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Basic removable appliance design

Basic removable appliance design

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Basic removable appliance design

  1. 1.  IntroductionIntroduction  HistoryHistory  Properties of Orthodontic wiresProperties of Orthodontic wires  ClassificationClassification  IndicationsIndications  AdvantagesAdvantages  DisadvantagesDisadvantages  Design ComponentsDesign Components  Commonly Used AppliancesCommonly Used Appliances  Soldering and WeldingSoldering and Welding  ConclusionConclusion
  2. 2. Weinstein has saidWeinstein has said ““There is only one disease that is malocclusion.There is only one disease that is malocclusion. The medicine is force and there are number ofThe medicine is force and there are number of ways of applying this force”ways of applying this force”
  3. 3. HISTORYHISTORY Victor Hugo JacksonVictor Hugo Jackson  chief proponent of removable appliances in the USchief proponent of removable appliances in the US Charles Hawley  Introduced Hawley’s appliance in 1908Introduced Hawley’s appliance in 1908 Martin SchwartzMartin Schwartz  In mid 20In mid 20thth century developed a variety of split platecentury developed a variety of split plate appliancesappliances
  4. 4. Philip AdamsPhilip Adams  Modified arrowhead clasp into ‘Adams Crib’Modified arrowhead clasp into ‘Adams Crib’  Became the basis for English removable appliancesBecame the basis for English removable appliances  Still the most effective clasp for orthodontic purposeStill the most effective clasp for orthodontic purpose George CrozatGeorge Crozat  In early 1900s developed a removable applianceIn early 1900s developed a removable appliance entirely in precious metalentirely in precious metal  Effective clasps on I molars modified from Jackson’sEffective clasps on I molars modified from Jackson’s designdesign  Heavy gold wires as frameworkHeavy gold wires as framework  Lighter gold finger springs for desired toothLighter gold finger springs for desired tooth movementmovement
  5. 5. At the beginning of the twentieth centuryAt the beginning of the twentieth century • vulcanite baseplate that covered the palatevulcanite baseplate that covered the palate • molars and premolars capped for retention.molars and premolars capped for retention. • Although the materials changed, removableAlthough the materials changed, removable appliances remained the principal appliance forappliances remained the principal appliance for orthodontic treatment in UK and Europe for the nextorthodontic treatment in UK and Europe for the next 70 years70 years.. • In contrast, it had little impact on AmericanIn contrast, it had little impact on American orthodontics, which at that time was dominated byorthodontics, which at that time was dominated by Edward AngleEdward Angle..
  6. 6. Development of Removable AppliancesDevelopment of Removable Appliances in Europein Europe 1.1. Angle’s dogmatic approach to occlusion, with itsAngle’s dogmatic approach to occlusion, with its emphasis on precise positioning of each teeth hademphasis on precise positioning of each teeth had less impact on Europeless impact on Europe 2.2. Social welfare systems developed much moreSocial welfare systems developed much more rapidly in Europe- providing limited treatment forrapidly in Europe- providing limited treatment for large number of patientslarge number of patients 3.3. Precious metals for fixed appliances were lessPrecious metals for fixed appliances were less available in Europeavailable in Europe
  7. 7. In the UK, the establishment of the National HealthIn the UK, the establishment of the National Health Service in 1948 favoured use of removableService in 1948 favoured use of removable appliances.appliances. • only ten specialist orthodontistsonly ten specialist orthodontists • so the vast majority of orthodontic treatment wasso the vast majority of orthodontic treatment was provided by general dental practitioners.provided by general dental practitioners. • Department of Health, and the then Dental EstimatesDepartment of Health, and the then Dental Estimates Board, were of the view that the near exclusive use ofBoard, were of the view that the near exclusive use of removable appliances was the most cost effective wayremovable appliances was the most cost effective way of providing UK orthodontic care.of providing UK orthodontic care.
  8. 8. 1970s:1970s: The length of postgraduate orthodontic trainingThe length of postgraduate orthodontic training increased from one to two yearsincreased from one to two years 1980s:1980s: to three years.to three years. Postgraduates were able to complete supervisedPostgraduates were able to complete supervised treatment of multibanded cases before they qualified.treatment of multibanded cases before they qualified. A series of technical advancesA series of technical advances • Prewelded, preformed orthodontic bandsPrewelded, preformed orthodontic bands • Directly bonded attachmentsDirectly bonded attachments • Pre-adjusted edgewise bracket reduced the needPre-adjusted edgewise bracket reduced the need for complex individually formed archwires.for complex individually formed archwires.
  9. 9. Measurements of treatment outcomeMeasurements of treatment outcome  The quality of outcome not as high as with fixedThe quality of outcome not as high as with fixed appliancesappliances  Higher discontinuation of treatment associated withHigher discontinuation of treatment associated with the use of removable appliancesthe use of removable appliances  Dental practitioners now refer their patients on toDental practitioners now refer their patients on to specialist orthodontists.specialist orthodontists.  Specialist orthodontists favour the use of fixedSpecialist orthodontists favour the use of fixed appliances due to the ability to precisely positionappliances due to the ability to precisely position teethteeth
  10. 10. Scope of removable appliancesScope of removable appliances The use of removable appliances still varies widelyThe use of removable appliances still varies widely between clinicians, but it is possible to achievebetween clinicians, but it is possible to achieve adequate occlusal improvement with theseadequate occlusal improvement with these appliances, provided suitable cases are chosen.appliances, provided suitable cases are chosen. It is vital to emphasize that cases suitable for removableIt is vital to emphasize that cases suitable for removable appliance treatment are those that require simpleappliance treatment are those that require simple tipping movements only, and surprisingly fewtipping movements only, and surprisingly few malocclusions will fall into this category.malocclusions will fall into this category.
