lingual arm is not activated, it lies flat contacting
the second premolars in one point. If the lingualpalatal arm is activated, it has to be bent bow
shaped onto the premolars.
Precurved auxiliaries
In the upper as well as in the lower jaw, for the
protrusion of the incisors auxiliaries are soldered
or lasered onto the lingual or palatal arms. A Uloop is incorporated in the area of the premolars
which extends over the gingival tissue. The active
part of the spring arm should contact the incisors.
The Pin
The single springs can be bent in different shapes
and serve different purposes. In this case, a simple
pin is soldered or lasered onto the labial arch for
moving the canine.
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basic high labial
The basic high labial is located, as its name
suggests, in the vestibule and then soldered or
lasered buccally onto the crib. One has to pay
attention to avoid the labial and lateral frenum.
The putters
For the mesial movement of teeth, the point of
force application should come from a distal wire
ending. A distal movement takes place through
springs adapted mesially.
Elastic hooks
The elastic hooks for the intermaxillary elastics are
soldered in the area of the canine onto the labial
arch.
Buccal hooks
In the lower jaw, the buccal hooks are soldered or
lasered onto the crib. These hooks serve for
engaging class II elastics.

For the soldering or lasering, all elements have to be
fixed with thermal wax onto the cast in order to check
the exact fitting of the single components once again.
In order to stabilize the single wire elements

sufficiently for the soldering, all wax areas are covered
with soldering plaster.
The completetly soldered or lasered appliance is

finished with small grindstones and smoothed out with
rubber polishers. The last step is to give shine to the
appliance which can be realized with a handpiece with
small brushes or carefully on the lathe.
Looking at the crib from the inside, the smooth inner

surface of the small soldered metal plate can be seen.
The exceeding parts of this metal plate have to be
worked out according to the shape of the wires.

A finished third phase lower Crozat appliance.
The wire appliance according to Meyer, bite

plane appliance, shielding appliance and braces
appliance
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Elements:
Function:
Description:
Basic bow 1.0 mm, transpalatal arch with molar rests 1.0 mm,
lingual basic bow 1.0 mm, anterior vertical support 0.8 mm
(remaloy wire)
Functional orthopedic appliance for anterior-posterior
problems, preferentially applied in Angle class II-1 patients
Delicate functional appliance which imposes slight restriction on
the tongue space and therefore promotes patients compliance
To ensure its stability the maxillary basic bow has

to be bent out of one piece of wire. It embraces the
incisor area buccally like a normal labial arch with
two U-loops in the canine region. From there, it is
bent orally along the premolars and molars and is
then bent towards the palate. In a distance of 1-2
mm the transpalatal arch follows the shape of the
palate and its function is to stabilize. Both of its
occlusal rests lie on the first molars and the palatal
part of the wire follows the extremes of the upper
basic bow. The mandibular basic bow follows the
lingual surfaces of the lower premolars until
distally, then it is bent towards the upper jaw to
form a soldering union with the transpalatal and
the upper basic bow.
The doubled casts are set into the fixator according

to the construction bite. Anterior vertical supports
are soldered in the height of the first premolars
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between
the upper and lower jaw for stabilization.
For the soldering process, the wires can be fixed
with either sticky wax or soldering plaster, or can
be pointed by a Spot Welding Unit. The wires
should all lie side by side and should be soldered
without tension in the assembled fixator. It is
favorable to use a Laser soldering unit because a
higher deformation and corrosion resistance can be
achieved.
An acrylic pad is incorporated into the appliance

for its support. The finishing of the appliance is
done as usual. For the final polishing, the use of a
handpiece is recommended because the danger of
distortion is greater on the lathe.
The bite plane appliance (AUF), which can be used

by class II patients with increased overbite or for
TMJ therapies, makes a construction bite of 2-3
mm sagital/vertical step without joint sounds
necessary. The anterior bite plane exceeds the
lower incisors horizontally. When the lower
Incisors are protruded, the acrylic covers the lower
incisal edges so that these are grasped 1-2 mm.
The shielding appliance (AB) is effective in

patients with lateral or anterior open bites, as well
as visceral swallow pattern, hypotonic big tongue
(M. Down) or sucking habits. The construction bite
is taken with a 2 mm overjet. In the posterior
region, the wax bite should be bitten through. To
shield off the tongue, a lingual shield which
reaches from the lower lingual arch up into the
upper incisor area should be added. In case of
lateral or partially lateral open bites, additional
vertical wires are soldered in the premolar region.
The braces appliance (MB) is used parallel to fixed

appliances, for example, in later dentitions,
angulation
or rotation. The labial arch is bent
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without U-loops and is placed incisally of the
brackets. In anterior open bites the labial arch is
located with its U-loops gingivally of the brackets
in order to use vertical elastics. The addition of a
moving pearl onto the transpalatal arch can also be
realized to achieve stimulation according to
Castillo Morales.
The Frozat appliance according to Mayes

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Elements:
Function:
Description:
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Lingual arch and lingual arms 1.0 mm remaloy

Depending on the activation: compression or expansion of the
arch, front protrusion, molar uprighting
Fixed appliance for a transversal and sagital arch expansion in
the mandible
The lingual arms and the lingual bow are bent from
one piece of wire. The lingual arms are extended
over the center up to the distal part of the lateral
incisor of the counter lateral half of the arch and lie
therefore double on the incisors.
The lingual bow has an even distance from the

gingival tissue of approximately 1-2 mm. In the
area of the premolars a slight bend is bent
lingually. The lingual arms adapt in the region of
the equator or cingulum of the teeth.
Once the appliance, bent out of one piece of wire,

lies ODONTOLOGICA
fitting passively with the anterior springs on
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the incisors and the lingual bow has the necessary
distance, it is point welded with the Spot Welding
Unit and then soldered. With the corresponding
activation the incisors can be protruded, the molars
can be uprighted and a transversal expansion or
compression can be achieved.
The manufacture of an appliance with lingual

cantilever according to Kinzinger
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Elements:
Function:
Description:
Lingual arch and unilateral anterior spring 1.0 mm remaloy

Unilateral molar distalisation
Fixed appliance for the sagital arch expansion in the lower jaw
After taking an impression with adapted bands, a

working cast is made.
The lingual arch is bent assuring an even distance

from the gingiva of 1- 2 mm with a small lingual
bent in the premolar area. The wire should contact
the molar band on its total lingual surface to ensure
a wide and solid soldered joint.

The precisely adapted Frozat appliance is fixed
onto the bands with a Spot Welding Unit.
When the solder used does not contain flux,

separate flux has to be applied on the soldered
joint.
The prepared appliance can finally be soldered to

the bands.
The unilateral lingual arm lies contacting in one

point in height of the equator in the premolar
region and on the cingulum in the anterior region.
It is extended up to the lateral incisor of the
counter lateral side.
The Lizat appliance (Lip bumper and Frozat)

according to Kinzinger
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Elements:
Function:
Description:
Lingual arch and anterior spring 1.0 mm remaloy, lip bumper

1.0 mm
Molar distalisation with simultaneous anchorage through the
lower lip
The lip bumper is mainly used to enhance anchorage, but can
also support the distalisation of the molars
The lingual Frozat appliance is bent as usual.

Special attention should be paid to avoid hindering
the lingual frenum when determining the position
of the lingual arch.
Buccal tubes are soldered onto the molar bands to

receive the individually made lip bumper. This lip
bumper has a wider and thicker acrylic shield than
the preformed ones.
The finished lip bumper has to be inserted easily

and without tension into the corresponding buccal
tubes by the patient.
The lingual arch according to Mershon

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Elements:
Lingual bow 0.8 mm spring hard, auxiliary springs 0.2-0.4 mm
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Function:
Description:
spring hard
Expansion of the arch
Through continuous force of the bow and possible auxiliary
springs, smooth tooth movement is possible
The lock, which is vertically soldered onto the

molar band, has to be grinded concavely to receive
the anchorage of the Mershon bow. If the molar
band is made out of band material occlusal rests
can be incorporated directly.
The double bent lock pin has to be bent together

tightly. The rest of the shape has to be adapted to
the molar band exactly according to the
illustration. The gingival anchorage has to have
some tension to engage underneath the vertical
lock into the concavely grinded nut.
Besides, for single tooth movements, small springs

can be added to the lingual bow.
The Herbst appliance

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Elements:
Occlusal rests, TPA and lingual bow 1 mm hard or one piece
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Function:
Description:
casting method
Achievement of a neutral occlusion after tooth eruption is
finished
In order to avoid a transversal movement of the anchorage teeth,
the rigid construction of the Herbst appliance is chosen
The preformed crowns are adapted and big

perforations are made in the middle of the occlusal
surfaces in order to allow the cement to flow and to
make the removal of the bands after treatment
easier. In the upper jaw, the TPA and the occlusal
rests can be bent out of one piece of wire and then
be soldered. In the lower jaw, the occlusal rests are
soldered separately on the premolars and the
lingual arch is soldered to the crowns.
The buccally located guiding hinges (for anchorage

reasons) are assembled and screwed. The length of
the guiding hinge has to be checked in the mounted
casts which are set into the fixator by a
construction bite.
In the Herbst appliance, made with the one piece

casting method, the attachments for the anchorage
of the guiding telescopes are soldered. In this
construction, the TPA in the upper jaw is not
absolutely necessary.
The Herbst appliance with soldered bands

