Removable Orthodontic Appliances

Removable Appliances (RA s)

Indications Advantages & disadvantages Brief history & development Major uses of removables
Growth modification Limited tooth movement Retention Adjuncts to treatment Mild to moderate malocclusions

Removable Appliances


Can be taken out of the mouth for cleaning by the patient and adjustment by the orthodontist Apply their forces by means of springs, screws, and bows of various types Can tip teeth only

Removable Appliances

Indications
For simple movements of teeth in a mild to moderate malocclusions  For transmission of forces to blocks of teeth  As an adjunct to Fixed appliances  Useful means of applying Extra oral traction to segments of teeth / whole arch


Indications
Mild Arch Expansion  Flat anterior bite plane / Buccal capping


To influence the development of buccal segment teeth and/or To free the occlusion with the lower arch


Retention after Orthodontic therapy

Development of Removables
USA- fixed appliances- Edward Angle
Minimal usage of removable appliances Precise positioning of teeth

Europe-removable appliances
Geographic separation Social welfare systems-limited tx. for masses Scarcity of precious metals for fixed appliances Alterations in function produced by removables give stable correction of malocclusion

Removables in Europe
Growth Guidance with Functional Appliances Change mandibular posture
Open & forward

Pressure from stretch of muscle & soft tissues transmitted to teeth & bone moving teeth and modifying growth

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Basic Tooth Movements

Basic Tooth Movements

Basic Tooth Movements

Basic Tooth Movements

Basic Tooth Movements

Basic Tooth Movements

ANCHORAGE
For every action there is an equal and opposite reaction (Newtons 3rd law)  The area from which the force is applied to move the teeth.
 

Resistance to unwanted tooth movement - Proffit, 1993 Anchorage is the term used to describe the resistance to reactionary forces generated by the active components of the appliances

HOW TO CONSERVE / INCREASE ANCHORAGE (Anchorage Reinforcement) Reinforcement)

1. Clasp more teeth 2. Move only one or two teeth at a time 3. Use lighter forces 4. Occlusal capping 5. Add headgear

ANCHORAGE

ANCHORAGE

ANCHORAGE

Removable Appliances Advantages

Appealing to patients especially adults Inexpensive Easy to make and adjust Initially less chair time Allow for some types of growth guidance Removable for socially sensitive occasions

Removable Appliances Advantages

Palatal coverage increases anchorage Overbite reduction in a growing child, without a lower appliance Acrylic can be thickened to form flat anterior bite plane/buccal capping Useful as a passive retainer/space maintainer Can be used to transmit forces to blocks of teeth

Removable Appliances Disadvantages

Totally cooperation dependant !!! Limited to less complex movement Affect speech Limited range of movement Good technician required Inter-maxillary traction not practical Lower RA s are difficult to tolerate In efficient for multiple individual tooth movements

Components


A = ACTIVE COMPONENTS R = RETENTIVE COMPONENTS A = ANCHORAGE B = BASEPLATE

Base Plate (Acrylic)

Maintenance Plate Stabilize Space maintenance Replace tooth Bite Plane Posterior overlay

Base Plate


Has 3 functions
Provides foundation to support other components Contributes to anchorage May be built up into bite planes

Anterior Bite plane

Principal use is for the reduction of overbite in a growing patient. Decreases the eruption of incisors while allowing the molars to erupt.

Anterior Bite Plane

Retention
Hawley Circumferential Spring Invisible Essix Positioner

Hawley Retainer
With or without ant. or post. biteplate

Circumferential Retainer

Spring Retainer

Invisible Essix Retainer

Vacupressureformed

Biostar Machine

Positioner

Adjuncts to Treatment
Biteplate

Nightguard

Removable Appliances Used in Mild to Moderate Malocclusion

Retention
Achieved by clasps of various types Adams cribs - molars and premolars  Southend clasps - incisors  Ball hooks - interdental embrasure


Clasps & Rests

Adams

Clasps & Rests

Ball

Arrowhead

Clasps & Rests

Occlusal rest

Retention
Adams cribs molar clasps in 0.7mm stainless steel round wire premolar / deciduous clasps in 0.6mm wire Southend 0.6 mm wire Ball hooks 0.7 or 0.6 mm wire with soldered ball on end

Southend Clasp

Active Components
Expansion screws Repositioning teeth springs Space closing labial bow & springs

Transverse Expansion by Screws



Coffin springs in 1.25 SS are used

Expansion Screws

Expansion Screws

Expansion Screws

Active Components


SPRINGS - 0.5mm or 0.7mm wire 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 lighter the force exerted

FORCE AND DEFLECTION OF STAINLESS STEEL SPRINGS

MECHANISM OF ACTION Most orthodontic springs are variants of simple cantilever. For a round wire, the force generated by a small deflection within its elastic limit is given as:

F = k .d .r4 l3

FORCE AND DEFLECTION OF STAINLESS STEEL SPRINGS F = k .d .r4 l3

where r = radius of the wire d = deflection of the wire l = length of the spring k = stiffness of the wire (Youngs Modulus)

FORCE AND DEFLECTION OF STAINLESS STEEL SPRINGS

Increasing the radius of the wire by 2 will result in the force applied increasing by 16 times; Increasing the length of the spring by 2 will reduce the force applied by 8 times

Springs
Force  In most cases the force used to produce tipping movement in a single rooted tooth should be in the range of 25 50g. Deflection  The expected rate of tooth movement is between 1mm to 2mm a month, which means monthly adjustments are sufficient if an activation of 3mm is used

Stability Ratio


The stability ratio is the stiffness in the direction of unwanted tooth displacement divided by the stiffness in the intended direction of tooth movement. Ideally for a spring it should be greater than 1 but never less than 1.

Coils  Are incorporated to increase the length of the spring thus reducing their stiffness.

Point of contact


When a tooth is contacted by a spring at a single point, it will move in the direction of resultant force, which is perpendicular to the tangent at the point of contact with the tooth. If the resultant force does not pass through the long axis of the tooth, rotation will be induced.

Palatal Springs:
    

Used where the tooth to be moved is in the line of the arch The coil is positioned so that it unwinds as the tooth moves Made in 0.5mm SS for 1-5 0.6mm SS for 6 Stability is improved by incorporating guard wire or boxing in by baseplate

For Buccal Teeth:



T-Springs in 0.6mm SS are used

Buccal Springs:
Used where a tooth is to be moved palatally as well as distally.  Classically made in two designs  Self-supported one in 0.7mm wire. Its stability ratio is less than 1.  Supported one in 0.5mm SS with proximal part covered by SS sleeve. Stability ratio is more than 1 and is also less stiff than the other. Can be activated by 2-3mm.


Bows For Incisors Retraction

Labial Bows:


Made in 0.7mm SS is frequently used to reduce mild overjets and slight incisor irregularities. Recurved labial bow or labial bow with reverse loop are used to increase the effective length of the wire thus reducing the stiffness

Roberts Retractor


Made from 0.5mm SS supported by tubing, is not as stiff as labial bow.

Recurved Labial Bow

Adjustable Labial Bow

Clinical scenarios
1. Upper incisor cross bite  2. Class III incisors & deep bite  3. Increased OJ - extract 1st premolars  4. Palatal displacement of upper premolar  5. Upper canine displaced buccally  6. Class 2 div 1 & compromised 6s  7. Lower 2nd premolar impeded


Simple Removable Appliance

Where canines are bucally placed, use buccal canine retractors, made in either 0.7mm wire or 0.5mm wire supported by 0.5mm internal diameter tubing where it emerges from the acrylic

Canines can be pushed palatally into the line of the arch as they move distally

The labial segment can be retracted also with a 0.5mm labial bow with tubing support.

ACTIVATION OF LABIAL BOW: Press the vertical leg towards the tubing

Position of helix is very important - it must be placed half-way between the starting position of the tooth and the desired finishing position

Helix too far anteriorly - tooth will move palatally

Helix too far distally - tooth will move buccally

WHY IS IT NECESSARY TO REDUCE THE OVERBITE BEFORE REDUCING THE OVERJET?

As incisors tip, the lower incisors prevent further overjet reduction due to increasing overbite

By incorporating an anterior bite plane, the overjet can be successfully reduced without increasing the overbite as the incisors tip palatally

Trimming to allow the incisors to retrocline: trim on palatal aspect, with bur parallel to palatal surface. Dont trim from the occlusal surface - reduces width of bite plane excessively.

PROBLEM 4: /5 deflected palatally, /6 has drifted mesially

RETENTION: Adams cribs 6 / 46 , southend clasp 1/1

ACTIVE COMPONENT: Screw section to /6 , Z-spring to /5

PROBLEM 5: Buccally placed canine /3

Retention: Adams cribs 6/6 and 4/4

ANCHORAGE REINFORCEMENT: Headgear tubes on 6/6

ACTIVE COMPONENT: Screw section to distalise /456

ANCHORAGE REINFORCEMENT: headgear to tubes on 6/6

Problem 6: Class II div 1, and both upper first permanent molars are carious

Adams cribs on 73/37, finger springs 5/5 and 4/4, fitted labial bow 21/12

Extract 6/6

Retract 5/5 (with or without headgear support)

Retract 4/4

Adams cribs 74/47, finger springs 3/3, Southend clasp 1/1

Upper 3/3 retracted

URA with labial bow to retract 21/12

Problem 7: an unerupted 5/ where extraction of the 4/ would give too much space

Springs
Anterior Alignment

Anterior Cross-bite Primary Dentition Cross-

Anterior Cross-bite Mixed Dentition Cross-

Springs
Posterior space regaining
Spring winding

correct

incorrect

Springs
Space Closure

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