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The ultimate reference work on removable appliances
Atlas of orthodontic and orofacial orthopedic technique
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.
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
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
different orthodontic plates Chapter 4 Double plates. splints.Content Chapter 1 Models. activators. bionators. snoring appliance . function regulator appliances Chapter 6 Wire appliances. appliance retaining elements. rapid palatal expansion (RPE) appliances Chapter 7 Nance and pendulum appliance. labial bows. support elements Chapter 2 Spring elements Chapter 3 Shield elements. space maintainer. bimaxillar appliances Chapter 5 Bimaxillar appliances. cleft and stimulation plate Chapter 8 Retention appliances.
CHAPTER 1 The ultimate reference work on removable appliances .
square or rubber form bases. When putting the models on their heel or back surface they should always stand in habitual occlusion. • U The simple labial bow U Function: Additional retention The labial bow is bent as usual. It should be right angled to the tuber plane (2) and the model base should be trimmed parallel to the occlusal plane (3). 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. The midpalatal raphe (1) corresponds to the midsagittal line. they should be prepared very accurately. After shaping the models. Occlusal plane As study models could be considered the presentation card of every orthodontist. positive or negative. This way models can be stored dustfree for years. soap or shine liquid. all bubbles. In all procedures the general guidelines are: 1. Tuber plane 3. they always have to be fixed in habitual occlusion. have to be removed and the surface is polished and sealed with talcum powder. The lateral surfaces can be trimmed in a round or square shape or be cast in plastic forms. . Then some zigzag inflections must be bent into the incisal part of the wire as retention means for the acrylic.• U The dental models U Function: Basis for treatment planning Description: Plaster models are the most important records for diagnosis. they are smoothed out with wet sandpaper.
In order to avoid occlusal interferences. In order to scatter the acrylic better. it is useful to frame the labial bow with wax. 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. the labial bow has to be adapted deeper. On this occasion attention. should be paid on the counter bite. . This wax frame should be shaped in a dimension that later corresponds to the thickness of the acrylic shield.In order to scatter the acrylic better. occasionally. This wax frame should be shaped in a dimension that later corresponds to the thickness of the acrylic shield. Then some zigzag inflections must be bent into the incisal part of the wire as retention means for the acrylic.
if it is labially positioned or partially erupted The M-loop moves the tooth primarily in a lingual direction.On this occasion attention. In order to avoid occlusal interferences. 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. occasionally. should be paid on the counter bite. should lie as close as possible to the premolar if the gap distal of the canine is to be closed. . Depending on the location of the centre part of the loop. the tooth can also be rotated. avoiding contact with the gingival tissue. bent over from the labial to the lingual side (transversal tag).
the canine can be moved mesially. Then distal of the lateral incisor it is bent into the transversal tag. In order to avoid interference with the occlusion. This loop can tip the canine distally as well as lingually. there has to be some space between the distal surface of the canine and the transversal tag. the labial bow and the transversal tag should not lie too high. • 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. If the loop is bent the other way around. If the tooth should be moved distally.• U The labial bow with retractive canine loop U Function: Alignment of labially rotated canines To optimize the point of force application.
. the canine can not migrate labially during its eruption. Because of the transversal tag distal of the lateral incisor. the transversal tag should contact the lateral incisor. • 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.If the four incisors have to be stabilized. this labial bow maintains open the space for the canine. 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 . Because of the loop design.
. 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. There. • U The labial bow with intrusion hooks U Function: Vertical movement of incisors The loops are bent as usual.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 horizontal part of the labial bow runs along the centre of the crown up to the teeth which are to be moved.
• U The modified labial bow U Function: Engagement of elastics and soldering of springs For the application of elastics. different hooks can be attached by laser or conventional welding. Force is applied on the anterior segment by the elastics and consequently the incisors are tipped lingually Elastics can also be installed vertically. or can also be bent in. They allow the extrusion of retained teeth. The elastics are engaged on soldered or bent-in devices of the labial bow. . For tooth movements in different directions. on to a bonded attachment on the tooth. springs can be soldered on. Two loops integrated into the labial bow allow the engagement of vertical elastics to align incisors.
Two hooks are soldered in opposite directions on the labial bow to rotate an incisor with elastics. .A hook is soldered on the loop of the labial bow to engage vertical elastics for the alignment of canines. combined with Adams clasps and a base plate. 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.
It is also possible to solder or laser a separately bent intermaxillary bow onto a standard labial bow on the upper jaw. It is important to remember that conventional or laser weldable wire has to be used for both bows. 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. the horizontal part runs along the lower teeth in centric occlusion. Normally. At canine level the wire is bent 90° forming the loops and then is anchored in the upper jaw.• 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. • U The triangular clasp U Function: Simple retention for removable appliances of all types .
The horizontally lying triangle continues into a vertical part. . The tag should be bent exactly over the triangle to avoid disturbing the occlusion. The buccal part is not bent over the triangle. the open part of the triangle should face distally. then into the transversal tag and finally ends in the retention portion. but directly back into the transversal tag. If the triangular clasp is used as an additional retention in the front. • 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. In order to protect the cheek. the transversal tag has to run over the labial bow.
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. . After unifying the triangle in the middle of the buccal part. The tag should be bent as close as possible to the occlusal surface of the teeth to avoid disturbing the counter jaw in occlusion. • 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. the wire is bent towards occlusal into the transversal tag. The transversal tag should be adjusted as deep as possible into the interdental space so that the occlusion is not disturbed.
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. .This variation of the triangular clasp allows a good activation . In the mixed dentition. The triangles should be aligned to the occlusal plane in order to make activation possible.
Seen from occlusal. a 9 cm long wire is marked parting from the middle at precisely 3. 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.5 mm to the left and to the right so that a 7 mm long piece is marked in the centre of the wire. These loops should have such height that the horizontal part of the clasp runs 1 . the bridge portion and the transversal part is approximately 45°. the angle between the loops. 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°. .• U The Adams clasp according to Adams U Function: Anchorage. The clinical crown determines the height of the loops. • U The Adams clasp according to Tenti U Function: Improved retention in comparison to the original Adams clasp Depending on the tooth width.2 mm below the cusps. 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. Therefore the loops find retention in the undercuts of the crown in the transition from buccal to interproximal. This part forms the buccal bridge portion between the two loops.