  11. 11. Properties of Orthodontic wiresProperties of Orthodontic wires 1)1) Esthetics Kusy, AO 1997Esthetics Kusy, AO 1997 2)2) StiffnessStiffness 3)3) StrengthStrength 4)4) RangeRange 5)5) SpringbackSpringback 6)6) FormabilityFormability 7)7) ResiliencyResiliency 8)8) FrictionFriction 9)9) BiohostabilityBiohostability 10)10) BiocompatibilityBiocompatibility 11)11) WeldabilityWeldability
  12. 12. 1) Esthetics:1) Esthetics: -desirable property -no compromise on mechanical-desirable property -no compromise on mechanical propertiesproperties -composite wires-composite wires 2) Stiffness/Load deflection rate:2) Stiffness/Load deflection rate: -Magnitude of force delivered by the appliance for a-Magnitude of force delivered by the appliance for a particular amount of deflection.particular amount of deflection. LDR=Load/DeflectionLDR=Load/Deflection
  13. 13. FFααEdrEdr44 dd αα ll33 ll33 rr44 E- Modulus of elasticityE- Modulus of elasticity d- Deflectiond- Deflection r- Radiusr- Radius l- Lengthl- Length Doubling radius = Increases force 16 foldDoubling radius = Increases force 16 fold Doubling length = Reduces force 8 foldDoubling length = Reduces force 8 fold
  14. 14. LL33 αα d (2l)d (2l)33 αα 8d8d 11αα dd 11 αα 16d16d rr44 (r/2)(r/2)44
  15. 15. Low stiffness or LDR impliesLow stiffness or LDR implies i.i. Low forces will be appliedLow forces will be applied ii.ii. Forces more constant as appliance deactivatesForces more constant as appliance deactivates iii.iii. Greater ease & accuracy in applying a given forceGreater ease & accuracy in applying a given force -For active components low LDR-For active components low LDR -For retentive components high LDR-For retentive components high LDR ‘‘Variable Cross-section Orthodontics’-BurstoneVariable Cross-section Orthodontics’-Burstone ‘‘Variable Modulus Orthodontics’Variable Modulus Orthodontics’ NiTi ≤ TMA ≤ ss wireNiTi ≤ TMA ≤ ss wire
  16. 16. 3)3) Strength: Force required to activate an archwire to aStrength: Force required to activate an archwire to a specific distance- Kusyspecific distance- Kusy Shape and cross-section of wire have an effectShape and cross-section of wire have an effect 4)4) Range: Distance to which an archwire bendsRange: Distance to which an archwire bends elastically, before permanent deformation occurs-elastically, before permanent deformation occurs- ProffitProffit 5)5) Springback: The extent to which the wire reverses itsSpringback: The extent to which the wire reverses its shape after permanent deformation.shape after permanent deformation. Wire can be activated to a large extent hence fewerWire can be activated to a large extent hence fewer activations will be neededactivations will be needed
  17. 17. 6)6) Formability: Ability to bend wire in desiredFormability: Ability to bend wire in desired configuration.configuration. 7)7) Resiliency: Amount of energy stored in a body.Resiliency: Amount of energy stored in a body.
  18. 18. 8)8) Friction: While closing spaces in continuous archwireFriction: While closing spaces in continuous archwire technique, involves relative motion of bracket over wire.technique, involves relative motion of bracket over wire. Excess friction- loss of anchorExcess friction- loss of anchor - binding- binding Least amount of friction desiredLeast amount of friction desired 9)9) Biohostability: Ability of a wire to accumulate, or be a siteBiohostability: Ability of a wire to accumulate, or be a site of accumulation of bacteria, spores or virusesof accumulation of bacteria, spores or viruses 10)10) Biocompatibility: Resistance to corrosion and tissueBiocompatibility: Resistance to corrosion and tissue tolerance to elements in the wire.tolerance to elements in the wire. 11)11) Weldability: Ease by which a wire can be joined to otherWeldability: Ease by which a wire can be joined to other metals by actually melting the 2 metals in the area of themetals by actually melting the 2 metals in the area of the bondbond
  19. 19. 1meter = 39.37in1meter = 39.37in 1.0mm = 0.3937in1.0mm = 0.3937in 1mm = 401mm = 40 thousandths of anthousandths of an inchinch 1mm = 0.040in1mm = 0.040in mmmm inchinch thou ofthou of an inchan inch gaugegauge 1.51.5 1.251.25 1.01.0 0.90.9 0.80.8 0.70.7 0.60.6 0.50.5 0.0590.059 0.0490.049 0.0390.039 0.0350.035 0.0320.032 0.0280.028 0.0240.024 0.0200.020 6060 5050 4040 3636 3232 2828 2424 2020 -- -- 1919 2020 2121 2222 2323 2424
  20. 20. Definition:Definition: Mechanical Orthodontic Appliances are instrumentsMechanical Orthodontic Appliances are instruments which apply pressure or offer resistance to the teethwhich apply pressure or offer resistance to the teeth for the purpose of stimulating alveolar bone changefor the purpose of stimulating alveolar bone change bringing about changes in the position of teeth.bringing about changes in the position of teeth.
  21. 21. ClassificationClassification  Appliances that affect actual tooth movementAppliances that affect actual tooth movement through adjustment of springs or attachments withinthrough adjustment of springs or attachments within the appliance-the appliance- ACTIVE PLATEACTIVE PLATE  Appliances that stimulate reflex muscle activityAppliances that stimulate reflex muscle activity which in turn produces desired tooth movement-which in turn produces desired tooth movement- FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES
  22. 22. II.II. According to site of appliance placementAccording to site of appliance placement 1.1. ExtraoralExtraoral 2.2. IntraoralIntraoral 3.3. CombinationCombination III.III. According to plane of movementAccording to plane of movement 1.1. TransverseTransverse 2.2. SaggitalSaggital 3.3. VerticalVertical
  23. 23. IV.IV. Based on method of curingBased on method of curing 1.1. Heat cureHeat cure 2.2. Self cureSelf cure 3.3. Light cureLight cure
  24. 24. Minor tooth movement technique may be consideredMinor tooth movement technique may be considered o Malposition limited to relatively few teethMalposition limited to relatively few teeth o Desired movement not more than few mmDesired movement not more than few mm o Adequate space between adjacent teeth to permitAdequate space between adjacent teeth to permit entry of teeth to be movedentry of teeth to be moved o Allowable axial inclination corrected by tippingAllowable axial inclination corrected by tipping forcesforces o Correctable etiologic factorsCorrectable etiologic factors o Favorable periodontal and periapical prognosisFavorable periodontal and periapical prognosis o Absence of contraindicationsAbsence of contraindications IndicationsIndications
  25. 25. • Excessive flaring of maxillary anterior teethExcessive flaring of maxillary anterior teeth • Diastima closureDiastima closure • Crossbite correctionCrossbite correction • Anterior crowdingAnterior crowding  PreprostheticPreprosthetic • Closing of spacesClosing of spaces • Uprighting of teethUprighting of teeth
  26. 26.  Preventive PeriodonticPreventive Periodontic • Migration of mandibular incisorsMigration of mandibular incisors  Correction of Speech DefectsCorrection of Speech Defects  Facilitation of Oral Surgical ProceduresFacilitation of Oral Surgical Procedures  Retention after corrected malocclusionRetention after corrected malocclusion •
  27. 27.  ProceduralProcedural • To gain spaceTo gain space  Preventive and interceptive orthodonticsPreventive and interceptive orthodontics
  28. 28. 1.Tipping movement 2.Can be removed -for cleaning of teeth & appliance -if in pain -on socially sensitive occasion 3.Less conspicuous 4.Can be undertaken by general practitioner with adequate training 5.Manufactured in lab -less chair side time -more patients can be treated 6.Inexpensive 1.Only simple malocclusion can be corrected 2.Multiple rotations cannot be corrected 3.Uncooperative patients may leave out the appliance- prolongs treatment 4.Multiple tooth movement - one at a time- prolongs Rx duration 5.Lower appliance not well tolerated 6.Cases other than I premolar extraction cannot be treated easily AdvantagesAdvantages DisadvantagesDisadvantages
  29. 29. Components of removable appliancesComponents of removable appliances  Retentive ComponentsRetentive Components  BaseplateBaseplate  Active componentsActive components
  30. 30. Retentive ComponentsRetentive Components Retention: Means whereby displacement of appliance isRetention: Means whereby displacement of appliance is resisted.resisted. Clasp: any hook or band attached to a natural tooth andClasp: any hook or band attached to a natural tooth and used to anchor a partial denture or an orthodonticused to anchor a partial denture or an orthodontic appliance.appliance.