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Elements:
Bands for soldering, upper connecting bow and connecting bow
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Function:
Description:
in the lower jaw, lingual and buccal 0.9 mm hard

Achievement of a neutral occlusion after tooth eruption is
finished
This delicate version of the Herbst appliance has no coverage
of the occlusal surfaces of the molars
After adapting the canine bands in the lower jaw,

the practitioner has to place a band two sizes
bigger over the first band. These bands are sent to
the laboratory where the first band is sandblasted
on the outside and the second band on the inside
and then both are soldered together. Therefore, one
holds the first bands mesio-aproximally with
tweezers and puts solder around it.
Afterwards, both bands are carefully assembled up

to the solder point. The union of both bands is held
by tweezers from occlusal and gingival sides and
then the first band is warmed up from the inside to
make the solder flow. Through uniform pressure of
the tweezers from gingival and occlusal, the bands
are pushed together. This way a stable band for the
lower canines is made.
The soldered canine bands are adapted again in the

patients mouth. Now the impression for the
working casts is taken together with the other
bands on molars and premolars. The bands are
fixed with a small piece of wire (0.5 mm)
gingivally onto the impression and then poured
with dental stone.

The casts are mounted on the articulator with a
construction bite. For this purpose, a simple openclose articulator (articulator according to Krner)
can be used.
Now the connecting wires can be bent and fixed

with thermal wax. In the lower jaw, a lingual bow
is bent from molar to molar out of one piece. On
the buccal side, the connecting wires from the first
premolar to the first molar contain a U-loop. In the
upper jaw, a continuous palatal bow is bent again
from molar to molar. The connecting wires are
fixed either with thermal wax or with the Spot
Welding Unit.
The fixed buccal connecting wires have to be fixed

relatively gingival on the canine bands to avoid
interfering with the base of the Herbst appliance
which is fixed in the centre of the band.
In the articulator, with the help of a fixing

instrument, the Herbst appliance pivots are held
onto the bands then pointed with a Spot Welding
Unit, or directly soldered with the bands.

After fixing all elements, the thermal wax is
covered with solder plaster or the wires are pointed
with a Spot Welding Unit. Now the appliance can
be soldered, finished and polished.
Finished Herbst appliance with soldered bands.
The removable Herbst appliance

0TU
Elements:
Function:
Description:
U0T
One pair of guiding telescopes with attachments

Achievement of a neutral occlusion
With soldered retentions on the attachments, the Herbst
appliance can be integrated into splints and therefore be
removable
The working casts are mounted onto the fixator

with the construction bite. The vacuum formed
foils are made out of 1 mm material and are
finished like normal splints. Retentions are
soldered onto the attachments and then heated to
be pressed into the splints for their fixation.

The length of the guiding hinges has to be checked
and if necessary, modified.
Now the splints can be built up with acrylic in the

molar area for the definitive fixation and
stabilization. In order to achieve corresponding
planes in the upper and lower jaw, first, the lower
splint is finished, polished and isolated; afterwards,
the upper jaw is built up with acrylic and set
together in the fixator. Then only the exceeding
acrylic material has to be removed.
Appliances with spikes

0TU
Elements:
Function:
Description:
U0T
Connecting bow 1.0 mm hard, spikes 0.8 - 0.9 mm hard

To shield the tongue from the incisors
Lingual/palatal bow with sharp spikes
The connecting bow is bent in height of the

gingival margin assuring a small but even distance
and then soldered onto the molar bands. The
number of spikes is variable.

The spikes are fixed horizontal to the occlusal
surface in order to hinder the tongue from pressing
against the incisors.
The spikes can also be designed as a removable

appliance, in this example, with the MIA-System
(with bent locks).
The tongue shield for mesialisation

0TU
Elements:
Function:
Description:
U0T
Tongue shield 1.0 mm hard

Mesialisation of the molars
Through the permanent pressure of the tongue, the molars are moved
mesially
The bands once fixed in the alginate impression are

slightly waxed out before the pouring. The tongue
guard is bent according to the transversal width of
the arch.

The extended arm of the tongue crib is guided
straight to the molars which are to be moved
mesially. There, it is fixed with the Spot Welding
Unit to the bands and then soldered.
It is important to maintain enough distance from

the tongue shield to the gingival tissue in order to
allow the molar movement.
The rapid palatal expansion appliance (RPE) with

Hyrax screw
0TU
U0T
Elements:
Function:
Description:
Preformed Hyrax expansion screw

Rapid palatal expansion
Fixed appliance
A working cast with 4 bands is needed. On this

cast the Hyrax screw is adapted to the palate.
Neither the screw nor the connecting wires should
contact the gingival tissue.
The screw should lie as deep as possible in the

centre of the palate. The connecting wires are led
PDFREE COMUNIDAD
ODONTOLOGICA
towards
the bands, then bent, and afterwards,
united between the first premolars and the first
molars in order to achieve a maximum stability of
the appliance. The adapted Hyrax appliance is
soldered with laser or fixed with a Spot Welding
Unit to the bands and then ideally soldered on the
cast.
A clinical view of a patient with an activated

Hyrax screw. The open diastema makes the rapid
palatal expansion evident.
The rapid palatal expansion appliance (RPE)

according to McNamara
0TU
U0T
Elements:
Function:
Description:
Circular clasp 0.8 mm hard, Hyrax expansion screw

Rapid palatal expansion
Appliance with acrylic coverage of the occlusal surface for a
better retention of the anchorage teeth
First, the circular clasp is bent approximately 1

mm underneath the occlusal surfaces and the
incisal edges. Then the four wire extensions of the
Hyrax screw are bent in a distance of 1 mm from
the palate to the circulating clasp; finally,
everything is lasered or soldered together.
PDFREE COMUNIDAD
ODONTOLOGICA
Once
the appliance is polished, acrylic is added on
the occlusal surfaces up to slightly under the
circulating clasp. The bite block should not be too
voluminous, the vertical opening should
correspond to the height of the construction bite.
Small perforations are grinded into the finished

bite blocks to allow the cement to flow while
inserting the appliance.

an interchangeable Hyrax screw
0TU
U0T
Elements:
Function:
Description:
0.8 mm / 0.032 rectangular stainless steel wire, Hyrax screw

Correction of extreme cross-bites
When the expansion capacity of a single screw is not sufficient,
the treatment can be performed in several steps with this
appliance
The bands once adapted into the impression are

waxed out slightly and poured as usual. The bands
should be blocked out with a very thin layer of
wax, so that although they are fixed well on the
cast, they can be removed easily from the cast after
finishing. Before, the bands should be replenished
with brackets on the palatal side.

The rectangular wire should be adapted on both
sides from the first premolar to the first molar into
these brackets. Special attention should be paid
that this rectangular wire is ligated passively into
these brackets.
Now the Hyrax screw is adapted in a distance of

1 mm to the palate and fixed with the Spot
Welding Unit to the rectangular wire. This way the
appliance can be soldered or welded and then
inserted.
After a couple of weeks, when the end of the screw

spindle is reached, the appliance is removed and an
impression is taken, then it is inserted again. In this
impression, transmission brackets are set in,
slightly waxed out, and then poured.
Now on this prepared cast, a second appliance can

be made. In the meantime the first appliance is
used passively to maintain the arch width. Before
making the second appliance, the screw has to be
opened 3 or 4 turns and then be adapted to the
palate.
After
this, a direct replacement can take place in
PDFREE COMUNIDAD
ODONTOLOGICA
the patients mouth. While inserting the appliance,
the screw is unscrewed to get past the brackets and
then is opened up again immediately. If the
dimension of the planned expansion makes it
necessary, a third appliance can be inserted.

a Nardella screw
0TU
U0T
Elements:
Function:
Description:
Connecting wires 1.0 mm soldable wire (remaloy)

Asymmetric rapid palatal expansion
The Nardella screw, with both its threads (anterior and
posterior) can be activated separately
For the making of this appliance an impression is

needed with 4 bands which are first waxed out and
then used for the working cast. The appliance can
be made using the cast prepared this way.
The Nardella screw can be fixed with wax onto the

model to guide the wire along both bands to the
retention of the screw. After preparing both sides,
the appliance is fixed with the Spot Welding Unit.