3 mm from the buccal bridge portion including the wire diameter. the wire is bent upward by 180° at the markings on both sides. . Holding the pliers horizontally.Now two marks are made on the vertical parts. With the round tip of the pliers. the mesial loop is bent 75° to the bridge. According to the central groove. A small V-shaped bend towards the gingival tissue at the central groove of the molar can be adapted to minimize occlusal interferences . the transversal tag can be bent gingivally in a V-shape to avoid occlusal interferences. 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 corresponding angles for the distal loop are 60° for the upper and 55° for the lower jaw. each 0.
Directly after this bend. the two wire ends are bent to form the retention. • 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. . the wire is bent afterwards 60° from the marginal gum. 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. parallel to the gingival tissue in a distance of 1 . According to the crown length. P. Afterwards. Now both wire ends run parallel to the buccal axis of the loop.2 mm.Function: Verbesserter Halt gegenüber der Adamsklammer nach C. Now the wire end runs parallel to the occlusal surface. the tag is bent again gingivally.
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. .Adams clasp with horizontally proceeding U-loop. also embracing two separated teeth. Another variation is the Adams clasp over two teeth with a centered arrow for additional hold. a V-shaped bend between both teeth is appropriate. An Adams clasp.
The bridge portion with the coil should not contact the teeth and should match the height of the coil on the opposite side. the wire is bent into a coil in order to anchor the extraoral traction. In the centre.• U The Adams clasp with anchorage for extraoral traction U Function: Anchorage for headgear The Adams clasp is bent over two teeth. This way. As shown here. exactly between both teeth. the headgear can be inserted without any problems into the Adams clasps. 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) .
The centrally localized triangle offers additional retention. • U The arrowhead clasp U Function: Anchorage for removable appliances in the deciduous. . Both loops are bent in the same way as in the simple Adams clasp .The Adams delta clasp is the combination of an Adams clasp and a triangular clasp. mixed and especially in the permanent dentition To achieve optimal hold. the arrows have to be adapted to the anatomical details.
it can be bent with one arrow and the sides fit tightly mesially and distally as shown here.The arrowhead is bent downward with the arrowbending pliers and laid horizontally into the interdental area. If the contiguous teeth have not erupted yet. To avoid occlusal interference. the mesial end can be bent in a retrograde way. . • U The modified arrowhead clasp U Function: Anchorage for removable appliances in the deciduous. 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.
Then the clasp leads loop shaped towards occlusal. . a V-shaped loop is bent which adjusts interdentally between the two anchor teeth. 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.Forming an additional loop on the distal tag. and is continued into the retention.
. Therefore. • 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.• 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. For the eyelet clasp in the lower jaw. In the upper jaw. the vertical part of the clasp which continues into the transversal tag should be long enough to allow a good activation. one has to pay attention to avoid causing any interference with the buccal cusps of the upper jaw. a small bent has to be made into the ascending part of the clasp.
the undercut areas of the tooth will expose. Then the fit of the clasp can be optimized activating the loop. mesial and distal of the tooth. Image of a completed appliance with a continuous eyelet clasp over several teeth. • 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. . As the eruption continues. The eyelets.The eyelets are to be located in the undercut area. have to fit preferably close to the gingiva.
• 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. it is necessary to slightly carve the papila. Its application is normally with short clinical crowns or with teeth that don’t have retentive undercuts (for example lower incisors). . For this.In order to avoid irritation the loop should not touch the gingival tissue. It should lie in the interdental area. gingival of the contact point.
Because the Lorenz spring consists of two separately bent parts. the wire is bent 180° and then back on the other side of the first part in order to be bent into the retention. 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. The occlusal rest is laid into the lingual groove of the molar and should not interfere with the occlusion. 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. On the occlusal surface.• 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. The first and lower part of the spring is bent from labial to occlusal and then towards lingual into the retention. appliances could sink into the floor of the mouth because of blocking out the undercuts. .
One can bend the occlusal rest to an eyelet. Therefore it is possible to activate the incisal rests for intrusion of the teeth. teeth can be held by short wires with an eyelet bent over the incisal edge. or can leave it ending in a simple wire. A wax layer should be applied to the upper third of the incisors before the polymerization of the base plate. • U The incisal rest U Function: Stabilization of removable appliances If vertical support is needed in the front. .
CHAPTER 2 Spring Elements .The incisal rests fixed in this manner prevent tipping of the incisors and tilting of the appliance.
the final loop is bent mostly in a vertical direction. The circumferential clasp for a first molar is usually placed from distal. If the circumferential clasp is to be activated. hereby. the active part has to be waxed out before the retention. . 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.• 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. the clasp should lie at the gingival margin on the buccal side in order to give enough retention to the appliance.
the circumferential clasp can be anchored between the tubes of the band. When the first molar is banded. On this occasion the loop reaches deep into the interdental area at the cervical margin. the final loop can be bent in a horizontal direction.Equally. 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 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. • 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 loop at the canine is bent. and afterwards the space maintaining part which simultaneously serves as a distal guiding rail for the canine. • U Modifications of the canine retracting spring U Function: Alignment of canines into the arch First.The loop has to be designed to neither contact the gingival tissue nor disturb the labial bow which afterwards is laid over it. . The canine retracting spring can also be bent V-shaped and with a helix. If the wire for the V-shaped helical spring is bent over a greater distance. the space maintaining part can be extended (analogous to the spring on the top of this side) as a guiding rail.
• 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. In smaller gaps. .Canine retracting spring with a long cantilever and helix. Usually the retracting spring is anchored in the base plate. 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. 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
The finger spring
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.
The protrusion spring
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
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.
The free end protrusion spring with mesial arm
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.
The double loop spring
The spring consists of two loops which run parallel to the occlusal plane.
