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o-atlas Dentaurum

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The ultimate reference work on removable appliances

Atlas of orthodontic and orofacial orthopedic technique

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

Author

Dental Technician Ursula Wirtz 1967 - 1971 1972 - 1982 1982 - 1984 Since 1984 Dental Technician Apprenticeship, Nickel Dental Laboratory, Stolberg, Germany KuAcrylic Re sto rati on s Technician (Orthodontics), Jacobs Laboratory, Würselen, Germany Technician at Graef Laboratory for Orthodontics, Würselen, Germany Technician for orthodontics at the Aachen University Clinic for Orthodontics (Principal: Prof. Dr. Dr. P. Diedrich) Key aspects of activity: Publications: As a speaker: Lingual-technique, autonomous apparatus, development of innovative treatment appliances. Quintessence Publishing: Quintessence Dental Technology Laboratory Fabrication of the pendulum appliance, laboratory production of mandible fìxed linguai bar apparatus. Urban and Fischer Publishers: PDZ Orthodontics III Book contribution Orthodontie Technique Dentaurum: o-atlas of orthodontie techniques Courses and lectures for Dentaurum, the Gesellschaft fur Kieferorthopâdische Zahntechnik e.V., and for the Aachen Vocational School II. Further éducation in the pendulum appliance for Dentaurum since 2003

Acknowledgements
This atlas was created while working at the clinic of the University of Aachen. Therefore, I want to express my special gratitude to Prof. Dr. med., Dr. med. dent. P. Diedrich, chief of orthodontics of the clinic of the University of Aachen. He enabled me to put my ideas into practice and supported me generously in all areas. Dr. W. Bauer made the professional orthodontic corrections in many hours of her time. Dr. T. Hetz translated this reference work into English and Spanish, so that it can be understood "in the whole world". Dr. G. Kinzinger collaborated mainly in the Pendulum appliances section. The idea and title of this atlas resulted together with Prof. Dr. med., Dr. med. dent H. Wehrbein. Mrs. I. Sous worked tirelessly finding and correcting errors with a trained eye, detailed the draft, supported me with ideas and valued advice and in this way sacrificed many hours for me. My husband Heinz supported me in every way, accepting restrictions of our free time activities in common. I owe them all a debt of gratitude. I would like to thank the Dentaurum Company sincerely for our friendly and good cooperation, as well as the extensive promotion which made possible the making of this project. Ursula Wirtz
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space maintainer. appliance retaining elements.Content Chapter 1 Models. bionators. support elements Chapter 2 Spring elements Chapter 3 Shield elements. splints. cleft and stimulation plate Chapter 8 Retention appliances. labial bows. rapid palatal expansion (RPE) appliances Chapter 7 Nance and pendulum appliance. function regulator appliances Chapter 6 Wire appliances. activators. bimaxillar appliances Chapter 5 Bimaxillar appliances. different orthodontic plates Chapter 4 Double plates. snoring appliance .

CHAPTER 1 The ultimate reference work on removable appliances .

In all procedures the general guidelines are: 1. The midpalatal raphe (1) corresponds to the midsagittal line. The lateral surfaces can be trimmed in a round or square shape or be cast in plastic forms. square or rubber form bases. After shaping the models. they should be prepared very accurately. • U The simple labial bow U Function: Additional retention The labial bow is bent as usual. Then some zigzag inflections must be bent into the incisal part of the wire as retention means for the acrylic. treatment planning and the working basis for removable and fixed appliances in the laboratory It does not matter if the models have round. Midpalatal raphe 2. When putting the models on their heel or back surface they should always stand in habitual occlusion. . It should be right angled to the tuber plane (2) and the model base should be trimmed parallel to the occlusal plane (3).• U The dental models U Function: Basis for treatment planning Description: Plaster models are the most important records for diagnosis. Occlusal plane As study models could be considered the presentation card of every orthodontist. This way models can be stored dustfree for years. they always have to be fixed in habitual occlusion. positive or negative. they are smoothed out with wet sandpaper. all bubbles. soap or shine liquid. have to be removed and the surface is polished and sealed with talcum powder. Tuber plane 3.

In order to scatter the acrylic better. On this occasion attention. should be paid on the counter bite. Then some zigzag inflections must be bent into the incisal part of the wire as retention means for the acrylic. This wax frame should be shaped in a dimension that later corresponds to the thickness of the acrylic shield. it is useful to frame the labial bow with wax. • U The acrylic covered labial bow U Function: Additional retention The labial bow is bent as usual. occasionally. This wax frame should be shaped in a dimension that later corresponds to the thickness of the acrylic shield. the labial bow has to be adapted deeper.In order to scatter the acrylic better. it is useful to frame the labial bow with wax. . In order to avoid occlusal interferences.

occasionally. should lie as close as possible to the premolar if the gap distal of the canine is to be closed. The tag. the labial bow has to be adapted deeper • U The labial bow with vertical M-loop U Function: Alignment of the canine. The loop should only lie on the most prominent part of the crown. . In order to avoid occlusal interferences. Depending on the location of the centre part of the loop. avoiding contact with the gingival tissue. if it is labially positioned or partially erupted The M-loop moves the tooth primarily in a lingual direction. bent over from the labial to the lingual side (transversal tag).On this occasion attention. the tooth can also be rotated. should be paid on the counter bite.

the labial bow and the transversal tag should not lie too high. If the tooth should be moved distally. This loop can tip the canine distally as well as lingually. In order to avoid interference with the occlusion. . • U The labial bow with canine loop U Function: Stabilization of the incisor segment The labial bow is led to the end of the canine gap and there it is bent back 180°. the loop should embrace the tooth surface as far as possible. Then distal of the lateral incisor it is bent into the transversal tag. there has to be some space between the distal surface of the canine and the transversal tag. the canine can be moved mesially. If the loop is bent the other way around.• U The labial bow with retractive canine loop U Function: Alignment of labially rotated canines To optimize the point of force application.

If the four incisors have to be stabilized. • U The labial bow with Andresen loop U Function: Retrusion of the canines The loop should embrace the canine completely but should not contact the gingival tissue. Because of the transversal tag distal of the lateral incisor. . the transversal tag should contact the lateral incisor. Because of the loop design. this labial bow maintains open the space for the canine. the canine can not migrate labially during its eruption. The transversal tag between the canine and the first premolar should be placed in a way that the wire does not hinder the alignment of the canine .

• U The labial bow with intrusion hooks U Function: Vertical movement of incisors The loops are bent as usual. There. The horizontal part of the labial bow runs along the centre of the crown up to the teeth which are to be moved.The labial bow with Andresen loop plays a rather subordinate role in orthodontics. it is often used in technical school as a bending exercise. The transversal tag is covered by a wax layer so that the hooks can be activated. the wire is bent in a right angle to form a loop over the incisors and afterwards bent back to the normal course of the labial bow. .

. They allow the extrusion of retained teeth. For tooth movements in different directions. Two loops integrated into the labial bow allow the engagement of vertical elastics to align incisors. Force is applied on the anterior segment by the elastics and consequently the incisors are tipped lingually Elastics can also be installed vertically. The elastics are engaged on soldered or bent-in devices of the labial bow. or can also be bent in.• U The modified labial bow U Function: Engagement of elastics and soldering of springs For the application of elastics. springs can be soldered on. different hooks can be attached by laser or conventional welding. on to a bonded attachment on the tooth.

The partial labial bow embraces only a section of anterior teeth corresponding to the specific oral circumstances The individual labial bow is contoured along the gingival margin contacting the anterior teeth cervically and is led by a canine loop into the retention. A labial bow bent circularly. . to form a retainer involving the whole arch. Two hooks are soldered in opposite directions on the labial bow to rotate an incisor with elastics. combined with Adams clasps and a base plate.A hook is soldered on the loop of the labial bow to engage vertical elastics for the alignment of canines.

A variation of the intermaxillary bow is a labial bow with an additional helix in the loops in order to increase the elasticity of the bow. It is important to remember that conventional or laser weldable wire has to be used for both bows. At canine level the wire is bent 90° forming the loops and then is anchored in the upper jaw. the horizontal part runs along the lower teeth in centric occlusion. Normally. • U The triangular clasp U Function: Simple retention for removable appliances of all types .• U The intermaxillary bow U Function: Influence of the lower jaw in a posterior direction In certain cases the labial bow of the upper jaw can be extended to influence the lower jaw. It is also possible to solder or laser a separately bent intermaxillary bow onto a standard labial bow on the upper jaw.

but directly back into the transversal tag. • U The triangular clasp according to Zimmer U Function: Simple hold for removable appliances of all types The triangular clasp according to Zimmer varies in a way that the triangle closes interdentally. then into the transversal tag and finally ends in the retention portion. the open part of the triangle should face distally. If the triangular clasp is used as an additional retention in the front. In order to protect the cheek. The buccal part is not bent over the triangle. the transversal tag has to run over the labial bow.The horizontally lying triangle continues into a vertical part. . The tag should be bent exactly over the triangle to avoid disturbing the occlusion.

The transversal tag should be adjusted as deep as possible into the interdental space so that the occlusion is not disturbed. The tag should be bent as close as possible to the occlusal surface of the teeth to avoid disturbing the counter jaw in occlusion. the wire is bent towards occlusal into the transversal tag. • U The triangular clasp according to Tränkmann U Function: Simple retention for removable appliances The triangular clasp is characterized by the fact that the open part of the triangle is located buccally. After unifying the triangle in the middle of the buccal part. It is formed directly into the transversal tag and then into the retention. This open end has to be rounded off with a rubber polisher so that the cheek is not injured by a sharp end of the wire. .The buccal component should not be overdimensioned in direction of the cheek.

The triangles should be aligned to the occlusal plane in order to make activation possible. In the mixed dentition. .This variation of the triangular clasp allows a good activation . this clasp is fitted appropriately on the first permanent molar but it can also serve as a retention element on other teeth. • U The double triangular clasp U Function: Retention for the first molar if the second molar is missing The double triangular clasp consists of two triangles which are interconnected as in the Adams clasp.

Seen from occlusal.2 mm below the cusps. a 9 cm long wire is marked parting from the middle at precisely 3. the bridge portion and the transversal part is approximately 45°. • U The Adams clasp according to Tenti U Function: Improved retention in comparison to the original Adams clasp Depending on the tooth width. . The square part of the angle wire bending pliers (for example Dentaurum REF 004-139-00) is positioned from the inside at the markings and the wire is bent downward slightly over 90°. The bridge portion of the clasp should keep a distance of approximately 1 mm to the buccal surface of the tooth so that the clasp can be activated. usually used on molars It consists of a horizontal part and two U-shaped loops that merge from the transversal clasp parts to the retention. The clinical crown determines the height of the loops.• U The Adams clasp according to Adams U Function: Anchorage.5 mm to the left and to the right so that a 7 mm long piece is marked in the centre of the wire. This part forms the buccal bridge portion between the two loops. Therefore the loops find retention in the undercuts of the crown in the transition from buccal to interproximal. These loops should have such height that the horizontal part of the clasp runs 1 . the angle between the loops.

the transversal tag can be bent gingivally in a V-shape to avoid occlusal interferences. With the round tip of the pliers. . The corresponding angles for the distal loop are 60° for the upper and 55° for the lower jaw. the mesial loop is bent 75° to the bridge. each 0. The square part of the angle wire bending pliers (for example Dentaurum REF 004-139-00) is positioned 2 mm mesially and distally of the curve of the loop and the wire is bent lingually 90° to the axis of the loop. the wire is bent upward by 180° at the markings on both sides. Holding the pliers horizontally.3 mm from the buccal bridge portion including the wire diameter.Now two marks are made on the vertical parts. A small V-shaped bend towards the gingival tissue at the central groove of the molar can be adapted to minimize occlusal interferences . According to the central groove.

Adams At the level of the lingual cusps the wire is bent around the square part of the angle wire bending pliers (for example Dentaurum REF 004-139-00) 60° towards the gingival tissue. P. parallel to the gingival tissue in a distance of 1 . Directly after this bend. • U Six modifications of the Adams clasp U Function: Anchorage of individually standing teeth and molars Adams clasp with an S-shaped loop bent in a vertical direction. According to the crown length. the wire is bent afterwards 60° from the marginal gum. the tag is bent again gingivally. the two wire ends are bent to form the retention.Function: Verbesserter Halt gegenüber der Adamsklammer nach C.2 mm. . Now both wire ends run parallel to the buccal axis of the loop. Afterwards. Now the wire end runs parallel to the occlusal surface.

a V-shaped bend between both teeth is appropriate. Adams clasp with only one mesial loop because of unfavorable gingival architecture on the last molar If the Adams clasp should serve as a retention element for two teeth. The clasp is activated contracting the centered U-loop. also embracing two separated teeth.Adams clasp with horizontally proceeding U-loop. Another variation is the Adams clasp over two teeth with a centered arrow for additional hold. . An Adams clasp.

exactly between both teeth.• U The Adams clasp with anchorage for extraoral traction U Function: Anchorage for headgear The Adams clasp is bent over two teeth. in an upper twin block appliance the labial bow can be laid under the Adams clasp • U The Adams delta clasp U Function: Good retention if the Adams clasp is the only retentive component (in an incomplete tooth row) . This way. the wire is bent into a coil in order to anchor the extraoral traction. In the centre. the headgear can be inserted without any problems into the Adams clasps. The bridge portion with the coil should not contact the teeth and should match the height of the coil on the opposite side. As shown here.

The centrally localized triangle offers additional retention.The Adams delta clasp is the combination of an Adams clasp and a triangular clasp. Both loops are bent in the same way as in the simple Adams clasp . mixed and especially in the permanent dentition To achieve optimal hold. . the arrows have to be adapted to the anatomical details. • U The arrowhead clasp U Function: Anchorage for removable appliances in the deciduous.

To avoid occlusal interference. • U The modified arrowhead clasp U Function: Anchorage for removable appliances in the deciduous. it can be bent with one arrow and the sides fit tightly mesially and distally as shown here. . the mesial end can be bent in a retrograde way.The arrowhead is bent downward with the arrowbending pliers and laid horizontally into the interdental area. If the contiguous teeth have not erupted yet. mixed and especially in the permanent dentition An arrowhead clasp bent with two arrows in which its mesial tag can be used with an additional bend for the movement of canines.

a V-shaped loop is bent which adjusts interdentally between the two anchor teeth.Forming an additional loop on the distal tag. a buccally positioned tooth can be aligned into the tooth row. • U The eyelet clasp according to Groth U Function: Retention for removable appliances in the deciduous dentition First. and is continued into the retention. . Then the clasp leads loop shaped towards occlusal.

one has to pay attention to avoid causing any interference with the buccal cusps of the upper jaw. • U The double eyelet clasp U Function: Anchorage of one or more teeth in removable appliancesa The eyelets are bent lying in the cervical area of the tooth and can be activated with movements towards lingual. In the upper jaw. a small bent has to be made into the ascending part of the clasp. Therefore.• U The eyelet clasp according to Stahl U Function: Retention in the deciduous and mixed dentition The size of the eyelet depends on the width of the interdental area of both anchor teeth. the vertical part of the clasp which continues into the transversal tag should be long enough to allow a good activation. . For the eyelet clasp in the lower jaw.

• U The universal clasp U Function: Retention of removable appliances with incompletely erupted molars The universal clasp is a retaining element which can be activated for better hold with a loop. the undercut areas of the tooth will expose. mesial and distal of the tooth. Then the fit of the clasp can be optimized activating the loop. Image of a completed appliance with a continuous eyelet clasp over several teeth. . As the eruption continues. have to fit preferably close to the gingiva.The eyelets are to be located in the undercut area. The eyelets.

gingival of the contact point. For this. it is necessary to slightly carve the papila.In order to avoid irritation the loop should not touch the gingival tissue. . It should lie in the interdental area. • U The ball clasp U Function: Anchorage of removable appliances. frequently applied on incisors and small posterior teeth The ball clasp can be bent in different manners under the condition that the ball is always inserted gingivally in the interdental area. Its application is normally with short clinical crowns or with teeth that don’t have retentive undercuts (for example lower incisors).

. the wire is bent 180° and then back on the other side of the first part in order to be bent into the retention. On the occlusal surface. appliances could sink into the floor of the mouth because of blocking out the undercuts. Because the Lorenz spring consists of two separately bent parts. The occlusal rest is laid into the lingual groove of the molar and should not interfere with the occlusion. The first and lower part of the spring is bent from labial to occlusal and then towards lingual into the retention. it can reach far into the undercuts and is therefore a very strong retaining element • U The occlusal rest U Function: Stabilization of lower appliances against vertical forces Without the use of occlusal rests. The second and upper part of the spring is bent from lingual to occlusal above the contact points into the undercut beside the first part.• U The Lorenz spring U unction: Especially strong anchorage of removable appliances The plaster casts are carved interdentally on the oral and buccal side so that the holding springs can be inserted deep into the retentive area.

A wax layer should be applied to the upper third of the incisors before the polymerization of the base plate. or can leave it ending in a simple wire. . Therefore it is possible to activate the incisal rests for intrusion of the teeth.One can bend the occlusal rest to an eyelet. • U The incisal rest U Function: Stabilization of removable appliances If vertical support is needed in the front. teeth can be held by short wires with an eyelet bent over the incisal edge.

The incisal rests fixed in this manner prevent tipping of the incisors and tilting of the appliance. CHAPTER 2 Spring Elements .

. the clasp should lie at the gingival margin on the buccal side in order to give enough retention to the appliance.• U The active circumferential clasp U Function: Mesial or distal tooth movement It is bent exactly like a normal circumferential clasp used in general dental technique. If the circumferential clasp is to be activated. The circumferential clasp for a first molar is usually placed from distal. the only difference is the free end which is bent into a small loop so that it can be introduced into the area of the papilla. As clinical crowns in adolescents are mostly short. the active part has to be waxed out before the retention. hereby. the final loop is bent mostly in a vertical direction.

Equally. When the first molar is banded. the final loop can be bent in a horizontal direction. On this occasion the loop reaches deep into the interdental area at the cervical margin. • U The canine retracting spring U Function: Alignment of teeth into the arch It attacks the tooth from buccal. . The transversal tag continues into the retention. The transversal tag should lie as close as possible to the bicuspid and should not project too far buccally in order to allow enough space for the transversal tag of the labial bow and to avoid disturbing the occlusion. The resilient part of the retracting spring is bent U-shaped and at the end continued into the transversal tag which prevents the posterior teeth to migrate mesially. the circumferential clasp can be anchored between the tubes of the band.

• U Modifications of the canine retracting spring U Function: Alignment of canines into the arch First. . the space maintaining part can be extended (analogous to the spring on the top of this side) as a guiding rail. If the wire for the V-shaped helical spring is bent over a greater distance. the loop at the canine is bent. The canine retracting spring can also be bent V-shaped and with a helix. and afterwards the space maintaining part which simultaneously serves as a distal guiding rail for the canine.The loop has to be designed to neither contact the gingival tissue nor disturb the labial bow which afterwards is laid over it.

Canine retracting spring with a long cantilever and helix. • U The helical finger spring U Function: Mesial or distal movement of single teeth The finger spring is placed in the interdental area of the teeth with a small loop. . However it can also be soldered directly onto the labial bow. the retracting spring can be bent oval shaped and led back exactly over the starting point into the acrylic. Usually the retracting spring is anchored in the base plate. In smaller gaps. The end of the loop is bent overlying the cantilever into the transversal tag as a guide to hold the spring in proper position.

The helix is positioned directly under the tooth crown and covered with wax together with the active portion.

The helix lies always opposite to the direction to which the tooth should be moved (safety pin principle). View of the lower side of the mandibular plate

.


U

The finger spring
U

Function: Tooth movement in sagittal and transversal direction

The spring contacts the tooth being moved interdentally and therefore, is also called interdental spring, intermediate spring, mesial or distal spring.

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

When the spring is covered properly with wax and the appliance is finished there is enough free play to activate the spring.


U

The protrusion spring
U

Function: Movement of a single tooth or entire tooth groups
The free end protrusion spring for single tooth movement (0.5 mm spring hard) is exactly as wide as the tooth being moved. It is fixed with wax as deep as possible at the tooth crown, so that the tooth tips as less as possible.

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

Because of the wax cover, the active portion remains freely movable for activation.

The free end protrusion spring with retaining function
U U

Function: Protrusion of teeth with simultaneous retaining function and diastema closing
The multifunctional protrusion spring serves as a retaining element because of the bent over of the free end; through corresponding activation it can also function as a mesial spring.

Accordingly, the parts being activated have to be covered with wax to make activation possible.

In this example only the retention is anchored in the acrylic. The remaining parts of the spring are freely movable for activation.


U

The free end protrusion spring with mesial arm
U

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

The finished spring consists of a mesial arm which embraces the tooth being moved extensively and a protrusive portion. As far as the retention, the spring lies exposed over the acrylic.


