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7/22/2019 Basic Removable Appliances Design
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C O N T E N T S H i s t o r y
S c o p e o f R e m o v a b l e A p p l i a n c e s
C l a s s i f i c a t i o n
I n d i c a t i o n s
A d v a n t a g e s
D i s a d v a n t a g e s
L i m i t a t i o n s
D e s i g n C o m p o n e n t s P a t i e n t i n s t r u c t i o n s a n d A p p l i a n c e
C a r e
C o n c l u s i o n
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HISTORY
Victor Hugo Jackson Chief proponent of removable
appliances in the US
Charles Hawley Introduced Hawleys appliance in
1908
Martin Schwartz In mid 20th century developed a
variety of split plate appliances
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Philip Adams
Modified arrowhead clasp into Adams Crib
Became the basis for English removable appliances
Still the most effective clasp for orthodontic purpose
George Crozat
In early 1900s developed a removable applianceentirely in precious metal
Heavy gold wires as framework Lighter gold finger springs for desired tooth
movement
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Norman W. Kingsley (1879)
Described his p la te for Jumping the
b i te P ioneer in or thodont ic therapy for the
forward pos i t ion ing of the mandib le.
Monobloc by Pierre Robin(1902)Passive posi t ioning device
Modif ied from bi te jumpingvulcani te maxi l lary guide planesdesigned by Norman Kingsley
Indica ted in pa t ien ts wi th severe
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S cope of removable appliances The quality of outcome is not as high as with
fixed appliances
Higher chances of discontinuation of treatment
associated with the use of removable
appliances
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The use of removable appl iances s t i l l
var ies widely between c l in ic ians, buti t
i s p o s s i b l e t o a c h i e v e a d e q u a t e
o c c l u s a l i m p r o v e m e n t w i t h t h e s e
a p p l i a n c e s , p r o v i d e d s u i t a b l e c a s e s
a r e c h o s e n .
I t i s v i ta l to emphas ize that casessui tab le for removable appl iancet reatment are those that requi re s implet ipp ing movements on ly, andsurpr is ingly few malocc lus ions wi l l fa l lin to th is category.
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Definition:
REMOVABLE ORTHODONTIC APPLIANCE:
An appliance which can be removed forcleaning by the patient or for adjustment bythe orthodontist.
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Classification
Given by Graber for removable appliance
Group A :- tooth supported appliances
E.G.- Catlans appliance, inclined planes, etc.
Group B :-tooth/tissue supported
E.G.-Activator, bionator, twin block, etc
Group C :-vestibular positioned applianceswith isolated support from tooth/tissue
Frankel appliance, lip bumper,etc
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At present removable appliances are indicatedfor three major uses
Growth modification
Limited (Tipping) tooth movements
Retention
Indications
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Majority of malocclusions which require
simple tipping of teeth can besatisfactorily treated with removable
appliance
Can be incorporated with bite platforms to
eliminate occlusal interference and
displacement
Manufactured in the laboratory and
adjustments takes less chair side time.
Advantages
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Can be removed by the patient for
cleaning both teeth and appliance.
Damaged appliances that applyundesirable forces can be removed.
They are aesthetically better
accepted than fixed appliance.
They can also be used as a muscle
exerciser.
They are Inexpensive
removable
fixed
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Disadvantages PATIENT COMPLIANCE
Uncooperative patient may sometimes leaveout the appliance which prolongs the treatmentand uncontrolled drifting of teeth occurs.
Rotation of one or two upper incisors canbe dealt but multiple rotations cannotreadily be treated.
Lower removable appliances are not welltolerated due to encroachment on tongue
space and retention problems.
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If the appliance is not adjusted carefully it
brings about uncontrolled tipping of teeth.
Patients may have have excessive
salivation initially
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LIMITATIONS
Removable Appliances permit only
TIPPING movements
Patient will have difficulty in speech
initially
Appliance can be easily damaged if
care is not taken
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Components of removable appliances
Retentive Components Baseplate
Active components
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Retentive
Components
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IDEAL REQUIREMENTS
Should not impinge
Close contact to the tooth
Usable in both deciduous and permanent
dentition.