After the provisional fixing, the wires are
definitely lasered or soldered. The screw contains
two threads, one anterior and one posterior which
can be activated symmetric or asymmetrically.

hooks for the Delaire face mask
0TU
Elements:
Function:
Description:
0T
0T
Hyrax screw, hooks 1.2 mm spring hard (occlusal rests 0.8 mm

hard)
Anterior traction of the maxilla or movement of the upper
dentition when lower forces are applied
The elastics of the Delaire mask are engaged into the hooks
which lie in the canine area
The Hyrax screw is adapted to the palate as usual

and fixed onto the bands with the Spot Welding
Unit or with solder plaster. The hooks for the face
mask are usually bent into a loop in height of the
centre of the canine and then rounded off. They
unify the premolar and molar bands from buccally.
To ensure
a good oral hygiene, the hooks are
PDFREE COMUNIDAD
ODONTOLOGICA
attached in a distance of 2 mm from the tooth row.
If vertical opening is desired, the premolar bands
are not needed. Instead, occlusal rests are adapted
onto the first premolars which are intraorally
bonded to simultaneously open the bite.
The fixed elements are lasered or soldered and then

polished.
Modified rapid palatal expansion appliance (RPE)

0TU
Elements:
Function:
Description:
U0T
Hyrax screw
Rapid palatal expansion with simultaneous vertical opening
The acrylic bite blocks in the premolar region open the bite
vertically for the correction of lateral cross-bites
When in a rapid palatal expansion appliance, only

molar bands are used; the Hyrax screw is adapted
to the palate and soldered as usual.
In order
to simultaneously open the bite vertically
PDFREE COMUNIDAD
ODONTOLOGICA
with this appliance, acrylic bite blocks are
attached. In the area of the bite blocks a wax stripe
can be attached to limit the acrylic to achieve a
faster finishing. The casts should be set into the
fixator to guarantee a better adaptation.
The vertical opening of the finished appliance

should only open the bite so far that the upper and
lower tooth rows can slightly pass each other.
Elements:
Function:
Description:
Different screws and modified connecting wires

Rapid palatal expansion with simultaneous vertical opening
The connecting wires have to be designed according to the individual oral
situations
The bite blocks can be laid over the canines and

premolars. In this case, the space availability and
the height of the vertical opening depend on the
design.

The RPE appliance can also include a buccally
lasered or soldered reinforcement wire. For this
purpose 4 bands are recommended.
Additional bands and wires can be attached in an

asymmetric RPE appliance. In this case, a Nardella
screw was used again.
Elements:
Function:
Description:
Simple expansion screw without anchorage elements

Rapid palatal expansion with simultaneous vertical
openingGaumennahterweiterung mit gleichzeitiger Bisssperrung
The acrylic bite blocks in the premolar region open the bite vertically for
the correction of lateral cross-bites
The RPE appliance with an acrylic plate and a

simple screw is just as effective. The screw is fixed
on the working cast and the acrylic base limited by
wax stripes.

The occlusal surfaces of the posterior teeth are
grasped up to the buccal surfaces. The vertical bite
opening is determined by a construction bite in a
fixator.
Small holes are grinded into the bite blocks to

ensure a proper flow of the cement.
Elements:
Function:
Description:
RPE screw
Protrusion of the premaxilla in lip-jaw-palatal cleft patients
Anterior movement of the premaxilla through a horizontally inserted screw
In order to move the premaxilla anteriorly in

bilateral cleft patients, the RPE Screw can be
incorporated horizontally. Both posterior arms are
lasered or soldered onto the molar bands and then
the anterior arms are bent into the retention for the
acrylic shield.

The retentive spots of the cleft are blocked out and
the extension of the acrylic base is limited with
wax.
In situations where the premaxilla is inclined in

such a way that for the insertion the retentive area
is very extensive, the screw has to be opened 3 to 6
turns before its fixation. After finishing, the screw
is screwed back and the appliance can be inserted
without any problems.
Elements:
Function:
Description:
RPE Screw (rapid palatal expander screw)RPE-Schraube (Rapid-PalatalExpander-Schraube)

Expansion of the upper and lower arch
Delicate design of an expansion appliance
In the upper jaw, a fast expander is bent with the

RPE compact screw. The screw body lies close to
the palate in height of the second premolars; the
extensions are soldered or welded onto the molar
bands and contact up to the first premolar.
When
the lower arch is to be expanded, the screw
PDFREE COMUNIDAD
ODONTOLOGICA
body is located directly behind the incisors, the
extensions are soldered on the bands of the first
premolars and to increase the stability, brackets are
fixed in the molar area. The bracket bases are
bonded intraorally simultaneously with the bands.
For stabilization after a successful expansion, a

passive double TPA made of 1 mm SS wire is
soldered onto the molar bands.
Hilgers Palatal Expander (HPE)

0TU
Elements:
Function:
Description:
U0T
Rotation bow with occlusal rest 0.7 mm spring hard, expansion

screw
Rapid palatal expansion with simultaneous rotation of the
molars
A delicate appliance which resembles the pendulum appliance
The occlusal rest and the rotation loop are bent out
of one piece of wire. The connecting part of the
wire serves as retention. The loop is placed distally
of the tooth to be rotated and should, in no case,
contact the gingival tissue. To position the
elements, the wire is pointed on and lasered or
soldered either before or after the polymerization.

The expansion screw is fixed with wax in height of
the second premolars on the mid palatal suture and
the acrylic base is limited with wax stripes.
The bands of the finished HPE appliance are

cemented in the mouth and the occlusal rests
bonded. This resin serves to open the bite
vertically in order to be able to move the upper
molars without occlusal interferences.
Modified HPE
0TU
Elements:
Function:
Description:
U0T
Rotation bow with occlusal rest 0.7 mm spring hard, expansion

screw
Rapid palatal expansion with simultaneous rotation of the
molars
A delicate appliance which resembles the pendulum appliance
When a lateral incisor is located in the palate, this

expander can be replenished easily with protrusion
springs.

With a Nardella screw, the anterior and posterior
area can be expanded in a different way.
An acrylic shield can slightly enhance the pressure

of the screw.
The Quad-Helix appliance

0TU
Elements:
Function:
Description:
U0T
1.0 mm soldable wire (remaloy)

Rotation of the molars with simultaneous expansion of the
dental arch
The helix cause an optimal force effect on molars and the dental
arch
The Quad-Helix appliance is bent out of one piece

of wire. One starts with the two middle helixes in
height of the first premolars and extends from there
distally under the molars, then up to the molar
bands along the premolars and up to the incisors if
necessary.

The helix has to be bent opposite in the same way
and should not contact the palate. The distance
between the appliance and the gingival tissue
should be approximately 1 mm.
The corresponding appliance for the lower jaw is

the Bi-Helix.
Modifications of the Quad-Helix or Bi-Helix

appliance
0TU
U0T
It is possible to solder or laser other elements (spikes or

similar) onto the Quad-Helix appliance without any
problems, here for example, a MIA-System.
Spikes can also be lasered or soldered without any

problems to a Wilson appliance.
The Bi-Helix appliance also exists preformed for the MIA or Wilson System.
CHAPTRR 7
Nance and pendulum appliance, space

maintained cleft and stimulation plate
The soldered Nance appliance (Nance holding

arch)
0TU
U0T
Elements:
Function:
Description:
Soldered extensions 1.0 mm soldable wire, for example

remaloy
Stabilization of the molars
The acrylic shield supports the molars
The Nance appliance consists of an acrylic shield

and the connecting wires to the bands. It is
important that the connecting wires do not touch
the palate. They are bent, fixed onto the bands with
a Spot Welder and then soldered.
The acrylic shield is formed, finished and polished

from the inside and outside. It should not touch the
gingival margin. In order to achieve a wide
extension, it can be designed heartshaped.
The solder union should be clean and also be

polished thoroughly to guarantee a good hygiene
and avoid irritating the tongue.
Modified Nance appliances