The spring is prepared in such a way that the entire active part is covered with wax. . • U The double helical spring U Function: Maximizing the elasticity of the protrusion spring First. then two helixes are bent opposite and horizontally to the occlusal plane. the remaining part is freely movable and through the wax cover easily accessible. Only the retention is anchored in the acrylic. therefore the spring is less resilient.It is fixed in the lower third of the clinical crown and is covered with wax. both wire ends are anchored in the acrylic. instead. a small loop is bent which contacts distally on the tooth in order to prevent a distal migration. he spring does not finish in a free end.
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.• 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. The retention has to be anchored properly in the acrylic to be able to resist the high strain. . The active portion should be blocked out completely with wax so that the spring can be activated easily.
the activators whole interocclusal acrylic is preserved. the rest of the spring lies free for activation. This area has to be covered with wax during the preparation. . In order to create a counter base.It proceeds horizontally to the occlusal surface and is covered with wax in the usual manner. preferably in the activator The buccal box spring emerges out of the interocclusal acrylic in a distance of approximately 1 . Both retention tags are anchored in the acrylic base.2 mm to the tooth being moved. therefore. 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. • U The buccal box spring U Function: Oral movement of buccally standing single teeth.
The acrylic of the activator has to be removed in such a way that the tooth is not hindered in its movement. The spring should lie as extensive and precise as possible on the lingual surface. The active part has to be covered with wax and both ends of the wire have to be anchored in the acrylic base. The buccal box spring is mainly used in activators. • 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. . It can also be used for buccal movement of posterior teeth.
after its bending it is covered with wax to allow space for its activation. . If the appliance design includes protrusion springs. As with all other springs. the intrusion hooks have to be adapted.• 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. the paddle spring is frequently bent using larger wire than in the front. • 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. In the posterior area.
In the finished appliance. the active portion is covered with wax. Then depending on the crown length the spring is bent together in an S-shape. • U The sheet spring U Function: Protrusion of single teeth First. the springs and the intrusion hooks have to lie freely so that they can be activated without any effort. The retention portion is carved with a disc.The entire spring area has to be covered with wax and the screw has to be fixed before finishing the appliance. . according to the mesiodistal diameter of the tooth the matching sheet spring is chosen.
The sheet spring has to emerge sufficiently out of the acrylic to allow enough free play for its activation. The cantilever proceeds straight (like a beam) and is then bent into the retention. . The spring presents advantages in restricted areas. • 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 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. for example in steep palates. The space opening and spring activation take place simultaneously. For space opening additional C-clamps and expansion screws are used.
• U The buccal spring U Function: Uprighting of lingually tipped teeth The spring has a loop that is directed distally. Both teeth are moved simultaneously. the wire portion contacting the tooth should be positioned under the equator of the tooth. The spring has only one retention portion. the spring is bent approximately 3 . this means the open side shows towards mesial.4 mm downwards and then turned again upwards 180° to finish into the retention. For achieving an optimal effect with this spring. After the loop. • 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. .
so that the wire end which lies in the centre does not irritate the cheek tissue. which attacks from buccal and resembles the Bonyhard clasp. is predominantly used on bicuspids but can also be applied on molars as shown here. or the according acrylic on the base plate is removed. they are covered with wax on their lingual or palatal surface. 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. The buccal spring lies close to the teeth.In order to make the oral movement of those teeth possible. . • U The pressure spring U Function: Oral movement of bicuspids and molars The pressure spring.
. • 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 base plate is either covered with wax or trimmed free in the direction of the movement.The exposed loop makes activation easy. 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.
In this case. . 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. the wire continues 5 to 7 mm horizontally to the occlusal plane and straight towards oral. and is then bent in a right angle into the retention. The retention should be anchored sufficiently in the acrylic so that the spring is not torn off because of the resulting forces.• 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. After crossing the contact point. This active portion has to be covered with wax as usual. 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.
also alveolar remodeling takes place in oral direction as a result of the bone remodeling during tooth movement. not only the tooth crown can be tipped lingually. . With the oral spring. The entire clasps are covered with wax as far as their retention portions. • 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. The springs can only be applied in combination with a transversal screw. the palatal portions of the clasp are bent parallel over each other.
• U The closed intermediate spring with loop U Function: Diastema closure Here. the closed intermediate spring has a loop on the labial side. 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. On the palatal side. The consistent mesial pressure from labial and palatal sides moves both teeth towards one another guided by the acrylic. Through activating the loop (see below) the central incisors can be moved together in an optimal way. Both clasps have to be covered with wax as far as their retention. the spring anchored in the acrylic base can be activated properly. This way. .
CHAPTER 3 Shields elements. different orthodontie plates .
2 mm spring hard Function: Closing stimulation of the lips Description: Appliance which follows the safety pin principle and represents exercise for the lips . The tongue guard is often combined with an oral screen.• U The tongue guard U Elements: The tongue guard runs inside along the tooth rows in the area of the open bite. • U The lip activator according to Dass U Elements: Stimulation spring 1. but can also be integrated into an active plate. Function: Abhalten der Zunge von den Frontzähnen Description: mäanderförmig gebogenes Gitter Das Zungengitter verläuft innerhalb der Zahnreihen im Bereich des offenen Bisses. 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.
corresponding with the shape of the lip. The following zigzag bent is used for activation if the tension decreases. is anchored in the buccal tubes of the molar bands. The acrylic shield is finished concave to the labial surface.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.The spring. which in this example is made individually. which also serves as a grip. The retention works simultaneously as reinforcement for the acrylic shield. . • U The lip bumper U Elements: Lip bumper 1. The wire end and the retention are underlaid with a wax plate and framed with a wax stripe. is bent once around the loop forming pliers.
• U Lip pads with an engaged labial bow U Elements: Function: Description: Modified wire of the lip pads. When the finished lip bumper is in place. The area in which the lip pads should keep away the lip has to be underlaid with wax.3 mm. engaged labial bow 0.In order to have the lip pads in a certain distance from the gingival tissue.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. 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. the bent lip bumper wire is underlaid with wax. . The distance between the wire and the wax layer is about 1 mm.