U

The double loop spring
U

Function: Protrusion
The spring consists of two loops which run parallel to the occlusal plane.

the remaining part is freely movable and through the wax cover easily accessible. a small loop is bent which contacts distally on the tooth in order to prevent a distal migration. Only the retention is anchored in the acrylic. instead. both wire ends are anchored in the acrylic. • U The double helical spring U Function: Maximizing the elasticity of the protrusion spring First. he spring does not finish in a free end. The spring is prepared in such a way that the entire active part is covered with wax. therefore the spring is less resilient. . then two helixes are bent opposite and horizontally to the occlusal plane.It is fixed in the lower third of the clinical crown and is covered with wax.

. The retention has to be anchored properly in the acrylic to be able to resist the high strain. The retention tags are parallel to the palatal gingival tissue. • U The closed protrusion spring for incisors U Function: Alignment of the dental arch The closed protrusion spring can be used in conjunction with the labial bow to align the dental arch. The active portion should be blocked out completely with wax so that the spring can be activated easily.• U The helical protrusion spring for the anterior segment U Function: Protrusion of the entire anterior segment The loops are bent opposite and horizontally to the incisal plane over the entire width of the anterior segment. This spring is bent lying on the most prominent parts of the lingual tooth arch.

This area has to be covered with wax during the preparation. . therefore. the activators whole interocclusal acrylic is preserved. it encloses the tooth lying buccally at the gingival margin. The area where the teeth are being moved is excluded. the activator is stable guaranteeing the proper function of the spring.2 mm to the tooth being moved. the rest of the spring lies free for activation. • U The buccal box spring U Function: Oral movement of buccally standing single teeth.It proceeds horizontally to the occlusal surface and is covered with wax in the usual manner. Both retention tags are anchored in the acrylic base. preferably in the activator The buccal box spring emerges out of the interocclusal acrylic in a distance of approximately 1 . In order to create a counter base.

• U The paddle spring U Function: Protrusion of incisors with triangular shaped palatal surfaces The paddle spring has a wider base in comparison to the lingual protrusion spring.The acrylic of the activator has to be removed in such a way that the tooth is not hindered in its movement. The buccal box spring is mainly used in activators. . The spring should lie as extensive and precise as possible on the lingual surface. It can also be used for buccal movement of posterior teeth. The active part has to be covered with wax and both ends of the wire have to be anchored in the acrylic base.

• U The intrusion hook U Function: Intrusion of single anterior teeth The wire for the intrusion hook is bent in the centre by 180° so it is led double from labial across the incisal edge towards lingual. after its bending it is covered with wax to allow space for its activation. In the posterior area.• U The paddle spring over several teeth U Function: Buccal movement of several teeth A paddle spring over several teeth is often used in the making of bionators for the anterior and also for the posterior areas. . As with all other springs. the intrusion hooks have to be adapted. the paddle spring is frequently bent using larger wire than in the front. If the appliance design includes protrusion springs.

• U The sheet spring U Function: Protrusion of single teeth First. the active portion is covered with wax.The entire spring area has to be covered with wax and the screw has to be fixed before finishing the appliance. The retention portion is carved with a disc. the springs and the intrusion hooks have to lie freely so that they can be activated without any effort. Then depending on the crown length the spring is bent together in an S-shape. according to the mesiodistal diameter of the tooth the matching sheet spring is chosen. . In the finished appliance.

The beam shaped cantilever of the spring is covered with wax in such a way that the spring is freely movable in direction of the base plate. The space opening and spring activation take place simultaneously. . The cantilever proceeds straight (like a beam) and is then bent into the retention. For space opening additional C-clamps and expansion screws are used. • U The beam spring U Function: Buccal movement of bicuspids and molars The spring is placed underneath the equator at the lingual/palatal surface of the tooth being moved.The sheet spring has to emerge sufficiently out of the acrylic to allow enough free play for its activation. for example in steep palates. The spring presents advantages in restricted areas.

this means the open side shows towards mesial. The spring has only one retention portion. • U The buccal spring according to Schneemann U Function: Lingual or palatal movement of two teeth The buccal spring is bent out of one piece of wire embracing two teeth. For achieving an optimal effect with this spring. the spring is bent approximately 3 . After the loop. .• U The buccal spring U Function: Uprighting of lingually tipped teeth The spring has a loop that is directed distally.4 mm downwards and then turned again upwards 180° to finish into the retention. Both teeth are moved simultaneously. the wire portion contacting the tooth should be positioned under the equator of the tooth.

The bridge portion that leads to the retention should be bent in such a way that the tooth is not disturbed in its oral movement. • U The pressure spring U Function: Oral movement of bicuspids and molars The pressure spring. which attacks from buccal and resembles the Bonyhard clasp. or the according acrylic on the base plate is removed.In order to make the oral movement of those teeth possible. they are covered with wax on their lingual or palatal surface. is predominantly used on bicuspids but can also be applied on molars as shown here. so that the wire end which lies in the centre does not irritate the cheek tissue. The buccal spring lies close to the teeth. .

Both ends of the wire are narrowly adjusted to the contour of the teeth being moved and then bent into the retention. . The T-loop is activated narrowing both T-loop tags and bending the “T” towards lingual.The exposed loop makes activation easy. The base plate is either covered with wax or trimmed free in the direction of the movement. • U The T-loop spring U Function: Lingual or palatal movement of posterior teeth The spring is bent in the same way as the T-loop in the fixed appliance technique.

the wire continues 5 to 7 mm horizontally to the occlusal plane and straight towards oral.• U The lingual or palatal spring U Function: Lingual or palatal movement in the posterior area The tip of the clasp is bent over and the tooth is completely embraced from buccal. In this case. The retention should be anchored sufficiently in the acrylic so that the spring is not torn off because of the resulting forces. the lingual or palatal surface of the tooth should also be covered with wax so that the acrylic does not lie directly on the tooth and its oral movement is not hindered. • U The oral spring U Function: Lingual or palatal movement of buccally erupted teeth The tooth is embraced with a precisely adapted one armed clasp. and is then bent in a right angle into the retention. This active portion has to be covered with wax as usual. The activation loops are bent in an S-shape in a distance of 2 mm to the lingual or palatal area of the tooth crown. After crossing the contact point. .

• U The crossed over mesial springs U Function: Diastema or space closure at incisors The endings of the clasps are bent into small loops.The active portion of the clasp is covered with wax on the lingual side in order to avoid damaging the wire while trimming the base plate. Through the opening of the screw both spring parts are pulled together. With the oral spring. . also alveolar remodeling takes place in oral direction as a result of the bone remodeling during tooth movement. The springs can only be applied in combination with a transversal screw. The entire clasps are covered with wax as far as their retention portions. not only the tooth crown can be tipped lingually. the palatal portions of the clasp are bent parallel over each other.

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

CHAPTER 3 Shields elements. different orthodontie plates .

• U The lip activator according to Dass U Elements: Stimulation spring 1.2 mm spring hard Function: Closing stimulation of the lips Description: Appliance which follows the safety pin principle and represents exercise for the lips .• U The tongue guard U Elements: The tongue guard runs inside along the tooth rows in the area of the open bite. Function: Abhalten der Zunge von den Frontzähnen Description: mäanderförmig gebogenes Gitter Das Zungengitter verläuft innerhalb der Zahnreihen im Bereich des offenen Bisses. but can also be integrated into an active plate. The tongue guard is often combined with an oral screen. It consists of multiple loops which are bent in a distance of 3 to 4 mm and shield the open area of the bite from the tongue.

The retention works simultaneously as reinforcement for the acrylic shield. corresponding with the shape of the lip. • U The lip bumper U Elements: Lip bumper 1. The acrylic shield is finished concave to the labial surface.The spring. is bent once around the loop forming pliers.0 mm spring hard Function: Separating the lip from the incisors Description: A bow in the shape of the arch with zigzag bents for retention of the lip pads The lip bumper. which also serves as a grip. The wire end and the retention are underlaid with a wax plate and framed with a wax stripe. is anchored in the buccal tubes of the molar bands. which in this example is made individually. The following zigzag bent is used for activation if the tension decreases. .

In order to have the lip pads in a certain distance from the gingival tissue. . the bent lip bumper wire is underlaid with wax. The area in which the lip pads should keep away the lip has to be underlaid with wax. the distance from the gingival tissue should be 1 . the wire between the canine and the bicuspid is bent into a loop to allow the engagement of the labial bow. When the finished lip bumper is in place. The distance between the wire and the wax layer is about 1 mm. engaged labial bow 0.3 mm. • U Lip pads with an engaged labial bow U Elements: Function: Description: Modified wire of the lip pads.7 mm spring hard Protection from the upper lip (combination with the engaged labial bow) The lip pads wire contains a closed loop in order to be able to engage the labial bow In this case of special lip pads.

Depending on the desired function. simple retention elements and a labial bow are bent. the labial bow can be either engaged or not. For the making of a fixed inclined plane. Special care should be taken with the retention elements to guarantee a good anchorage because of the load. first the retentive parts of the teeth have to be blocked out with wax and the model has to be articulated in reference to the construction bite.7 mm spring hard Movement of single teeth or tooth groups Simple appliance for the correction of the position of single teeth or tooth groups in anterior cross-bites and for the anterior movement of the mandible For the inclined plane. • U The inclined plane U Elements: Function: Description: Simple retention elements and labial bow 0. .

only coarse details have to be eliminated. or to advance the mandible from a distal bite into a neutral occlusion. active plates can serve many different purposes For the making of an active plate the models are prepared in such a way that all blisters have to be eliminated and the undergoing parts have to be covered with wax. The model should not to be isolated if the plaster is not synthetic. Afterwards. On the lower side. Otherwise. depending on the design In combination with resilient wire elements and pressure or traction screws. the plate is detailed. . the active parts are covered with wax and the screws are positioned on the model. the screw sections are sawed and the active elements are uncovered. The prepared model can be watered. • U The active plate U Elements: Function: Description: According to the planned design Different purposes.The inclined plane in the anterior area of a maxillary plate can be used to move the mandibular teeth forward. The basis plate is only polished on the upper side. the lower side remains untreated in order to adjust as precise as possible onto the model. The chosen clasps are bent according to the planned design. The acrylic can be scattered on and can be polymerized in the pressure vessel for around 10 minutes.

7 mm spring hard. . Adams clasps are bent over the first bicuspids. In order to adjust the distal springs between the bicuspid and the molar.• U The Cetlin appliance U Elements: Function: Description: Distal spring 0. The springs and the acrylic shield are blocked out with wax and covered with acrylic. The distal limit of the acrylic base reaches the A-line. The acrylic does not contact the last molars. the plaster model has to be slightly erased in this area. modified labial bow 17 x 24 rectangular stainless steel wire Distal movement of the last molars using a headgear Simple plate to move the last molars distally with fixed bands for extra oral traction The labial bow is only laid over the four incisors and an acrylic shield is adapted. Therefore they can be banded without any problems and the teeth can glide distally along the acrylic.

one has to pay attention in order that the retentions of the clasps do not reach into the sawing area.• U Upper and lower plate with pressure-traction screw according to Heller U Elements: Function: Description: According to the planned design Movement of single teeth mesially or distally This screw moves single teeth in anterior-posterior direction using the anchorage of all other teeth which are not to be moved While designing and bending the elements. The acrylic underneath the screw can continue in order to make the appliance more stable. . A view of the plate with a completely open screw: The Adams clasps for the bicuspids which are to be moved lie on the distal end of the gap. The acrylic base has to be sawed or grinded free in all the extension of the gap.

When the screw is totally closed and a gap remains between the teeth. n the area of the gap. the acrylic edges are grinded off parallel so that the screw can be closed without any obstacles. after a new impression. The retention should be bent again in such a way that it does not invade the later sawing area. one can proceed gradually. • U The gap closing plate with diastema screw U Elements: Function: Description: According to the planned design Gap or diastema closing with a screw This is about a sturdy screw with activation extensions which are added to close a gap or a diastema . the plate is changed inserting a new screw in order to close the gap completely.• U Appliance with open screw U Elements: Function: Description: According to the planned design Gap closure The screw creates a continuous force used for gap closure The open screw is available in different sizes depending on the size of the gap.

The diastema screw is centered with its plastic holder in the middle of the arch. In the area of activation the extensions have to be covered with wax. then the tension extension is screwed back in order to create a free space in the acrylic for the later activation. First. After scattering. • U The active plate with rotation screw U Elements: Function: Description: According to the planned design Rotation of single teeth through pressure or tension The screw has two extensions with which the tooth is pushed on one side and on the other. the pressure extension is adapted on the tooth. The activation extensions are adapted on the distal surface of the tooth and are eventually shortened. finishing and polishing the appliance the proper function of the screw has to be proved. . It has a pressure and a tension extension. pulled into the right position After bending and fixing all clasps and holding elements the screw is adapted.The elements are bent according to the planned design.

• U Plate or appliance with piston spring screw U Elements: Function: Description: According to the planned design Single tooth movement in labial direction The punctual contact point of this screw moves the tooth around its axis The assembly screw is first screwed into the prepared nut until the tip exposes 0. At this moment of the making. the retention of the tension extension still lies inside the acrylic. For the insertion of the plate. the tension extension is screwed back the estimated amount and is adapted to the tooth contour.5 mm. . The active plate is covered with acrylic and finished. a drop of wax is placed. pressed onto the wax and positioned in the desired direction. The screw and the nut have to be heated slightly. On the point of force application on the tooth.The whole length of the extensions and the slots of the screw are covered with wax.

The small pan plate has to be adjusted on the tooth to be moved and has to be covered with wax together with the hinge joint. The resilient pin of the screw should only emerge slightly out of the nut. Before finishing the appliance. The piston spring screw is activated with a small screwdriver. The pan lever is connected to a hinge joint with a spring for a firm adjustment.The acrylic is scattered as usual. Possible acrylic or polishing residues are removed and the desired piston spring screw is screwed in. • U The lever activating screw U Elements: Function: Description: According to the planned design Labial inclination of lingually inclined molars or molar rotation Lingually inclined teeth are gradually set upright with this screw The screw consists of a base plate and a pan lever on which a small movable pan plate is fixed. the spring and the activation screw. There are three different screw lengths (4/6/8 mm) therefore a labial movement up to 7 mm can be achieved. the assembly screw is unscrewed. .

This force couple results in a rotational movement of the molar. . The activation screw changes the position of the pan lever and moves the distal part of the molar labially. the lever pan screw can also be used to rotate a molar. In combination with a labial spring. A labial spring which can be soldered on the Adams clasp serves as counterpart for the rotation and exerts pressure towards lingual on the mesial part of the molar. • U Appliance with Bertoni screw (Y-plate) U Elements: Function: Description: According to the planned design Simultaneous transversal and anterior-posterior expansion of the arch The three dimensional screw allows a combination of transversal and anterior-posterior expansion of the arch During the construction of the appliance.If the inclination of the tooth is severe. it is important to observe that the retentions do not lie in the area of the sawing traces. the point of application of the pan plate does not have to lie under the biggest circumference of the tooth in order to avoid interferences when inserting the appliance.

The retentions of the wire elements lie in the corresponding section according to their function. The Y-plate is often used for anterior-posterior expansion in order to gain space for the alignment of upper canines. This way. The retentions have to lie in such a way that they do not hinder the later sawing. multisectional screw according to Beutelspacher U Elements: Function: Description: According to the planned design Combined transversal and anterior-posterior expansion of the mandible Combined transversal expansion of the lower arch analogous to the Bertoni screw in the upper arch After designing the appliance. . the protrusion springs have to be adjusted horizontally and vertically before fixing the screw onto the model. the wire elements are bent and covered with wax. The saw-tracing of the finished appliance forms a Yshape. they can maintain their function even after a strong activation. • U Plate with three dimensional.The three dimensional screw allows a transversal expansion of the arch with simultaneous protrusion of the incisors. The screw has to be adapted in such a way that it allows an independent activation of all plate sections. In order to define the direction of the protrusion force.

.After the polymerization of the acrylic. The two piece expansion screw has the advantage that through the separate fixation of the screw and hinge. Posterior expansion. the lever is longer so that the fan type expansion is enhanced. Both have the same function. to expand the anterior or posterior region fan shaped. Anterior expansion. the mounting of the screws is removed and the appliance is finished. The function of the multisectional screw according to Beutelspacher is analogous to the function of the Bertoni screw in the maxilla. Afterwards. • U The fan type expansion plate with different screws and applications U Elements: Function: Description: According to the planned design Enhanced expansion in specific areas Enhanced expansion in the maxilla: 1. the sawing is performed. Eccentric expansion The fan type expansion screw exists in two designs: As a one piece or two piece expansion screw. 2. 3.

and the hinge has to be cleared of wax and acrylic residues. It should not stand out over the A-line.1. there is more space for the retentions of the wire elements. The separate joint that forms part of the hinge has to be covered with wax. the hinge of the one piece screw has to be covered with wax. Anterior expansion Fan type expansion plate with divided screw The divided screw is smaller and is therefore favored in narrow jaws. . The finished appliance is also sawed. Fan type split plate with fan type expansion screw in one piece In the same way as in the two piece screw. The appliance has to be extended notoriously further into the palate than a simple split plate. The fan type plate is often used for expansion in patients with lip and palate cleft. To assure an opening without interference the hinge should lie uncovered on the posterior limit of the plate. The appliance can be expanded like a fan after its sawing. 2T 2T The finished appliance shows that the hinge which lies on the dorsal end of the plate is not covered with acrylic. This way.

3. The screw is built in as usual. 2T 2T . it can be cut wider. The hinge is covered with wax as usual and the sawing cut is widened wedge shaped from the hinge to the front . If the wedge shaped cut is insufficient for the planned expansion. 2.The top view of an activated fan type split plate with one piece screw. Posterior expansion Fan type plate with reverse built-in. The activated screw shows that the wedge shaped cut is closed in the anterior region. divided screw The screw can also be adapted in the opposite direction. Eccentric expansion Fan type appliance with one piece screw for eccentric expansion An eccentric expansion is achieved by the oblique fixation of the screw. then its function is the posterior expansion of the maxilla. then it is covered with wax and the plate is sawed.

The opened bow screw expands the mandible almost fan shaped. • U The Mandibular plate with bow screw according to Müller U Elements: Function: Description: According to the planned design Expansion in the anterior arch section The anterior arch section is expanded wider. . the activation results in an eccentric rotation of the arch. This way. as in this example. Then the screw is fixed on the model. space can be gained in specific parts of the arch. in the area of the lip and palatal cleft. analogous to the fan type screw in the upper arch The wire elements are bent according to the design. The retentions of the clasps should not disturb the area of the screw.Because of the oblique position of the screw. The mandibular bow screw is adjusted in the same way as a transversal expansion screw into the plate. the appliance is sawed. After finishing and polishing.

Adams clasps with soldered tubes are used as retention elements.7 mm spring hard Alignment of the incisors The incisors are aligned with a set-up which is transferred with an acrylic covered labial arch A slight anterior crowding or wrong position of the incisors can be compensated with a set-up from canine to canine. The plaster model has to be duplicated for the making of the appliance. . which is covered with acrylic in the anterior region. The distal part of the labial arch. is inserted into the molar tubes which serve as guide rails.• U Labial spring bow plate according to Bandulet U Elements: Function: Description: Adams clasp 0. a continuous pressure is applied on the incisors which results in their alignment according to the set-up. From these loops. elastic springs are attached to the distal endings of the labial bow that slide out of the molar tube. Both sides of the labial bow have small loops distal of the incisor coverage.7 mm hard. labial arch 0. This way.

the tubes are pulled over the wire.6 mm spring hard. Adams clasp 0. To enhance the transversal mesial tags of the labial arch. small tubes or the needle of a syringe of corresponding size are pulled over the wire. can serve specifically as an active element. the retentions are bent. . and with the enforcement in place.7 mm hard Retraction of the incisors Simple appliance for the retraction of incisors The special part of this appliance is the labial arch. This way the thinner active part of the labial arch. The tubes start from the loop to the beginning of the retention. with additional loops in the U-loops. The transversal screw activates the labial bow automatically. If the labial arch is bent almost completely only resting the retentions.• U The Roberts retractor U Elements: Function: Description: Labial arch 0.

VD-plate) U Elements: Function: Description: According to the planned design Protrusive movement of the mandible The incline of the upper guards contacts the inclined plateau of the lower plate and results in a protrusion of the mandible The double bite jumping plate with preformed guards and integrated screws in the upper and lower jaw The result of the incline of the upper guards contacting the inclined plateau of the lower plate is a protrusion of the mandible.• U The double bite jumping plate (VSD. . After that. the plateau of the finished mandibular plate is covered with a very thin layer of wax and then. the acrylic is scattered on the maxillary plate and both parts of the fixator are set together carefully. then the acrylic is added and the appliance is finished. The mandibular plate is totally finished. Preformed mandibular expansion screws for double plates can be used when screws are integrated into the double plates. The models are mounted in the fixator according to a construction bite and the retention elements are bent according to the design. The acrylic plateau in the incisor area is designed 1 mm over the incisal edges. The screw with holder and mounting pattern for the adjustment of the incline is adapted on the lower plaster model. Following the plateau an inclined plane of 60° in relation to the occlusal plane is added as a gliding surface for the guards. the preformed maxillary expansion screw with guards is fixed. First. Acrylic can be added to the maxillary plate if the expansion screw is not covered adequately.