0TU
U0T
The Nance appliance can also be designed

removable. For an easier use, the MIA System is
recommended. The loops from a preformed QuadHelix appliance are eliminated so that only the
active extensions with the lock are used and bent
into the appliance. After this, the acrylic shield is
added.
If the molars are to be slightly rotated, the posterior

loops of the preformed Quad-Helix appliance are
used and the extensions are horizontally bent into
the appliance.
If additional extension for activation is desired, it

is easier to use a preformed lingual arch which can
be transformed into the Nance appliance without
any problems.
Removable modified Nance appliance

0TU
U0T
Elements:
Palatal extensions with Wilson locks, hooks for engaging
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
elastics
Stabilization of the first molars with simultaneous oral traction
of the second molars
While the first molars are held in place, the second molars can
be moved through elastics in an oral direction
For an easy adaptation of the palatal extension, a

preformed palatal bow according to Wilson is cut
in half and then bent into the corresponding
retention. The wax limit is designed according to
the acrylic base which extends behind the second
molars because of the hooks in the molar area.
The acrylic base is finished. Small depressions are

grinded into the upper limit of the acrylic base in
order to receive the hooks and to avoid an irritation
of the tongue.
Finally, the hooks are polymerized into the base of

the Nance appliance. The elastics are engaged from
these hooks to the second molars.
The manufacture of the pendulum spring

0TU
U0T
Elements:
Pendulum spring out of 0.8 mm rematitan SPECIAL
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
Molar Distalisation
Special spring consisting of a part which is bent back for its
insertion into the molar lock, a U-loop and a closed loop
The pendulum spring is bent of 0.8 mm rematitan

SPECIAL wire. This wire has to be bent with
special caution because material conditioned TMA
alloys have the quality of breaking easily when
bent over a sharp edge. The extension of the molar
lock determines the length of the wire until its bent
by 90 with the pointed beak pliers.
The wire is grasped slightly further towards the

short end of the wire and carefully bent slightly
over 90.
Now, the V-shaped wire is set into the guiding

grooves of the pointed beak pliers and these are
closed carefully. The result is a bent of 180.

Afterwards, the wire is bent 90 twice in a distance
of 5 mm.
After that the U-loop is bent with round pliers

around the rounded extreme. Depending on the
type of the appliance, this U-loop can be open
towards mesial or distal.
After the U-loop another 90 bent is made towards

the closed pendulum loop.
The pendulum loop is bent around the round

extreme of the Young loop bending pliers. The
wire ending has to be bent around towards the
palate, so that the loop lies on top.

The end of the wire lies in the centre of the palate,
points anteriorly and is bent into the retention.
If the pendulum spring is designed removable, the

wire is bent 180 as carefully as in the beginning of
the spring. This double wire ending can be either
anchored in a Goshgarian lock or it can simply be
blocked out with wax in order to anchor the
removable spring in the acrylic.
The standard pendulum appliance with horizontal

loops according to Hilgers
0TU
Elements:
Function:
Description:
0T
0T
Pendulum spring double ended with a horizontal U-loop out of

0.8 mm rematitan SPECIAL round, occlusal rests 0.7 mm
spring hard
Molar distalisation, for example for a dentoalveolar correction
of class II malocclusions
The pendulum appliance is anchored completely intraorally, and
is effective without the compliance of the patient
For the intraoral fixation of the pendulum

appliance, occlusal rests are bent over premolars or
deciduous molars. For the pendulum spring, a
closed loop is bent near the mid palatal suture.
Then follows a horizontal U-loop (mesially open),
to finish in a double ended extreme. This double
wire ending is inserted into the palatal locks of the
molar bands.
For ODONTOLOGICA
the spray-on technique of acrylic application,
PDFREE COMUNIDAD
the springs are fixed with wax distal to the molars
and the closed loop is blocked out with wax. The
extension of the palatal plate, which resembles the
one in a Nance appliance, can be limited with wax
stripes.
The preactivated double ended springs are inserted

into the palatal locks of the banded molars. This
force application results in the distal movement of
the molars without the need of the patients
compliance.
Pendex/Pend-X: The pendulum appliance with

transversal screw according to Hilgers
0TU
U0T
Elements:
Function:
Description:
Pendulum spring single ended without horizontal U-loop out of

0.8 mm rematitan SPECIAL round, occlusal rests 0.7 mm
spring hard
Simultaneous expansion and molar distalisation
The tendency of creating cross-bites because of the radius of the
pendulum springs is compensated with the expansion of the arch
The rests are laid onto the premolars. The

pendulum spring has a loop in the centre of the
palate, from there, it goes straight into the palatal
locks and is single ended. The retentions are placed
in such a way that they do not interfere with the
separation cut.
PDFREE COMUNIDAD
TheODONTOLOGICA
expansion screw should be laid near the mid
palatal suture to be able to design the whole
appliance delicately. The pendulum springs are
fixed under the body of the screw and are located
mainly distally of the molars to be moved.
The finished Pend-X appliance should be polished

with the handpiece so that the very mobile
pendulum springs are not distorted on the lathe.
The transversal screw is regularly activated by the
practitioner to achieve transversal expansion.
The RPE-pendulum appliance according to

Snodgrass
0TU
U0T
Elements:
Function:
Description:
Pendulum spring double ended without U-loop out of 0.8 mm

rematitan SPECIAL, occlusal rests 0.7 mm spring hard,
connecting wire (palatal plate molar bands) 0.7 mm spring hard
Simultaneous expansion and molar distalisation
Transversal and anterior-posterior arch corrections are not
corrected simultaneously but consecutively
The occlusal rests are laid as usual on the

premolars or deciduous molars. Additionally,
connecting wires are soldered onto the molar
bands. The pendulum springs with the closed loops
lie right and left of the centre of the palate and are
bent without loops, double ended, to the palatal
locks of the molar bands.
PDFREE COMUNIDAD
TheODONTOLOGICA
soldering of the connecting wires can be done
before the scattering of the plate (or afterwards,
cautiously with a small soldering flame). The
transversal screw is fixed in the centre of the
acrylic plate.
The transversal expansion screw of this pendulum

is activated daily during 14 days; afterwards, a
pause of one month is made. Then the connecting
wires are removed and therefore leave the
preactivated pendulum springs free for derotation
and distal movement.
The M-pendulum according to Scuzzo

0TU
Elements:
Function:
Description:
U0T
Occlusal rests 0.7 mm spring hard, removable pendulum spring

out of 0.8 mm rematitan SPECIAL
Removable pendulum springs for their extraoral activation
Bayonet shaped, double ended retentions which are anchored
removable in the acrylic
The occlusal rests are located onto the anchorage

teeth. The pendulum spring lies with its closed
loop near the mid palatal suture. In this appliance,
the U-loop is open towards distal.
The double ending bent retentions are wrapped

PDFREE COMUNIDAD
ODONTOLOGICA
around
with ligature wire, and then with a small
flame, silver solder is melted in between. This way
a stop is created. Afterwards, they are covered with
a very thin layer of wax in order to create a
corresponding reception space to anchor the
retentions.
After finishing the desired distal movement, the

pendulum springs are taken out and replaced with
passive SS bows. This way, the pendulum
appliance is converted into a quick Nance
appliance to stabilize the molars in their new
position.
The K pendulum type DS (Distal Screw)

according to Kinzinger
0TU
Elements:
Function:
Description:
0T
0T
Occlusal rests 0.7 mm spring hard, double ending pendulum

spring out of 0.8 mm rematitan SPECIAL with closed loop and
mesially open loop
Extensive straight distal movement through the activation of the
distal screw, and therefore, new adaptation of the arc on which
the molars are moved distally
The pendulum springs lay close to the mid palate suture and
should be localized as close as possible to the distal part of the
molars to be moved
The occlusal rests are placed as usual. The

pendulum springs with the closed loop are fixed
minimally beneath the distal screw and posterior to
the molars which are to be moved. The open part
of the U-loop should show mesially. The retentions
of the springs have to be located beneath the
movable part of the distal screw.