  31. 31. Circumferential ClaspCircumferential Clasp • Fabricated using wire 0.9mmFabricated using wire 0.9mm • -Also known as ‘C’ clasp or Three Quarter Clasp-Also known as ‘C’ clasp or Three Quarter Clasp  Simple clasp used to engage buccocervical undercutSimple clasp used to engage buccocervical undercut  Cannot be used in partially erupted teethCannot be used in partially erupted teeth
  32. 32. Jackson’s ClaspJackson’s Clasp - Fabricated using 0.9mm wire- Fabricated using 0.9mm wire - Also known as Full clasp or ‘U’ clasp- Also known as Full clasp or ‘U’ clasp - Engages both buccocervical undercuts- Engages both buccocervical undercuts  Simple designSimple design  Offers adequate retentionOffers adequate retention  Inadequate retention in partially erupted teethInadequate retention in partially erupted teeth
  33. 33. Triangular ClaspTriangular Clasp -Fabricated using 0.6mm wire-Fabricated using 0.6mm wire -used between adjacent posterior teeth-used between adjacent posterior teeth -Indicated for additional retention-Indicated for additional retention
  34. 34. Adam’s ClaspAdam’s Clasp -Also known as Liverpool Clasp,-Also known as Liverpool Clasp, Universal Clasp,Universal Clasp, Modified Arrowhead ClaspModified Arrowhead Clasp PartsParts BridgeBridge ArrowheadArrowhead Retentive armsRetentive arms
  35. 35. Advantages:Advantages:  Small, neat, unobtrusive, occupies minimum spaceSmall, neat, unobtrusive, occupies minimum space  Rigid, offers excellent retentionRigid, offers excellent retention  Used on any tooth in the archUsed on any tooth in the arch  If broken can be repaired by solderingIf broken can be repaired by soldering  Permits modifications in designPermits modifications in design  Extensive wire bending incorporates stresses in theExtensive wire bending incorporates stresses in the wirewire
  36. 36. ModificationsModifications Adams clasp with single arrowhead:Adams clasp with single arrowhead: Adams clasp with J hookAdams clasp with J hook Adams clasp with helixAdams clasp with helix Adams clasp with additional arrowheadAdams clasp with additional arrowhead Adams clasp with soldered buccal tubeAdams clasp with soldered buccal tube
  37. 37. Adams clasp with distal extensionAdams clasp with distal extension Double clasp on maxillary central incisorsDouble clasp on maxillary central incisors
  38. 38. Schwarz ClaspSchwarz Clasp Designed by C. M. SchwarzDesigned by C. M. Schwarz Oldest & for a considerable amount of time mostOldest & for a considerable amount of time most generally usedgenerally used Adj: Arrowhead bent towards papilla to engageAdj: Arrowhead bent towards papilla to engage undercutsundercuts  Can be used in deciduous or permanent teethCan be used in deciduous or permanent teeth  Skill to fabricateSkill to fabricate  Can be used only on posterior teethCan be used only on posterior teeth
  39. 39. Duyzings ClaspDuyzings Clasp -Simple design-Simple design -engages buccal undercut of molars-engages buccal undercut of molars -half clasp can also be constructed-half clasp can also be constructed Adj: Bending towards the tooth or undercut areaAdj: Bending towards the tooth or undercut area
  40. 40. Eyelet ClaspEyelet Clasp -similar to triangular clasp-similar to triangular clasp -used as single eyelet or multiple eyelet clasp-used as single eyelet or multiple eyelet clasp -eyelets placed in embrasures-eyelets placed in embrasures Adj: Bending eyelet interdentally towards the toothAdj: Bending eyelet interdentally towards the tooth  No sharp bends, breakage unlikelyNo sharp bends, breakage unlikely  Does not interfere with eruption of teethDoes not interfere with eruption of teeth  On single tooth does not have firm gripOn single tooth does not have firm grip
  41. 41. Delta ClaspDelta Clasp • Designed by William J. ClarkDesigned by William J. Clark • Similar to Adams clasp in principleSimilar to Adams clasp in principle • Engage interdental undercutsEngage interdental undercuts Adj: -hold retentive loop and twist inwardsAdj: -hold retentive loop and twist inwards -bending towards interdental undercut as it-bending towards interdental undercut as it emerges from acrylicemerges from acrylic
  42. 42. Southend ClaspSouthend Clasp -0.7 mm wire-0.7 mm wire -spans two adjacent margins of anterior teeth-spans two adjacent margins of anterior teeth Adj: readapting into interdental areaAdj: readapting into interdental area  Esthetically more pleasingEsthetically more pleasing
  43. 43. Ballend ClaspBallend Clasp • Wire having a knob or ball like structure on one endWire having a knob or ball like structure on one end • utilizes interdental undercutsutilizes interdental undercuts • Indicated when additional retention requiredIndicated when additional retention required
  44. 44. BaseplateBaseplate Greatest portion of removable applianceGreatest portion of removable appliance 1-2mm thick1-2mm thick 3 main purposes3 main purposes 1.1. Act as vehicle to carry all parts of the applianceAct as vehicle to carry all parts of the appliance 2.2. Serve as anchorageServe as anchorage 3.3. Become an active part of appliance itselfBecome an active part of appliance itself
  45. 45. ANCHORAGEANCHORAGE AnchorageAnchorage resists forces of reaction generated by activeresists forces of reaction generated by active components. Thus, sites of anchorage must be equal incomponents. Thus, sites of anchorage must be equal in magnitude but opposite in direction to those generatedmagnitude but opposite in direction to those generated by active components.by active components. Simple AnchorageSimple Anchorage: Teeth which offer greater resistance: Teeth which offer greater resistance to movement, used as anchorage for movement ofto movement, used as anchorage for movement of lesser resistancelesser resistance
  46. 46. • Usually made of AcrylicUsually made of Acrylic • As thin as possible(1-2mm)As thin as possible(1-2mm) • Closely adaptedClosely adapted • Extend as far as necessary to obtain anchorageExtend as far as necessary to obtain anchorage • Lower baseplate- U shaped, relatively thickerLower baseplate- U shaped, relatively thicker • Shallow lingual sulcus reinforced with ss wire or barShallow lingual sulcus reinforced with ss wire or bar Heat cureHeat cure Self cureSelf cure Light cureLight cure Biocryl: Biostar pressure molding machineBiocryl: Biostar pressure molding machine
  47. 47. BASEPLATE Anterior Posterior Upper Lower Parallel to occ plane Inclined to occ plane
  48. 48. Anterior biteplaneAnterior biteplane -Platform behind upper incisor teeth-Platform behind upper incisor teeth -Height enough to separate-Height enough to separate posterior teeth by 1.5-2mmposterior teeth by 1.5-2mm -Reduce overbite of anterior teeth-Reduce overbite of anterior teeth -‘opening the bite’-‘opening the bite’ -Height of plane gradually increased-Height of plane gradually increased Proclination of upper incisorsProclination of upper incisors *Placement of labial bow*Placement of labial bow *Sved biteplane*Sved biteplane
  49. 49. Sved BiteplaneSved Biteplane -Introduced by Sved in 1944-Introduced by Sved in 1944 -Covers incisal edges of upper anteriors-Covers incisal edges of upper anteriors -Pressure transmitted axially-Pressure transmitted axially -Retention questionable-Retention questionable -Ideal in growing individuals-Ideal in growing individuals
  50. 50. Posterior BiteplanePosterior Biteplane • displacing activity of mandibledisplacing activity of mandible • unilateral posterior crossbiteunilateral posterior crossbite