This is important to distribute the pressure evenly over the appliance and therefore avoid overloading and breaking of the guards. these surfaces show towards dorsal.2 mm spring hard): If the double plates do not include an expansion screw. In this variation. the mandibular plate is finished first including guide planes in the area of the first molars. the contact of the upper and lower plateau is flat and extensive. Following these precautions. when the lingual area is reduced. In models of Angle class II patients. the width of the wire should correspond to the width of the inclined plane on the lower plate. In this case.2 mm spring hard): In this case. a one piece protrusion wire can be added. 1 mounting pattern and user instructions. While polishing the maxillary plate one has to pay attention not to damage the upper plateau.• U Modifications of the bite jumping guards U Individually bent guards (1. It is only sanded down and polished. these prefabricated Müller spurs can be a good solution. Lateral guiding spurs (Müller spurs): The guiding spurs can also be applied in the posterior region. The models have to be mounted in the fixator as mentioned before with a construction bite. . Bite jumping handle (1. 1 adapter (large). Again. the wire should not extend lingually over the mandibular plate. For example. 1 adapter (small). two wire loops are added into the maxillary plate. • U The double bite jumping plate system according to Schaneng U A complete fitting set for the double bite jumping plate system according to Schaneng consists of: 3 expansion screws with bridge.

The combination of guards and expansion screw is fixed onto the inclined plane. The plastic adapter is fixed over the guiding surface onto the holder of the screw. After fixing the mandibular screw. the holder lies between the guiding surfaces of the pattern and these have to adapt closely to the body of the screw. the loops have to be covered with wax in order to maintain their elasticity. The finished lower plate is isolated with a very thin wax layer. The inclined plane of the mandibular plate which resulted from the use of the mounting pattern is slightly sanded and polished. hydrated and scattered. Before fixing the guards. This inclined plane will always be of 60° because of the mounting pattern. . The gap that results between the body of the screw and the adapter is the space for the acrylic inclined plane.The elements are bent according to the design. the mounting pattern is held parallel to the occlusal plane over the mandibular model. This way the mandibular plate can be prepared. Here. The mounting pattern is removed.

When closing the fixator the screw should be close to the palate without contacting it. When the transversal screw is expanded widely. After this. The exact following of the construction principles and the correct adjustment of the angles are the conditions for a proper elastic bite jumping double plate. the surfaces on which the thorns glide along are directed mesially.2 mm strong M-loop. During the finishing the loops have to be uncovered without grinding them. These can be neutralized by simply bending open the 1. . the mandibular plate is finished and polished first. Again. tension can be produced on the guards. the acrylic can be applied on the maxillary model. • U The class III double plate (RD-plate) U Elements: Function: Description: Clasps according to the planned design. Müller thorns (preformed elements) Retrusive movement of the mandible Müller thorns are built in reversed (exchanging left and right) In appliances of patients which present a class III.

• U The RD-plate with screw according to Sander U Elements: Function: Description: Bending of the clasps according to the planned design Retrusive movement of the mandible The activation of the screws results in a retrusive movement of the mandible After bending the elements. the screws are fixed on the lower model. The finished mandibular plate is covered with wax to avoid sticking on the maxillary plate. . the acrylic is scattered and the appliance is finished. The activation of the screws produces a retrusive movement onto the mandible. View of both finished and polished appliances.The thorns are fixed with wax as mentioned before onto the lower plate. The mounting templates have to be adapted onto the screw holder and for the maxillary appliance the guards are fixed. Now acrylic can be applied on the upper plate and the fixator has to be closed while the acrylic is not yet polymerized.

bimaxillar appliances .CHAPTER 4 Double plates.

6 mm spring hard.• U The Roberts retractor as bite jumping appliance U Elements: Function: Description: Labial bow 0. A transversal split screw can be added into the dorsal part of the acrylic base if desired. The lower inclined plane lies behind the mandibular incisors and causes the advancement of the entire mandible. The acrylic base of the upper plate is extended into the lower jaw. The bimaxillar effectiveness can be appreciated in a lateral view: . The base plate is designed as an inclined plane.Advancement of the mandible because of the inclined plane.7 mm hard Mandibular advancement The addition of an inclined plane into the acrylic base results in a mandibular advancement The maxillary elements are fixed as usual. Adams clasp 0.Retrusion of the upper incisors because of the labial arch . .

thorns 0. only a labial bow and two continuous clasps are attached. The upper plate has the same bite blocks which in height are adapted in relation to the lower ones in such a way that they adapt exactly and produce a vertical opening. The lower plate is stabilized through thorns between the canines and the lateral incisors and other thorns distal of the first molar.7 mm spring hard Increase of the vertical dimension This double plate appliance serves to increase the vertical dimension This double plate appliance can also be used without clasps.• U The double plate according to Planas U Elements: Function: Description: Labial bow 0. In the upper jaw. With this double plate appliance it is very important to achieve a good fitting of the bite blocks. circular clasp 0.7 mm spring hard. The lower plate has two horizontally laying bite blocks which are located in the lingual molar area.7 mm spring hard. . They have to be designed quite delicately in order to avoid restricting the lingual area and to hinder the pronunciation as less as possible. Both plates can be modified using transversal screws.

headgear hook 0. labial bow 0. labial pads 0. In the anterior region. they rest with their incisal edge on a plateau which simultaneously supports the lower incisors. The retentions have to be designed according to the reduced base plate.8 mm spring hard Treatment of mandibular prognathism in the mixed dentition Bimaxillar appliance with a strong lingual shield which can be used in the mixed dentition . The hooks for the extraoral traction are located between the upper lateral incisor and the canine.8 mm hard Mandibular advancement Combined with a headgear the upper jaw is restricted in its growth Ball clasps are used in the buccal area. For this appliance a construction bite is needed.8 mm spring hard. ball clasp. The plateau covers all teeth. the incisors are not covered on the palatal side. The lingual shield is positioned along the inner alveolar curve and reaches into the area of the first premolar.• U The Berlin reactivator U Elements: Function: Description: Connecting wire for the lingual shield 1. The upper base plate reaches slightly under the gingival margin in the posterior region.2 mm spring hard. • U The bimaxillar prognathism upper plate according to Buño U Elements: Function: Description: Anterior intermaxillary bow 0.8 mm spring hard. The support wire of the lingual shield is fixed firmly into the upper plate. The reactivation of this appliance occurs by activating the wire which emerges out of the upper base plate towards the front. The wire diameter can vary according to the tooth dimension.

7 mm spring hard Forward positioning of the lower jaw into a neutral position The mandible is positioned forward through the removable lingual bow This appliance only consists of an upper plate with a removable lingual bow to enhance the forward positioning of the lower jaw. lingual bow 0. The upper plate is furnished with a strong acrylic lingual shield. Therefore the models are covered with wax in the area of the lower teeth and of the lingual shield. In order to distract the tongue from the incisors. .7 mm spring hard. This acrylic shield should not touch the mandible. The part which lies on the lower incisors is covered with a spring and a plastic tube. the mandible is supposed to be restricted or even moved backwards. The opening of the tubes should be covered with wax before adding the acrylic. For the positioning of the mandible the wire is put into the tubes and is fixed with wax to the molars. Through this free space to the lingual shield and the intermaxillary bow.7 mm spring hard. The labial pads are similar to those of Fränkel’s function regulator although in the centre they are not connected . • U The bi-block appliance according to Chateau U Elements: Function: Description: Labial bow 0. Loops are bent on both sides of the intermaxillary bow. The wire elements are bent and the tubes are incorporated into the upper base plate.The upper plate is anchored with simple retention thorns. arrow clasps 0. this bimaxillar prognathism plate also includes a Coffin spring.

The Coffin spring is bent closed distally.9 mm spring hard.9 mm spring hard.After the polymerization. the lingual bow is removed from the tube to finish the plate.9 mm spring hard. . anterior spring 0.8 mm spring hard Treatment of protruded incisors The appliance is a delicate functional appliance with a low acrylic share The labial bow is bent contacting closely the upper incisors. the lingual bow is fit to the lower jaw and its proper anchorage is assured. The opening of the tube should be slightly inclined backwards on the surface of the upper plate in order to allow a safe anchorage of the labial bow and to prevent a sharp transition to the acrylic base. The anterior springs lie on the most prominent parts of the incisors. • U The Bimler appliance type A U Elements: Function: Description: Labial bow 0. The lingual bow should contact the cervical third (of the crowns) of the lower incisors and premolars. On the height of the second premolars. labiolingual bow 0. Coffin spring 0. the wire is bent backwards by 180° and passed between the canines and first premolars into the retention. After polishing the upper plate.

. The acrylic base of the finished appliance is very small and therefore it has to be polished carefully. In the lower jaw. After this. The whole appliance should be preferably worked on with a manual motor and not with the lathe. In the upper jaw the side wings. From there. To reduce the force application the anterior springs are upholstered with plastic tubes. and in the lower jaw the labial shield are limited with wax.While bending the lower labio-lingual bow the wire is positioned in the centre of the incisors. it is bent by 180° back to the molar and from there arched into the upper jaw for retention. the anterior spring is closed cervically and is anchored with its retention labially in the acrylic shield of the labio-lingual bow. it is bent towards occlusal and then in height of the first premolar is guided back to the canine.

From there. combined with an expansion screw The expansion bow for the retruded central incisors lies horizontally on the palatal surface similar to a common protrusion spring. . In the lower jaw the labio-lingual bow and the anterior springs are bent in the same way as in the type A. The transversal screw is fixed before adding wax and then the wax collar for the incisor shield in the lower jaw is added. the wire is bent between the canine and the first premolar over to the buccal side embracing the first premolar.8 mm spring hard. On the buccal side a loop is bent between the lateral incisor and the canine and wire ends are bent over. A retention thorn is fit on the mesial side of the molars and its retention is anchored in the upper acrylic base plate.• U The Bimler appliance type B U Elements: Function: Description: Anterior spring 0.9 mm spring hard.8 mm spring hard Base appliance type B for the treatment of retruded central incisors The appliance consists of a rigid upper base plate. expansion bow 0. retention thorn 0. Anterior springs are added to correct the protruded lateral incisors.9 mm spring hard.8 mm spring hard. Then the wire is bent between the first and second premolar back to the palatal area into the lateral acrylic shields. anterior loop 0. labio-lingual bow 0.

• U The Bimler appliance type C U Elements: Function: Description: Intermaxillary bow 0.9 mm spring hard. mandibular bow 0. occlusal rest 0. After finishing the appliance. In the lower jaw the anterior spring and the labio-lingual bow are anchored in the incisor shield.8 mm spring hard. The Coffin spring is closed distally.8 mm spring hard. The occlusal rests have to be horizontal to the occlusal surfaces.The design of the upper base plate is delicate. Coffin spring 0.9 mm spring hard.9 mm spring hard Base appliance type C for the treatment of prognathism with anterior cross-bite An elastic appliance with intermaxillary bow and lingual pads The upper intermaxillary bow is bent contacting the lower incisors and in distance to the upper U-loops. The anterior spring is bent contacting on the most prominent parts. . mandibular connection bow 0. anterior spring 0. the anterior springs are covered with plastic tubes.9 mm spring hard.

Both lingual bows are joined through a connecting wire with three zigzag bents into the lingual acrylic pads. After a loop formed indentation towards anterior. In the upper jaw. . The finished appliance is a delicate design and has therefore to be handled with caution during polishing and finishing procedures. then buccally between the canine and the first premolar.In the lower jaw. On the buccal side the wire is bent into a mesial loop and then back distally. small acrylic shields are made in the canine and premolar area in order to anchor the connecting wire. the lingual bows are led from the mesial edge of the canine distally. In the lower jaw. the lingual bow moves over to the acrylic base plate of the upper jaw. After completely finishing the appliance. the occlusal rests are covered with plastic tubes in order to make the vertical opening more elastic. Now the wire is led between the first and second premolar over to the oral side again. the lateral acrylic shields are limited with wax stripes. the anterior spring can also be covered with a plastic tube. In the upper jaw.

The lower plate only includes ball clasps in the anterior region and Adams clasps in the posterior region.• U The twin block appliance U Elements: Function: Description: Labial bow 0. .8 mm spring hard.7 mm hard Correction of mandibular retrognathism The mandibular position is determined with a construction bite and is fixed through inclined bite planes In the upper plate the labial bow is passed between the second premolar and the first molar into the acrylic base.8 mm spring hard. Through these two inclined planes the occlusion is fixed and the mandible is determined in its position. Adams clasp with spring for extraoral traction 0. the lower plate is finished. It includes a small bite block in the premolar area which is sloped distally. Adams clasp 0. including a spring in the centre to anchor the headgear. First.0 mm spring hard. In the upper plate the bite block is sloped in the opposite direction and therefore fits exactly onto its counterpart. The Adams clasp is bent over two teeth. ball clasp 1.

7 mm spring hard.0 mm hard Retrusion of the mandible and anterior movement of the upper jaw Elastics are engaged in soldered ball hooks in order to adjust the occlusion Arrow clasps and two hooks for the engagement of elastics are incorporated into the upper plate. Occlusal rests are bent over the lower molars. the interdental areas have to be erased to guarantee a firm adjustment especially while opening.• U The double plate with intermaxillary elastics according to Neuner U Elements: Function: Description: Arrow clasp 0. The counter hooks in the lower jaw for the intermaxillary elastics are soldered on the labial bow which afterwards is covered with acrylic. For the lingual shield. This way the vertical force component can be minimized. labial bow 1.0 mm hard. occlusal rest 1. The limits of the acrylic cover are slightly underneath the incisal edge and over the point of the papilla. thorns for elastics 1.0 mm spring hard. Ideally. the position of the hooks on both plates has to allow a horizontal course of the engaged elastics. .

. In this case. The spring bows with its retentions are bent without tension into the upper plate. labial bow 0. or simple transversal screws as well as all different sorts of springs. First. the upper plate is finished with its buccal pads which serve to control the buccinator muscle and if needed. anterior springs for an incisor correction were added. alveolar tooth movements are induced and the position of the upper jaw in relation to the cranial base is altered The upper plate is finished according to its design. The screw has to be adapted in such a way that it allows an independent activation of all plate sections. screws according to Bertoni or Beutelbacher. tooth groups or the tooth rows. The three dimensional screw allows a transversal expansion of the arch with simultaneous protrusion of the incisors. After its polishing. multi sector screws.2 mm spring hard. The connecting wires for the buccal pads are bent in a slight distance from the gingival tissue and are then fixed. the upper plate is grinded free for the retention tags of the lower spring bows in order to connect the lower and the upper plate. keep its effect from the alveolar bone.• U The bimaxillar appliance according to Sevinc U Elements: Function: Description: Guiding bow 1. All different screws can be incorporated: for example the fan type expansion screw.7 mm spring hard. connecting wires 0. The tongue pad with its guiding wires is finished separately.7 mm hard Alteration of the position of the upper jaw in relation to the cranial base By the application of force onto single teeth.

8 mm spring hard. The elements are bent according to the planned design.The lingual pad located in the anterior region allows a reduction or increase of the vertical effects. A finished bimaxillar appliance consists of the upper base plate and the integrated guiding bow with its tongue pad. It is important to remember that the retention tags of the lower plate have to be located on the buccal or labial side because this is where the acrylic will be added. guiding thorns 1. Similarly. incisal spring 0. • U The buccal double plate according to Bierschenk U Elements: Function: Description: Adams clasps 0.5 mm spring hard.2 mm spring hard Treatment of mandibular retrognathism using an upper expansion plate and a lower buccal plate This combination of an upper and lower plate with guiding thorns and notch in the bite blocks is very pleasant for the tongue The models are mounted with a construction bite in a fixator. . a retrusion of the whole mandible can be achieved by an activation of the spring bow. A vertical opening of approximately 5 mm is necessary to integrate the inclined planes into the posterior bite blocks.5 mm spring hard. helical protrusion spring for the anterior segment 0.7 mm hard. canine retracting spring 0.

8 mm spring hard Pressure is exerted on the jaws while opening and swallowing Smooth occlusal covers towards both teeth and the occlusal plane are the distinct feature of this appliance The wire elements are bent and fixed with wax onto the model. and on the lingual side. In the area of the second premolars these smooth bite blocks are grinded to form inclined planes of 45°. the crowns of the molars should only contact the acrylic from the equator on to the beginning of the gingival tissue. labial bows 0. the occlusal surfaces of the posterior teeth are covered with wax up to the cuspids. When closing. the acrylic occlusal surfaces are replaced with occlusal springs. • U The rilinator U Elements: Function: Description: Adams clasps 0. In a vertical plane. Wax is also added on the lingual surfaces in a right angle so that the acrylic contacts only the tips of the cuspids. The inner pressure bow and the labial bows are used to align the incisors. . When the treatment goal is bite closure. In the anterior region. an expansion screw can also be added.7 mm hard.On each side the upper plate has posterior bite blocks. inner pressure bows 0.5 mm spring hard. the lower buccal plate is supported with incisal rests. the guiding thorn of the lower plate is driven into these inclined planes and therefore guided into the desired occlusion. the guiding thorns have to emerge slightly in order to slide into the inclined planes of the upper bite blocks. For the making of the acrylic surfaces.

7 mm spring hard. presoldered tubes with wire can be used. • U The rilinator with Jasper Jumper U Elements: Function: Description: Labial bow 0.5 mm spring hard Fast conversion from an Angle class II-1 to class I Instead of the VSD-planes. the occlusal planes have to glide over each other.The special features of the rilinator are the lateral occlusal covers. protrusion springs 0. the Jasper Jumper produces the advance As in the base appliance. In this occlusal view.7 mm hard. protrusion springs and Adams clasps are fixed on the model. The acrylic has to be finished and polished smoothly in order to guarantee a firm contact and to increase the vertical dimension evenly. in this case. Adams clasps 0. The posterior teeth can be maintained in their vertical position. otherwise. . When expanding. so that only the tips of the cuspids contact the acrylic. the occlusal surfaces of the premolars and molars are grasped in acrylic. For the occlusal covers in the posterior region. one can confirm that the planes are grinded completely smooth and that they fit perfectly onto one another. The clinical crowns of the first molars are covered with wax. For this appliance headgear tubes have to be soldered onto the Adams clasps. they can erupt grinding the acrylic or being intruded using occlusal springs. The bow for the Jasper Jumper is fixed directly with one or several pearls into the lower plate. labial bows.

labial pads 1. wax has to be added on the palatal side of the incisors 2 mm from the incisal edge up to covering 5 mm of the gingival margin. In addition to the setting in the acrylic base. In order to insert the labial pads into the vestibular shields. The torque spring is bent carefully over the round edge of the pliers in order to reduce the risk of breakage and is then fixed onto the model.0 mm spring hard Mandibular advancement Growth stimulation due to the vestibular shields First. The finished plate is set onto the model and then the wax layer is added for the vestibular shields and labial pads. The tubes have to be sealed with wax on both ends before fixing them onto the model. The posterior part of the plate should be designed as delicate as possible. vestibular shields 1. A penetration of the acrylic into the tubes should be avoided.7 mm hard. an acrylic step can be designed behind the central incisors.0 mm spring hard. . it is recommended to solder the tubes onto the Adams clasps. the acrylic can be added including the occlusal planes. Before bending the torque spring for the incisors. After placing the screw onto the model. This tube is inserted into the labial pad.6 mm spring hard. The tubes have to be covered with acrylic as far to guarantee enough retention for the shields with labial pads. An alternative is to use preformed vestibular shields. torque springs 0. a tube is soldered onto the individually bent retention tags. the Adams clasps are bent over the molars and the first or second premolars (or second deciduous molars). Vestibular shields and labial pads can only be finished after covering the tubes with the inserted wires with a thin wax layer.2 mm spring hard.• U The Bass appliance U Elements: Function: Description: Adams clasps 0. lingual pads 1. This way. The retention tags for the vestibular shields are bent individually.