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. simple retention elements and a labial bow are bent. .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.Depending on the desired function.
The acrylic can be scattered on and can be polymerized in the pressure vessel for around 10 minutes. the screw sections are sawed and the active elements are uncovered. The chosen clasps are bent according to the planned design. The basis plate is only polished on the upper side. or to advance the mandible from a distal bite into a neutral occlusion. • U The active plate U Elements: Function: Description: According to the planned design Different purposes. The prepared model can be watered. . On the lower side. depending on the design In combination with resilient wire elements and pressure or traction screws.The inclined plane in the anterior area of a maxillary plate can be used to move the mandibular teeth forward. Afterwards. 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 plate is detailed. only coarse details have to be eliminated. The model should not to be isolated if the plaster is not synthetic. Otherwise. the lower side remains untreated in order to adjust as precise as possible onto the model. the active parts are covered with wax and the screws are positioned on the model.
The acrylic does not contact the last molars. 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.• U The Cetlin appliance U Elements: Function: Description: Distal spring 0. In order to adjust the distal springs between the bicuspid and the molar. Therefore they can be banded without any problems and the teeth can glide distally along the acrylic. Adams clasps are bent over the first bicuspids. the plaster model has to be slightly erased in this area. The springs and the acrylic shield are blocked out with wax and covered with acrylic.7 mm spring hard. . The distal limit of the acrylic base reaches the A-line.
The acrylic underneath the screw can continue in order to make the appliance more stable.• 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. one has to pay attention in order that the retentions of the clasps do not reach into the sawing area. . The acrylic base has to be sawed or grinded free in all the extension of the gap. 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 edges are grinded off parallel so that the screw can be closed without any obstacles. The retention should be bent again in such a way that it does not invade the later sawing area. When the screw is totally closed and a gap remains between the teeth. after a new impression. 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. n the area of the gap. 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 .
It has a pressure and a tension extension. finishing and polishing the appliance the proper function of the screw has to be proved. the pressure extension is adapted on the tooth.The elements are bent according to the planned design. First. . 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. • 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. pulled into the right position After bending and fixing all clasps and holding elements the screw is adapted. The diastema screw is centered with its plastic holder in the middle of the arch. The activation extensions are adapted on the distal surface of the tooth and are eventually shortened. After scattering.
The active plate is covered with acrylic and finished. the tension extension is screwed back the estimated amount and is adapted to the tooth contour. The screw and the nut have to be heated slightly. At this moment of the making. . • 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. For the insertion of the plate.5 mm.The whole length of the extensions and the slots of the screw are covered with wax. a drop of wax is placed. the retention of the tension extension still lies inside the acrylic. pressed onto the wax and positioned in the desired direction. On the point of force application on the tooth.
• 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. There are three different screw lengths (4/6/8 mm) therefore a labial movement up to 7 mm can be achieved. The pan lever is connected to a hinge joint with a spring for a firm adjustment. The piston spring screw is activated with a small screwdriver. Before finishing the appliance. the spring and the activation screw. . 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 assembly screw is unscrewed.The acrylic is scattered as usual. Possible acrylic or polishing residues are removed and the desired piston spring screw is screwed in. The resilient pin of the screw should only emerge slightly out of the nut.
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.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. 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. . 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. In combination with a labial spring. the lever pan screw can also be used to rotate a molar.
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 wire elements are bent and covered with wax. The Y-plate is often used for anterior-posterior expansion in order to gain space for the alignment of upper canines. The saw-tracing of the finished appliance forms a Yshape. The retentions have to lie in such a way that they do not hinder the later sawing.The three dimensional screw allows a transversal expansion of the arch with simultaneous protrusion of the incisors. the protrusion springs have to be adjusted horizontally and vertically before fixing the screw onto the model. • U Plate with three dimensional. This way. they can maintain their function even after a strong activation. The retentions of the wire elements lie in the corresponding section according to their function. 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.
The function of the multisectional screw according to Beutelspacher is analogous to the function of the Bertoni screw in the maxilla.After the polymerization of the acrylic. to expand the anterior or posterior region fan shaped. the mounting of the screws is removed and the appliance is finished. Afterwards. 3. 2. Posterior expansion. Eccentric expansion The fan type expansion screw exists in two designs: As a one piece or two piece expansion screw. • 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 two piece expansion screw has the advantage that through the separate fixation of the screw and hinge. . Both have the same function. the lever is longer so that the fan type expansion is enhanced. the sawing is performed. Anterior expansion.
The appliance can be expanded like a fan after its sawing. Fan type split plate with fan type expansion screw in one piece In the same way as in the two piece screw.1. there is more space for the retentions of the wire elements. To assure an opening without interference the hinge should lie uncovered on the posterior limit of the plate. The separate joint that forms part of the hinge has to be covered with wax. This way. . 2T 2T The finished appliance shows that the hinge which lies on the dorsal end of the plate is not covered with acrylic. the hinge of the one piece screw has to be covered with wax. The fan type plate is often used for expansion in patients with lip and palate cleft. The finished appliance is also sawed. Anterior expansion Fan type expansion plate with divided screw The divided screw is smaller and is therefore favored in narrow jaws. and the hinge has to be cleared of wax and acrylic residues. It should not stand out over the A-line. The appliance has to be extended notoriously further into the palate than a simple split plate.
then its function is the posterior expansion of the maxilla. Posterior expansion Fan type plate with reverse built-in. 2T 2T . it can be cut wider. The activated screw shows that the wedge shaped cut is closed in the anterior region. then it is covered with wax and the plate is sawed. Eccentric expansion Fan type appliance with one piece screw for eccentric expansion An eccentric expansion is achieved by the oblique fixation of the screw.The top view of an activated fan type split plate with one piece screw. divided screw The screw can also be adapted in the opposite direction. If the wedge shaped cut is insufficient for the planned expansion. 2. The hinge is covered with wax as usual and the sawing cut is widened wedge shaped from the hinge to the front . 3. The screw is built in as usual.