  51. 51. • wide enough to contact buccal & palatal cuspswide enough to contact buccal & palatal cusps • occlusion disengagedocclusion disengaged • equal on both sidesequal on both sides • after correction appliance acts as retainerafter correction appliance acts as retainer
  52. 52. Lower Inclined PlaneLower Inclined Plane • Catlan more than 200 yrs agoCatlan more than 200 yrs ago • Anterior crossbiteAnterior crossbite • 45 degrees to occ plane45 degrees to occ plane • Upper incisors guided intoUpper incisors guided into correct position labiallycorrect position labially • indicated when incisors are inindicated when incisors are in early stage of eruptionearly stage of eruption  If used for more than 6wks-If used for more than 6wks- anterior open bite resultsanterior open bite results  May need frequent cementationMay need frequent cementation
  53. 53. Pre-treatment Post-treatmentPre-treatment Post-treatment
  54. 54. Active componentsActive components  LabialbowLabialbow  SpringsSprings  ElasticsElastics  ScrewsScrews
  55. 55. LABIAL BOWSLABIAL BOWS May have 2 functionsMay have 2 functions 1)1) Serve as active element for movement of teethServe as active element for movement of teeth 2)2) Hold the plate in place & retain the teethHold the plate in place & retain the teeth
  56. 56. Labial Bow with ‘U’ loopLabial Bow with ‘U’ loop • 0.7 mm wire0.7 mm wire • flexibility depends on vertical height of ‘U’ loopsflexibility depends on vertical height of ‘U’ loops • Only minor overjet reduction or incisor alignmentOnly minor overjet reduction or incisor alignment requiredrequired
  57. 57. Adj: Compressing of ‘U’ loopAdj: Compressing of ‘U’ loop Displaced palatally by only 1mmDisplaced palatally by only 1mm
  58. 58. Long Labial BowLong Labial Bow • Used to close space between canine and premolarUsed to close space between canine and premolar • Can control the canineCan control the canine • Used for retentionUsed for retention
  59. 59. Split Labial BowSplit Labial Bow • flexibility increasedflexibility increased • incisor retractionincisor retraction Adj: at the ‘U’ loopAdj: at the ‘U’ loop
  60. 60. Labial Bow with Reverse LoopLabial Bow with Reverse Loop • Prevents buccal drifting of caninePrevents buccal drifting of canine Adj: Done in 2 stagesAdj: Done in 2 stages 1)1) Vertical loop opened by compressing with plierVertical loop opened by compressing with plier 2)2) This lowers the bow in incisor regionThis lowers the bow in incisor region compensating bends at the base of the loopcompensating bends at the base of the loop
  61. 61. Mills Bow /Extended Labial BowMills Bow /Extended Labial Bow • Made of 0.7mm wireMade of 0.7mm wire • Extensive loops- flexibility greatly increasedExtensive loops- flexibility greatly increased Indications -Reducing large overbitesIndications -Reducing large overbites -Alignment of irregular incisors-Alignment of irregular incisors  Flexible, lighter forces, long range of actionFlexible, lighter forces, long range of action  In mixed dentition when canines not eruptedIn mixed dentition when canines not erupted  Due to extensive loops less comfortableDue to extensive loops less comfortable
  62. 62. High Labial Bow with Apron SpringHigh Labial Bow with Apron Spring • Heavy base arch of 0.9mm wireHeavy base arch of 0.9mm wire • Apron spring 0.3-0.4mmApron spring 0.3-0.4mm Adj: Bent towards the teethAdj: Bent towards the teeth
  63. 63.  Retraction of teeth with severe proclinationRetraction of teeth with severe proclination  Light forcesLight forces  Longer range of actionLonger range of action  Not well tolerated by the patientNot well tolerated by the patient  Time consuming to fabricateTime consuming to fabricate  Cannot be used in patients with shallow sulcusCannot be used in patients with shallow sulcus
  64. 64. Roberts RetractorRoberts Retractor • Flexible bow constructed of 0.5mm wireFlexible bow constructed of 0.5mm wire • Steel tubing to give supportSteel tubing to give support • Coil placed at the point of emergence from the tubingCoil placed at the point of emergence from the tubing • Ajd: Vertical limb below the coilAjd: Vertical limb below the coil
  65. 65. Fitted Labial BowFitted Labial Bow • 0.7 mm wire0.7 mm wire • Adapted closely to labial surface of anterior teethAdapted closely to labial surface of anterior teeth • Used for retentionUsed for retention  Time consumingTime consuming
  66. 66. Beggs Retenton BowBeggs Retenton Bow • 0.7mm wire extends till last erupted molar0.7mm wire extends till last erupted molar • ’’U’ loops made between I & II premolarsU’ loops made between I & II premolars  Allows settling of occlusionAllows settling of occlusion  If not constructed well retention may not be goodIf not constructed well retention may not be good
  67. 67. SPRINGSSPRINGS Most commonly used active elementsMost commonly used active elements Requirements:Requirements:  springs should deliver optimum forcesprings should deliver optimum force  should possess high degree of elasticityshould possess high degree of elasticity  should have long range of actionshould have long range of action
  68. 68. Force systems delivered depend onForce systems delivered depend on Intrinsic properties-Intrinsic properties- cannot be altered by operatorcannot be altered by operator -modulus of elasticity-modulus of elasticity -yield strength-yield strength Extrinsic properties-Extrinsic properties- operator can exercise controloperator can exercise control -length of wire-length of wire -thickness of wire-thickness of wire Small changes in diameter and length have a profoundSmall changes in diameter and length have a profound impact on the force deliveredimpact on the force delivered
  69. 69. Effect of wire diameter on force deliveredEffect of wire diameter on force delivered -amount of activation-amount of activation 0.5mm- 3mm activation0.5mm- 3mm activation 0.7mm- 1mm activation- little margin of error0.7mm- 1mm activation- little margin of error Effect of wire lengthEffect of wire length Coil- increase length of springCoil- increase length of spring Lower force with same amount of activationLower force with same amount of activation
  70. 70. Classification of SpringsClassification of Springs II.. Based on direction of tooth movementBased on direction of tooth movement 1.1. Springs for mesio-distal tooth movementSprings for mesio-distal tooth movement 2.2. Spring for labio-lingual tooth movementSpring for labio-lingual tooth movement 3.3. Springs for expansion of archesSprings for expansion of arches II.II. Based on nature of supportBased on nature of support 1.1. Self supported springsSelf supported springs 2.2. Guided springsGuided springs 3.3. Auxiliary springsAuxiliary springs III.III. Based on presence of loop or helixBased on presence of loop or helix
  71. 71. Single Cantilever SpringSingle Cantilever Spring active armactive arm Parts coilParts coil retentive armretentive arm • 0.5-0.6mm wire0.5-0.6mm wire • coil with internal diameter of 3mmcoil with internal diameter of 3mm • used to move teeth labio-lingually or mesio-diatallyused to move teeth labio-lingually or mesio-diatally
  72. 72. Double Cantilever Spring / Z springDouble Cantilever Spring / Z spring • Constructed using 0.5 or 0.6 mm wireConstructed using 0.5 or 0.6 mm wire • Spring perpendicular to palatal surface of toothSpring perpendicular to palatal surface of tooth • Indicated where incisors are to be proclinedIndicated where incisors are to be proclined Activation: Opening both coilsActivation: Opening both coils  If not perpendicular to palatial surface of teeth, itIf not perpendicular to palatial surface of teeth, it tends to intrude teeth.tends to intrude teeth.