Adams clasp 0.6 mm spring hard wire. • U The Hansa plate according to Hasund U Elements: Function: Description: Closed torque spring 0. the retention tags are bent according to the situation. Both models are put together in the fixator in order to centre the lingual pads 4 to 5 mm underneath the gingival margin of the lower premolars. the mesial retention tag is anchored in the lower plate. The split fan type expansion screw is built in without its joint. are bent of 0.0 mm hard. The pair of spring bows should not contact the gingival tissue or teeth.The anterior tube on the palatal side of the plate is used as opening for the labial pads. The Adams clasps over 54 and 64 are bent of 0. The buccal tubes are placed on the second deciduous molars or on the second premolars. the reduced lower plate is connected with the upper jaw through a labial shield and a pair of especially designed spring bows for this plate. With this spring bow.7 mm spring hard. and also over 16 and 26. upper connecting bow 1. the distal tag is anchored into the lateral bite block in height of the occlusal plane. In the mandible. The finished Bass appliance can be up up-fitted to allow the patient to get used to the appliance gradually.6 and 0. .7 mm spring hard wire. the Adams clasps over 55 and 65. the connecting bow is located directly behind.7 mm spring hard Treatment of Angle class II-1 malocclusions In this functional orthopedic appliance special springs connect the upper plate to the lower plate The closed torque spring which serves to receive the Jhooks is located with loops distally of 11 and 21.

which is anchored in the upper plate.When all wire elements are bent. A slim wax stripe limits the free part of the palate and simultaneously blocks out the connecting bow. The buccal tubes are also sealed with wax. For this purpose. The wax lining of the lower model covers the cuspids of the posterior teeth in such a way that the compensation curve is maintained. or the first deciduous molar. the retention tag is passed between the canine and the first premolar. is positioned in height of the lateral bite blocks parallel to the occlusal plane. . a narrow wax stripe is fixed on the labial side of the upper tooth row. the wax is added in the same manner as in the posterior region so that there is no transition between them. Finally. It is advisable to add a wax frame in order to manufacture easier the upper reduced plate. The thickness of this wax stripe is of approximately two wax plates. The retention for the lower jaw lies lingually underneath the tooth row. The connecting bow has to lie free in such a way that it can be activated parallel to the screw. into the lower acrylic base ideally with a mesial direction. the torque springs should lie free and the buccal tubes should extend over the lateral bite planes. to make the application of the acrylic easier. The bite plane should embrace the teeth as far as possible although the Adams clasps should lie free. The other retention. Prepared this way. the acrylic can be added on the upper plate and it can be finished. Now acrylic can be added separately on the lower plate and it can be finished. a wax frame is fixed around the previous wax layer. The lateral and anterior bite planes should have even contact with small impressions for the lower teeth. The retention tags of the spring bows are bent distally. The lower lip shield is bent in average with 6 loops. The upper plate is finished first. the wax layer for the reduced lower plate is added. In the anterior region.

9 . The base plate ends on the level of the 2nd. and 2nd. The finished plates are positioned onto the models to mark the spots where the retentions of the spring bows are anchored into the upper plate.0 mm spring hard. premolar into the acrylic base. If necessary.1.8 mm spring hard Three dimensional double plate being activated through wire loops and springs The design of the double plate is more delicate with wire loops and springs as with screws The labial bow is laid between the 1st. the buccal tubes have to be grinded free minimally. the separately finished appliances can be polished without problems. . In the incisal or lingual area the plate has to be shortened in order avoid interfering with the height determined by the construction bite. The superfluous acrylic is grinded and polished. This way. In the area of the loops a small groove is milled to make the insertion of the headgear easier.1. The expansion springs for the upper and lower jaw are fixed onto the model in such a way that the active parts are covered with wax and only the retentions lie free.7 mm spring hard. Depending on the planned design. The retentions are integrated into the acrylic of the lateral bite blocks parallel to the occlusal plane.The lower plate is also finished separately.5 mm spring hard. • U The selective orthopedic double plate according to Marillo U Elements: Function: Description: Labial bow 0.0 . posterior wire loops 1. premolar. deciduous molar or distally of the 2nd. protrusion spring 0. occlusal rests 0. expansion spring 0. protrusion springs and the occlusal rests can be included in the lower plate.2 mm spring hard.

only simple labial bows are bent. The spring loops can then be fixed with acrylic into the polished plates.To increase the support.2 mm spring hard Treatment of anterior cross bites With the distal spring loops the double plate can be reactivated As wire elements. small acrylic pillars are added in the canine region. The posterior wire loops are not integrated into the plates until the end. . The retentive parts have to be blocked out with wax and the extension of the plate is also limited with wax. The models are mounted into the fixator with the construction bite. In the molar area.7 mm spring hard. spring loops 1. the support is given through the posterior loops. • U The double plate with distal spring loops according to Schwarz U Elements: Function: Description: Labial bow 0. Through the activation of these loops the correction of the occlusion can be achieved in an anterior-posterior and vertical plane.

a dividing metal sheet (B) and a mounting pattern (C). The acrylic bases are only connected through the installation of both screws on the right and left side.In order to be able to activate the springs better. The occluding pattern (A) which is used for the construction bite indicates the horizontal dividing line of the bimaxillar appliance.8 mm spring hard Treatment of Angle class III patients A bimaxillar appliance which can retrude the mandible by activation of the screw For the correct installation of the LS-Duobloc spring. they are extended minimally over the base plate. labial bow with pads 0. the complete installation kit is needed which consists of an occluding pattern (A). • U The LS-Duobloc according to Leger/Soerensen U Elements: Function: Description: Labial bow 0. . The models are mounted into the fixator in such a way that the mounting pattern and the fixator do not hinder each other.8 mm spring hard.

In the upper jaw the acrylic covers the anterior third of the palate. he screws have to be proved for their parallelism and the proximity to the dental arch and after that. When the screws adapt well into the grinded boxes. In order to integrate the screws. the fixator is divided and a wax embankment is added around the upper and lower model. After the polymerization of the acrylic. the metal sheet is removed and the plates are finished. on the right and left side. For this purpose.After bending the labial bow in the lower jaw and the labial bow with integrated pads in the upper jaw. The position of the screws is determined by the mounting pattern (C) and eventually the acrylic has to be grinded slightly more. the screws with the mounting pattern can be polymerized into the acrylic. the screws are covered with wax except for their retentions. The dividing metal sheet (B) with a Vaseline layer is adapted onto the lower model and the fixator is closed until its closing limit. the plates are grinded. the screw slot is liberated of its wax and the appliance is finished . The screws are fixed in the mounting pattern and the free part of the holding slot is also covered with wax. box shaped. The mounting pattern is removed from the mounted LSDuobloc screws. the acrylic can be added.

. In an asymmetric combination on the right and left side of the mentioned malocclusions. the type III appliance is indicated.• U The application field of the LS-Duobloc screw U In case of a mesial relation of the molars and incisors the type I appliance is used. In case of a neutral occlusion in the molar region and an anterior cross-bite. the type II appliance is recommended.

activators. bionators. function regulator appliances .CHAPTER 5 Bimaxillar appliances.

For the acrylic base. With the inclusion of a screw an additional transversal expansion is possible.8 mm fh. the model can be blocked out additionally in order to accelerate the grinding and finishing. The retention thorns only anchor the molars maximally. does not have any elements that can be activated and is designed as delicate as possible. • U The Herren activator U Elements: Function: Description: Labial bow 0. not the appliance.8 mm fh Modification of the muscular effect through an over dimensional opening of the occlusion The over dimensional vertical opening of the occlusion.8 mm spring hard Mandibular advancement and opening of the vertical dimension By this passive and loose appliance functional stimuli are transmitted to the bone tissue via muscle activity for example during swallowing The classical activator according to Andresen and Häupl is still one of the main appliances for changing the position of the mandible and for the opening of the vertical dimension. This appliance. retention thorns 0.8 mm spring hardLabialbogen 0. Labial bows and retention thorns are fixed with wax onto the model. whose ideal function is as an exercise device. which is intended to alter the muscular activity. This base appliance can include interocclusal acrylic. originally called Monobloc. they are set together in the fixator. The transitions are smoothed with additional acrylic. After the models are prepared this way and hydrated. is characteristic for this appliance . It can also be used for the lateral side shifting of the lower jaw.Haltedorne 0.• U The activator U Elements: Function: Description: Labial bow and retention thorns 0.8 mm spring hard. acrylic can be added on each one individually and before its polymerization. or it can be grinded free in order to achieve a passive opening of the vertical dimension.

The design of the appliance of the finished activator does not differ from the classic activator. • U The propulsor according to Mühlemann/Hotz U Elements: Function: Description: None Treatment of maxillary dentoalveolar protrusions in the mixed dentition Bimaxillar appliance without wire elements The models are located in the fixator according to the construction bite. The elements are bent as in the traditional activator and a wax collar is fixed for the limitation of the acrylic. It is important to observe that the fixator does not hinder the application of the acrylic. The vertical opening for the Herren activator is 8 to 10 mm.The Herren activator differs from the classic activator only in the high vertical opening. . determined by the construction bite and then set in the fixator.

When the retentive parts are blocked out. The lower incisal edges are also mounted into acrylic in order to prevent the lower incisors from tipping. The lateral bite plane reaches to the centre of the occlusal surfaces. In the premolar region. Between the central and lateral incisors the short and strong outer bows are set into the acrylic of the activator. The lower incisors are grasped labially 2 mm in acrylic in order to avoid their protrusion. The connection of the upper buccal shield to the lower lingual shield serves also as occlusal support and stabilizer for the appliance. the models are covered with wax for the acrylic base. in the lower jaw the lingual surface. The position of the mandible is achieved through the long lingual wings of the lower base. • U The headgear activator according to van Beek U Elements: Function: Description: Headgear 1. The lingual surfaces remain free. The upper base plate is kept small. In combination with a high pull headgear. . the lower base is extended as far as possible downwards. The upper incisors are also grasped in acrylic.2 mm spring hard Treatment of malocclusions class II-1 This headgear activator achieves the mandibular position through the lingual wings of its lower base The models are set into the fixator by a construction bite with a vertical opening of approximately 10 mm. The palatal area of the upper anterior teeth is blocked out with wax in order to allow a retrusion. In the posterior area the interocclusal acrylic is removed in order to allow the premolars to erupt. this appliance with bite block can be used to intrude the upper teeth. In the upper jaw the complete labial surface is covered with acrylic.

The activator additionally consists of lateral bite blocks and an incisal cap in the lower anterior region. mesial movement of the lower teeth with simultaneous distal movement of the upper teeth. In the original appliance only a modified labial bow with a soldered triangular clasp is bent The canine loops of the labial arch are placed as usual in the canine area. the headgear is only used combined with the fixator The impressions are filled with the bands in order to be able to adapt the finished appliance better. . The lower impression has to depict the lingual area very well in order to extend the lower lingual wings as far as possible into the sublingual area.• U The activator according to Pfeiffer and Grobety U Elements: Function: Description: Modified labial bow with soldered triangular clasp 0. and under influence of the masticatory muscles. The screw is fixed in the upper jaw and the base plate is limited with wax stripes. Then the wire is bent distally and between the first and second premolar it is bent into the retention.8 mm spring hard Retraction of the upper jaw with simultaneous distal movement of the upper teeth Retraction of the upper jaw.

7 mm hard Treatment of class II-1 or class III Depending on the position of the labial wire. triangular clasp 0. from the mesial third of 13 to the mesial third of 23. Class III Treatment: When the labial wire adapts on the lower front teeth. the lower front teeth which are blocked out with wax can be retruded and the upper lip can be maintained off the upper incisors. from the mesial third of 33 to the mesial third of 43. • This is a lateral view of the activator with its pronounced lower wings. • U The Functionator according to Eschler U Elements: Function: Description: Labial wire 0. then it is bent with distance to the lower incisor area. the upper front can be retruded (class II treatment) or the lower front can be moved lingually (class III treatment) Class II-1 treatment: When the labial wire adapts on the upper front teeth. Adams clasp 0. This way. then it is bent with distance to the upper incisor area. . This way.8 mm spring hard.The lower wings of the activator should be very pronounced on the lingual side favoring the activity of the masticatory muscles.7 mm spring hard. the upper front teeth which are blocked out with wax can be moved orally and the lower lip can be maintained off the lower incisors.

A screw can be added to the appliance. For a desired anterior-posterior correction an inclined anterior plane can be integrated in addition to the bite block.


U

The activator with spring bows according to Schwarz
U

Elements: Function: Description:

Labial bow 0.8 mm spring hard, spring bow 1.2 mm spring hard Activation through muscle function Through the spring bows, which can be activated horizontally or vertically, the muscle activity is stimulated

The base appliance only contains few elements, but can be replenished in any way. A labial bow is bent for each upper and lower jaw and the single plates are finished with plane lateral bite blocks.

The polished and finished plates are set onto the models which were articulated according to the construction bite. Now the unifying spring bows can be bent and be added into the acrylic of the single plates of the activator. These spring bows are supposed to enhance muscle activity.

The spring bows reach distally over the base plate for a proper activation. Different directions for their activation are possible (horizontal, vertical).


U

The open bite activator with tongue crib
U

Elements: Function: Description:

Labial bow 0.8 mm spring hard, Coffin spring 1.2 mm spring hard, tongue crib 1.0 mm spring hard, mandibular connection bow 1.0 mm spring hard Intrusion of the posterior teeth, extrusion of the incisors and simultaneous protection of the tongue The tongue is kept from the teeth because of the tongue loop which follows the curve of the dental arch

The models are set into the fixator with the construction bite and the vertical opening is determined. The labial bows are bent as usual. The connecting bow in the lower jaw and the Coffin spring in the upper jaw are fixed each 1 mm from the gingival tissue. The divided tongue crib is fixed parallel to the lingual or palatal area of the incisors.

The tongue crib consists of two divided loops. For the first half, the wire is bent back 180° in the middle. The separation of the parallel wires corresponds to half of the area to be closed off. The loop is bent according to the curvature of the anterior segment. Both wire ends are bent over for retention and are anchored in the lateral part of the activator. The second half is bent like a mirror image and is set on the other side. The acrylic body of the open activator is designed quite delicately. The anterior open base and the adapted tongue crib make this a well accepted appliance by patients.


U

The SKEL activator according to Ruhland type II-1
U

Elements:

Function: Description:

For class II-1 – II-2: Labial arch 0.9 mm spring hard, Coffin spring 0.9 mm spring hard, occlusal molar rests 0.8 mm spring hard, occlusal rests canine 0.7 mm spring hard, protrusion spring 0.7 mm spring hard For class III: Labial arch 0.9 mm spring hard, Coffin spring 1.1 mm spring hard, lingual bow 0.9 mm spring hard, connection spring 0.9 mm spring hard A reduced elastic activator with different tasks for class II-1, II-2 and III A reduced elastic activator

Type II-1 In the upper as well as in the lower jaw, the labial bows are set into the acrylic between the 1st and 2nd premolar. The distally closed Coffin spring is located in the molar region. The lower incisors area is shaped with protrusion springs. The canines in the upper jaw are held with C-clasps.
2T 2T

The acrylic base is reduced in its anterior part and has no interocclusal acrylic. The delicate design of the acrylic and the relative thin wire elements make this appliance very flexible.

Altogether the acrylic body is kept small.


U

The SKEL activator according to Ruhland type II-2
U

Elements:

Function: Description:

For class II-1 – II-2: Labial arch 0.9 mm spring hard, Coffin spring 0.9 mm spring hard, occlusal molar rests 0.8 mm spring hard, occlusal rests canine 0.7 mm spring hard, protrusion spring 0.7 mm spring hard For class III: Labial arch 0.9 mm spring hard, Coffin spring 1.1 mm spring hard, lingual bow 0.9 mm spring hard, connection spring 0.9 mm spring hard A reduced elastic activator with different tasks for class II-1, II-2 and III A reduced elastic activator

Type II-2 The upper and lower front region is developed using protrusion springs. The labial arch passes between the 1st and 2nd premolar into the acrylic. The first molars are maintained by thorns. The Coffin spring is positioned in the same way as in type II-1.
2T 2T

The acrylic base is the same as in type II-1. From the mesial part of the canines to the distal end of the molars both acrylic parts of the upper and lower jaw are connected

. The making of this appliance corresponds mainly to the one of type II-1, it differs only in the protrusion springs in the upper jaw and the lacking of the occlusal rests for the canines.

With a construction bite.9 mm spring hard A reduced elastic activator with different tasks for class II-1. Coffin spring 1.9 mm spring hard. the upper and lower parts are connected in the articulator through spring bows in the distal part of the plates. The upper jaw consists of protrusion springs.• U The SKEL activator according to Ruhland type III-a U Elements: Function: Description: For class II-1 – II-2: Labial arch 0.7 mm spring hard.9 mm spring hard.7 mm spring hard For class III: Labial arch 0. are finished separately.9 mm spring hard. Interocclusal acrylic is not necessary. an intermaxillary bow and a Coffin spring. .1 mm spring hard. occlusal molar rests 0. both parts. protrusion spring 0.8 mm spring hard.9 mm spring hard. II-2 and III A reduced elastic activator Type III-a The appliance for class III is horizontally divided. lingual bow 0. Coffin spring 0. occlusal rests canine 0. Through activation of the intermaxillary bow and both spring bows the lower jaw is retruded. 2T 2T The elements in the lower jaw are two holding thorns and a connecting bow. connection spring 0. Two distal spring bows connect the upper and lower part. First. upper and lower.

7 mm spring hard For class III: Labial arch 0. . View of the finished appliance type III b.7 mm spring hard.9 mm spring hard. protrusion spring 0.8 mm spring hard. Coffin spring 0. 2T 2T The appliance is also divided horizontally and is activated through the far distally fixed spring bows. occlusal rests canine 0. Coffin spring 1. occlusal molar rests 0. The tongue crib prevents a negative influence of the tongue.9 mm spring hard.9 mm spring hard.• U The SKEL activator according to Ruhland type III-b U Elements: Function: Description: For class II-1 – II-2: Labial arch 0. Support thorns can also be placed before the molars if needed. lingual bow 0. connection spring 0. The intermaxillary bow makes a distal movement of the mandible possible . the same type can be replenished with a tongue crib which simultaneously serves as a connecting bow.9 mm spring hard A reduced elastic activator with different tasks for class II-1.9 mm spring hard.1 mm spring hard. II-2 and III A reduced elastic activator Type III-b In the lower part.

1 mm spring hard.9 mm spring hard. occlusal molar rests 0. . In order to install the prognathism screw parallel. occlusal rests canine 0. a metal pattern is needed for their installation. protrusion spring 0.7 mm spring hard. The SKEL activator type III-c according to Ruhland works through the bilateral activation of the lower screws which move the base of the lower jaw distally against the base of the upper jaw.8 mm spring hard.9 mm spring hard A reduced elastic activator with different tasks for class II-1.7 mm spring hard For class III: Labial arch 0. a prognathism screw (LS-Duobloc. Through this screw a more uniform distal activation of the lower part is possible.9 mm spring hard. 2T 2T The acrylic is added in one process by means of a dividing metal plate. connection spring 0. lingual bow 0.9 mm spring hard. Coffin spring 0.• U The SKEL activator according to Ruhland type III-c U Elements: Function: Description: For class II-1 – II-2: Labial arch 0.Screw) was installed.9 mm spring hard. Coffin spring 1. II-2 and III A reduced elastic activator Type III-c Instead of the spring bows between the upper and lower jaw.

• U The elastic open activator according to Klammt (EOA) U Elements: Function: Description: Palatal bow 1. From there. . Under the palatal bow.9 mm hard Alignment of the anterior teeth Open activator with wide space for the tongue The labial bows lie parallel to each other and are bent buccally of the first molars into a loop. The occlusal surfaces are not covered with acrylic and a vertical support by the acrylic is left only in the canine area. labial bow 0. For an ergonomic finish and material saving. a wax spacer is placed to ensure adequate clearance for tissue comfort. The acrylic shares lay orally from the canines to the last molars forming a small band contacting teeth and gingiva. the models are blocked out with wax.2 mm spring hard. they are guided back mesially of the canines from where they are bent palatal or lingual into the retention. The palatal bow is bent similar to a Coffin spring and connects the acrylic parts.

protrusion spring 0.8 mm spring hard.9 mm hard. with this appliance expansion of the jaws is not possible .5 mm hard.• U The rigid open activator (SOA) U Elements: Function: Description: Connecting bow 1. Because of the rigid connecting bow. The rigid connecting bow gives the body of the appliance certain stability.7 mm spring hard Alignment of the anterior teeth Delicate activator with wide space for the tongue For the SOA the elements are bent according to the planned design and are fixed with wax. supporting thorns 0. The acrylic base is designed as in the EOA. labial bow 0. The rigid connecting bow is underlaid with tin foil before its fixation in the area of the first molars of the upper jaw to guarantee an even distance from the palatal gingival tissue. as delicate as possible with interocclusal acrylic.

an expansion screw can be incorporated and in the anterior region paired guiding wires can be added.8 mm spring hard.7 mm spring hard.• U Modifications of the EOA and the SOA U Instead of the palatal bow. triangular clasps 0. protrusion loop 0. the retentions have to be bent according to this situation being anchored into this acrylic segment. The finished elements are fixed onto the model.1 mm spring hard wire are located lateral in this appliance and therefore do not hinder the tongue For the making of the spring activator the models are set in the fixator. Adams clasps 0. With corresponding carving of the models (in this example an EOA). • U The spring activator according to Sander U Elements: Function: Description: Labial bow 0.5 mm half round steel wire.0 x 1.0-1. If the canines should be influenced separately (in this example an EOA). As the acrylic base of the upper jaw is reduced. palatal bow 3. In order to distract the tongue from the incisors the Coffin spring can be replenished with a small movable plastic pearl.0-1.1 mm spring hard wire with simple or triple loop Treatment of skeletal open bites and rehabilitation after TMJ injuries Special springs of 1. an additional M or U-loop can be bent into the labial wire.5 mm thick to guarantee an even distance of the palatal bow and to avoid pressure areas.7 mm hard.1. a special spring system according to Sander: 1. The highest part of the palate is covered with a tin foil which is 1 .8 mm spring hard. . acrylic is added and the plate is finished. labial shields or pads can be added for functional enhancement.