Adequate retention
No active force on the anchor tooth
Should be rigid
Easy to fabricate and also replace if needed
Not interfere with the growth of jaws and
eru tion of teeth
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Circum ferent ial Clasp
Fabricated using wire 0.8 mm
-Also known as C clasp or Three Quarter Clasp
Simple clasp used to engage buccocervical undercut Adequate retention.
Easy to fabricate.
Easy to replace.
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Disadvantages
Cannot be used in partially erupted teeth
Decalcification of cervical margin.
Gingival irritation. Plaque accumulation enhanced.
Can easily distort.
J k Cl
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Jacksons Clasp
- Fabricated using 0.8 mm wire
- Also known as Full clasp or U clasp
- Engages both bucco-cervical and proximal undercuts
Offers adequate retention
X Inadequate retention in partially erupted teeth
X Difficult to adjust
C
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Triangu lar Clasp
Fabricated using 0.6mm wire
Used between adjacent posterior
teeth Indicated for additional retention
Elastics can be engaged
Not usefull if adjacent tooth is
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ADAMS CLASPAlso known as Liverpool Clasp,
Universal Clasp,
Modified Arrowhead Clasp
Parts
Bridge
Arrowhead
Retentive arms
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CHARACTERISTICS
The bridge is 2/3rd the mesio dital width of thetooth, or slightly less then the distance betweenmesiobuccal and distobuccal undercuts, or length
should be equal to the intercuspal distance.
Is 1-2mm away from the buccal surface of the
tooth.
Angulated at 45o to the long axis of the tooth.
Bridge
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Arrowheads
They should lie in the disto- andmesio buccal undercuts.
Shaped according to the curveof the gum margins into theinterdental papilla.
Long enough to keep the brideat a proper distance.
Should not touch the adjacentteeth
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ADVANTAGES
Small, neat, occupies minimum space
Rigid, offers excellent retention
Used on any tooth in the arch
If broken can be repaired by soldering
Permits modifications in design
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DISADVANTAGES
Extensive wire bending incorporates
stresses in the wire
Unwanted palatal tipping if it getsactivated.
Can be repaired only if fractured
through the arrowheads.
Cannot be given on proclined
anteriors.
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Modifications
Adams clasp with single
arrowhead
Adams clasp with J hook
Adams clasp with helix
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Adams clasp with additional
arrowhead
Adams clasp with soldered
buccal tube
Adams clasp with distal
extensionDouble clasp on maxillary central incisors
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Schwarz Clasp
Designed by C. M. Schwarz
One of the oldest clasps and is considered as the
predecessor of the Adams Clasp
Can be used in deciduous or permanent teeth
Skill to fabricate
Eyelet Clasp
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Eyelet Clasp
Similar to triangular clasp
Used as single eyelet or multiple eyelet clasp
Eyelets placed in embrasures
On single tooth does not have firm grip so
multiple eyelet clasp is preferred
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Southend Clasp
Spans two adjacent margins of anterior
teeth
Esthetically more pleasing
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Bal lend Clasp
Wire having a knob or ball like structure
on one end
utilizes interdental undercuts
Indicated when additional retention
required
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Crozat c lasp
It resembles a full clasp but
has a additional piece of
wire soldered which engagesinto the mesial and distal
proximal undercut
Offers better retention than
full clasp
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Baseplate
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Greatest portion of removable
appliance and is1-2mm thick
It serves 3 main purposes
1. Act as vehicle to carry all parts
of the appliance
2. Serve as anchorage
3. Become an active part of
appliance itself
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Anter ior bi teplane
Platform behind upper incisorteeth with a 60degree inclination
Height enough to separate
posterior teeth by 1.5-2mm
Reduces overbite of anterior teeth
and causes
opening of the bite
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Sved B iteplane
Introduced by Sved in 1944
Covers incisal edges of upper anteriors
Pressure transmitted axially
Provides reinforces anchorage
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Pos ter ior B itep lane
Can be used for treating
Posterior crossbites
Anterior crossbitesAnterior openbite
after correction appliance acts as a retainer
Lower Inc l ined Plane
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Lower Inc l ined Plane
Introduced by Catlan more than200 yrs ago
Used for treating Anterior crossbite
Inclined at 45 degrees to the
occlusal plane
If used for more than 6wks-
anterior open bite results
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Activecomponents
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LABIAL BOWs
SPRINGS
ELASTICS
SCREWS
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LAB IAL BOWS
Parts of labial bow
1. Incisor segment
2. Vertical loops
3. Cross over section
4. Retentive arm
May have 2 functions
1) Serve as active element for movement of teeth2) Hold the plate in place & retain the teeth
Incisor segment
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Incisor segmentUsual ly in the junct ion o f middle th ird
and incisal th i rd .