. the appliance is sawed. space can be gained in specific parts of the arch. Then the screw is fixed on the model. After finishing and polishing. The retentions of the clasps should not disturb the area of the screw. analogous to the fan type screw in the upper arch The wire elements are bent according to the design. in the area of the lip and palatal cleft. The mandibular bow screw is adjusted in the same way as a transversal expansion screw into the plate. The opened bow screw expands the mandible almost fan shaped. as in this example. the activation results in an eccentric rotation of the arch. This way.Because of the oblique position of the screw. • 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.
Both sides of the labial bow have small loops distal of the incisor coverage. a continuous pressure is applied on the incisors which results in their alignment according to the set-up. labial arch 0.• U Labial spring bow plate according to Bandulet U Elements: Function: Description: Adams clasp 0. This way. The plaster model has to be duplicated for the making of the appliance. which is covered with acrylic in the anterior region. Adams clasps with soldered tubes are used as retention elements. elastic springs are attached to the distal endings of the labial bow that slide out of the molar tube.7 mm hard. . From these loops. is inserted into the molar tubes which serve as guide rails.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 distal part of the labial arch.
If the labial arch is bent almost completely only resting the retentions. the tubes are pulled over the wire. the retentions are bent. can serve specifically as an active element. The tubes start from the loop to the beginning of the retention.6 mm spring hard. and with the enforcement in place. This way the thinner active part of the labial arch.7 mm hard Retraction of the incisors Simple appliance for the retraction of incisors The special part of this appliance is the labial arch. To enhance the transversal mesial tags of the labial arch. The transversal screw activates the labial bow automatically. Adams clasp 0. . with additional loops in the U-loops.• U The Roberts retractor U Elements: Function: Description: Labial arch 0. small tubes or the needle of a syringe of corresponding size are pulled over the wire.
First. then the acrylic is added and the appliance is finished. The screw with holder and mounting pattern for the adjustment of the incline is adapted on the lower plaster model. the acrylic is scattered on the maxillary plate and both parts of the fixator are set together carefully. The mandibular plate is totally finished. the preformed maxillary expansion screw with guards is fixed. the plateau of the finished mandibular plate is covered with a very thin layer of wax and then. After that. Acrylic can be added to the maxillary plate if the expansion screw is not covered adequately. Preformed mandibular expansion screws for double plates can be used when screws are integrated into the double plates. 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. Following the plateau an inclined plane of 60° in relation to the occlusal plane is added as a gliding surface for the guards. 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. .
• U Modifications of the bite jumping guards U Individually bent guards (1. It is only sanded down and polished. • 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. . a one piece protrusion wire can be added.2 mm spring hard): In this case. This is important to distribute the pressure evenly over the appliance and therefore avoid overloading and breaking of the guards. Bite jumping handle (1. these prefabricated Müller spurs can be a good solution. the wire should not extend lingually over the mandibular plate. 1 adapter (small). the mandibular plate is finished first including guide planes in the area of the first molars. For example.2 mm spring hard): If the double plates do not include an expansion screw. two wire loops are added into the maxillary plate. Following these precautions. the width of the wire should correspond to the width of the inclined plane on the lower plate. Lateral guiding spurs (Müller spurs): The guiding spurs can also be applied in the posterior region. While polishing the maxillary plate one has to pay attention not to damage the upper plateau. In this case. these surfaces show towards dorsal. when the lingual area is reduced. In models of Angle class II patients. Again. The models have to be mounted in the fixator as mentioned before with a construction bite. the contact of the upper and lower plateau is flat and extensive. In this variation. 1 mounting pattern and user instructions. 1 adapter (large).
The elements are bent according to the design. . This inclined plane will always be of 60° because of the mounting pattern. the loops have to be covered with wax in order to maintain their elasticity. Before fixing the guards. The mounting pattern is removed. the holder lies between the guiding surfaces of the pattern and these have to adapt closely to the body of the screw. The gap that results between the body of the screw and the adapter is the space for the acrylic inclined plane. The plastic adapter is fixed over the guiding surface onto the holder of the screw. The inclined plane of the mandibular plate which resulted from the use of the mounting pattern is slightly sanded and polished. the mounting pattern is held parallel to the occlusal plane over the mandibular model. This way the mandibular plate can be prepared. The finished lower plate is isolated with a very thin wax layer. The combination of guards and expansion screw is fixed onto the inclined plane. After fixing the mandibular screw. Here. hydrated and scattered.
These can be neutralized by simply bending open the 1.When closing the fixator the screw should be close to the palate without contacting it. . 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. tension can be produced on the guards. During the finishing the loops have to be uncovered without grinding them. 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. After this. • U The class III double plate (RD-plate) U Elements: Function: Description: Clasps according to the planned design. the surfaces on which the thorns glide along are directed mesially. the mandibular plate is finished and polished first. Again.2 mm strong M-loop. the acrylic can be applied on the maxillary model. When the transversal screw is expanded widely.
. the screws are fixed on the lower model. View of both finished and polished appliances. The finished mandibular plate is covered with wax to avoid sticking on the maxillary plate. Now acrylic can be applied on the upper plate and the fixator has to be closed while the acrylic is not yet polymerized. The activation of the screws produces a retrusive movement onto the mandible. The mounting templates have to be adapted onto the screw holder and for the maxillary appliance the guards are fixed. • 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 thorns are fixed with wax as mentioned before onto the lower plate. the acrylic is scattered and the appliance is finished.
CHAPTER 4 Double plates. bimaxillar appliances .
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. The bimaxillar effectiveness can be appreciated in a lateral view: .• U The Roberts retractor as bite jumping appliance U Elements: Function: Description: Labial bow 0.6 mm spring hard.Retrusion of the upper incisors because of the labial arch . A transversal split screw can be added into the dorsal part of the acrylic base if desired.Advancement of the mandible because of the inclined plane. The acrylic base of the upper plate is extended into the lower jaw. . The base plate is designed as an inclined plane. The lower inclined plane lies behind the mandibular incisors and causes the advancement of the entire mandible. Adams clasp 0.
only a labial bow and two continuous clasps are attached. thorns 0. Both plates can be modified using transversal screws. The lower plate is stabilized through thorns between the canines and the lateral incisors and other thorns distal of the first molar. circular clasp 0.7 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. With this double plate appliance it is very important to achieve a good fitting of the bite blocks.• U The double plate according to Planas U Elements: Function: Description: Labial bow 0. The lower plate has two horizontally laying bite blocks which are located in the lingual molar area. 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. .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. In the upper jaw.7 mm spring hard.