If the headgear tubes are incorporated in the area of the first premolars the triangular clasps cease to apply. . After polishing both individually made plates and the bite blocks lay even on each other. Isolated with a thick wax layer. Because of the extremely high load on the wire. Another option is to separate both plates with a metal plate Special attention should be paid to the fact that the labial bow with its occlusal parts does not lie over the occlusal plane. the spring activator can also be fitted with a transversal expansion screw or headgear tubes. the height has to be checked in the fixator according to the construction bite.The base of the upper plate should extend palatally as much as to guarantee sufficient retention and stability for the special spring. The widths of the lateral bite blocks have to be adapted orally so that the spring bow can glide past the acrylic to connect the upper with the lower jaw. While occluding firmly with the spring activator there should not be any interfering contacts in the anterior area. The retentions of the springs have to be anchored as far as possible into the distal area of the acrylic segments. the springs should be made out of 1. The decision on whether to incorporate one or three loops into the spring design depends on the oral space availability. the upper bite block can be set onto the polymerizing lower plate. Instead of the palatal bow. The loops have to be bent in such a way that while closing the wire is pushed into the loop. which means it is activated (safety pin principle). The length of the spring can be calculated reaching from the last molar approximately to the first premolar or canine.1 mm wire. The upper plate is finished and polished completely in order to allow an even adjustment of the upper and lower bite blocks. The springs should be incorporated into the plate without strain.

finished and polished separately. The area of retention in the lower jaw is blocked out with wax. the upper expansion screw is anchored in the lower jawin diesem horizontal geteilten bimaxillären Gerät ist die Oberkiefer. The fixator should be able to open and close without interference. In the interocclusal area. the upper and lower bite blocks of the divided activator show a separation of almost one millimeter. the lower jaw is finished separately and polished. . That is the reason why this area is covered with wax to this height. in the anterior region. in this case. Therefore. This way the upper plate can be sawed. While the acrylic is still malleable the fixator is closed.• U The divided activator with screw for the upper jaw U Elements: Function: Description: Labial bow and retention thorns 0.Dehnschraube im Unterkiefer verankert The elements are bent following the design. In this horizontally divided appliance. Now acrylic is added on the upper jaw.8 mm spring hard Separate expansion of the maxilla In this horizontally divided bimaxillar appliance. additionally with two protrusion springs. In the upper jaw. The extension of the acrylic base is limited with wax. two notches have to be grinded into the lower base plate. The wax layer in the retention area of the screw prevents the union of the upper and lower plate. after bending the elements. the screw is centered and fixed with wax so that the retentions of the screw stick out into the lower jaw.

The upper part of this activator can be expanded without the lower jaw. Now the retentions of the screw are polymerized into the lower plate and therefore both plates are unified to one bimaxillar appliance. For this purpose. Only the retention part of the screw is grasped in the acrylic.8 mm spring hard. retention thorns 0. the division and the interocclusal area close to the screw are covered with wax. through the effect of the screw according to Weise a continuous retropositioning of the mandible and a simultaneous advancement of the upper jaw are strived for The body of the Weise screw unifies the upper plate with the lower plate through a strong U-shaped bow.After this. • U The Prognathism activator according to Wunderer with screw according to Weise U Elements: Function: Description: Labial bow 0. The sagittal divided screw lets the upper plate glide over the lower plate . both separately produced plates are unified to one appliance.8 mm spring hard Continuous retropositioning of the mandible with simultaneous advancement of the upper jaw In this horizontally divided activator. The bow extends orally over the acrylic base.

The labial bow for the upper jaw normally does not contact the incisors while in the lower jaw it contacts the incisors passively. The connecting bow from the upper to the lower part and the part of the body of the screw that extends orally are not covered with acrylic. The bite block of the lower plate can be covered with an even layer of wax in order to avoid a later division of the activator. in the upper part of the base plate a small opening can be grinded from the palatal side in order to activate the screw. The prognathism screw according to Weise is polymerized into the lower plate in such a way that it does not hinder the upper jaw in its occlusion also verifying that the body of the screw is parallel to the occlusal plane. . It is important that the occlusal and interdental tooth surfaces are grasped with acrylic. The retention thorns are bent as usual. In the finished activator. acrylic can be added on the upper part of the activator. After this preparation of the lower base plate. Through the continuous activation of the sagittal screw spindle a retropositioning of the lower jaw and an advancement of the upper jaw are possible. The parts of the upper and lower jaw are finished and polished separately. only the retentions of the screw . The finished acrylic base has to be designed as delicately as possible. The retention part of the screw has to be well covered with acrylic. Nevertheless the screw can also be activated from the oral side with a screwdriver.

In this type I distal activator the arms of the U-bow point anteriorly.• U The U-bow activator according to Karwetzky U Elements: Function: Description: U-bow 1. both plates are joined to a bimaxillar appliance. the short upper arm shows mesially. Type III-a Pan activator In this type III-a two different bows are built in. which are anchored into the acrylic in the region of the first molars. the upper short arm shows distally. When activating the U-loops a panning movement to the right is produced. Type I distal activator Through both U-loops. The long arm of the U-bow is always fixed into the lower jaw. Type II prognathism activator In type II both anchored arms of the U-bow are directed posteriorly. The long arms are situated in the lower plate as seen here . . On the right side.2 mm spring hard. If screws are added into the plates. according to the specific type (type I-III) Through the addition of different U-bows into the elastic activator. on the left side. the short arm into the upper jaw. different directions of mandibular movement are possibl For the U-bow activator separate upper and lower plates with even grinded bite blocks and other elements (depending on the planed design) are made.8 mm spring hard Movement of the mandible in different directions. they only have effect on that specific jaw. labial bow 0.

The retention is in the interocclusal area. a panning movement to the left is the result.2 mm spring hard Inhibition of the development of the upper jaw with simultaneous mandibular advancement This headgear activator hinders the development of the upper jaw with simultaneous advancement of the mandible Base appliance with four torque springs The torque springs only contact the upper incisors in one point shortly underneath the gingival margin. torque springs 0. It is bent away slightly to avoid contact with the rest of the clinical crown. .5 mm spring hard. Coffin spring 1. This way. This draft shows a schematic representation of the U-loops of the different activator types and the movement which is produced by their activation (draft according to the tooth scheme). when activating. On the right side. on the left side the short upper arm shows distally. The interocclusal area should be high enough to allow a good anchorage of the retentions of the headgear tubes in the acrylic. The headgear tubes lie between both tooth rows in the area of the deciduous molars. It should also be checked from the occlusal point of view if they lie parallel to be able to insert the inner bow without any problems. • U The Teuscher activator U Elements: Function: Description: Headgear tubes. the short upper arm shows mesially.Type III-b Pan activator In the type III-b the U-bows are incorporated opposite as in type III-a.

2T 2T d) Lip bumper Also. • U Modifications of the Teuscher activator U 2T a) Torque springs on the central incisors The Teuscher activator allows the design of torque springs on the central incisors in combination with protrusion springs for labial movement on the lateral incisors. Therefore the limit of the vestibule has to be erased before making the appliance. It has to be positioned in height of the gingival margin in front of the lower incisors in a distance of approximately 1 mm. 2T 2T c) Labial pads On the Teuscher activator. and the upper incisors should be covered on the palatal side up to one half and on the labial side. only to the incisal edge. a lip bumper can be attached directly to the appliance in order to support a protrusion of the lower incisors. lip pads for the development of the lower jaw can be attached as in the function regulator according to Fränkel. 2T b) Sheet springs and labial bow The same effect can be achieved with sheet springs and a labial bow that should contact the most prominent teeth. 2T 2T .The acrylic base has to cover one third of the lower incisors.

the activator has to be liberated in the area of the molar tubes and the palate. The distalizing springs consist of a big loop in the molar region and have a distal cantilever mesial of the first molars and its retention in the incisal area . 2T 2T • U The Harvold-Woodside activator for class II-1 U Elements: Function: Description: Labial bow 0. distalizing springs 0.9 mm spring hard Functional change of the occlusal plane in a malocclusion class II-1 A vertical opening of up to 20 mm is necessary for this activator. the retention finishes in the area of the interocclusal opening. from there it is bent similar as the buccinator loop to shield the cheek and is then bent through a U-loop again towards the front.9 mm spring hard.e) Expansion screw Another variation for the expansion of both jaws: an expansion screw between the upper and lower jaw. 2T 2T f) Combination with fixed appliances If the Teuscher activator is used in combination with a transpalatal arch and upper molar bands. the smooth lateral bite plane maintains the upper incisors and the lower are grinded In this class II-1 activator the labial bow is bent contacting up to the canines.

The characterizing feature of this appliance is the large vertical opening in the buccal sections which is determined by a construction bite. In order to guide the anterior movement in the posterior region. higher than half of the vertical opening. only the retention of the distalizing springs is covered with acrylic. . The models prepared this way can be covered with acrylic and put into the pressure vessel for its polymerization. The labial bow only contacts the upper incisors. a thin wax plane is added in the upper jaw and a high wax plane. If the fixator is closed the separation between both wax planes in the buccal area should be of approximately one millimeter. In the finished appliance. The labial shield covers the incisors over one third of their clinical crown. so that the lateral bite plane presents enough stability. The distal limitation of the appliance is the A-line. the main purpose is to create plane surfaces for the acrylic platforms. The retention of the labial bow lies in the interocclusal acrylic right behind the upper incisors. The lateral bite planes have no contact at all with the posterior teeth in order to achieve the desired vertical eruption.The coverage with wax should be done carefully. is added in the lower jaw. for their proper activation. On the models the extension of the acrylic shield over the whole incisal area in the upper and lower jaw should be limited with a wax frame.

For its proper stability. The big vertical opening corresponds to the one in type-II. a wax plane that reaches over the half of the vertical opening is added onto the upper jaw. distalizing spring 0. Despite its location. Also. the acrylic in the interocclusal area should show a thickness of one millimeter. its task in the upper jaw is to shield off the lips through loops bent as labial pads. the wax is concavely shaped. from canine to canine. the loop and the distal cantilever of the distalizing spring are also covered with wax. The retention lies as in the class II appliance. the labial bow in the lower jaw is bent as an intermaxillary bow.• U The Harvold-Woodside activator for class III U Elements: Function: Description: Labial bow 0. In this case. the distalizing spring is bent with a big loop in the molar region. Before adding the acrylic both models have to be hydrated. The acrylic shield of this appliance only covers the lower incisal area and is correspondingly framed with a wax limitation. . As before. the wax coverage is very important. the retention ends in the anterior palatal area.9 mm spring hard Therapy of a class III malocclusion The class III activator should not hinder the buccal segments in their vertical eruption In this class III activator. the posterior teeth are slightly covered with wax and in the incisal area. In the lower jaw.9 mm spring hard. in the anterior area of the vertical opening. a sufficient anchorage has to be guaranteed for the retention of the labial bow. Although in this appliance the distal cantilevers are located behind the first molars.

9 mm spring hard. it is led distally as a buccinator loop up to the mesial cusp of the first molar. the distal limitation is also marked by the A-line. the labial bow does not contact but shields off the lip The upper teeth only contact the acrylic shield. The acrylic can be trimmed and shaped individually by the orthodontist. the labial part of the wire of the buccinator loop runs along the incisal third of the anterior teeth up to the centre of the canine. In the upper jaw. only the retention of the distalizing springs is grasped in acrylic. 2T 2T . From this point on. it is bent back along the upper teeth. From there the wire is bent diagonal downwards and then in a distance of 2 mm from the posterior teeth. The distance between the two wires of the buccinator loop should not exceed 1 cm in order to shield off and avoid the interposition of the cheek.2 mm spring hard Influence on the lip and tongue function A reduced activator with special influence on the function of the lips and tongue The three basic types of the bionator: 1) In the base appliance. Coffin spring 1. Once again.In this class III appliance. The lateral bite plane allows more vertical eruption for the upper posterior teeth. • U The bionator according to Balters U Elements: Function: Description: Buccinator loop 0.

the labial wire is located in the middle between the upper and lower incisors. 3) In the reverse appliance. The acrylic base of the shield appliance is closed in the front but it should not contact the incisors or the dentoalveolar margin so that the open bite can close. or be trimmed free after its finishing.The Coffin spring is bent distally closed. for example in patients with tongue dysfunction. The shape of the Coffin spring is opposite to the shape in the base and shield appliance. back over the upper molars. the labial bow only contacts the lower front teeth. it is then led distally up to the centre of the first molars and from there. This bow hinders the introduction of the lower lip between the arches. 2) The shield appliance has a similar labial bow as the base appliance. Because of the open bite. The bionator is a rigid appliance with a delicate design of its acrylic base. Between the canines and the first premolars in the upper jaw the labial bow is bent orally into the retention. The position of the tongue is influenced by the Coffin spring. . The appliance can be designed with an acrylic overhang for the lower incisors. This area can be blocked out with wax before the application of the acrylic.

The high labial bow is bent depending on the modification high into the vestibule and soldered onto the buccinator loop. as with an inclined plane. For the soldering it is recommended to cover the acrylic with heat protection paste.In the anterior region the acrylic base of the reverse appliance is vertically elongated in order to influence the upper incisors labially. the buccinator loops can present a longer distance than 1 cm. d) Labial pads in the upper jaw: It is also possible to add labial pads in the upper jaw. The HGtubes can be integrated into the interocclusal acrylic during its polymerization or they can be incorporated afterwards. In order to avoid the interposition of the cheek. These pads or shields are made following the same principles as in the making of the function regulator according to Fränkel. 2T 2T b) High labial bow: If the patient has problems maintaining the appliance in position while speaking or even in its rest position. Before this. it is important to underlay this area with wax to guarantee a sufficient distance from the lateral shields to the teeth in order to allow a transversal expansion. This bite plane serves as protrusion element for the maxillary anterior teeth. a high labial bow can be added onto the labial arch. Modifications of the bionator a) Headgear tubes: The appliance can be used with extraoral traction for the upper jaw including HG-tubes in height of the second deciduous molars or the second premolars. the loops are covered with acrylic. c) Lateral shields: If the vertical opening is wide. A precondition is a sufficient vertical opening which should be considered during the realization of the construction bite. here in a reverse appliance. .

has to be decided depending on each patient.8 mm spring hard Setting of a neutral occlusion Setting of a neutral occlusion with simultaneous elimination of an increased overjet and overbite The kybernator differs from the bionator mainly through its labial bow. .e) Labial pads in the lower jaw: To achieve an anterior-posterior development. or if it is plain. retention thorns and if necessary. all kinds of springs. labial bow and retention thorns 0. • U The kybernator U Elements: Function: Description: Coffin spring 1. or is removed totally.2 mm spring hard. Whether the lateral bite plane contains interdigitations. the labial pads can also be incorporated in the mandible. The Coffin spring ends in the molar area. The design can incorporate a labial bow in the upper jaw and an acrylic overhang in the lower jaw. It is also possible to add two labial bows.

8 mm spring hard Retrusion of the front The special construction of the labial bow retrudes extremely protruded incisors This appliance contains retention elements in the mandible. transversal or segmental screws can be added to this appliance.• U The bite restrainer according to van Thiel U Elements: Function: Description: Arrow clasps 0. • U The function regulator appliance according to Fränkel (FR I to FR IV) U Elements: Function: Description: Depending on the appliance Correction of functional disorders These bimaxillar appliances have to be seen as functional orthopedic exercise devices with labial and buccal shields . The appliance base is made according to the design of the bionator base appliance. Additionally. labial bow 0. in this example arrow clasps.7 mm spring hard. A labial bow is added both in the upper and lower jaw.

IV The buccal vestibule has to be measured intraorally in order to be able to carve the upper model for the labial pads and vestibular shields. the support wires between the labial pads and the vestibular shields as well as the connecting wire for the pads are 0.5 mm in the vestibular sulcus. It is also used in the class II-1 without an increased overbite and without a notorious mesial migration of the lateral segments. . The thickness of the wax relief is measured with a probing instrument. 1 lingual shield with lingual bow. Function: FR I The function regulator type I is planed for the transversal and sagittal compression of an Angle class I and II and for a slight developmental inhibition of the apical base. Components: 2 vestibular shields. The palatal wire with rest is bent out of 1.9 mm strong.9 mm) starts in the distobuccal aspect of the canine. it is bent completely around the canine and ends buccally in the lateral shield between the canine and the first premolar.0 mm wire In the lower jaw. If not.General prerequisites for the FR I .9 mm. Normally the orthodontist should carve the model himself during the appointment. 2 lower labial pads. In the FR I the wire diameter for the labial bow in the upper jaw is 0. The canine loop (wire diameter 0. he has to give the technician exact measurements which have to be transported onto the model. 1 palatal wire with occlusal rests. 2 canine loops in the upper jaw and the support or connecting wires of the pads and shields. The wax relief has to be done with the greatest care because only then a correct adjustment of the appliance and an expansion of the dentoalveolar ridge are guaranteed. and should be 3 mm in the area of the teeth and 2.

The connecting wire between the vestibular shield and the lingual shield is bent out of 1.0 mm wire. The lingual bows and the stiffening wire are bent out of 0.8 mm wire in this example.

The lingual shield of the FR I is designed in such a way that the lingual bows lie free and only the stiffening bow and the connecting wires are grasped with an acrylic pad.

The acrylic shields and the pads have a thickness of approximately 2.0 mm. The length of the vestibular shields has to correspond to the extension of the carvings.

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

Only the canine extension is bent in a different way as in the FR I. It runs along with a parallel bent wire over the labial surface of the canine and then is bent upwards to finish with its retention in the vestibular shields.

To activate the anterior segment of the vestibular shield and the connected lingual shield, the vestibular shield has to be sawed open and the vertical sawing line widened with a wax knife.

The lingual shield and the protrusion bow should not hinder each other.

Function: FR III The function regulator type III is designed for malocclusion class III, especially for patients with a notorious mandibular prognathism in combination with a midfacial insufficiency. Components: 2 vestibular shields, 2 upper labial pads, 1 protrusion bow, 1 lower labial bow and occlusal rests.

For the FR III the wax relief on the model has a different shape. The model has to be carved more than usual in the area of the upper lip pads. The wax relief is only added onto the upper model as in the area of the upper lip pads. Additionally, with a thin drill, a groove is grinded into the lower front in height of the gingival papilla in order to guarantee a tight fit of the lower labial bow onto the teeth.

The wire elements for the FR III: lower labial bow, 2 occlusal rests on the last lower molars, 1 protrusion bow or upper lingual wire in the upper jaw as well as the support wires for the lip pads and vestibular shields. If necessary, occlusal rests can also be added in the upper jaw.

In the mandible, the vestibular shields fit closely opposite to the upper jaw. When all the wire elements are bent, acrylic is added and the appliance is finished.

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

The elements in the upper jaw are: 1 labial bow, 2 occlusal rests led on the first molars from distal, 2 occlusal rests on the first premolars and 1 palatal bow that runs behind the first molar. In the lower jaw, the connecting wires and the rests on the first molars are bent.

In the FR IV the occlusal rests and the labial pads contact the model in contrast to both lateral shields.

Function regulator with integrated screw In all Fränkel appliances the vestibular shields can be replenished with screws. This allows a posterior activation of the lip pads if necessary. The wire elements are bent following the planned design and the screw is fixed onto the wax relief.

Acrylic is added on the function regulator, in this case, a FR II; it is finished exactly as usual and then the sawing cut is realized.

When the pads shall shield the lip further off, both screws are activated parallel.

rapid palatal expansion (RPE) appliances .CHAPTER 6 Wire appliances.

0 mm. extrusion or intrusion of teeth. body wire 1.8 mm.3 mm.8 mm. crescent (retention thorn) 0. .8 mm. Therefore the basic appliance has to be adapted passively on the cast and then the corresponding springs are soldered on.• 0TU The Crozat appliance U0T Elements: Function: Description: Crib (Jackson clasp) 0. cuspid hooks 0. expansion of the molars and premolars is induced and also derotation of the first molars if necessary. mesial or distal. distal extensions 0. rotations of incisors or premolars and transverse expansion in case of relapse. occlusal rest 1. pins.0 mm.3 mm. In the second phase.8 mm The Crozat appliance can perform all functions of an active plate In this appliance. buccal extension 1. lingual arm 1. In the third phase the following tasks are achieved: Movement of single teeth or tooth segments towards buccal palatal. elastic hooks 1.2 mm. the wire elements are not anchored in an acrylic base. The retention period starts after the third phase. putters 0. elastic hooks 0. basic high labial arches 1. using the basic appliance.7 mm.7-0. canines and second molars are aligned or rotated.8 mm. precurved auxiliaries 0. but lasered or soldered together The treatment sequence of Crozat appliances takes place in three phases: In the first phase.8 mm.0 mm.