  73. 73. ‘‘T’ SpringT’ Spring • Constructed using 0.5 mm wireConstructed using 0.5 mm wire • Buccal movement of premolars and molarsBuccal movement of premolars and molars Activation: Pulling spring away from the baseplateActivation: Pulling spring away from the baseplate
  74. 74. Coffin SpringCoffin Spring • Described by Walter.H.Coffin in 1881Described by Walter.H.Coffin in 1881 • Made in 2 segments, large enough to make contactMade in 2 segments, large enough to make contact with all teeth to be movedwith all teeth to be moved • Made of 1.25 mm wireMade of 1.25 mm wire • Spring stands 1 mm away from the soft tissuesSpring stands 1 mm away from the soft tissues
  75. 75. Indications:Indications: Transverse arch expansion – Unilateral crossbite withTransverse arch expansion – Unilateral crossbite with lateral mandibular displacementlateral mandibular displacement Advantage over screw – Differential expansion can beAdvantage over screw – Differential expansion can be obtained.obtained.  Unless expertly made and adjusted, tends to be raterUnless expertly made and adjusted, tends to be rater unstable.unstable.
  76. 76. ActivationActivation
  77. 77. Canine RetractorsCanine Retractors • Type of springType of spring • used to move canine in distal directionused to move canine in distal direction CLASSIFICATIONCLASSIFICATION I.I. Based on location -buccalBased on location -buccal -palatal-palatal II.II. Based on presence of helix or loopBased on presence of helix or loop III.III. Based on mode of action -push typeBased on mode of action -push type -pull type-pull type
  78. 78. Buccal Self Sopported Canine RetractorBuccal Self Sopported Canine Retractor • 0.7 mm wire0.7 mm wire • buccally placed canine is to be moved palatally andbuccally placed canine is to be moved palatally and distallydistally • coil just distal to long axis of toothcoil just distal to long axis of tooth
  79. 79. Activation:Activation: by 1mmby 1mm Distal -closing the loopDistal -closing the loop Palatal -anterior limb is bent towards the toothPalatal -anterior limb is bent towards the tooth after it emerges from the coilafter it emerges from the coil  Uncomfortable to patientUncomfortable to patient  Stability increased- flexibility compromisedStability increased- flexibility compromised
  80. 80. Supported Buccal Canine RetractorSupported Buccal Canine Retractor • identical in design to self supported retractoridentical in design to self supported retractor • 0.5mm wire supported in tubing0.5mm wire supported in tubing Activation: by 2mmActivation: by 2mm
  81. 81. Reverse Loop Canine RetractorReverse Loop Canine Retractor • can be used in shallow sulcuscan be used in shallow sulcus Activation: 1mmActivation: 1mm i.i. cut off 1mm from the free end & readapt itcut off 1mm from the free end & readapt it ii.ii. opening the coilopening the coil
  82. 82. ‘‘U’ Loop Buccal Canine RetractorU’ Loop Buccal Canine Retractor • can be used in sallow sulcuscan be used in sallow sulcus Activation: free end is cut by 1mm & readaptedActivation: free end is cut by 1mm & readapted  Requires frequent adjustmentRequires frequent adjustment
  83. 83. Palatal Canine RetractorPalatal Canine Retractor -canine placed palatally requiring distal buccal-canine placed palatally requiring distal buccal movementmovement -coil of 3mm placed between the initial & final position-coil of 3mm placed between the initial & final position of canineof canine
  84. 84. Boxing & GuardingBoxing & Guarding • Boxing to protect from damageBoxing to protect from damage • Spring lies in the recess between baseplate &mucosaSpring lies in the recess between baseplate &mucosa • Guard to prevent distortion during removalGuard to prevent distortion during removal
  85. 85. -often cranked-often cranked Activation: 1-2mm by opening the coilActivation: 1-2mm by opening the coil -should not be bent where it merges from the baseplate-should not be bent where it merges from the baseplate
  86. 86. Dr.SafeenaDr.Safeena
  87. 87. ScrewsScrews Used for moving individual teeth or group of teethUsed for moving individual teeth or group of teeth Types of screwsTypes of screws 2 types of expansion screws2 types of expansion screws  Skeletal expansion screwSkeletal expansion screw  Dental expansion screwDental expansion screw
  88. 88. Types of ScrewsTypes of Screws Maxillary expansionMaxillary expansion Mandibular expansionMandibular expansion Bilateral expansionBilateral expansion Sectional expansionSectional expansion Radial expansionRadial expansion Expansion in three directionsExpansion in three directions
  89. 89. ActivationActivation Screw is turned 90 degreesScrew is turned 90 degrees Will drive the parts of the plate apart by 0.2 mmWill drive the parts of the plate apart by 0.2 mm Narrows periodontal membrane by 0.1 mm on eachNarrows periodontal membrane by 0.1 mm on each sideside Ideal orthodonticIdeal orthodontic condition for transformation of bonecondition for transformation of bone
  90. 90. Uses :Uses : Baseplate divided into sections driven apart byBaseplate divided into sections driven apart by one or more screwsone or more screws 1)1) Split along midline – Bilateral crossbite and minorSplit along midline – Bilateral crossbite and minor crowding of incisorscrowding of incisors
  91. 91. 2)2) Split into a larger and a smaller partSplit into a larger and a smaller part
  92. 92. PretreatmentPretreatment
  93. 93. Post-treatmentPost-treatment
  94. 94. 3)3) Lingually locked and crowded upper centralLingually locked and crowded upper central incisor tipped forward using springs afterincisor tipped forward using springs after space provided by moderate expansionspace provided by moderate expansion
  95. 95. 4)4) Expansion and reduction of overjetExpansion and reduction of overjet
  96. 96. 5)5) Y-Plates – For alignment of crowded canines byY-Plates – For alignment of crowded canines by saggital and lateral expansionsaggital and lateral expansion
  97. 97. ElasticsElastics Resembles rubber bandResembles rubber band Made of latex rubberMade of latex rubber Available in various diameters – force applied dependsAvailable in various diameters – force applied depends on their diameteron their diameter Colour coded for easy identificationColour coded for easy identification Uses :Uses : For movement of singe teeth and groups of teethFor movement of singe teeth and groups of teeth For intermaxillary tractionFor intermaxillary traction
  98. 98. Molar intrusion with removable a applianceMolar intrusion with removable a appliance Giuilio Alessandri Bonatti, Daniela GiuntaGiuilio Alessandri Bonatti, Daniela Giunta JCO Aug 1996JCO Aug 1996 CASE 1CASE 1
  99. 99. After 4 months Prosthetic replacementAfter 4 months Prosthetic replacement CASE 1CASE 1
  100. 100. CASE 2CASE 2
  101. 101. CASE 2CASE 2