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 lingual shield is positioned along the inner alveolar curve and reaches into the area of the first premolar. The plateau covers all teeth.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. labial bow 0. • U The bimaxillar prognathism upper plate according to Buño U Elements: Function: Description: Anterior intermaxillary bow 0. ball clasp. labial pads 0. 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.• U The Berlin reactivator U Elements: Function: Description: Connecting wire for the lingual shield 1. For this appliance a construction bite is needed. headgear hook 0. the incisors are not covered on the palatal side. they rest with their incisal edge on a plateau which simultaneously supports the lower incisors.2 mm spring hard. The upper base plate reaches slightly under the gingival margin in the posterior region.8 mm spring hard. The wire diameter can vary according to the tooth dimension. The retentions have to be designed according to the reduced base plate. In the anterior region.8 mm spring hard. The hooks for the extraoral traction are located between the upper lateral incisor and the canine.
• U The bi-block appliance according to Chateau U Elements: Function: Description: Labial bow 0. The labial pads are similar to those of Fränkel’s function regulator although in the centre they are not connected . the mandible is supposed to be restricted or even moved backwards. lingual bow 0. Through this free space to the lingual shield and the intermaxillary bow. The part which lies on the lower incisors is covered with a spring and a plastic tube. Loops are bent on both sides of the intermaxillary bow. The upper plate is furnished with a strong acrylic lingual shield.The upper plate is anchored with simple retention thorns.7 mm spring hard.7 mm spring hard.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. The wire elements are bent and the tubes are incorporated into the upper base plate. this bimaxillar prognathism plate also includes a Coffin spring. For the positioning of the mandible the wire is put into the tubes and is fixed with wax to the molars. arrow clasps 0. This acrylic shield should not touch the mandible. In order to distract the tongue from the incisors. The opening of the tubes should be covered with wax before adding the acrylic. . Therefore the models are covered with wax in the area of the lower teeth and of the lingual shield.
. the lingual bow is removed from the tube to finish the plate. 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.9 mm spring hard. the wire is bent backwards by 180° and passed between the canines and first premolars into the retention.After the polymerization.9 mm spring hard. The lingual bow should contact the cervical third (of the crowns) of the lower incisors and premolars. labiolingual bow 0. The anterior springs lie on the most prominent parts of the incisors. After polishing the upper plate. • U The Bimler appliance type A U Elements: Function: Description: Labial bow 0.9 mm spring hard. the lingual bow is fit to the lower jaw and its proper anchorage is assured. On the height of the second premolars. Coffin spring 0. 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 Coffin spring is bent closed distally.
From there. To reduce the force application the anterior springs are upholstered with plastic tubes. The acrylic base of the finished appliance is very small and therefore it has to be polished carefully. In the upper jaw the side wings. In the lower jaw. it is bent towards occlusal and then in height of the first premolar is guided back to the canine. After this. and in the lower jaw the labial shield are limited with wax. The whole appliance should be preferably worked on with a manual motor and not with the lathe. .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.
. Then the wire is bent between the first and second premolar back to the palatal area into the lateral acrylic shields. In the lower jaw the labio-lingual bow and the anterior springs are bent in the same way as in the type A. From there. the wire is bent between the canine and the first premolar over to the buccal side embracing the first premolar. Anterior springs are added to correct the protruded lateral incisors. retention thorn 0.8 mm spring hard. A retention thorn is fit on the mesial side of the molars and its retention is anchored in the upper acrylic base plate.9 mm spring hard.8 mm spring hard. expansion bow 0. 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.8 mm spring hard Base appliance type B for the treatment of retruded central incisors The appliance consists of a rigid upper base plate. anterior loop 0. The transversal screw is fixed before adding wax and then the wax collar for the incisor shield in the lower jaw is added.• U The Bimler appliance type B U Elements: Function: Description: Anterior spring 0.9 mm spring hard. labio-lingual bow 0. On the buccal side a loop is bent between the lateral incisor and the canine and wire ends are bent over.
mandibular connection bow 0. anterior spring 0.8 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 design of the upper base plate is delicate. The occlusal rests have to be horizontal to the occlusal surfaces. • U The Bimler appliance type C U Elements: Function: Description: Intermaxillary bow 0. the anterior springs are covered with plastic tubes.9 mm spring hard. occlusal rest 0. The anterior spring is bent contacting on the most prominent parts. mandibular bow 0. . Coffin spring 0.9 mm spring hard.8 mm spring hard.9 mm spring hard. In the lower jaw the anterior spring and the labio-lingual bow are anchored in the incisor shield. The Coffin spring is closed distally. After finishing the appliance.
In the upper jaw. In the lower jaw. the occlusal rests are covered with plastic tubes in order to make the vertical opening more elastic. small acrylic shields are made in the canine and premolar area in order to anchor the connecting wire. . The finished appliance is a delicate design and has therefore to be handled with caution during polishing and finishing procedures. the lingual bows are led from the mesial edge of the canine distally. Both lingual bows are joined through a connecting wire with three zigzag bents into the lingual acrylic pads. On the buccal side the wire is bent into a mesial loop and then back distally. the lateral acrylic shields are limited with wax stripes.In the lower jaw. In the upper jaw. then buccally between the canine and the first premolar. Now the wire is led between the first and second premolar over to the oral side again. After a loop formed indentation towards anterior. the anterior spring can also be covered with a plastic tube. After completely finishing the appliance. the lingual bow moves over to the acrylic base plate of the upper jaw.
ball clasp 1. Adams clasp with spring for extraoral traction 0. First.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. In the upper plate the bite block is sloped in the opposite direction and therefore fits exactly onto its counterpart. Adams clasp 0. the lower plate is finished. The Adams clasp is bent over two teeth. including a spring in the centre to anchor the headgear. Through these two inclined planes the occlusion is fixed and the mandible is determined in its position. It includes a small bite block in the premolar area which is sloped distally.• U The twin block appliance U Elements: Function: Description: Labial bow 0.0 mm spring hard. The lower plate only includes ball clasps in the anterior region and Adams clasps in the posterior region.8 mm spring hard. .