To achieve a stable soldering surface as well as a smooth and clean inner side of the appliance a thin metal band is pushed behind the crib and crescent. the crescent does not crush the papilla. After the laser or conventional soldering. The gingival triangles.8 mm drill into the mesial and distal area of the cast. The curve of the crescent has to lie mesio-distally. If necessary. The crib The crib is the most important clasp of the entire appliance. It is important not to erase too deep. thin band material such as the one used in banding technique for the anterior teeth is employed. For this purpose. This small piece of band is pushed along the buccal surface of the molar behind the clasps. the cast is now duplicated to make a soldering cast. A careful erasement guarantees a good support even when a stronger strain is applied. the crescent has to be shortened according to the holes drilled. The unpolished side of the band shows outwards. The crescent In the interdental space on the buccal side of the first molar. so that once inserted. For the later soldering the crescent on the buccal side has to lie exactly along the crib. small holes are made with a 0. and therefore. the buccal equator of the teeth is determined with a parallelometer in order to indicate the position of the horizontal buccal part of the clasp. These holes allow a better fitting of the crescents onto the soldering cast. The horizontal buccal part of the clasp lies over the equator. underneath has to be enough distance to the gingival margin in the buccal area for the crescent. mesially and distally of the molar. exactly onto the buccal contour of the molar and the extremes have to lie in the holes. has to be adapted very precisely to the shape of the tooth. The erasing has to be done parallel to the occlusal plane.The preparation of the cast First. . It fits tightly on the first molar and has to grasp the tooth interproximally in such a way that even its rotation is possible. are removed from the plaster cast.

the lingualarm is bent adapting up to the first premolar. The end of the wire is bent concavely to ensure a sufficient distance to the gingiva. The buccal extension simultaneously makes the removing of the appliance easier for the patient without deforming the crib. The endings of the palatal rest lie along the horizontal parts of the crib. it can serve for the buccal expansion of the appliance (e. The bent between the first molar and the second premolar has to be located in the interdental space. high labial arch).g.The occlusal rest The occlusal rest adapts onto the palatal groove and the occlusal surface of the same molar (with the clasp). The buccal extensions It is fixed buccally on the center of the first molar. To avoid occlusal interferences. The length of the bow should not exceed 12 mm. After the soldering. The wire is bent in a 90 degree angle. . The lingualarm Continuing exactly with the occlusal rest. the rest has to end shortly before the central fossa. without compromising the solder union of the crib or crescent. It is important to keep an even distance of 1 mm to the gingival tissue. the U or W-loop is adapted onto the model. a corresponding shortening is possible. the rest of the entire arm can either contact in one point or can be curved and also reach into the interproximal area. The palatal rest has to be bent slightly inwards according to the shape of the palate. In the upper jaw The body wire First. Later on.

If the lingualpalatal arm is activated. A Uloop is incorporated in the area of the premolars which extends over the gingival tissue. The remaining elements are bent according to those in the upper jaw. Precurved auxiliaries In the upper as well as in the lower jaw. In the centre of both molars a right angle is bent towards occlusal and in height of the crescent. The wire has to have an even distance to the cast and assure symmetry in the horizontal plane. . In this case. a simple pin is soldered or lasered onto the labial arch for moving the canine. Concerning the lingual arm and the palatal arm. it is important that the bent between the first molar and the second premolar reaches into the interproximal space. it lies flat contacting the second premolars in one point. The active part of the spring arm should contact the incisors.In the lower jaw The body wire When the crib and crescent for the lower jaw are finished. another bend is made mesially. it has to be bent bow shaped onto the premolars. The Pin The single springs can be bent in different shapes and serve different purposes. When the lingual arm is not activated. for the protrusion of the incisors auxiliaries are soldered or lasered onto the lingual or palatal arms. the lingual arch can first be adapted manually into U-shape in the approximate size of the sublingual space.

the point of force application should come from a distal wire ending. in the vestibule and then soldered or lasered buccally onto the crib. The putters For the mesial movement of teeth. One has to pay attention to avoid the labial and lateral frenum. . Elastic hooks The elastic hooks for the intermaxillary elastics are soldered in the area of the canine onto the labial arch. These hooks serve for engaging class II elastics.The basic high labial The basic high labial is located. the buccal hooks are soldered or lasered onto the crib. A distal movement takes place through springs adapted mesially. as its name suggests. Buccal hooks In the lower jaw.

The exceeding parts of this metal plate have to be worked out according to the shape of the wires. The last step is to give shine to the appliance which can be realized with a handpiece with small brushes or carefully on the lathe. all wax areas are covered with soldering plaster. Looking at the crib from the inside. The completetly soldered or lasered appliance is finished with small grindstones and smoothed out with rubber polishers. . the smooth inner surface of the small soldered metal plate can be seen. In order to stabilize the single wire elements sufficiently for the soldering. all elements have to be fixed with thermal wax onto the cast in order to check the exact fitting of the single components once again.For the soldering or lasering.

8 mm (remaloy® wire) Functional orthopedic appliance for anterior-posterior problems.0 mm.0 mm. In a distance of 1-2 mm the transpalatal arch follows the shape of the palate and its function is to stabilize. The mandibular basic bow follows the lingual surfaces of the lower premolars until distally. bite plane appliance. . anterior vertical support 0. preferentially applied in Angle class II-1 patients Delicate functional appliance which imposes slight restriction on the tongue space and therefore promotes patients compliance To ensure its stability the maxillary basic bow has to be bent out of one piece of wire.0 mm. • 0TU The wire appliance according to Meyer. then it is bent towards the upper jaw to form a soldering union with the transpalatal and the upper basic bow. Both of its occlusal rests lie on the first molars and the palatal part of the wire follows the extremes of the upper basic bow. transpalatal arch with molar rests 1.A finished third phase lower Crozat appliance. It embraces the incisor area buccally like a normal labial arch with two U-loops in the canine region. From there. shielding appliance and braces appliance U0T Elements: Function: Description: Basic bow 1. lingual basic bow 1. it is bent orally along the premolars and molars and is then bent towards the palate.

For the final polishing. The anterior bite plane exceeds the lower incisors horizontally. In the posterior region. It is favorable to use a Laser soldering unit because a higher deformation and corrosion resistance can be achieved. or can be pointed by a Spot Welding Unit. Down) or sucking habits. the use of a handpiece is recommended because the danger of distortion is greater on the lathe. In case of lateral or partially lateral open bites. a lingual shield which reaches from the lower lingual arch up into the upper incisor area should be added. An acrylic pad is incorporated into the appliance for its support. The construction bite is taken with a 2 mm overjet. hypotonic big tongue (M. The finishing of the appliance is done as usual. . the wires can be fixed with either sticky wax or soldering plaster. The shielding appliance (AB) is effective in patients with lateral or anterior open bites. as well as visceral swallow pattern. the acrylic covers the lower incisal edges so that these are grasped 1-2 mm. For the soldering process. makes a construction bite of 2-3 mm sagital/vertical step without joint sounds necessary. the wax bite should be bitten through. Anterior vertical supports are soldered in the height of the first premolars between the upper and lower jaw for stabilization.The doubled casts are set into the fixator according to the construction bite. When the lower Incisors are protruded. The wires should all lie side by side and should be soldered without tension in the assembled fixator. To shield off the tongue. The bite plane appliance (AUF). which can be used by class II patients with increased overbite or for TMJ therapies. additional vertical wires are soldered in the premolar region.

• 0TU The Frozat appliance according to Mayes U0T Elements: Function: Description: Lingual arch and lingual arms 1. In the area of the premolars a slight bend is bent lingually. The lingual arms are extended over the center up to the distal part of the lateral incisor of the counter lateral half of the arch and lie therefore double on the incisors.0 mm remaloy® Depending on the activation: compression or expansion of the arch. The labial arch is bent without U-loops and is placed incisally of the brackets. The lingual bow has an even distance from the gingival tissue of approximately 1-2 mm. The lingual arms adapt in the region of the equator or cingulum of the teeth. angulation or rotation. in later dentitions. for example. In anterior open bites the labial arch is located with its U-loops gingivally of the brackets in order to use vertical elastics. The addition of a moving pearl onto the transpalatal arch can also be realized to achieve stimulation according to Castillo Morales. front protrusion.The braces appliance (MB) is used parallel to fixed appliances. molar uprighting Fixed appliance for a transversal and sagital arch expansion in the mandible The lingual arms and the lingual bow are bent from one piece of wire. .

With the corresponding activation the incisors can be protruded.0 mm remaloy® Unilateral molar distalisation Fixed appliance for the sagital arch expansion in the lower jaw After taking an impression with adapted bands. a working cast is made. the molars can be uprighted and a transversal expansion or compression can be achieved.Once the appliance. • 0TU The manufacture of an appliance with lingual cantilever according to Kinzinger U0T Elements: Function: Description: Lingual arch and unilateral anterior spring 1. The lingual arch is bent assuring an even distance from the gingiva of 1. The wire should contact the molar band on its total lingual surface to ensure a wide and solid soldered joint.2 mm with a small lingual bent in the premolar area. bent out of one piece of wire. lies fitting passively with the anterior springs on the incisors and the lingual bow has the necessary distance. . it is point welded with the Spot Welding Unit and then soldered.

It is extended up to the lateral incisor of the counter lateral side. When the solder used does not contain flux. separate flux has to be applied on the soldered joint. The unilateral lingual arm lies contacting in one point in height of the equator in the premolar region and on the cingulum in the anterior region. The prepared appliance can finally be soldered to the bands. .The precisely adapted Frozat appliance is fixed onto the bands with a Spot Welding Unit.

This lip bumper has a wider and thicker acrylic shield than the preformed ones. The finished lip bumper has to be inserted easily and without tension into the corresponding buccal tubes by the patient. Buccal tubes are soldered onto the molar bands to receive the individually made lip bumper.0 mm Molar distalisation with simultaneous anchorage through the lower lip The lip bumper is mainly used to enhance anchorage. . lip bumper 1. Special attention should be paid to avoid hindering the lingual frenum when determining the position of the lingual arch.• 0TU The Lizat appliance (Lip bumper and Frozat) according to Kinzinger U0T Elements: Function: Description: Lingual arch and anterior spring 1. but can also support the distalisation of the molars The lingual Frozat appliance is bent as usual.0 mm remaloy®.

. The rest of the shape has to be adapted to the molar band exactly according to the illustration. smooth tooth movement is possible The lock. The gingival anchorage has to have some tension to engage underneath the vertical lock into the concavely grinded nut. for single tooth movements. auxiliary springs 0. has to be grinded concavely to receive the anchorage of the Mershon bow.2-0. Besides.4 mm spring hard Expansion of the arch Through continuous force of the bow and possible auxiliary springs.• 0TU The lingual arch according to Mershon U0T Elements: Function: Description: Lingual bow 0. If the molar band is made out of band material occlusal rests can be incorporated directly. The double bent lock pin has to be bent together tightly.8 mm spring hard. small springs can be added to the lingual bow. which is vertically soldered onto the molar band.

TPA and lingual bow 1 mm hard or one piece casting method Achievement of a neutral occlusion after tooth eruption is finished In order to avoid a transversal movement of the anchorage teeth. the TPA and the occlusal rests can be bent out of one piece of wire and then be soldered. the occlusal rests are soldered separately on the premolars and the lingual arch is soldered to the crowns. The buccally located guiding hinges (for anchorage reasons) are assembled and screwed. the TPA in the upper jaw is not absolutely necessary. In the Herbst® appliance. made with the one piece casting method. In the upper jaw. the attachments for the anchorage of the guiding telescopes are soldered. The length of the guiding hinge has to be checked in the mounted casts which are set into the fixator by a construction bite. the rigid construction of the Herbst® appliance is chosen The preformed crowns are adapted and big perforations are made in the middle of the occlusal surfaces in order to allow the cement to flow and to make the removal of the bands after treatment easier. In this construction. In the lower jaw.• 0TU The Herbst® appliance U0T Elements: Function: Description: Occlusal rests. .

one holds the first bands mesio-aproximally with tweezers and puts solder around it. This way a stable band for the lower canines is made. lingual and buccal 0. the bands are pushed together.9 mm hard Achievement of a neutral occlusion after tooth eruption is finished This delicate version of the Herbst® appliance has no coverage of the occlusal surfaces of the molars After adapting the canine bands in the lower jaw. Through uniform pressure of the tweezers from gingival and occlusal. both bands are carefully assembled up to the solder point. . The soldered canine bands are adapted again in the patient’s mouth. Afterwards. These bands are sent to the laboratory where the first band is sandblasted on the outside and the second band on the inside and then both are soldered together.5 mm) gingivally onto the impression and then poured with dental stone. The bands are fixed with a small piece of wire (0. Therefore. the practitioner has to place a band two sizes bigger over the first band. The union of both bands is held by tweezers from occlusal and gingival sides and then the first band is warmed up from the inside to make the solder flow.• 0TU The Herbst® appliance with soldered bands U0T Elements: Function: Description: Bands for soldering. Now the impression for the working casts is taken together with the other bands on molars and premolars. upper connecting bow and connecting bow in the lower jaw.

Now the connecting wires can be bent and fixed with thermal wax. the Herbst® appliance pivots are held onto the bands then pointed with a Spot Welding Unit. For this purpose. the connecting wires from the first premolar to the first molar contain a U-loop. or directly soldered with the bands. with the help of a fixing instrument. a simple “openclose” articulator (articulator according to Körner) can be used. The fixed buccal connecting wires have to be fixed relatively gingival on the canine bands to avoid interfering with the base of the Herbst® appliance which is fixed in the centre of the band. In the articulator. .The casts are mounted on the articulator with a construction bite. a lingual bow is bent from molar to molar out of one piece. a continuous palatal bow is bent again from molar to molar. In the upper jaw. The connecting wires are fixed either with thermal wax or with the Spot Welding Unit. On the buccal side. In the lower jaw.

the Herbst® appliance can be integrated into splints and therefore be removable The working casts are mounted onto the fixator with the construction bite. finished and polished. Finished Herbst® appliance with soldered bands. . Now the appliance can be soldered.After fixing all elements. Retentions are soldered onto the attachments and then heated to be pressed into the splints for their fixation. the thermal wax is covered with solder plaster or the wires are pointed with a Spot Welding Unit. • 0TU The removable Herbst® appliance U0T Elements: Function: Description: One pair of guiding telescopes with attachments Achievement of a neutral occlusion With soldered retentions on the attachments. The vacuum formed foils are made out of 1 mm material and are finished like normal splints.

modified. • 0TU Appliances with spikes U0T Elements: Function: Description: Connecting bow 1. The number of spikes is variable. the lower splint is finished.9 mm hard To shield the tongue from the incisors Lingual/palatal bow with sharp spikes The connecting bow is bent in height of the gingival margin assuring a small but even distance and then soldered onto the molar bands.The length of the guiding hinges has to be checked and if necessary. the upper jaw is built up with acrylic and set together in the fixator. In order to achieve corresponding planes in the upper and lower jaw. Now the splints can be built up with acrylic in the molar area for the definitive fixation and stabilization. .8 . first. polished and isolated.0 mm hard. spikes 0.0. afterwards. Then only the exceeding acrylic material has to be removed.

. The tongue guard is bent according to the transversal width of the arch.0 mm hard Mesialisation of the molars Through the permanent pressure of the tongue. • 0TU The tongue shield for mesialisation U0T Elements: Function: Description: Tongue shield 1. The spikes can also be designed as a removable appliance.The spikes are fixed horizontal to the occlusal surface in order to hinder the tongue from pressing against the incisors. the molars are moved mesially The bands once fixed in the alginate impression are slightly waxed out before the pouring. in this example. with the MIA-System (with bent locks).

it is fixed with the Spot Welding Unit to the bands and then soldered. On this cast the Hyrax® screw is adapted to the palate. Neither the screw nor the connecting wires should contact the gingival tissue. .The extended arm of the tongue crib is guided straight to the molars which are to be moved mesially. • 0TU The rapid palatal expansion appliance (RPE) with Hyrax® screw U0T Elements: Function: Description: Preformed Hyrax® expansion screw Rapid palatal expansion Fixed appliance A working cast with 4 bands is needed. It is important to maintain enough distance from the tongue shield to the gingival tissue in order to allow the molar movement. There.

The connecting wires are led towards the bands. everything is lasered or soldered together. and afterwards. then bent. • 0TU The rapid palatal expansion appliance (RPE) according to McNamara U0T Elements: Function: Description: Circular clasp 0.8 mm hard. united between the first premolars and the first molars in order to achieve a maximum stability of the appliance. The open diastema makes the rapid palatal expansion evident. . A clinical view of a patient with an activated Hyrax® screw. Then the four wire extensions of the Hyrax® screw are bent in a distance of 1 mm from the palate to the circulating clasp. finally. the circular clasp is bent approximately 1 mm underneath the occlusal surfaces and the incisal edges.The screw should lie as deep as possible in the centre of the palate. The adapted Hyrax® appliance is soldered with laser or fixed with a Spot Welding Unit to the bands and then ideally soldered on the cast. Hyrax® expansion screw Rapid palatal expansion Appliance with acrylic coverage of the occlusal surface for a better retention of the anchorage teeth First.

so that although they are fixed well on the cast. The bands should be blocked out with a very thin layer of wax. Small perforations are grinded into the finished bite blocks to allow the cement to flow while inserting the appliance. they can be removed easily from the cast after finishing. . • 0TU The rapid palatal expansion appliance (RPE) with an interchangeable Hyrax® screw U0T Elements: Function: Description: 0. Before. the bands should be replenished with brackets on the palatal side. The bite block should not be too voluminous.032” rectangular stainless steel wire.Once the appliance is polished. acrylic is added on the occlusal surfaces up to slightly under the circulating clasp. the treatment can be performed in several steps with this appliance The bands once adapted into the impression are waxed out slightly and poured as usual.8 mm / 0. Hyrax® screw Correction of extreme cross-bites When the expansion capacity of a single screw is not sufficient. the vertical opening should correspond to the height of the construction bite.

In this impression. Now on this prepared cast. After a couple of weeks. a second appliance can be made. the screw has to be opened 3 or 4 turns and then be adapted to the palate. Now the Hyrax® screw is adapted in a distance of 1 mm to the palate and fixed with the Spot Welding Unit to the rectangular wire. and then poured. Special attention should be paid that this rectangular wire is ligated passively into these brackets. slightly waxed out. the appliance is removed and an impression is taken.The rectangular wire should be adapted on both sides from the first premolar to the first molar into these brackets. . when the end of the screw spindle is reached. transmission brackets are set in. In the meantime the first appliance is used passively to maintain the arch width. This way the appliance can be soldered or welded and then inserted. Before making the second appliance. then it is inserted again.

a direct replacement can take place in the patient’s mouth. a third appliance can be inserted. While inserting the appliance. with both its threads (anterior and posterior) can be activated separately For the making of this appliance an impression is needed with 4 bands which are first waxed out and then used for the working cast. The Nardella screw can be fixed with wax onto the model to guide the wire along both bands to the retention of the screw. . After preparing both sides. The appliance can be made using the cast prepared this way.0 mm soldable wire (remaloy®) Asymmetric rapid palatal expansion The Nardella screw.After this. the screw is unscrewed to get past the brackets and then is opened up again immediately. • 0TU The rapid palatal expansion appliance (RPE) with a Nardella screw U0T Elements: Function: Description: Connecting wires 1. the appliance is fixed with the Spot Welding Unit. If the dimension of the planned expansion makes it necessary.

one anterior and one posterior which can be activated symmetric or asymmetrically. hooks 1. They unify the premolar and molar bands from buccally.2 mm spring hard (occlusal rests 0.After the provisional fixing. The hooks for the face mask are usually bent into a loop in height of the centre of the canine and then rounded off. . • 0TU The rapid palatal expansion appliance (RPE) with hooks for the Delaire face mask U 0T 0T Elements: Function: Description: Hyrax® screw. the wires are definitely lasered or soldered. The screw contains two threads.8 mm hard) Anterior traction of the maxilla or movement of the upper dentition when lower forces are applied The elastics of the Delaire mask are engaged into the hooks which lie in the canine area The Hyrax® screw is adapted to the palate as usual and fixed onto the bands with the Spot Welding Unit or with solder plaster.

• 0TU Modified rapid palatal expansion appliance (RPE) U0T Elements: Function: Description: Hyrax® screw Rapid palatal expansion with simultaneous vertical opening The acrylic bite blocks in the premolar region open the bite vertically for the correction of lateral cross-bites When in a rapid palatal expansion appliance. Instead. The fixed elements are lasered or soldered and then polished. the hooks are attached in a distance of 2 mm from the tooth row. occlusal rests are adapted onto the first premolars which are intraorally bonded to simultaneously open the bite.To ensure a good oral hygiene. the premolar bands are not needed. . only molar bands are used. If vertical opening is desired. the Hyrax® screw is adapted to the palate and soldered as usual.