To avoid the contact of the acrylic with the curve
of the palate, this part is previously underlaid with
wax.
The posterior extension of the appliance, including the

springs and the active part of the screw, should not
surpass the limit of the hard and soft palate.
The Bi/Quad pendulum according to Kinzinger

0TU
Elements:
Function:
Description:
U0T
Occlusal rests 0.7 mm spring hard, pendulum spring out of 0.8 mm

rematitan SPECIAL
First and second molars are moved distally one at a time
The removable pendulum springs can be activated or deactivated
The pendulum springs are bent double ended with

their retentions for straight Goshgarian locks, the
loops are placed near the mid palatal suture and the
U-loops are bent open mesially. The extreme can
be simple or double ended.
To prepare
the acrylic application, the retentions of
PDFREE COMUNIDAD
ODONTOLOGICA
the pendulum springs are engaged into the
Goshgarian locks. The small hooks (cleats) on the
locks are bent over and serve as retention in the
acrylic. The engaged retentions of the springs and
the locks are covered with wax on their surface.
Through the removable pendulum springs, the

second molars can be moved distally activating the
springs; simultaneously, the first molars can be
incorporated into the anchorage segment through
the passive springs. Afterwards, the second molar
is stabilized through deactivation, while the spring
of first molar is activated resulting in distal
movement.
The F-pendulum according to Favero

0TU
Elements:
Function:
Description:
U0T
Occlusal rests 0.7 mm spring hard, segmented arch wire for

lingual technique out of 0.8 mm rematitan SPECIAL, single
ended pendulum spring with mesially open U-loop, lingual
brackets
Leveling of the incisors through the segmented arch wire with
simultaneous anchorage of the appliance
The placement of the segmented wire in the anterior region
makes the extension of the acrylic base wider
The occlusal rests are fixed as usual on the

premolars or deciduous molars. The U-loop of the
pendulum spring is open mesially and the wire
ends simple in the molar bands. These have a
double tube. One slot serves for receiving the
pendulum spring and the other for the later fixation
of a TPA after the distal molar movement.
PDFREE COMUNIDAD
TheODONTOLOGICA
segmented wire for the lingual technique is
fixed passively into the bracket slots. These can be
either already bonded directly in the patient's
mouth and be represented well on the working
cast, or fixed onto the cast for indirect bonding.
The anterior segmented arch wire should be

employed mainly for passive anchorage rather than
for leveling the incisors.
The penguin pendulum according to Mayes

0TU
Elements:
Function:
Description:
U0T
Occlusal rests 0.7 mm spring hard, pendulum spring out of 0.8

mm rematitan SPECIAL
The loops of the rematitan SPECIAL springs are moved from
the horizontal to the sagital plane to move the molars distally
without transversal side effects
Big designed pendulum loops without U-loops, removable
The pendulum springs are bent with big loops

which are not placed near the mid palatal suture,
but fixed sagitally underneath the molars. This way
the length of the pendulum is notoriously shorter.
The relatively big palatal plate is extended in a

PDFREE COMUNIDAD
ODONTOLOGICA
mushroom
shape behind the loops of the pendulum
spring. To be able to activate the springs
extraorally, they are slightly blocked out in the
retention area. This wax coverage is minimal so
that the retention does not sit too loose in the
acrylic but is still removable.
In order to guarantee an almost normal swallowing

and speaking pattern and to prevent tonguepressing, the acrylic base has to be finished very
thin. The penguin is Mayes distinguishing mark.
The K pendulum type TDS (Transversal Distal

Screw) according to Kinzinger
0TU
U0T
Elements:
Function:
Description:
Pendulum spring out of 0.8 mm rematitan SPECIAL round,

occlusal rests 0.7 mm spring hard
Distal molar movement with simultaneous transversal expansion
of the arch
Through the activation of the Bertoni screw the pendulum
springs are on one hand moved distally and on the other hand, a
transversal expansion can be realized
With this pendulum plate, the rests are bent as

usual. Each of the pendulum springs contain a loop
near the mid palatal suture and a mesially open Uloop. As Goshgarian locks used in this case are
soldered onto the bands, the end is double bent.
The retentions are shortly bent to find space
beneath the Bertoni screw.
TheODONTOLOGICA
pendulum spring is first underlaid with wax,
PDFREE COMUNIDAD
then fixed in its preactivated position onto the cast.
The Bertoni screw is placed with the anterior part
of the screw over the retentions of the spring.
Afterwards, a wax stripe can be added to limit the
acrylic base.
After the occlusal rests are bonded intraorally onto

the occlusal surfaces the springs can be engaged
into the palatal locks of the molars. The screw is
intraorally activated, transversally and distally.
The Aachener Implant Pendulum (AIP) according

to Kinzinger
0TU
U0T
Elements:
Function:
Description:
Anchorage bow 1.2 mm rectangular SS wire, Goshgarian locks,

pendulum spring out of 0.8 mm rematitan SPECIAL
Distal molar movement with anchorage of the pendulum
through a palatal implant
When in the posterior region the anchorage situation is not
sufficient, for example because of periodontal damage, the
pendulum can be fixed onto an implant placed into the palate
In order to connect the implant cap with the

pendulum base retentions have to be fixed onto the
stainless steel cap. A corresponding cut is made
into the stainless steel cap.
The height of the cut corresponds to the thickness

of the wire. The rectangular wire is adapted exactly
to this cut.
Besides, the retention wire should not contact the

palatal tissue. A clean connection of the stainless
steel cap and the retentions is achieved through a
lasered union.
Elements:
Anchorage bow 1.2 mm rectangular SS wire, Goshgarian locks, pendulum
spring out of 0.8 mm rematitan SPECIAL

Function:
Distal molar movement with anchorage of the pendulum through a palatal
implant
PDFREE COMUNIDAD
ODONTOLOGICA
Description:
When in the posterior region the anchorage situation is not sufficient, for
example because of periodontal damage, the pendulum can be fixed onto an
implant placed into the palate
The flaps on the Goshgarian locks are bent for

retention, and then double ended; bent pendulum
springs are inserted with a U-loop open towards
distal. The hollow body of the locks is blocked out
with wax in order to avoid filling them with
acrylic. Therefore, the springs are removable. The
closed loops are also covered with wax and
simultaneously fixed onto the model. After this,
the base can be limited with a wax stripe.
For an easier finishing and polishing, the pendulum

springs are taken out after the polymerization and
are only inserted back after the completion.
As the implant is equipped with an octagonal edge,

the pendulum can always be inserted exactly in the
same position.
Pendulum GNE Distalizer (PhD) according to

Hilgers, GrumRax appliance, modified GrumRax
appliances
0TU
Elements:
Function:
Description:
0T
0T
RPE screws, sectional screws, bands with palatal/lingual locks,

modified extender
Transversal expansion of the upper jaw & symmetric or
asymmetric distal molar movement & rotation of the upper first
molars. This can happen simultaneously or consecutively
The shown modifications of the pendulum appliance are partly
designed for activation, to allow a more effective treatment
course
A: Pendulum GNE Distalizer (PhD) according

to Hilgers
For the pendulum GNE Distalizer (PhD) according
to Hilgers first the RPE screw is adapted to the
palate. The extender is bent to be laid onto the
anchorage teeth. Afterwards, Goshgarian locks are
soldered underneath the body of the screw in
which the pendulum springs with U-loops are
engaged.
B: GrumRax appliance according to

Grummons
The GrumRax appliance is used for arch expansion
with simultaneous molar distalisation. The distal
extender of the Hyrax screw is removed and
soldered on the anterior extender as occlusal rests
on premolars or deciduous molars. Palatal locks for
the pendulum springs are soldered onto the screw
body.
C: Modified GrumRax appliance

To simultaneously rotate the molars, the pendulum
spring is fixed laterally on the posterior part of the
RPE screw.
Labial bow pendulum according to Kinzinger, K

type Bi-DS Pendulum according to Kinzinger
0TU
U0T
Elements:
Function:
Description:
RPE screws, sectional screws, bands with palatal/lingual locks,

modified extender
Transversal expansion of the upper jaw & symmetric or
asymmetric distal molar movement & rotation of the upper first
molars. This can happen simultaneously or consecutively
The shown modifications of the pendulum appliance are partly
designed for activation, to allow a more effective treatment
course
D: Labial bow pendulum according to

Kinzinger
Both labial bows contacting labially and palatally
on the incisors are anchored into the acrylic base
for additional force resistance.
E: K pendulum type Bi-DS according to

Kinzinger
Through the insertion of two distal screws, the
right and left side can be activated separately so
that the molars can be moved distally in different
amounts.
After achieving the distal movement, the pendulum

appliance is removed and replaced by a Nance
appliance. If the molars are to be rotated slightly
more, horizontal loops are bent in the distal area of
the molars.
The space mantainer with teeth

0TU
U0T
Elements:
Adams clasps 0.6 mm hard
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
Prevention of the mesialization towards the support zones,

support of the masticatory function and reduction of the speech
impediment
Proper function is only guaranteed if special attention is paid to
the good adjustment of the space maintainer
The gingival margin is slightly erased because of

the missing undercut areas on the deciduous teeth.
This way the childrens denture gets good support.
As the deciduous crowns are normally quite small,

the retention elements are bent out of thinner wire
than usual. The Adams clasp is recommended for
this appliance. It should be bent with due care and
should adapt exactly.
The preformed teeth are grinded in shape if

deciduous preformed teeth are not available.
Eventually they are set onto the cast with small
spaces.

