Removable orthodontic appliances: new perspectives on capabilities and efficiency

Removable orthodontic appliances: new perspectives on capabilities and efficiency

European 160 Journal of Paediatric Dentistry vol. 14/2-2013

Group 3-Aishah,Amalina, Anis, Asmat, Fadhila, Fatimah, Hamzi, Laila, Ruhaizan,Zahid

1. IntroductionAdvantages Disadvantages affordable easy adjustable for orthodontists treatment with fixed appliance may be shortened by a previous treatment with a removable applianceBettter control of oral hygiene socially unacceptable (extraoral appliance) success of treatment can be very patient-dependentTipping movement onlyAppliance designappliance design has a key role in success

1. location and type of clasps (for better retention and no tissue irritation)the location of finger springs (for maximum range of activation) and their direction (for highest rate of activation)C-clasp has better retention than Adams clasp due to the design of the C clasp creates a contact surface with the anchor tooth rather than a two-point contact by Adams clasp

C-clasp less tissue irritation, easier adjustability and fabricationImportant points to be considered when using a removable appliance for tooth movementPreferred for a noncompliant patient to an out-of-mouth gadget (i.e. headgear). Oral hygiene maintenance is much less complicated for patients. Sometimes a removable appliance can promote the full growth potential and consequently favour teeth eruption in the proper position. It can be used for cases that require unilateral mechanics. It shortens the fixed orthodontic treatment when used in the preliminary stage of the tx plan. Interceptive method excess overjet (protruded upper ant teeth) in the middle mixed dentition.It requires simple adjustments at the chairside. It has a lower relapse rate during retention period compared to fixed appliancesIt is more affordable when used for selected cases requiring specific designs.2. MATERIALS AND METHODSCase 114-year-old girlProblem: buccally erupting upper right canine Aim: provide space for the canineAppliance design: A removable appliance is fabricated with 2 ball claspsa labial bowfinger spring to be placed between second premolar and first molar

Case 213-year-old boyProblem: upper left canine has no enough space to erupt Aim: provide space for the canineprevent later malposition of canine Appliance design: A removable appliance fabricated with a c clasp, a ball clasp, and a labial bow. Two finger springs is designated to distalize second and first molars in upper left quadrant

Case 39-year-old boyProblem: 12 & 22 have no enough space to erupta little space exists between upper central incisorsAim: prevent later malposition of lateral incisorsTo close space between upper central incisorsAppliance design: A removable appliance fabricated with four c clasps on upper Ds and Es for full retention, and 2 finger springs are designed to move the upper central incisors toward midline.

Case 442-year-old female Problem: severe attrition due to longterm edge-to-edge incisor relationship with a very unpleasant smileanterior crowding with labial displacement of centrals and lingual displacement of laterals rotational displacement of centrals Aims:to resolve the lower anterior crowdingmoving the lower central incisors lingually and the lateral incisors slightly labiallyAppliance design: A removable appliance is fabricated with 4 ball claspsa labial bow is designed to force centrals lingually and to retain the applianceA lingual bow is included to push laterals labially, simultaneously. Two occlusal rest on 6s hold the appliance verticallyFinally, the patient underwent aesthetic restoration of the upper and lower incisors

Case 514-year-old girlProblem: protruded anterior teeth with excessive overjet Appliance design: A Hawley retainer with a circumferential wire was fabricated for maxillary arch. Gradual tightening of loops and simultaneous acryl reduction on the palatal side of anterior teeth permits gradual lingual tipping of anterior teeth.

3.DiscussionPatient would prefer to wear less visible appliance.Speech disturbance resolves faster in patient comply to the treatment.4 factors should be considered when employing springs: Location of the spring should be located on the midway of the mesiodistal aspect of the molar Direction of the spring loopThe loop on the opposite direction of movementNo spring should be placed at the tooth that require passive drifting.No interdental acrylic extension to allow passive drifting

RetainerThe same appliance can be used as retainer for the retention phase within period of time.Essix retainer, has been demanded by many patient, especially socially active adults due to less visible and easy to use. (Sheridan et al., 1993) 4. CONCLUSIONSIntraoral removable appliances are the treatment of choice for youngsters and adult patients.Less compliant patient tend to removable appliances as it is hidden.Finger springs more effective than other devices with complicated design and screws.Cost is affordable.Less oral hygiene complication.Device is simple to adjust.Easy management by patient.It is very dependable treatment option in orthodontics