In this case.In order to simultaneously open the bite vertically with this appliance. The vertical opening of the finished appliance should only open the bite so far that the upper and lower tooth rows can slightly pass each other. In the area of the bite blocks a wax stripe can be attached to limit the acrylic to achieve a faster finishing. Elements: Function: Description: Different screws and modified connecting wires Rapid palatal expansion with simultaneous vertical opening The connecting wires have to be designed according to the individual oral situations The bite blocks can be laid over the canines and premolars. The casts should be set into the fixator to guarantee a better adaptation. the space availability and the height of the vertical opening depend on the design. . acrylic bite blocks are attached.

For this purpose 4 bands are recommended.The RPE appliance can also include a buccally lasered or soldered reinforcement wire. . a Nardella screw was used again. In this case. Additional bands and wires can be attached in an asymmetric RPE appliance. Elements: Function: Description: Simple expansion screw without anchorage elements Rapid palatal expansion with simultaneous vertical openingGaumennahterweiterung mit gleichzeitiger Bisssperrung The acrylic bite blocks in the premolar region open the bite vertically for the correction of lateral cross-bites The RPE appliance with an acrylic plate and a simple screw is just as effective. The screw is fixed on the working cast and the acrylic base limited by wax stripes.

the RPE Screw can be incorporated horizontally. The vertical bite opening is determined by a construction bite in a fixator. Elements: Function: Description: RPE screw Protrusion of the premaxilla in lip-jaw-palatal cleft patients Anterior movement of the premaxilla through a horizontally inserted screw In order to move the premaxilla anteriorly in bilateral cleft patients.The occlusal surfaces of the posterior teeth are grasped up to the buccal surfaces. Small holes are grinded into the bite blocks to ensure a proper flow of the cement. . Both posterior arms are lasered or soldered onto the molar bands and then the anterior arms are bent into the retention for the acrylic shield.

Elements: Function: Description: RPE Screw (rapid palatal expander screw)RPE-Schraube (Rapid-PalatalExpander-Schraube) Expansion of the upper and lower arch Delicate design of an expansion appliance In the upper jaw. a fast expander is bent with the RPE compact screw. In situations where the premaxilla is inclined in such a way that for the insertion the retentive area is very extensive. After finishing. the screw has to be opened 3 to 6 turns before its fixation.The retentive spots of the cleft are blocked out and the extension of the acrylic base is limited with wax. the screw is screwed back and the appliance can be inserted without any problems. . The screw body lies close to the palate in height of the second premolars. the extensions are soldered or welded onto the molar bands and contact up to the first premolar.

The loop is placed distally of the tooth to be rotated and should.When the lower arch is to be expanded.7 mm spring hard. . To position the elements. the extensions are soldered on the bands of the first premolars and to increase the stability. the screw body is located directly behind the incisors. contact the gingival tissue. a passive double TPA made of 1 mm SS wire is soldered onto the molar bands. in no case. The connecting part of the wire serves as retention. brackets are fixed in the molar area. The bracket bases are bonded intraorally simultaneously with the bands. expansion screw Rapid palatal expansion with simultaneous rotation of the molars A delicate appliance which resembles the pendulum appliance The occlusal rest and the rotation loop are bent out of one piece of wire. For stabilization after a successful expansion. the wire is pointed on and lasered or soldered either before or after the polymerization. • 0TU Hilgers Palatal Expander (HPE) U0T Elements: Function: Description: Rotation bow with occlusal rest 0.

This resin serves to open the bite vertically in order to be able to move the upper molars without occlusal interferences. . The bands of the finished HPE appliance are cemented in the mouth and the occlusal rests bonded.The expansion screw is fixed with wax in height of the second premolars on the mid palatal suture and the acrylic base is limited with wax stripes.7 mm spring hard. this expander can be replenished easily with protrusion springs. • 0TU Modified HPE U0T Elements: Function: Description: Rotation bow with occlusal rest 0. expansion screw Rapid palatal expansion with simultaneous rotation of the molars A delicate appliance which resembles the pendulum appliance When a lateral incisor is located in the palate.

then up to the molar bands along the premolars and up to the incisors if necessary. • 0TU The Quad-Helix appliance U0T Elements: Function: Description: 1. the anterior and posterior area can be expanded in a different way.With a Nardella screw.0 mm soldable wire (remaloy®) Rotation of the molars with simultaneous expansion of the dental arch The helix cause an optimal force effect on molars and the dental arch The Quad-Helix appliance is bent out of one piece of wire. . One starts with the two middle helixes in height of the first premolars and extends from there distally under the molars. An acrylic shield can slightly enhance the pressure of the screw.

here for example. • 0TU Modifications of the Quad-Helix or Bi-Helix appliance U0T It is possible to solder or laser other elements (spikes or similar) onto the Quad-Helix appliance without any problems. . The distance between the appliance and the gingival tissue should be approximately 1 mm. a MIA-System. Spikes can also be lasered or soldered without any problems to a Wilson appliance.The helix has to be bent opposite in the same way and should not contact the palate. The corresponding appliance for the lower jaw is the Bi-Helix.

.The Bi-Helix appliance also exists preformed for the MIA or Wilson System.

CHAPTER 7 Nance and pendulum appliance. space maintained cleft and stimulation plate .

It should not touch the gingival margin. The solder union should be clean and also be polished thoroughly to guarantee a good hygiene and avoid irritating the tongue.0 mm soldable wire. They are bent. it can be designed heartshaped. fixed onto the bands with a Spot Welder and then soldered. .• 0TU The soldered Nance appliance (Nance holding arch) U0T Elements: Function: Description: Soldered extensions 1. for example remaloy® Stabilization of the molars The acrylic shield supports the molars The Nance appliance consists of an acrylic shield and the connecting wires to the bands. The acrylic shield is formed. It is important that the connecting wires do not touch the palate. finished and polished from the inside and outside. In order to achieve a wide extension.

the acrylic shield is added. . The loops from a preformed QuadHelix appliance are eliminated so that only the active extensions with the lock are used and bent into the appliance. the posterior loops of the preformed Quad-Helix appliance are used and the extensions are horizontally bent into the appliance. For an easier use. If the molars are to be slightly rotated. If additional extension for activation is desired.• 0TU Modified Nance appliances U0T The Nance appliance can also be designed removable. the MIA System is recommended. it is easier to use a preformed lingual arch which can be transformed into the Nance appliance without any problems. After this.

The elastics are engaged from these hooks to the second molars. The acrylic base is finished. a preformed palatal bow according to Wilson is cut in half and then bent into the corresponding retention.• 0TU Removable modified Nance appliance U0T Elements: Function: Description: Palatal extensions with Wilson locks. the hooks are polymerized into the base of the Nance appliance. The wax limit is designed according to the acrylic base which extends behind the second molars because of the hooks in the molar area. hooks for engaging elastics Stabilization of the first molars with simultaneous oral traction of the second molars While the first molars are held in place. Finally. the second molars can be moved through elastics in an oral direction For an easy adaptation of the palatal extension. . Small depressions are grinded into the upper limit of the acrylic base in order to receive the hooks and to avoid an irritation of the tongue.

Now.• 0TU The manufacture of the pendulum spring U0T Elements: Function: Description: Pendulum spring out of 0. . a U-loop and a closed loop The pendulum spring is bent of 0.8 mm rematitan® SPECIAL Molar Distalisation Special spring consisting of a part which is bent back for its insertion into the molar lock. The extension of the molar lock determines the length of the wire until its bent by 90° with the pointed beak pliers. This wire has to be bent with special caution because material conditioned TMA alloys have the quality of breaking easily when bent over a sharp edge. The result is a bent of 180°.8 mm rematitan® SPECIAL wire. the V-shaped wire is set into the guiding grooves of the pointed beak pliers and these are closed carefully. The wire is grasped slightly further towards the short end of the wire and carefully bent slightly over 90°.

this U-loop can be open towards mesial or distal. The wire ending has to be bent around towards the palate. . After that the U-loop is bent with round pliers around the rounded extreme. so that the loop lies on top. the wire is bent 90° twice in a distance of 5 mm. The pendulum loop is bent around the round extreme of the Young loop bending pliers.Afterwards. Depending on the type of the appliance. After the U-loop another 90° bent is made towards the closed pendulum loop.

occlusal rests 0. This double wire ending is inserted into the palatal locks of the molar bands. • 0TU The standard pendulum appliance with horizontal loops according to Hilgers U 0T 0T Elements: Function: Description: Pendulum spring double ended with a horizontal U-loop out of 0. the wire is bent 180° as carefully as in the beginning of the spring. If the pendulum spring is designed removable. Then follows a horizontal U-loop (mesially open). This double wire ending can be either anchored in a Goshgarian lock or it can simply be blocked out with wax in order to anchor the removable spring in the acrylic.The end of the wire lies in the centre of the palate. points anteriorly and is bent into the retention. a closed loop is bent near the mid palatal suture.8 mm rematitan® SPECIAL round. . for example for a dentoalveolar correction of class II malocclusions The pendulum appliance is anchored completely intraorally. and is effective without the compliance of the patient For the intraoral fixation of the pendulum appliance.7 mm spring hard Molar distalisation. occlusal rests are bent over premolars or deciduous molars. to finish in a double ended extreme. For the pendulum spring.

7 mm spring hard Simultaneous expansion and molar distalisation The tendency of creating cross-bites because of the radius of the pendulum springs is compensated with the expansion of the arch The rests are laid onto the premolars. it goes straight into the palatal locks and is single ended.8 mm rematitan® SPECIAL round. This force application results in the distal movement of the molars without the need of the patient’s compliance. can be limited with wax stripes. occlusal rests 0. which resembles the one in a Nance appliance. from there. The pendulum spring has a loop in the centre of the palate.For the spray-on technique of acrylic application. • 0TU Pendex/Pend-X: The pendulum appliance with transversal screw according to Hilgers U0T Elements: Function: Description: Pendulum spring single ended without horizontal U-loop out of 0. The extension of the palatal plate. . The retentions are placed in such a way that they do not interfere with the separation cut. The preactivated double ended springs are inserted into the palatal locks of the banded molars. the springs are fixed with wax distal to the molars and the closed loop is blocked out with wax.

connecting wires are soldered onto the molar bands. The transversal screw is regularly activated by the practitioner to achieve transversal expansion.7 mm spring hard Simultaneous expansion and molar distalisation Transversal and anterior-posterior arch corrections are not corrected simultaneously but consecutively The occlusal rests are laid as usual on the premolars or deciduous molars. .7 mm spring hard. • 0TU The RPE-pendulum appliance according to Snodgrass U0T Elements: Function: Description: Pendulum spring double ended without U-loop out of 0. to the palatal locks of the molar bands.8 mm rematitan® SPECIAL. The finished Pend-X appliance should be polished with the handpiece so that the very mobile pendulum springs are not distorted on the lathe. Additionally. connecting wire (palatal plate molar bands) 0. double ended. The pendulum springs are fixed under the body of the screw and are located mainly distally of the molars to be moved. occlusal rests 0.The expansion screw should be laid near the mid palatal suture to be able to design the whole appliance delicately. The pendulum springs with the closed loops lie right and left of the centre of the palate and are bent without loops.

The transversal screw is fixed in the centre of the acrylic plate. Then the connecting wires are removed and therefore leave the preactivated pendulum springs free for derotation and distal movement. In this appliance. The transversal expansion screw of this pendulum is activated daily during 14 days. cautiously with a small soldering flame). the U-loop is open towards distal.The soldering of the connecting wires can be done before the scattering of the plate (or afterwards. The pendulum spring lies with its closed loop near the mid palatal suture.7 mm spring hard. a pause of one month is made. • 0TU The M-pendulum according to Scuzzo U0T Elements: Function: Description: Occlusal rests 0. . afterwards.8 mm rematitan® SPECIAL Removable pendulum springs for their extraoral activation Bayonet shaped. double ended retentions which are anchored removable in the acrylic The occlusal rests are located onto the anchorage teeth. removable pendulum spring out of 0.

The retentions of the springs have to be located beneath the movable part of the distal screw.7 mm spring hard. The open part of the U-loop should show mesially. This way. The pendulum springs with the closed loop are fixed minimally beneath the distal screw and posterior to the molars which are to be moved. silver solder is melted in between. Afterwards. the pendulum appliance is converted into a quick Nance appliance to stabilize the molars in their new position. and then with a small flame. they are covered with a very thin layer of wax in order to create a corresponding reception space to anchor the retentions. and therefore. . double ending pendulum spring out of 0. This way a stop is created. After finishing the desired distal movement.8 mm rematitan® SPECIAL with closed loop and mesially open loop Extensive straight distal movement through the activation of the distal screw. the pendulum springs are taken out and replaced with passive SS bows.The double ending bent retentions are wrapped around with ligature wire. • 0TU The K pendulum type DS (Distal Screw) according to Kinzinger U 0T 0T Elements: Function: Description: Occlusal rests 0. new adaptation of the arc on which the molars are moved distally The pendulum springs lay close to the mid palate suture and should be localized as close as possible to the distal part of the molars to be moved The occlusal rests are placed as usual.

8 mm rematitan® SPECIAL First and second molars are moved distally one at a time The removable pendulum springs can be activated or deactivated The pendulum springs are bent double ended with their retentions for straight Goshgarian locks. should not surpass the limit of the hard and soft palate.7 mm spring hard. the loops are placed near the mid palatal suture and the U-loops are bent open mesially. this part is previously underlaid with wax. . pendulum spring out of 0. The extreme can be simple or double ended. including the springs and the active part of the screw. • 0TU The Bi/Quad pendulum according to Kinzinger U0T Elements: Function: Description: Occlusal rests 0.To avoid the contact of the acrylic with the curve of the palate. The posterior extension of the appliance.

The U-loop of the pendulum spring is open mesially and the wire ends simple in the molar bands. the second molars can be moved distally activating the springs. . One slot serves for receiving the pendulum spring and the other for the later fixation of a TPA after the distal molar movement. while the spring of first molar is activated resulting in distal movement. segmented arch wire for lingual technique out of 0. simultaneously. the second molar is stabilized through deactivation. Through the removable pendulum springs. Afterwards. The small hooks (cleats) on the locks are bent over and serve as retention in the acrylic.To prepare the acrylic application. lingual brackets Leveling of the incisors through the segmented arch wire with simultaneous anchorage of the appliance The placement of the segmented wire in the anterior region makes the extension of the acrylic base wider The occlusal rests are fixed as usual on the premolars or deciduous molars. The engaged retentions of the springs and the locks are covered with wax on their surface.8 mm rematitan® SPECIAL. the retentions of the pendulum springs are engaged into the Goshgarian locks.7 mm spring hard. the first molars can be incorporated into the anchorage segment through the passive springs. • 0TU The F-pendulum according to Favero U0T Elements: Function: Description: Occlusal rests 0. single ended pendulum spring with mesially open U-loop. These have a double tube.

• 0TU The penguin pendulum according to Mayes U0T Elements: Function: Description: Occlusal rests 0. These can be either already bonded directly in the patient's mouth and be represented well on the working cast. This way the length of the pendulum is notoriously shorter. The anterior segmented arch wire should be employed mainly for passive anchorage rather than for leveling the incisors. pendulum spring out of 0.The segmented wire for the lingual technique is fixed passively into the bracket slots.7 mm spring hard. or fixed onto the cast for indirect bonding. but fixed sagitally underneath the molars.8 mm rematitan® SPECIAL The loops of the rematitan® SPECIAL springs are moved from the horizontal to the sagital plane to move the molars distally without transversal side effects Big designed pendulum loops without U-loops. . removable The pendulum springs are bent with big loops which are not placed near the mid palatal suture.

As Goshgarian locks used in this case are soldered onto the bands. The retentions are shortly bent to find space beneath the Bertoni screw. they are slightly blocked out in the retention area.The relatively big palatal plate is extended in a mushroom shape behind the loops of the pendulum spring. The penguin is Mayes distinguishing mark. the end is double bent. • 0TU The K pendulum type TDS (Transversal Distal Screw) according to Kinzinger U0T Elements: Function: Description: Pendulum spring out of 0. the rests are bent as usual. . occlusal rests 0.8 mm rematitan® SPECIAL round. Each of the pendulum springs contain a loop near the mid palatal suture and a mesially open Uloop. To be able to activate the springs extraorally. In order to guarantee an almost normal swallowing and speaking pattern and to prevent tonguepressing.7 mm spring hard Distal molar movement with simultaneous transversal expansion of the arch Through the activation of the Bertoni screw the pendulum springs are on one hand moved distally and on the other hand. the acrylic base has to be finished very thin. a transversal expansion can be realized With this pendulum plate. This wax coverage is minimal so that the retention does not sit too loose in the acrylic but is still removable.

a wax stripe can be added to limit the acrylic base. The screw is intraorally activated. transversally and distally. The Bertoni screw is placed with the anterior part of the screw over the retentions of the spring. then fixed in its preactivated position onto the cast.The pendulum spring is first underlaid with wax. Afterwards. . After the occlusal rests are bonded intraorally onto the occlusal surfaces the springs can be engaged into the palatal locks of the molars.

2 mm rectangular SS wire. Goshgarian locks.2 mm rectangular SS wire. The rectangular wire is adapted exactly to this cut. A clean connection of the stainless steel cap and the retentions is achieved through a lasered union. the pendulum can be fixed onto an implant placed into the palate In order to connect the implant cap with the pendulum base retentions have to be fixed onto the stainless steel cap. pendulum . pendulum spring out of 0.8 mm rematitan® SPECIAL Distal molar movement with anchorage of the pendulum through a palatal implant When in the posterior region the anchorage situation is not sufficient. Goshgarian locks. Besides.• 0TU The Aachener Implant Pendulum (AIP) according to Kinzinger U0T Elements: Function: Description: Anchorage bow 1. The height of the cut corresponds to the thickness of the wire. Elements: Anchorage bow 1. the retention wire should not contact the palatal tissue. for example because of periodontal damage. A corresponding cut is made into the stainless steel cap.

. bent pendulum springs are inserted with a U-loop open towards distal.8 mm rematitan® SPECIAL Distal molar movement with anchorage of the pendulum through a palatal implant When in the posterior region the anchorage situation is not sufficient. the base can be limited with a wax stripe.Function: Description: spring out of 0. the springs are removable. the pendulum can always be inserted exactly in the same position. Therefore. The hollow body of the locks is blocked out with wax in order to avoid filling them with acrylic. The closed loops are also covered with wax and simultaneously fixed onto the model. for example because of periodontal damage. the pendulum springs are taken out after the polymerization and are only inserted back after the completion. As the implant is equipped with an octagonal edge. After this. the pendulum can be fixed onto an implant placed into the palate The flaps on the Goshgarian locks are bent for retention. For an easier finishing and polishing. and then double ended.

The extender is bent to be laid onto the anchorage teeth. modified extender Transversal expansion of the upper jaw & symmetric or asymmetric distal molar movement & rotation of the upper first molars. This can happen simultaneously or consecutively The shown modifications of the pendulum appliance are partly designed for activation. Afterwards. Goshgarian locks are soldered underneath the body of the screw in which the pendulum springs with U-loops are engaged.• 0TU Pendulum GNE Distalizer (PhD) according to Hilgers. B: GrumRax appliance according to Grummons The GrumRax appliance is used for arch expansion with simultaneous molar distalisation. the pendulum spring is fixed laterally on the posterior part of the RPE screw. bands with palatal/lingual locks. . C: Modified GrumRax appliance To simultaneously rotate the molars. sectional screws. to allow a more effective treatment course A: Pendulum GNE Distalizer (PhD) according to Hilgers For the pendulum GNE Distalizer (PhD) according to Hilgers first the RPE screw is adapted to the palate. modified GrumRax appliances U 0T 0T Elements: Function: Description: RPE screws. GrumRax appliance. Palatal locks for the pendulum springs are soldered onto the screw body. The distal extender of the Hyrax® screw is removed and soldered on the anterior extender as occlusal rests on premolars or deciduous molars.

sectional screws. If the molars are to be rotated slightly more. the pendulum appliance is removed and replaced by a Nance appliance. the right and left side can be activated separately so that the molars can be moved distally in different amounts. to allow a more effective treatment course D: Labial bow pendulum according to Kinzinger Both labial bows contacting labially and palatally on the incisors are anchored into the acrylic base for additional force resistance. E: K pendulum type Bi-DS according to Kinzinger Through the insertion of two distal screws. This can happen simultaneously or consecutively The shown modifications of the pendulum appliance are partly designed for activation. K type Bi-DS Pendulum according to Kinzinger U0T Elements: Function: Description: RPE screws.• 0TU Labial bow pendulum according to Kinzinger. modified extender Transversal expansion of the upper jaw & symmetric or asymmetric distal molar movement & rotation of the upper first molars. horizontal loops are bent in the distal area of the molars. After achieving the distal movement. . bands with palatal/lingual locks.