On the anterior and posterior teeth a small bit of
gingival tissue is modeled. This enhances the
support and optimizes the esthetics as the upper lip
does not seem so retruded.
The prepared teeth are fixed with a barrier of

silicon or plaster in order to eliminate the wax and
replace it with acrylic. A normal expansion screw
can be incorporated to activate the plate according
to the growth of the patients jaw.
The base of the plate of the space maintainer can

be made with the normal spray-on technique.
The gap or space mantainer

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U0T
Elements:
Different, depending on the design
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
Maintenance of temporal gaps

To maintain the space for the later erupting of permanent teeth,
a gap can be effectively maintained open through different rigid
wire appliances
A wire which is soldered onto two bracket bases

serves as a simple and delicate gap maintainer.
This space maintainer is bonded onto the bucal
surfaces of the teeth which stand on the right and
left side of the gap.
Another alternative is to unify two bands buccally

and palatal/lingually with two wires. With this
variation, special attention has to be paid to
erupting teeth.
Another possibility is to make a simple acrylic

plate. The acrylic plate is extended into the open
gaps, or the gaps are maintained open with simple
C-clasps.
The cleft plate

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Elements:
Eventually stimulating pearls
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
Covering of the palatal cleft

This palatal covering is also known as a drink plate and has to
cover the whole cleft area in order to avoid the food from
introducing into the nasal area; if necessary, it can be extended
into the pharynx
If the vestibule is not impressed accurately it has to

be erased slightly to achieve the needed vacuum
effect. If the palatal cleft reaches into the pharynx,
but this area is not impressed accurately enough on
the impression, it has to be erased slightly. This
should only be done in agreement with the
practitioner.
The retentive parts of the palatal cleft have to be

covered with wax. In the pharynx region the cleft
is built up with wax. The resulting cone is the
coverage of the pharynx area. Later, this cone has
to be shaped and polished by the practitioner.
In the anterior part of the cleft, the palatal plate has

to be built up in such a way that it resembles a
normal palatal anatomy, so that from early on, the
tongue gets used to the later palatal form.
PDFREE COMUNIDAD
TheODONTOLOGICA
palatal plate has to have in its whole extension
the same height as a complete palate. For the curve
of the descending cone, one can use the own thumb
as measure. But anyway, the cone has still to be
individually adapted to the curve of the palate.
The length of the cone always depends on the cleft.

Either the treating orthodontist determines an
approximate length, or the technician first designs
it and afterwards consults it with the doctor.
The final palatal plate has to be finished as thin as

possible. The functional margins have to be
designed exactly as in a normal denture.
The stimulation plate according to Castillo

Morales
0TU
0T
0T
Elements:
Function:
Description:
Fixing wire for a movable pearl

Distraction of the tongue through appealing attachments
Palatal plate with stimulation elements for tongue and lips
In the 6th to 8th week after birth an individual

impression of the edentulous upper jaw is taken.
The working cast is provided with a functional
edge. If this is not exactly impressed, it can be
slightly erased.
For stimulation of the tongue on the posterior part

of the plate a button is attached which can be
changed on every appointment. Labially
stimulation channels for the lip muscles are
grinded in, which can also be changed, so that with
every stimulation change the plate is made
interesting again.
Through a movable pearl in the posterior edge of

the plate, the stimulus is enhanced notoriously. For
securing the plate, it can be bound with floss to the
shirt of the child. If the plate contains a stimulation
button, it is finished retentively, to be able to fix
the floss.
CHAPTRR 8
Retention appliances splints,

snoring appliance
he retention plate
0TU
U0T
Elements:
Function:
Description:
Labial bow and retention elements 0.7 mm spring hard,

Orthocryl
Retention
The retention plates are used after the active phase of
orthodontic treatments for stabilizing the tooth position
The plates should include as few elements as

possible to avoid disturbing the occlusion and to
allow the teeth to stabilize with their own dynamic.
The design of the bent wire elements is small.
The acrylic base is also designed delicately; this

should be considered while making the wax
limitation.
The acrylic base should be finished as thin as

possible in order to avoid interfering with the
occlusion.
The
splint type
PDFREE COMUNIDAD
ODONTOLOGICA
0TU
Elements:
Function:
Description:
retainer
U0T
Vacuum formed thermoplastic foil

Retention
Simple and fast made retention appliance
The finished cast is set in the vacuum forming

machine into the granules as deeply as the retentive
parts are covered.
The splint is vacuum formed and taken out of the

machine. The exceeding granules are knocked off
over the machine.
When a 0.5 mm vacuum formed thermoplastic foil

is used, the splint can be trimmed with scissors.
When a thicker foil is used, a bur is used to cut the
material and contour the limits. It is important to
always end the splint disregarding its thickness 1
mm incisally of the gingival margin.
The Essix retainer

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Elements:
Function:
Description:
Vacuum formed thermoplastic foil 0.75 mm

Retention
Delicate, transparent retention appliance after treatment with
fixed appliances
For this retainer a 0.75 mm thick co-polyester

vacuum formed thermoplastic foil is required for
the upper and lower jaw. Once again, the cast is set
into the granules of the vacuum forming machine
so that only the teeth which are to be covered with
the plastic foil are visible.
The thermoplastic foil is vacuum formed as usual

and trimmed one millimeter over the cervical tooth
margin.
This retainer can be used in the upper and lower

jaw.
The Osamu retainer

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Elements:
Function:
Description:
Vacuum formed thermoplastic foil (Bioplast 1.5 mm, Imprelon S

0.75 mm)
Retention
Through the combination of a rigid and flexible foil this
retention appliance has a high mechanical retention capacity
reducing the danger of relapse
First, the limit of the retainer is marked 1-2 mm

underneath the gingival margin with a pencil. The
base of the cast is trimmed 5 mm underneath this
line in order to place the plaster cast on the
platform of the vacuum former and to vacuum
form the flexible 1.5 mm silicone foil (for example
Bioplast) onto the dental arch.
The vacuum formed Bioplast foil is trimmed with

scissors along the base of the cast. In the same
manner, the incisal edges and occlusal surfaces are
cut up to the contact points. The reduced Bioplast
foil is placed again onto the cast and the 0.75 mm
Imprelon S foil is heated as indicated. During the
last 10 seconds of the heating time, Osamu bond is
applied on the Bioplast foil for the bonding of both
foils.
Now the Osamu retainer is cut along the marked

line with scissors. The limits are smoothed out
with stones or burs. Because of the thin occlusal
coverage, the upper and lower jaw can occlude
without problems. As with the positioner, small
tooth movements and corrections can be achieved
when a previous set-up is made.
The van der Linden retainer

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Elements:
Function:
Description:
Labial bow with canine loop 0.8 mm spring hard, C-clasps 0.8
mm spring hard
Retention
Retention appliance without interfering occlusal contacts
The labial bow lies in height of the equator

adapting exactly onto the labial surfaces of the
incisors. The canine loop reaches into the retentive
cervical area of the canine and crosses between the
lateral incisor and the canine into the palatal
retention. This labial bow has to adapt precisely to
serve as retention element for the plate.
Both C-clasps are bent behind the last molars

slightly over the gingival margin. The endings of
the C-clasps are bent over and should reach as far
as possible into the interproximal area.
The base plate is reduced slightly in the posterior

region. The posterior margin is located in height of
the molars or premolars.
The Hawley retainer

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Elements:
Function:
Description:
Circumferential labial bow, eventually with eyelets 0.8 mm

spring hard
Retention
Retention plate without retention elements
A circumferential labial bow used as the wire

element is bent over all teeth in the upper and
lower jaw. In the area between the first and second
premolar a small U-loop is bent in.
Additionally, between the lateral incisor and the

canine, a small eyelet can be bent to enhance the
support of the labial bow.
Again, the acrylic base is designed as delicate as

possible.
PDFREE COMUNIDAD
TheODONTOLOGICA
Hawley retainer can be replenished with
Adams clasps. For this purpose, both Adams clasps
and the labial bow have to be bent out of soldable
wire. In this case, the labial bow includes small Uloops in the premolar/canine area.
In the lower jaw occlusal rests can be added on the

last molars. Once again, in this example, the Uloops can lie in the premolar/canine area. The
labial bow should adapt without tension and be
soldered before or after adding the acrylic with the
spray-on technique.
The base is finished as delicate as possible.
The retention plate with engaged labial bow