  102. 102. SolderingSoldering Soldering is the joining of two metals by the use of fillerSoldering is the joining of two metals by the use of filler metal which has a substantially low fusionmetal which has a substantially low fusion temperature than that of the metal parts being joinedtemperature than that of the metal parts being joined Fusion temperature of filler metal ≤ 450Fusion temperature of filler metal ≤ 450°° BrazingBrazing Fusion temperature of filler metal ≥ 450°Fusion temperature of filler metal ≥ 450°
  103. 103. Dental soldersDental solders Dental solders are alloys used as intermediary or fillerDental solders are alloys used as intermediary or filler metals to join two or more metallic parts.metals to join two or more metallic parts. Composed of gold, silver, copper, zinc, tin, nickelComposed of gold, silver, copper, zinc, tin, nickel Requisites of a solderRequisites of a solder 1.1. Good tarnish & corrosion resistanceGood tarnish & corrosion resistance 2.2. Fusion temperature should be lower than that ofFusion temperature should be lower than that of parts being joined. (50parts being joined. (50°°-100-100°° less)less) 3.3. Should be free flowing and adequately wet the metalShould be free flowing and adequately wet the metal parts for good adhesionparts for good adhesion 4.4. Strength of solder comparable to metals beingStrength of solder comparable to metals being joinedjoined 5.5. Colour of solder should match with parts beingColour of solder should match with parts being solderedsoldered
  104. 104. Flux:Flux: in Latin means ‘flow’in Latin means ‘flow’ • Removes oxide coating to increase flow of the moltenRemoves oxide coating to increase flow of the molten soldersolder • Dissolves any surface impuritiesDissolves any surface impurities • Prevents oxidation of metalsPrevents oxidation of metals • Reduces melting point of dental solderReduces melting point of dental solder Flux used commonlyFlux used commonly Borax Glass- 55%Borax Glass- 55% Boric acid- 35%Boric acid- 35% Silica- 10%Silica- 10% Fluoride fluxes- Boric acid : Potassium fluoride(1:1)Fluoride fluxes- Boric acid : Potassium fluoride(1:1)
  105. 105. AntifluxAntiflux Material used to confine the flow of molten solder overMaterial used to confine the flow of molten solder over metals being joinedmetals being joined GraphiteGraphite
  106. 106. Stainless steel is difficult to solderStainless steel is difficult to solder 1)1) No union between solder & steelNo union between solder & steel under conditions of stress & strain in the mouth-under conditions of stress & strain in the mouth- Joint failureJoint failure 2)2) Heating to temperature required for solderingHeating to temperature required for soldering anneals- useless for spring purposeanneals- useless for spring purpose 3)3) Passive surface film of chromium protects it fromPassive surface film of chromium protects it from further oxidation- inhibits flow of solderfurther oxidation- inhibits flow of solder  Good designGood design  Accurate control of heat distributionAccurate control of heat distribution  Use of fluoride containing fluxUse of fluoride containing flux
  107. 107. Soldering techniqueSoldering technique
  108. 108. • Miniature butane blow lampMiniature butane blow lamp • Jet of fine needle flame 1cm longJet of fine needle flame 1cm long • Reducing zone of flameReducing zone of flame • Twisting one wire around the otherTwisting one wire around the other • Overheating-burning of wire and solder –rough pittedOverheating-burning of wire and solder –rough pitted surface on soldering.surface on soldering. • Soldering to be performed in one heating if possible.Soldering to be performed in one heating if possible. • Localization of heat to the site of solder.Localization of heat to the site of solder.
  109. 109. WeldingWelding Welding is process by which surfaces of metal areWelding is process by which surfaces of metal are joined by mixing, with or without use of heatjoined by mixing, with or without use of heat Design of welder for orthodontic purposeDesign of welder for orthodontic purpose Fred in 1938Fred in 1938 Mc Keag in 1939Mc Keag in 1939 Principle design features- speed & powerPrinciple design features- speed & power
  110. 110. Cold welding- done by hammering or pressure.Cold welding- done by hammering or pressure. Hot welding- Heat of sufficient intensity to melt metalsHot welding- Heat of sufficient intensity to melt metals being joined.being joined. 3 methods of welding used in dentistry3 methods of welding used in dentistry 1)1) Spot weldingSpot welding 2)2) Pressure weldingPressure welding 3)3) Laser weldingLaser welding
  111. 111. Spot weldingSpot welding Convenient method of uniting pieces of metal of theConvenient method of uniting pieces of metal of the same kindsame kind Clean, Quick, produces joints that are strong & reliableClean, Quick, produces joints that are strong & reliable Basic Principles- Heat & pressureBasic Principles- Heat & pressure Electric current conducted through 2 copper electrodesElectric current conducted through 2 copper electrodes Resistance offered generates very high temperatureResistance offered generates very high temperature Copper electrodes simultaneously apply pressure onCopper electrodes simultaneously apply pressure on metalsmetals Metal melts at contact points and pressure squeezesMetal melts at contact points and pressure squeezes metal into each othermetal into each other
  112. 112.  Circuite diagram:Circuite diagram:
  113. 113. Spot WelderSpot Welder
  114. 114. Pressure WeldingPressure Welding Metal parts placed togetherMetal parts placed together Sufficiently large force applied perpendicular to theSufficiently large force applied perpendicular to the surface- welding occurssurface- welding occurs Force applied should be sufficiently largeForce applied should be sufficiently large Laser WeldingLaser Welding High intensity pulse of light that can be focusedHigh intensity pulse of light that can be focused Select duration & intensity of pulse- metal melts inSelect duration & intensity of pulse- metal melts in small region without micro structural damage tosmall region without micro structural damage to surrounding areassurrounding areas
  115. 115. APPLIANCESAPPLIANCES ClassificationClassification 1.1. RetentionRetention 2.2. Preventive & InterceptivePreventive & Interceptive 3.3. Active tooth movementActive tooth movement  TransverseTransverse  SaggitalSaggital  VerticalVertical
  116. 116. Hawley’s ApplianceHawley’s Appliance Designed by Charles Hawley in 1908Designed by Charles Hawley in 1908 Most frequently used retainerMost frequently used retainer Short labial bowShort labial bow Adams Clasp on molarsAdams Clasp on molars