Right angle bend a t the dis ta l th i rd of la te ra l inc isors or mesia l th i rd of canine
Contacts only the most prominent teeth
Vertical loopsConsis t s of para l le l ver t ica l legs jo ined
by a smooth curve.
I t i s usual ly 9-12 mm in length ,extending 2-3 mm.
At the gingival level the loop is 1-
1.5mm above the gin gival margin
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The various types of labial
bows are Short labial bow
Long labial bow
Split labial bow Reverse labial bow
Roberts retractor
Mills retractor
High labial bow with apron springs
Fitted labial bow
Beggs retention bow
Short Labial Bow
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Short Labial Bow
Fabricated with a 0.7 mm wire
Flexibility depends on vertical height of U
loops
Used when only minor overjet reduction or
incisor alignment required
Retentive arm distal to canine.
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Adjustment : Compressing of U loop
so that the incisor component is displaced
palatally by only 1mm
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Long Labial Bow
Used to close space between canine and
premolar
Provides better control over the positionof the canine
Used for retention purposes
S
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Spl i t Labial Bow
The flexibility of the wire is increased
Used for incisor retraction and Closure ofdiastemas
Adjustment : at the U loop 1-2 mm at a time.
L bi l B i h R L
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Labial Bow w ith Reverse Loop
Prevents buccal drifting of
canine
Mil ls Bow /Extended Labial Bow
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Mil ls Bow /Extended Labial Bow
Made of 0.7mm wire
Extensive loops- flexibility greatly increased
Indications -Reducing large overjets
-Alignment of irregular incisors
Lighter forces, longer range of action
Due to extensive loops less comfortable
Hi h L bi l B i th A S i
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High Labial Bow w i th Ap ron Spr ing
Used mainly for carrying Apron Springs Heavy base arch made of 0.9-1 mm wire
Apron spring are made of 0.3-0.4mm wire
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Used for retraction of teeth with
severe proclination
Lighter forces
Longer range of action
Not well tolerated by the patient
Time consuming to fabricate
Cannot be used in patients with
shallow sulcus
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Roberts Retracto r
Flexible bow constructed of 0.5mm wire
Steel tubing in the form a buccal sleeve to
give support
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Fit ted Labial Bow
Fabricated with a 0.7 mm wire Adapted closely to labial surface of anterior
teeth
Used for retention
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Beggs Retent ion Bow
0.7mm wire extends till last erupted
molar
U loops made between I & II premolars
Allows better settling of occlusion
Oth M difi ti
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Other Modifications
The labial bow with
retractive canine loop
The modified labial bow
Funct ion : Engagement of
elast ics and so lder ing of
spr ings
The labial bow with
vertical M-loop
Funct ion: Al ignment of the
can ine, if it is labial ly
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SPRINGSThese are the most commonly used
active elements.
Requirements: springs should deliver optimum force
should possess high degree of
elasticity
should have long range of action and
apply light forces.