6 mm hard Prevention of the mesialization towards the support zones. . The preformed teeth are grinded in shape if deciduous preformed teeth are not available. Eventually they are set onto the cast with small spaces. As the deciduous crowns are normally quite small. the retention elements are bent out of thinner wire than usual. The Adams clasp is recommended for this appliance. This way the children’s denture gets good support.• 0TU The space mantainer with teeth U0T Elements: Function: Description: Adams clasps 0. support of the masticatory function and reduction of the speech impediment Proper function is only guaranteed if special attention is paid to the good adjustment of the space maintainer The gingival margin is slightly erased because of the missing undercut areas on the deciduous teeth. It should be bent with due care and should adapt exactly.

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

The prepared teeth are fixed with a barrier of silicon or plaster in order to eliminate the wax and replace it with acrylic. A normal expansion screw can be incorporated to activate the plate according to the growth of the patients jaw.

The base of the plate of the space maintainer can be made with the normal spray-on technique.


0TU

The gap or space mantainer
U0T

Elements: Function: Description:

Different, depending on the design Maintenance of temporal gaps To maintain the space for the later erupting of permanent teeth, a gap can be effectively maintained open through different rigid wire appliances

A wire which is soldered onto two bracket bases serves as a simple and delicate gap maintainer. This space maintainer is bonded onto the bucal surfaces of the teeth which stand on the right and left side of the gap.

Another alternative is to unify two bands buccally and palatal/lingually with two wires. With this variation, special attention has to be paid to erupting teeth.

Another possibility is to make a simple acrylic plate. The acrylic plate is extended into the open gaps, or the gaps are maintained open with simple C-clasps.


0TU

The cleft plate
U0T

Elements: Function: Description:

Eventually stimulating pearls Covering of the palatal cleft This palatal covering is also known as a drink plate and has to cover the whole cleft area in order to avoid the food from introducing into the nasal area; if necessary, it can be extended into the pharynx

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

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

In the anterior part of the cleft, the palatal plate has to be built up in such a way that it resembles a normal palatal anatomy, so that from early on, the tongue gets used to the later palatal form.

The palatal plate has to have in its whole extension the same height as a complete palate. For the curve of the descending cone, one can use the own thumb as measure. But anyway, the cone has still to be individually adapted to the curve of the palate.

The length of the cone always depends on the cleft. Either the treating orthodontist determines an approximate length, or the technician first designs it and afterwards consults it with the doctor.

The final palatal plate has to be finished as thin as possible. The functional margins have to be designed exactly as in a normal denture.

it can be slightly erased.• 0TU The stimulation plate according to Castillo Morales U 0T 0T Elements: Function: Description: Fixing wire for a movable pearl Distraction of the tongue through appealing attachments Palatal plate with stimulation elements for tongue and lips In the 6th to 8th week after birth an individual impression of the edentulous upper jaw is taken. so that with every stimulation change the plate is made interesting again. If this is not exactly impressed. it can be bound with floss to the shirt of the child. which can also be changed. it is finished retentively. to be able to fix the floss. . For stimulation of the tongue on the posterior part of the plate a button is attached which can be changed on every appointment. The working cast is provided with a functional edge. Through a movable pearl in the posterior edge of the plate. For securing the plate. If the plate contains a stimulation button. Labially stimulation channels for the lip muscles are grinded in. the stimulus is enhanced notoriously.

CHAPTER 8 Retention appliances splints. snoring appliance .

 he retention plate 0TU U0T Elements: Function: Description: Labial bow and retention elements 0. The acrylic base is also designed delicately. this should be considered while making the wax limitation. The design of the bent wire elements is small. The acrylic base should be finished as thin as possible in order to avoid interfering with the occlusion. .7 mm spring hard. Orthocryl® Retention The retention plates are used after the active phase of orthodontic treatments for stabilizing the tooth position The plates should include as few elements as possible to avoid disturbing the occlusion and to allow the teeth to stabilize with their own dynamic.

. the splint can be trimmed with scissors. It is important to always end the splint disregarding its thickness 1 mm incisally of the gingival margin. The splint type retainer 0TU U0T Elements: Function: Description: Vacuum formed thermoplastic foil Retention Simple and fast made retention appliance The finished cast is set in the vacuum forming machine into the granules as deeply as the retentive parts are covered. a bur is used to cut the material and contour the limits. When a 0.5 mm vacuum formed thermoplastic foil is used. When a thicker foil is used. The splint is vacuum formed and taken out of the machine. The exceeding granules are knocked off over the machine.

transparent retention appliance after treatment with fixed appliances For this retainer a 0. . The thermoplastic foil is vacuum formed as usual and trimmed one millimeter over the cervical tooth margin. This retainer can be used in the upper and lower jaw.75 mm thick co-polyester vacuum formed thermoplastic foil is required for the upper and lower jaw. The Essix retainer 0TU U0T Elements: Function: Description: Vacuum formed thermoplastic foil 0. the cast is set into the granules of the vacuum forming machine so that only the teeth which are to be covered with the plastic foil are visible.75 mm Retention Delicate. Once again.

During the last 10 seconds of the heating time. Imprelon S 0. The Osamu retainer 0TU U0T Elements: Function: Description: Vacuum formed thermoplastic foil (Bioplast 1. The reduced Bioplast foil is placed again onto the cast and the 0. The base of the cast is trimmed 5 mm underneath this line in order to place the plaster cast on the platform of the vacuum former and to vacuum form the flexible 1. the incisal edges and occlusal surfaces are cut up to the contact points. the upper and lower jaw can occlude without problems. The vacuum formed Bioplast foil is trimmed with scissors along the base of the cast. the limit of the retainer is marked 1-2 mm underneath the gingival margin with a pencil. . As with the positioner.75 mm Imprelon “S” foil is heated as indicated. Osamu bond is applied on the Bioplast foil for the bonding of both foils. In the same manner. The limits are smoothed out with stones or burs. Because of the thin occlusal coverage. small tooth movements and corrections can be achieved when a previous set-up is made.5 mm silicone foil (for example Bioplast) onto the dental arch.5 mm. Now the Osamu retainer is cut along the marked line with scissors.75 mm) Retention Through the combination of a rigid and flexible foil this retention appliance has a high mechanical retention capacity reducing the danger of relapse First.

This labial bow has to adapt precisely to serve as retention element for the plate. . The base plate is reduced slightly in the posterior region.8 mm spring hard. The van der Linden retainer 0TU U0T Elements: Function: Description: Labial bow with canine loop 0. The posterior margin is located in height of the molars or premolars.8 mm spring hard Retention Retention appliance without interfering occlusal contacts The labial bow lies in height of the equator adapting exactly onto the labial surfaces of the incisors. The endings of the C-clasps are bent over and should reach as far as possible into the interproximal area. Both C-clasps are bent behind the last molars slightly over the gingival margin. C-clasps 0. The canine loop reaches into the retentive cervical area of the canine and crosses between the lateral incisor and the canine into the palatal retention.

Again. the acrylic base is designed as delicate as possible. The Hawley retainer 0TU U0T Elements: Function: Description: Circumferential labial bow. In the area between the first and second premolar a small U-loop is bent in.8 mm spring hard Retention Retention plate without retention elements A circumferential labial bow used as the wire element is bent over all teeth in the upper and lower jaw. eventually with eyelets 0. between the lateral incisor and the canine. a small eyelet can be bent to enhance the support of the labial bow. . Additionally.

The base is finished as delicate as possible. For this purpose.7 mm spring hard Retention Retention plate without retention elements .  The retention plate with engaged labial bow 0TU U0T Elements: Function: Description: Labial bow and hooks 0. The labial bow should adapt without tension and be soldered before or after adding the acrylic with the spray-on technique. both Adams clasps and the labial bow have to be bent out of soldable wire. In this case.The Hawley retainer can be replenished with Adams clasps. the Uloops can lie in the premolar/canine area. in this example. In the lower jaw occlusal rests can be added on the last molars. the labial bow includes small Uloops in the premolar/canine area. Once again.

The labial bow is bent individually with a slight distance from the teeth and covered with acrylic. No occlusal interferences should exist. . Around the last molar a hook similar to a C-clasp is bent with its retention. The elastic ligature connects the palatal and the labial part of the appliance firmly. it is connected to the covered labial bow through an elastic ligature. The teeth are supported orally from the palatal plate and labially through the covered labial bow.

 The retention plate with interdental spurs 0TU U0T Elements: Function: Description: Simple labial bow and interdental spurs 0.7 mm spring hard. .7 mm hard Retention Retention plate without real retention elements For these retention plates the cast has to be prepared: the premolars and molars are erased interproximally (with a separating disc) in such a way that the gingival triangles are gone. Now simple straight spurs are bent which are laid onto the erased papillae and extend far over the cast. The spurs should be shortened in such a way that they reach 2 mm over the interdental area. Additional occlusal rests can be added in the lower jaw. The base plate is designed as usual. The labial bow is made as usual. The definitive adaptation of the spurs is done by the practitioner directly on the patient while inserting the appliance. occlusal rests 0.

 The spring retainer 0TU U0T Elements: Function: Description: Circumferential labial bow 0. It contacts the canines again on the oral and labial side. The retainer is bent out of one piece of wire. The desired incisor corrections are realized with a set-up (stripping is possible on the cast and intraorally) and then the set-up cast is doubled.7 mm spring hard Retention Retention appliance which allows small tooth movements for finishing Small corrections of the incisor position can be carried out with the spring retainer. . The wire is bent with certain distance on the oral and labial side.

A finished spring retainer.The incisors are limited with a wax box and the labial and oral acrylic shield is made using the spray-on technique. . The retainer should have as less acrylic as possible in order to avoid occlusal interferences.

This new situation is fixed with a wax bite with 2 mm of vertical opening and then the casts are duplicated. As an alternative the brackets can be left on the teeth. the brackets have to be erased on the cast. the positioner has notoriously more retention and single teeth can even be extruded. small corrections are possible with a set-up After an occlusal registration on the patient. The impressions can be taken after debonding or shortly before. After the active phase of treatment. After setting up all teeth correctly in the arch form. for the finishing. the casts are set into a semiadjustable articulator. the teeth to be slightly moved are set-up with wax into the desired position. This method has the advantage that the technician has more time for the manufacture of the appliance and that the plaster can dry properly for the set-up. the gingival architecture is modeled harmoniously. . When the impressions are taken in the last appointment before debonding. Sometimes the brackets are left on the teeth to enhance the retention of the positioner. In this way. The positioner 0TU U0T Elements: Function: Description: Vacuum formed thermoplastic foil (Bioplast) Retention and finishing of the occlusion Final appliance for stabilization after treatment with fixed appliances.

the duplicated casts are set into the fixator.On the basis of the new wax bite. The foils are heated until they slightly stick to the finger when touched. The fixator is set together and the foils are adapted with wet fingers in the areas of contact. both casts are reset in the fixator and set under the heating of the vacuum forming machine. a vacuum forming technique with Bioplast was chosen. a 3 mm Bioplast foil is vacuum formed.5 mm foil is vacuum formed onto the complete buccal surface. The foil is trimmed up to its approximate length with a hot wax knife. The casts are removed from the fixator and set onto their dorsal side in the vacuum former with the foils in place. Afterwards. The positioner can be manufactured of different flexible silicone types. and over each single jaw. both single foils now stick together as one appliance. For reinforcement a 1. The fixator should allow a simple removal and insertion of the casts. The casts are isolated. . In this case.

 The bonded retainer according to Wiechmann 0TU U0T Elements: Function: Description: Retainer wire 0. the positioner is set onto the casts. it is shortly passed through the flame of the Bunsen burner and is again adapted with damp fingers.45 mm braided or 0. a hard or a braided wire is bent onto the lingual or palatal surfaces of the teeth from canine to canine or first premolar to first premolar.After the cooling of the material. The edges are smoothed out with the “blue Jota”. .7 mm hard Retention Lingual bonded wire to retain the incisor position First. If the patient has problems breathing through his nose. holes can be drilled in the positioner with a sharp drill. the positioner can be cut neatly with scissors. As a conclusion.

Afterwards. . These are light cured again. a fluid silicone impression material (of a two phase material e. another modeling of the bonding spots is made with a more solid light-curing resin (ConTec LC/Dentaurum.g. Flowline/ Kulzer or Tetric-flow) is placed on each of the oral surfaces from canine to canine or first premolar to first premolar.Afterwards. Con Tec LCR/Dentaurum. LinguSil/Dentaurum) is injected around the wire of the retainer. Durafill/Kulzer or Tetric) to form small bonding bases. the tooth surfaces which are to be bonded are isolated (isolation agent/Dentaurum or Aislar/ Kulzer) and a drop of a fluid light-curing bonding (e. To manufacture the Transfer tray. the previously adapted retainer wire is set into these bonding drops and adapted as closely to the oral tooth surfaces as possible. Now the bonding is light cured with a UV lamp. In the second step.g.

the silicone material has to be cut open with a scalpel to ensure an easy removal of the key intraorally after bonding. the cast with the silicone key is hydrated during approximately 10 minutes so that the silicone key can be removed from the cast. Now the transfer key is removed from the cast.Afterwards. In the area of the wire. the polimerized fluid silicone material is covered with kneadable silicone (Lutesil/ Bisico) and formed into shape using the fingers. After the silicone is cured. . the grease of the bonding bases of this silicone key has to be removed with acetone and cotton pellets. Finally. The solid silicone should cover the incisal edges labially.

After a couple of minutes. all impressions of the counter jaw in the posterior and front region are reduced in such a way that only slight impressions remain. It is polymerized in a pressure vessel. For this purpose. This stop should be adjusted in the semiadjustable articulator with articulating tape. it is pressed onto the cast. The occlusal splint 0TU U0T Elements: Function: Description: None Treatment of cranio-mandibular disorders Completely polymerized occlusal splint in therapeutic position To be able to add the acrylic without problems. Spaces of missing teeth and retentive areas are also blocked out. The incisal edges and the occlusal surfaces have to be totally covered with acrylic. . when the dough does not flow any more. the models. an acrylic guiding surface is added for the fixation of the occlusion.5 mm over the gingival margin. The acrylic is not added with the spray-on technique but favorably with the dough technique. fixed in a semiadjustable articulator are blocked out with wax. a thin wax strip is laid around the tooth arch and fixed approximately 0. When working out. Distally of the canines.

.5 mm oval hard Treatment of patients with joint clicking sounds Reduced occlusal splint with extreme occlusal guidance which avoids shifting from the therapeutic position The ball retainer clasps for the posterior region in the lower jaw are bent and positioned. In both jaws. Then acrylic can be added onto the articulated casts. The teeth are grasped as far as possible by the splint in order to make the shifting out of the determined position impossible. The Gelb splint 0TU U0T Elements: Function: Description: Ball retainer clasps 0. The lingual bow is bent according to the shape of the mandible and is fixed in a distance of approximately 1-2 mm from the gingival tissue. lower jaw bow 2. The therapeutic occlusal position is previously determined on the patient and transferred with a wax bite. the teeth are limited with a wax stripe shortly over the gingival margin. Now the polymerization in the pressure vessel takes place.8 mm hard.

5 mm hard Treatment of cranio-mandibular disorders or for vertical opening Delicate but stable splint which can also be used in patients with fixed appliances The ball clasps can be installed in the posterior region as desired. bow 3.0 mm x 1.8 mm hard. The extremes of the bows are grinded with a separating disc for retention. ball clasps or Adams clasps can be used. If the splint is used for the treatment of patients with cranio-mandibular disorders. The lingual bow is fixed maintaining a distance of 2 mm to the gingiva. When using the splint for vertical opening for cross-bite corrections. . the bite block is left even. The retentions are positioned parallel to the gingival margin. In the lower jaw. the occlusal impressions are left in place. The upper bow is fixed transversally between the premolars and molars with a distance of 1-2 mm to the gingival tissue. The reduced splint 0TU U0T Elements: Function: Description: Ball retainer claps 0.

 Bite blocks 0TU U0T Elements: Function: Description: None Treatment of cranio-mandibular disorders Intraorally bonded bite blocks After setting the casts in relation to the facial structures into the articulator. The canine guidance in lateral jaw movement is as important in this appliance as in a complete splint. After the polymerization of the acrylic. both acrylic parts are adapted and finished separately. . the posterior teeth in the lower jaw are covered up to the occlusal surfaces (1 mm) with wax. In the upper jaw only the occlusal surfaces are limited with wax. The bite opening has to be checked again before adding the acrylic and the wax limits have to be reduced if necessary.

acrylic is added onto the retentions. The fixing points of the guiding telescopes in the upper jaw are located buccally and interocclusally in the molar area. The Duran® foils are roughed. In the posterior area. the main casts are set into the fixator with the aid of the measuring instrument according to George. The IST fixing attachments are set using the positioning aid and the retentions may have to be adapted to the tooth form. . the retentions of the attachments are heated with a flame and melted down into the foils. in the anterior area the incisal edges are covered 2 mm. The IST appliance according to Hinz 0TU U0T Elements: Function: Description: Guiding telescopes Snoring therapy Splints with guiding telescopes which advance the mandible For a controlled protrusive setting of the lower jaw. The retentive parts on the duplicated casts are blocked out with wax and then vacuum formed with 2.0 mm Duran® foil which was previously underlaid with space maintaining foils. the foil reaches up to 1 mm over the gingival margin. While finishing the splints. For the final fixation. and in the lower jaw buccally and interocclusally between the canine and the premolar.

Then the articulator pin is increased by 2 mm to give the splint a thickness of approximately 2 mm. Afterwards. The incisal pin has to be always in “0” position. To avoid the incisal edges from breaking. The casts and the base have a smooth surface to be able to draw the orientation scale for the model surgery. this splint has to be fitted on the patient. The surgical splint 0TU U0T Function: Centric splint = Blue splint: Serves to position the mandible to the cranial base for the fixation of the TMJ position Position splint = Red splint: Only used in bimaxillar operations for the positioning of the upper jaw in the new therapeutic position Definitive splint = Transparent splint: Serves to position the part of the mandible which holds the teeth into the therapeutic position and determines the post-operative occlusion Centric-splint: The casts are trimmed in all three dimensions after their pouring. the lower cast is mounted using a centric relation record. All teeth have to be blocked out with a wax limit in such a way that only the incisal edges and the occlusal surfaces can be covered with acrylic. The base of the articulator is trimmed together with the cast base. the acrylic is added and then polymerized in the pressure vessel without water. Only if the splint adapts correctly reference lines can be drawn. First. then finished and polished. it has to be adapted intraorally by grinding or adding acrylic and the lower cast has to be mounted again in this position. If not. . Afterwards. they are covered with an extremely thin wax layer. Before continuing the model surgery. the upper cast is mounted on a semiadjustable articulator using a transfer fork (bite fork) in the correct relation to the cranium. Only the occlusal surfaces of the casts are hydrated and then isolated.

After finishing the orientation scale the articulator pin is set back into “0” position. When detailing all three splints one must pay attention that the friction is not excessive when they are set onto the casts. the third (transparent) splint can be made. The articulator pin is set again into “0” position and the model surgery of the lower jaw can be started. the articulator base is trimmed.Positioning splint: The casts should be dry for the drawing of the orientation scale being able to use a water resistant pen. the upper cast is removed from the mounting ring and repositioned according to the surgical planning and fixed onto the base with sticky wax. The dental arches are once again covered with wax. not the cast. . If plaster surfaces interfere. then finished and polished. Therefore the lower cast is cut away from the articulator base repositioned according to the planning in all three dimensions and the interfering plaster surface of the base is trimmed if necessary. adding the acrylic. The reference lines should correspond to the vertical axis of the teeth. The articulator pin is raised again by 2 mm and the second (red) splint is made exactly the same as the first. The cast is firmly fixed with sticky wax. Definitive splint: Immediately afterwards. the drawing is realized in the area of the central incisors between the canine and the premolar and underneath the first molars. The vertical reference lines in the upper jaw are drawn between the cast and the base in the area of the lateral incisors between the canine and the premolar and over the first molars. In the lower jaw.

. Small grooves are grinded into the outer surface to receive the wire. They can be adapted if needed. Between the teeth a small hook is soldered to be able to wire both jaws together. When all splints are finished. The acrylic should extend minimally over the dental arch. After the fitting on the patient the orientation scale is drawn on the casts and base. the blue splint is made first. Between the single teeth in the upper jaw small holes are drilled into the splint to allow the intermaxillary wiring. the acrylic is added and the splint is finished. After hydrating and isolating. Now a circumferential wire splint is bent adapting on all labial surfaces of every tooth. the wax limitation is set around the teeth and the articulator pin is raised 2 mm exactly as with the other two splints. If a surgical splint is to be made on dental casts without brackets. all three are separately tried on before the surgery.Once again.

With the wire splints in place. the transparent or definite splint is made with the spray-on technique and then finished. . the model surgery is realized as usual in the articulator.After bending both splints.