  117. 117. Modifications :Modifications :  Long labial bow – Closing space distal to canineLong labial bow – Closing space distal to canine  Labial bow soldered to bridge of Adams clasp –Labial bow soldered to bridge of Adams clasp – avoids risk of space opening due to cross over wireavoids risk of space opening due to cross over wire  Fitted labial bow – Offers excellent retentionFitted labial bow – Offers excellent retention  Anterior bite plane – To retain or correct deep biteAnterior bite plane – To retain or correct deep bite casescases  Expansion screw with split labial bowExpansion screw with split labial bow  With tongue crib.With tongue crib.  With Z spring on second molars for lingualWith Z spring on second molars for lingual movement of molarsmovement of molars
  118. 118. Alexander,s RetainerAlexander,s Retainer • ‘‘C’ clasp on molarsC’ clasp on molars • Anterior labial bowAnterior labial bow
  119. 119. High Labial RetainerHigh Labial Retainer Harvey L. LavittHarvey L. Lavitt JCO Jan1972JCO Jan1972 • Control over each tooth seperatelyControl over each tooth seperately • Springs for correction of rotation and uprightingSprings for correction of rotation and uprighting • Both active and retentiveBoth active and retentive • More estheticMore esthetic
  120. 120. A Removable CUSPID-TO-CUSPID RetainerA Removable CUSPID-TO-CUSPID Retainer DOUGLAS J. SHILLIDAY (JCO 1973)DOUGLAS J. SHILLIDAY (JCO 1973)
  121. 121. Begg’s Wraparound retainerBegg’s Wraparound retainer Popularized by P.R.Begg.Popularized by P.R.Begg. Bow extending till last erupted molarBow extending till last erupted molar  No crossover wire, eliminates risk of space openingNo crossover wire, eliminates risk of space opening upup
  122. 122. Clip-on RetainerClip-on Retainer Wire runs labial to incisors, passes between canine andWire runs labial to incisors, passes between canine and premolarpremolar Both labial and lingual wire segments embedded inBoth labial and lingual wire segments embedded in strips of acrylicstrips of acrylic Brings out correction of rotation in lower anteriorBrings out correction of rotation in lower anterior segmentssegments
  123. 123. Van der Linden RetainerVan der Linden Retainer JCO May2003JCO May2003
  124. 124. Kesling’s Tooth positionerKesling’s Tooth positioner Described by H.D.Kesling in 1945Described by H.D.Kesling in 1945 Made of thermoplastic rubber like materialMade of thermoplastic rubber like material Spans interocclusal space and covers clinical crownsSpans interocclusal space and covers clinical crowns and a small portion of gingivaand a small portion of gingiva  No activation neededNo activation needed  Difficulty in speechDifficulty in speech  Risk of TMJ problemsRisk of TMJ problems
  125. 125. Essix Retainers- Fabrication and supervision forEssix Retainers- Fabrication and supervision for permanent retentionpermanent retention John. J. Sheridan, Willaim Ledoux, Robert McminJohn. J. Sheridan, Willaim Ledoux, Robert Mcmin JCO Jan 1993JCO Jan 1993
  126. 126. Wraparound cantilever retainerWraparound cantilever retainer Timonthy J. TremontTimonthy J. Tremont JCO Feb- 2003JCO Feb- 2003 •Ideal for a well finished caseIdeal for a well finished case •Cantilever arm- middle of first bicuspidCantilever arm- middle of first bicuspid soldered to labial bowsoldered to labial bow •Bow adjusted by giving a slight bend in the cantilever armBow adjusted by giving a slight bend in the cantilever arm
  127. 127. • Thermoplastic copolymer retainerThermoplastic copolymer retainer • Thin, yet strong, cuspid-cuspidThin, yet strong, cuspid-cuspid • Low cost & ease of fabricationLow cost & ease of fabrication • Brilliant appearance of teeth caused by light reflectionBrilliant appearance of teeth caused by light reflection • Thickness- .030”Space cut at distogingival marginThickness- .030”Space cut at distogingival margin to allow removal removalto allow removal removal
  128. 128. •Pontic can be incorporated for missing anterior toothPontic can be incorporated for missing anterior tooth
  129. 129. Habit Breaking/Restraining AppliancesHabit Breaking/Restraining Appliances Tongue crib applianceTongue crib appliance Tongue crib anchored to oral cavity by clasps and labialTongue crib anchored to oral cavity by clasps and labial bowbow Used for interception of habits like tongue thrusting andUsed for interception of habits like tongue thrusting and thumb sucking.thumb sucking.
  130. 130. Oral Screen/Vestibular screenOral Screen/Vestibular screen • Introduced by Newell in 1912Introduced by Newell in 1912 • Shield of acrylic placed in the labial vestibuleShield of acrylic placed in the labial vestibule • Designed to screen oral cavityDesigned to screen oral cavity • Metal ring projecting between upper and lower lipsMetal ring projecting between upper and lower lips • Used to intercept habits like thumb sucking, tongue thrustingUsed to intercept habits like thumb sucking, tongue thrusting and mouth breathing.and mouth breathing.
  131. 131. ModificationsModifications • For interception of tongue thrusting :For interception of tongue thrusting : • Additional screen placed in the lingual aspect,Additional screen placed in the lingual aspect, attached to the vestibular screen by means of a thickattached to the vestibular screen by means of a thick wirewire • For mouth breathing- when airways are openFor mouth breathing- when airways are open • Fabricated with a number of holes that are graduallyFabricated with a number of holes that are gradually closed.closed. • Open bite in deciduous & mixed dentitionOpen bite in deciduous & mixed dentition • Mild disto-occlosion with premaxillary protrusionMild disto-occlosion with premaxillary protrusion
  132. 132. Space MaintainersSpace Maintainers Space maintenance is a process of maintaining the spaceSpace maintenance is a process of maintaining the space previously occupied by a tooth or several teeth beforepreviously occupied by a tooth or several teeth before the eruption of permanent tooth.the eruption of permanent tooth. ClassificationClassification  Functional- teeth incorporated to aid in mastication,Functional- teeth incorporated to aid in mastication, speech and esthetics.speech and esthetics.  Nonfunctional- acrylic extension over edentulousNonfunctional- acrylic extension over edentulous area to prevent space closurearea to prevent space closure
  133. 133. Class I: Unilateral maxillary posteriorClass I: Unilateral maxillary posterior Class II: Unilateral mandibular posteriorClass II: Unilateral mandibular posterior Class III: Bilateral maxillary posteriorClass III: Bilateral maxillary posterior Class IV: Bilateral mandibular posteriorClass IV: Bilateral mandibular posterior
  134. 134. ‘‘C’ Space RegainerC’ Space Regainer
  135. 135. Tongue Blade TherapyTongue Blade Therapy