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0.5mm or 0.6mm wires are used to
move single teeth or groups of
teeth
Constructed in 18/8 austenitic
stainless steel
The more wire incorporated, the
greater the range of the spring
and the li hter the force
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Classification of Springs
I. Based on d irect ion of tooth movement1. Springs for mesio-distal tooth movement
2. Spring for labio-lingual tooth movement
3. Springs for expansion of archesII. Based on nature of suppo rt
1. Self supported springs
2.Guided springs
3. Auxiliary springs
III. Based on presence of loop o r helix
Sing le Can t i lever Spring
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Sing le Can t i lever Spring
active arm
Parts coilretentive arm
Fabricated with a 0.5-0.6mm wire
coil with internal diameter of 3mm
used to move teeth labio-lingually or mesio-
diatally
Double Cant i lever Spr ing / Z spr ing
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Double Cant i lever Spr ing / Z spr ing
Constructed using 0.5 or 0.6 mm wire Spring perpendicular to palatal surface of
tooth
Indicated where incisors are to be proclinedActivation: Done by opening both coils
If not perpendicular to palatal surface of teeth,
it tends to intrude teeth.
T Spring
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T Spring
Constructed using 0.5 mm wire Used for buccal movement of premolars
and molars
C ff i S i
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Coff in Spring
Described by Walter.H.Coffin in 1881
Made of 1.25 mm wire Can be used for slow dentoalveolar
transverse arch expansion
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Canine Retractors
used to move canine in distal direction
CLASSIFICATION
I. Based on location -buccal
-palatal
II. Based on presence of helix or loop
III. Based on mode of action -push type
-pull type
Buccal Sel f Sup po rted Canine Retracto r
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Buccal Self Suppo rted Canine Retracto r
Fabricated with a 0.7 mm wire
Used when buccally placed canine is to
be moved palatally and distally coil just distal to long axis of tooth
U Loop Buccal Canine Retractor
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U Loop Buccal Canine Retractor
Can be used in shallow sulcus
Requires frequent adjustment
Palatal Canine Retracto r
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Palatal Canine Retracto r
-Used for canine placed palatally
requiring distal movement
S
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Screws
Types of screws
The 2 types of expansion screws are
Skeletal expansion screw
Dental expansion screw
PITCH OF THE SCREW
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PITCH OF THE SCREW
When the expansion screw is given one
complete turn, i.e., four one-quarter turns, thetwo halves of the removable orthodontic
appliance advance a distance equal to the
space between the neighbouring lines oftencalled as threads. The distance moved is called
the pitch of the screw.
Act ivat ion
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Act ivat ion
Whenever the screw is turned 90
degrees itwill drive the parts of the plate apart by
0.2 mm which
narrows periodontal ligament by 0.1
mm on each side.
In the case of adult patient 1 quarterturn/week 0.2mm approx which is less than
width of periodontal ligament fibre
U
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Uses :Baseplate divided into sections driven
apart by one or more screws
1) Split along midlineFor correcting Bilateralcrossbites
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2) Split into a larger and a smaller part
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Y-PlatesFor saggital and lateral
expansion
El ti
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Elastics Resembles rubber band Made of latex rubber
Available in various diameters forceapplied depends on their diameter
Colour coded for easy identification
Uses :
For movement of singe teeth and groups ofteeth
For intermaxillary traction
Molar intrusion with removable a appliance
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Molar intrusion with removable a appliance
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Intermaxillary elasticswith removable
plates can be used
for the treatment ofClass II and Class III
Instuctions to the
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patients and Appliance
Care
Appliance should be worn all
the time.
Remove the appliance using
the clasps only.Remove the appliance only
during brushing and for
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Never wrap the appliance in napkin
or in pocketThe patient should avoid playing
with the appliance using the
tongue.
Initial problems faced by patientlike discomfort, pain ,excessivesalivation ,plastic taste anddifficulty in speech.