Occlusal rests are bent over the lower molars. The counter hooks in the lower jaw for the intermaxillary elastics are soldered on the labial bow which afterwards is covered with acrylic. The limits of the acrylic cover are slightly underneath the incisal edge and over the point of the papilla. . thorns for elastics 1.• U The double plate with intermaxillary elastics according to Neuner U Elements: Function: Description: Arrow clasp 0.0 mm hard.7 mm spring hard. For the lingual shield. the interdental areas have to be erased to guarantee a firm adjustment especially while opening. the position of the hooks on both plates has to allow a horizontal course of the engaged elastics. This way the vertical force component can be minimized. labial bow 1.0 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 rest 1.0 mm spring hard. Ideally.
All different screws can be incorporated: for example the fan type expansion screw.• U The bimaxillar appliance according to Sevinc U Elements: Function: Description: Guiding bow 1. After its polishing. anterior springs for an incisor correction were added. multi sector screws. keep its effect from the alveolar bone. the upper plate is finished with its buccal pads which serve to control the buccinator muscle and if needed. The spring bows with its retentions are bent without tension into the upper plate. The screw has to be adapted in such a way that it allows an independent activation of all plate sections. 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. In this case. screws according to Bertoni or Beutelbacher. or simple transversal screws as well as all different sorts of springs.2 mm spring hard.7 mm spring hard. First. The tongue pad with its guiding wires is finished separately. tooth groups or the tooth rows. . The connecting wires for the buccal pads are bent in a slight distance from the gingival tissue and are then fixed. labial bow 0. 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. The three dimensional screw allows a transversal expansion of the arch with simultaneous protrusion of the incisors.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. connecting wires 0.
helical protrusion spring for the anterior segment 0.7 mm hard. incisal spring 0. a retrusion of the whole mandible can be achieved by an activation of the spring bow. The elements are bent according to the planned design. . canine retracting spring 0.The lingual pad located in the anterior region allows a reduction or increase of the vertical effects. • U The buccal double plate according to Bierschenk U Elements: Function: Description: Adams clasps 0.5 mm spring hard. 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. A vertical opening of approximately 5 mm is necessary to integrate the inclined planes into the posterior bite blocks.5 mm spring hard. guiding thorns 1. A finished bimaxillar appliance consists of the upper base plate and the integrated guiding bow with its tongue pad.8 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. Similarly.
For the making of the acrylic surfaces. and on the lingual side. the guiding thorns have to emerge slightly in order to slide into the inclined planes of the upper bite blocks. When closing. the occlusal surfaces of the posterior teeth are covered with wax up to the cuspids. .5 mm spring hard. the lower buccal plate is supported with incisal rests. In the area of the second premolars these smooth bite blocks are grinded to form inclined planes of 45°.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. The inner pressure bow and the labial bows are used to align the incisors. an expansion screw can also be added. Wax is also added on the lingual surfaces in a right angle so that the acrylic contacts only the tips of the cuspids. the crowns of the molars should only contact the acrylic from the equator on to the beginning of the gingival tissue. In a vertical plane.On each side the upper plate has posterior bite blocks. inner pressure bows 0. the guiding thorn of the lower plate is driven into these inclined planes and therefore guided into the desired occlusion. the acrylic occlusal surfaces are replaced with occlusal springs. In the anterior region. When the treatment goal is bite closure. • U The rilinator U Elements: Function: Description: Adams clasps 0.7 mm hard. labial bows 0.
presoldered tubes with wire can be used. When expanding. one can confirm that the planes are grinded completely smooth and that they fit perfectly onto one another. Adams clasps 0. The acrylic has to be finished and polished smoothly in order to guarantee a firm contact and to increase the vertical dimension evenly. the Jasper Jumper produces the advance As in the base appliance.7 mm spring hard. In this occlusal view. For the occlusal covers in the posterior region. The clinical crowns of the first molars are covered with wax. the occlusal planes have to glide over each other. labial bows. otherwise. For this appliance headgear tubes have to be soldered onto the Adams clasps. protrusion springs 0. so that only the tips of the cuspids contact the acrylic. . in this case. the occlusal surfaces of the premolars and molars are grasped in acrylic.7 mm hard. • U The rilinator with Jasper Jumper U Elements: Function: Description: Labial bow 0. protrusion springs and Adams clasps are fixed on the model.5 mm spring hard Fast conversion from an Angle class II-1 to class I Instead of the VSD-planes. they can erupt grinding the acrylic or being intruded using occlusal springs.The special features of the rilinator are the lateral occlusal covers. The bow for the Jasper Jumper is fixed directly with one or several pearls into the lower plate. The posterior teeth can be maintained in their vertical position.
Before bending the torque spring for the incisors.7 mm hard. . This way. an acrylic step can be designed behind the central incisors. vestibular shields 1. labial pads 1. it is recommended to solder the tubes onto the Adams clasps.2 mm spring hard. The retention tags for the vestibular shields are bent individually. In addition to the setting in the acrylic base. After placing the screw onto the model. Vestibular shields and labial pads can only be finished after covering the tubes with the inserted wires with a thin wax layer. torque springs 0. 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. The finished plate is set onto the model and then the wax layer is added for the vestibular shields and labial pads. In order to insert the labial pads into the vestibular shields. A penetration of the acrylic into the tubes should be avoided.0 mm spring hard Mandibular advancement Growth stimulation due to the vestibular shields First. An alternative is to use preformed vestibular shields. The tubes have to be covered with acrylic as far to guarantee enough retention for the shields with 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. This tube is inserted into the labial pad.• U The Bass appliance U Elements: Function: Description: Adams clasps 0.6 mm spring hard. lingual pads 1. a tube is soldered onto the individually bent retention tags. the acrylic can be added including the occlusal planes. 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.0 mm spring hard. the Adams clasps are bent over the molars and the first or second premolars (or second deciduous molars).