  136. 136. Lip Bumper/ Lip ShieldLip Bumper/ Lip Shield Extends into the vestibular sulcus to the labial foldExtends into the vestibular sulcus to the labial fold No contact made between shield and incisorsNo contact made between shield and incisors Eliminates persistent hyperactivity of mentalis muscleEliminates persistent hyperactivity of mentalis muscle Class II div 1 malocclusionClass II div 1 malocclusion Class I flush terminal plane with large overjetClass I flush terminal plane with large overjet Shield the lower lip away- used for interception of lipShield the lower lip away- used for interception of lip sucking habitsucking habit To augment anchorageTo augment anchorage Distallisation of first molarsDistallisation of first molars As space regainers- early loss of deciduous molarsAs space regainers- early loss of deciduous molars
  137. 137. Denholtz ApplianceDenholtz Appliance Lip bumper for the maxillary archLip bumper for the maxillary arch Design similar to madibular lip bumperDesign similar to madibular lip bumper
  138. 138. Crozat Appliance Treatment of BuccalCrozat Appliance Treatment of Buccal CrossbiteCrossbite JCO 2003,JCO 2003, JuneJune Frank MarasaFrank Marasa
  139. 139. ACCOACCO • Acrylic Cervico Occipital anchorageAcrylic Cervico Occipital anchorage • Margolis 1976 & Spengeman 1967Margolis 1976 & Spengeman 1967 • Acrylic on labial bowAcrylic on labial bow • Auxiliaries- springs for posterior rotationAuxiliaries- springs for posterior rotation - minimal anterior crowding- minimal anterior crowding - minimal distalization- minimal distalization Jacobson splint- Used phase therapy or prefixedJacobson splint- Used phase therapy or prefixed appliance guidance.appliance guidance. Verdon combination appliance-WhenVerdon combination appliance-When mandibular protraction desiredmandibular protraction desired
  140. 140. Fixed Removable approach to presurgicalFixed Removable approach to presurgical Orthodontic TreatmentOrthodontic Treatment H.S.Orton, P.M.NobleH.S.Orton, P.M.Noble Lower full edgewise appliance JCO May 1990Lower full edgewise appliance JCO May 1990 Upper labial sectional edgewise applianceUpper labial sectional edgewise appliance Expansion plate with dams clasp for fixationExpansion plate with dams clasp for fixation
  141. 141. Design variation for class II div 2 casesDesign variation for class II div 2 cases Clasps on I premolar and I molarClasps on I premolar and I molar Palatal spring to intrude and procline upper incisorsPalatal spring to intrude and procline upper incisors
  142. 142. Bonding for Retention of Removable Appliances Leonard Gorelick, Arnold Geiger JCO 1986 JUNE Anatomic factors prevent adequateAnatomic factors prevent adequate retentionretention •Bell shaped posterior teethBell shaped posterior teeth •Teeth with abnormal axialTeeth with abnormal axial inclinationinclination •High palatal vault- poor tissueHigh palatal vault- poor tissue adaptation of acrylicadaptation of acrylic • Large tori that limit tissue supportLarge tori that limit tissue support Bondable eyeletBondable eyelet Composite bonding materialComposite bonding material
  143. 143. Bonded Composite Button for RemovableBonded Composite Button for Removable AppliancesAppliances JCO 2003 JuneJCO 2003 June Stephen Edward Grimm IIIStephen Edward Grimm III • Composite button made on lingual surfaceComposite button made on lingual surface • Undercut made on the gingival side of the buttonUndercut made on the gingival side of the button • Prevents the spring from being displacedPrevents the spring from being displaced • Allows full force to act on the toothAllows full force to act on the tooth
  144. 144. Instructions to patient • DiscomfortDiscomfort • PhoneticsPhonetics • Increased salivationIncreased salivation • Cleaned after eatingCleaned after eating • Initially full time wear except while eating for 6mtsInitially full time wear except while eating for 6mts • Later night time wearLater night time wear
  145. 145. ConclusionConclusion ““All you can do is push, pull or turn a tooth. I have givenAll you can do is push, pull or turn a tooth. I have given you an appliance and now for God’s sake use it”you an appliance and now for God’s sake use it” Edward.H.AngleEdward.H.Angle
  146. 146. ReferencesReferences  Orthodontic treatment with removable appliances- W.Orthodontic treatment with removable appliances- W. W.J.B. Houston, K.G. IssacsonW.J.B. Houston, K.G. Issacson  The Design, construction and use or RemovableThe Design, construction and use or Removable Orthodontic Appliances – C. Philip AdamsOrthodontic Appliances – C. Philip Adams  Removable Orthodontic Appliances- T.M. Graber,Removable Orthodontic Appliances- T.M. Graber, Bedrich NeumannBedrich Neumann  Orthodontics Principles and Practice- T.M. GraberOrthodontics Principles and Practice- T.M. Graber  Contemporary Orthodontics- ProffitContemporary Orthodontics- Proffit
  147. 147. ReferencesReferences  Orthodontics. Post graduate dental hand book- Spiro.Orthodontics. Post graduate dental hand book- Spiro. J. ChakonasJ. Chakonas  An Introduction to Orthodontics- Laura MitchellAn Introduction to Orthodontics- Laura Mitchell  Removable Partial Prosthodontics - McCracken’sRemovable Partial Prosthodontics - McCracken’s  Dentofacial Orthopedics with Functional Appliances,Dentofacial Orthopedics with Functional Appliances, Thomas. M. Graber, Thomas Rakosi, Alexandre G.Thomas. M. Graber, Thomas Rakosi, Alexandre G. PetrovicPetrovic  Removable Orthodontic Appliances. M.S.RaniRemovable Orthodontic Appliances. M.S.Rani
  148. 148. ReferencesReferences  High Labial Retainer Harvey.L.LevittHigh Labial Retainer Harvey.L.Levitt JCO Jan1972JCO Jan1972  A Removable cuspid-to-cuspid RetainerA Removable cuspid-to-cuspid Retainer Doglus J. Shilliday JCO 1973Doglus J. Shilliday JCO 1973  Crozat Princilples and Technique. Wendell H. Taylr. JCOCrozat Princilples and Technique. Wendell H. Taylr. JCO June 1985June 1985  Crozat Appliance Treatment of Buccal Crossbite FrankCrozat Appliance Treatment of Buccal Crossbite Frank Marasa. JCO June 2003Marasa. JCO June 2003  Essix Retainers- Fabrication and supervision for permanentEssix Retainers- Fabrication and supervision for permanent retention John. J. Sheridan, Willaim Ledoux, Robert Mcmin.retention John. J. Sheridan, Willaim Ledoux, Robert Mcmin. JCO Jan 1993JCO Jan 1993  Van der Linden RetainerVan der Linden Retainer JCO May2003JCO May2003
  149. 149. ReferencesReferences  Molar intrusion with removable a applianceMolar intrusion with removable a appliance Giuilio Alessandri Bonatti, Daniela GiuntaGiuilio Alessandri Bonatti, Daniela Giunta JCO Aug 1996JCO Aug 1996  Wraparound cantilever retainerWraparound cantilever retainer Timonthy J. TremontTimonthy J. Tremont,, JJCO Feb- 2003CO Feb- 2003  Notes & Compilation of Articles.Notes & Compilation of Articles. Dr.Arundhati P. TandurDr.Arundhati P. Tandur  Space maintainers in Pedodontics, Dr.N. Shivakumar,Space maintainers in Pedodontics, Dr.N. Shivakumar, Library thesis, Department of Pedodontics, ManipalLibrary thesis, Department of Pedodontics, Manipal

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