0TU
Elements:
Function:
Description:
Labial bow and hooks 0.7 mm spring hard

Retention
Retention plate without retention elements
U0T

The labial bow is bent individually with a slight
distance from the teeth and covered with acrylic.
Around the last molar a hook similar to a C-clasp

is bent with its retention; it is connected to the
covered labial bow through an elastic ligature.
The teeth are supported orally from the palatal

plate and labially through the covered labial bow.
No occlusal interferences should exist. The elastic
ligature connects the palatal and the labial part of
the appliance firmly.
The retention plate with interdental spurs

0TU
U0T
Elements:
Function:
Description:
Simple labial bow and interdental spurs 0.7 mm spring hard,

occlusal rests 0.7 mm hard
Retention
Retention plate without real retention elements
For these retention plates the cast has to be

prepared: the premolars and molars are erased
interproximally (with a separating disc) in such a
way that the gingival triangles are gone.
Now simple straight spurs are bent which are laid

onto the erased papillae and extend far over the
cast. The labial bow is made as usual. Additional
occlusal rests can be added in the lower jaw.
The base plate is designed as usual. The spurs

should be shortened in such a way that they reach 2
mm over the interdental area. The definitive
adaptation of the spurs is done by the practitioner
directly on the patient while inserting the
appliance.
The spring retainer

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Elements:
Circumferential labial bow 0.7 mm spring hard
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
Retention
Retention appliance which allows small tooth movements for
finishing
Small corrections of the incisor position can be

carried out with the spring retainer.
The desired incisor corrections are realized with a

set-up (stripping is possible on the cast and
intraorally) and then the set-up cast is doubled.
The retainer is bent out of one piece of wire. The

wire is bent with certain distance on the oral and
labial side. It contacts the canines again on the oral
and labial side.

The incisors are limited with a wax box and the
labial and oral acrylic shield is made using the
spray-on technique.
The retainer should have as less acrylic as possible

in order to avoid occlusal interferences.
A finished spring retainer.
The positioner
0TU
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Elements:
Function:
Description:
Vacuum formed thermoplastic foil (Bioplast)

Retention and finishing of the occlusion
Final appliance for stabilization after treatment with fixed
appliances, small corrections are possible with a set-up
After an occlusal registration on the patient, the

casts are set into a semiadjustable articulator. The
impressions can be taken after debonding or
shortly before. Sometimes the brackets are left on
the teeth to enhance the retention of the positioner.
When the impressions are taken in the last

appointment before debonding, the brackets have
to be erased on the cast. This method has the
advantage that the technician has more time for the
manufacture of the appliance and that the plaster
can dry properly for the set-up. As an alternative
the brackets can be left on the teeth. In this way,
the positioner has notoriously more retention and
single teeth can even be extruded.
After the active phase of treatment, for the

finishing, the teeth to be slightly moved are set-up
with wax into the desired position. After setting up
all teeth correctly in the arch form, the gingival
architecture is modeled harmoniously. This new
situation is fixed with a wax bite with 2 mm of
vertical opening and then the casts are duplicated.

On the basis of the new wax bite, the duplicated
casts are set into the fixator. The fixator should
allow a simple removal and insertion of the casts.
The positioner can be manufactured of different

flexible silicone types. In this case, a vacuum
forming technique with Bioplast was chosen. The
casts are isolated, and over each single jaw, a 3
mm Bioplast foil is vacuum formed. The foil is
trimmed up to its approximate length with a hot
wax knife.
Afterwards, both casts are reset in the fixator and

set under the heating of the vacuum forming
machine. The foils are heated until they slightly
stick to the finger when touched. The fixator is set
together and the foils are adapted with wet fingers
in the areas of contact; both single foils now stick
together as one appliance.
The casts are removed from the fixator and set

onto their dorsal side in the vacuum former with
the foils in place. For reinforcement a 1.5 mm foil
is vacuum formed onto the complete buccal
surface.
After
the cooling of the material, the positioner can
PDFREE COMUNIDAD
ODONTOLOGICA
be cut neatly with scissors. The edges are
smoothed out with the blue Jota. As a
conclusion, the positioner is set onto the casts; it is
shortly passed through the flame of the Bunsen
burner and is again adapted with damp fingers.
If the patient has problems breathing through his

nose, holes can be drilled in the positioner with a
sharp drill.
The bonded retainer according to Wiechmann

0TU
Elements:
Function:
Description:
U0T
Retainer wire 0.45 mm braided or 0.7 mm hard

Retention
Lingual bonded wire to retain the incisor position
First, a hard or a braided wire is bent onto the

lingual or palatal surfaces of the teeth from canine
to canine or first premolar to first premolar.
Afterwards, the tooth surfaces which are to be

PDFREE COMUNIDAD
ODONTOLOGICA
bonded
are isolated (isolation agent/Dentaurum or
Aislar/ Kulzer) and a drop of a fluid light-curing
bonding (e.g. Con Tec LCR/Dentaurum, Flowline/
Kulzer or Tetric-flow) is placed on each of the oral
surfaces from canine to canine or first premolar to
first premolar.
In the second step, the previously adapted retainer

wire is set into these bonding drops and adapted as
closely to the oral tooth surfaces as possible. Now
the bonding is light cured with a UV lamp.
Afterwards, another modeling of the bonding spots

is made with a more solid light-curing resin
(ConTec LC/Dentaurum, Durafill/Kulzer or Tetric)
to form small bonding bases. These are light cured
again.
To manufacture the Transfer tray, a fluid silicone

impression material (of a two phase material e.g.
LinguSil/Dentaurum) is injected around the wire of
the retainer.

Afterwards, the polimerized fluid silicone material
is covered with kneadable silicone (Lutesil/ Bisico)
and formed into shape using the fingers.
The solid silicone should cover the incisal edges

labially. After the silicone is cured, the cast with
the silicone key is hydrated during approximately
10 minutes so that the silicone key can be removed
from the cast.
Now the transfer key is removed from the cast. In

the area of the wire, the silicone material has to be
cut open with a scalpel to ensure an easy removal
of the key intraorally after bonding.
Finally, the grease of the bonding bases of this

silicone key has to be removed with acetone and
cotton pellets.
The occlusal splint

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Elements:
None
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
Treatment of cranio-mandibular disorders

Completely polymerized occlusal splint in therapeutic position
To be able to add the acrylic without problems, the

models, fixed in a semiadjustable articulator are
blocked out with wax. For this purpose, a thin wax
strip is laid around the tooth arch and fixed
approximately 0.5 mm over the gingival margin.
Spaces of missing teeth and retentive areas are also
blocked out.
The acrylic is not added with the spray-on

technique but favorably with the dough technique.
After a couple of minutes, when the dough does
not flow any more, it is pressed onto the cast. The
incisal edges and the occlusal surfaces have to be
totally covered with acrylic. It is polymerized in a
pressure vessel.
When working out, all impressions of the counter

jaw in the posterior and front region are reduced in
such a way that only slight impressions remain.
Distally of the canines, an acrylic guiding surface
is added for the fixation of the occlusion. This stop
should be adjusted in the semiadjustable articulator
with articulating tape.
The Gelb splint

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Elements:
Ball retainer clasps 0.8 mm hard, lower jaw bow 2.5 mm oval
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
hard
Treatment of patients with joint clicking sounds
Reduced occlusal splint with extreme occlusal guidance which
avoids shifting from the therapeutic position
The ball retainer clasps for the posterior region in

the lower jaw are bent and positioned. The lingual
bow is bent according to the shape of the mandible
and is fixed in a distance of approximately 1-2 mm
from the gingival tissue. In both jaws, the teeth are
limited with a wax stripe shortly over the gingival
margin.
The therapeutic occlusal position is previously

determined on the patient and transferred with a
wax bite. Then acrylic can be added onto the
articulated casts. Now the polymerization in the
pressure vessel takes place.
The teeth are grasped as far as possible by the

splint in order to make the shifting out of the
determined position impossible.
The reduced splint

0TU
U0T
Elements:
Function:
Description:
Ball retainer claps 0.8 mm hard, bow 3.0 mm x 1.5 mm hard