Storing the appliance in a proper
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PROBLEM 1: UPPER INCISOR INSIDE BITE
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RETENTION: Adams cribs 6/6 and 4/4
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Active component: Z-spring to 1/
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BITE OPENING: Posterior bite capping to654 / 456 (more comfortable
for patient)
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BASEPLATE: to connect everything together, alsosome anchorage
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ACTIVATE THE Z-SPRING....
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PROBLEM 2: All four incisors inside bite, with
deep reverse overbite
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RETENTION: Adams cribs 6/6 and 4/4
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ANTERIOR RETENTION: Southend clasp 1/1
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ACTIVE COMPONENT: Expansion screw tosection 21/12
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BITE OPENING: occlusal capping posteriorly
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Screw is opened by one quarter turn twice a weekand pushes upper incisors forward over the bite
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PROBLEM 3: Increased overjet, proclined incisors
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Extract 4/4 to allow overjet reduction
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RETENTION: Adams cribs on 6/6 ,Southend clasp 1/1
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ACTIVE COMPONENTS: Palatal finger springs 3/3
with wire guards for
stability
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BITE OPENING: flat anterior bite plane
Trim acrylic
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3/3 at end of canine retraction
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Canines retracted. Now the incisorsmust be retracted
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RETENTION: Adams cribs 6/6 with arrowheadextensions to 5/5
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Metal stops mesial to 3/3 to prevent theseteeth from moving forward
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ACTIVE COMPONENT: Labial bow in 0.7 mm wirewith large U-loops to allo
activation
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BITE OPENING: flat anterior bite plane
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Labial bow activated 1-2 mm at each visit bysqueezing vertical legs of U-loops together.
Palatal acrylic must be trimmed away by the
same amount.
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End of incisor retraction
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Where canines are bucally placed, use buccalcanine retractors, made in either 0.7mm wire
or 0.5mm wire supported by 0.5mm internal
diameter tubing where it emerges from the acrylic
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Canines can be pushed palatally into theline of the arch as they move distally
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The labial segment can be retracted also with a
0.5mm labial bow with tubing support.
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ACTIVATION OF LABIAL BOW: Press thevertical leg towards the tubing
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PROBLEM 4: /5 deflected palatally,
/6 has drifted mesially
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RETENTION: Adams cribs 6 / 46 ,
southend clasp 1/1
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ACTIVE COMPONENT: Screw section to /6 ,
Z-spring to /5
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PROBLEM 5: Buccally placed canine /3
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Retention: Adams cribs 6/6 and 4/4
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ANCHORAGE REINFORCEMENT:
Headgear tubes on 6/6
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ACTIVE COMPONENT: Screw section to distalis
/456
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ANCHORAGE REINFORCEMENT:
headgear to tubes on 6/6
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Problem 6: Class II div 1, and both upper first permanent
molars are carious
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Adams cribs on 73/37, finger springs 5/5 and
4/4, fitted labial bow 21/12
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Extract 6/6
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Retract 5/5 (with or without headgear support)
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Retract 4/4
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Adams cribs 74/47, finger springs 3/3,
Southend clasp 1/1
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Upper 3/3 retracted
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URA with labial bow to retract 21/12
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Conclus ionRemovable and fixed appliances are the two facets of the
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Removable and fixed appliances are the two facets of the
orthodontic world.
The science and art of designing and constructing
removable orthodontic appliances forms the basis for
managing most of the orthodontic patients
Sound theoretical knowledge of orthodontics helps us in
designing a removable orthodontic appliance where as
the construction of removable appliance is more of
an art which has to be learned meticulously followingthe procedure and by repeated practice.
References
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Orthodontic treatment with removableappliances- W. W.J.B. Houston, K.G. Issacson
The Design, construction and use or
Removable Orthodontic Appliances C. Philip
Adams Removable Orthodontic Appliances- T.M.
Graber, Bedrich Neumann
Orthodontics Principles and Practice- T.M.
Graber
Contemporary Orthodontics- Proffit
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