Treatment of cranio-mandibular disorders or for vertical
opening
Delicate but stable splint which can also be used in patients with
fixed appliances
The ball clasps can be installed in the posterior

region as desired. The retentions are positioned
parallel to the gingival margin. The upper bow is
fixed transversally between the premolars and
molars with a distance of 1-2 mm to the gingival
tissue.
In the lower jaw, ball clasps or Adams clasps can

be used. The lingual bow is fixed maintaining a
distance of 2 mm to the gingiva. The extremes of
the bows are grinded with a separating disc for
retention.
If the splint is used for the treatment of patients

with cranio-mandibular disorders, the occlusal
impressions are left in place. When using the splint
for vertical opening for cross-bite corrections, the
bite block is left even.
Bite blocks
0TU
U0T
Elements:
None
PDFREE COMUNIDAD
ODONTOLOGICA
Function:
Description:
Treatment of cranio-mandibular disorders

Intraorally bonded bite blocks
After setting the casts in relation to the facial

structures into the articulator, the posterior teeth in
the lower jaw are covered up to the occlusal
surfaces (1 mm) with wax. In the upper jaw only
the occlusal surfaces are limited with wax.
The bite opening has to be checked again before

adding the acrylic and the wax limits have to be
reduced if necessary.
After the polymerization of the acrylic, both

acrylic parts are adapted and finished separately.
The canine guidance in lateral jaw movement is as
important in this appliance as in a complete splint.
The IST appliance according to Hinz

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U0T
Elements:
Function:
Description:
Guiding telescopes
Snoring therapy
Splints with guiding telescopes which advance the mandible
For a controlled protrusive setting of the lower

jaw, the main casts are set into the fixator with the
aid of the measuring instrument according to
George.
The retentive parts on the duplicated casts are

blocked out with wax and then vacuum formed
with 2.0 mm Duran foil which was previously
underlaid with space maintaining foils. While
finishing the splints, in the anterior area the incisal
edges are covered 2 mm. In the posterior area, the
foil reaches up to 1 mm over the gingival margin.
The fixing points of the guiding telescopes in the

upper jaw are located buccally and interocclusally
in the molar area; and in the lower jaw buccally
and interocclusally between the canine and the
premolar. The IST fixing attachments are set using
the positioning aid and the retentions may have to
be adapted to the tooth form. The Duran foils are
roughed; the retentions of the attachments are
heated with a flame and melted down into the foils.
For the final fixation, acrylic is added onto the
retentions.
The surgical splint

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Function:
Centric splint = Blue splint: Serves to position the mandible to
PDFREE COMUNIDAD
ODONTOLOGICA
the cranial base for the fixation of the TMJ position
Position splint = Red splint: Only used in bimaxillar operations
for the positioning of the upper jaw in the new therapeutic
position
Definitive splint = Transparent splint: Serves to position the part
of the mandible which holds the teeth into the therapeutic
position and determines the post-operative occlusion
Centric-splint:
The casts are trimmed in all three dimensions after
their pouring. First, the upper cast is mounted on a
semiadjustable articulator using a transfer fork
(bite fork) in the correct relation to the cranium.
Afterwards, the lower cast is mounted using a
centric relation record. The incisal pin has to be
always in 0 position. The base of the articulator
is trimmed together with the cast base. The casts
and the base have a smooth surface to be able to
draw the orientation scale for the model surgery.
All teeth have to be blocked out with a wax limit in

such a way that only the incisal edges and the
occlusal surfaces can be covered with acrylic. To
avoid the incisal edges from breaking, they are
covered with an extremely thin wax layer. Then
the articulator pin is increased by 2 mm to give the
splint a thickness of approximately 2 mm.
Only the occlusal surfaces of the casts are hydrated

and then isolated. Afterwards, the acrylic is added
and then polymerized in the pressure vessel
without water, then finished and polished. Before
continuing the model surgery, this splint has to be
fitted on the patient. Only if the splint adapts
correctly reference lines can be drawn. If not, it has
to be adapted intraorally by grinding or adding
acrylic and the lower cast has to be mounted again
in this position.
Positioning splint:
The casts should be dry for the drawing of the
orientation scale being able to use a water resistant
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The vertical reference lines in the upper jaw
are drawn between the cast and the base in the area
of the lateral incisors between the canine and the
premolar and over the first molars. In the lower
jaw, the drawing is realized in the area of the
central incisors between the canine and the
premolar and underneath the first molars. The
reference lines should correspond to the vertical
axis of the teeth.
After finishing the orientation scale the articulator

pin is set back into 0 position, the upper cast is
removed from the mounting ring and repositioned
according to the surgical planning and fixed onto
the base with sticky wax. If plaster surfaces
interfere, the articulator base is trimmed, not the
cast. The dental arches are once again covered with
wax.
The articulator pin is raised again by 2 mm and the

second (red) splint is made exactly the same as the
first, adding the acrylic, then finished and polished.
When detailing all three splints one must pay
attention that the friction is not excessive when
they are set onto the casts.
Definitive splint:
Immediately afterwards, the third (transparent)
splint can be made. The articulator pin is set again
into 0 position and the model surgery of the
lower jaw can be started. Therefore the lower cast
is cut away from the articulator base repositioned
according to the planning in all three dimensions
and the interfering plaster surface of the base is
trimmed if necessary. The cast is firmly fixed with
sticky wax.
Once again, the wax limitation is set around the

teeth and the articulator pin is raised 2 mm exactly
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as with
the other two splints. After hydrating and
isolating, the acrylic is added and the splint is
finished. The acrylic should extend minimally over
the dental arch. Between the single teeth in the
upper jaw small holes are drilled into the splint to
allow the intermaxillary wiring. Small grooves are
grinded into the outer surface to receive the wire.
When all splints are finished, all three are

separately tried on before the surgery. They can be
adapted if needed.
If a surgical splint is to be made on dental casts

without brackets, the blue splint is made first. After
the fitting on the patient the orientation scale is
drawn on the casts and base.
Now a circumferential wire splint is bent adapting

on all labial surfaces of every tooth. Between the
teeth a small hook is soldered to be able to wire
both jaws together.
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After
bending both splints, the model surgery is
realized as usual in the articulator. With the wire
splints in place, the transparent or definite splint is
made with the spray-on technique and then
finished.

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PDFREE COMUNIDAD ODONTOLOGICA

The ultimate reference work on removable appliances

Atlas of orthodontic and orofacial

Dental Technician Ursula Wirtz

The ultimate reference work on

The dental models

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It does not matter if the models have round, square or

The midpalatal raphe (1) corresponds to the midsagittal

The simple labial bow

Function: Additional retention

In order to scatter the acrylic better, it is useful to

On this occasion attention, should be paid on the

The acrylic covered labial bow

Function: Additional retention

In order to scatter the acrylic better, it is useful to

On this occasion attention, should be paid on the

The labial bow with vertical M-loop

Function: Alignment of the canine, if it is labially positioned or

The loop should only lie on the most prominent part of

The labial bow with retractive canine loop

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In order to avoid interference with the occlusion, the

The labial bow with canine loop

Function: Stabilization of the incisor segment

If the four incisors have to be stabilized, the

Because of the transversal tag distal of the lateral

The labial bow with Andresen loop

Function: Retrusion of the canines

The transversal tag between the canine and the first

The labial bow with Andresen loop plays a rather

The labial bow with intrusion hooks

Function: Vertical movement of incisors

The transversal tag is covered by a wax layer so that

The modified labial bow

Elastics can also be installed vertically. They allow the

For tooth movements in different directions, springs

Two loops integrated into the labial bow allow the

A hook is soldered on the loop of the labial bow to

Two hooks are soldered in opposite directions on the

The partial labial bow embraces only a section of

The individual labial bow is contoured along the

A labial bow bent circularly, combined with Adams

The intermaxillary bow

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Influence of the lower jaw in a posterior direction

In certain cases the labial bow of the upper jaw can be

It is also possible to solder or laser a separately bent

A variation of the intermaxillary bow is a labial bow

The triangular clasp

Function: Simple retention for removable appliances of all types

The horizontally lying triangle continues into a vertical

The tag should be bent exactly over the triangle to

If the triangular clasp is used as an additional retention

The triangular clasp according to Zimmer

Function: Simple hold for removable appliances of all types

The triangular clasp according to Zimmer varies in a

The transversal tag should be adjusted as deep as

The triangular clasp according to Trnkmann

Function: Simple retention for removable appliances

The triangular clasp is characterized by the fact that

After unifying the triangle in the middle of the buccal