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. are bent of 0. . the mesial retention tag is anchored in the lower plate. The Adams clasps over 54 and 64 are bent of 0. the Adams clasps over 55 and 65. 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 split fan type expansion screw is built in without its joint. upper connecting bow 1. Adams clasp 0.6 and 0. In the mandible. With this spring bow. and also over 16 and 26. the distal tag is anchored into the lateral bite block in height of the occlusal plane. the retention tags are bent according to the situation.The anterior tube on the palatal side of the plate is used as opening for the labial pads. the connecting bow is located directly behind. • U The Hansa plate according to Hasund U Elements: Function: Description: Closed torque spring 0. The finished Bass appliance can be up up-fitted to allow the patient to get used to the appliance gradually. 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.6 mm spring hard wire.0 mm hard.7 mm spring hard.7 mm spring hard wire. The buccal tubes are placed on the second deciduous molars or on the second premolars. The pair of spring bows should not contact the gingival tissue or teeth.
the torque springs should lie free and the buccal tubes should extend over the lateral bite planes. or the first deciduous molar. For this purpose. Prepared this way. In the anterior region. to make the application of the acrylic easier. the wax layer for the reduced lower plate is added. The retention for the lower jaw lies lingually underneath the tooth row. the wax is added in the same manner as in the posterior region so that there is no transition between them. A slim wax stripe limits the free part of the palate and simultaneously blocks out the connecting bow. The upper plate is finished first. a narrow wax stripe is fixed on the labial side of the upper tooth row. the acrylic can be added on the upper plate and it can be finished. . Finally.When all wire elements are bent. The thickness of this wax stripe is of approximately two wax plates. which is anchored in the upper plate. The other retention. 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. 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 bite plane should embrace the teeth as far as possible although the Adams clasps should lie free. Now acrylic can be added separately on the lower plate and it can be finished. The buccal tubes are also sealed with wax. The lower lip shield is bent in average with 6 loops. a wax frame is fixed around the previous wax layer. It is advisable to add a wax frame in order to manufacture easier the upper reduced plate. The wax lining of the lower model covers the cuspids of the posterior teeth in such a way that the compensation curve is maintained. into the lower acrylic base ideally with a mesial direction. The connecting bow has to lie free in such a way that it can be activated parallel to the screw.
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.The lower plate is also finished separately. In the area of the loops a small groove is milled to make the insertion of the headgear easier. If necessary. occlusal rests 0. posterior wire loops 1. the separately finished appliances can be polished without problems. protrusion springs and the occlusal rests can be included in the lower plate.2 mm spring hard. premolar.5 mm spring hard. deciduous molar or distally of the 2nd. the buccal tubes have to be grinded free minimally. Depending on the planned design. The retentions are integrated into the acrylic of the lateral bite blocks parallel to the occlusal plane. protrusion spring 0. The superfluous acrylic is grinded and polished. .0 mm spring hard.9 . • U The selective orthopedic double plate according to Marillo U Elements: Function: Description: Labial bow 0.7 mm spring hard. This way. In the incisal or lingual area the plate has to be shortened in order avoid interfering with the height determined by the construction bite. premolar into the acrylic base.0 . expansion spring 0. 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.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 base plate ends on the level of the 2nd.1.1.
The posterior wire loops are not integrated into the plates until the end. small acrylic pillars are added in the canine region.2 mm spring hard Treatment of anterior cross bites With the distal spring loops the double plate can be reactivated As wire elements.7 mm spring hard. Through the activation of these loops the correction of the occlusion can be achieved in an anterior-posterior and vertical plane. spring loops 1. The spring loops can then be fixed with acrylic into the polished plates. 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. The models are mounted into the fixator with the construction bite.To increase the support. only simple labial bows are bent. The retentive parts have to be blocked out with wax and the extension of the plate is also limited with wax. . In the molar area.
The acrylic bases are only connected through the installation of both screws on the right and left side. The occluding pattern (A) which is used for the construction bite indicates the horizontal dividing line of the bimaxillar appliance. • U The LS-Duobloc according to Leger/Soerensen U Elements: Function: Description: Labial bow 0. labial bow with pads 0.8 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. a dividing metal sheet (B) and a mounting pattern (C).8 mm spring hard.In order to be able to activate the springs better. . the complete installation kit is needed which consists of an occluding pattern (A). The models are mounted into the fixator in such a way that the mounting pattern and the fixator do not hinder each other. they are extended minimally over the base plate.
After the polymerization of the acrylic. box shaped. the plates are grinded. The screws are fixed in the mounting pattern and the free part of the holding slot is also covered with wax. he screws have to be proved for their parallelism and the proximity to the dental arch and after that. The position of the screws is determined by the mounting pattern (C) and eventually the acrylic has to be grinded slightly more. In order to integrate the screws. When the screws adapt well into the grinded boxes. the acrylic can be added. The dividing metal sheet (B) with a Vaseline layer is adapted onto the lower model and the fixator is closed until its closing limit. on the right and left side.After bending the labial bow in the lower jaw and the labial bow with integrated pads in the upper jaw. the screws with the mounting pattern can be polymerized into the acrylic. the screws are covered with wax except for their retentions. For this purpose. the metal sheet is removed and the plates are finished. the screw slot is liberated of its wax and the appliance is finished . the fixator is divided and a wax embankment is added around the upper and lower model. The mounting pattern is removed from the mounted LSDuobloc screws. In the upper jaw the acrylic covers the anterior third of the palate.
In an asymmetric combination on the right and left side of the mentioned malocclusions. .• 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. the type III appliance is indicated.
CHAPTER 5 Bimaxillar appliances. function regulator appliances . activators. bionators.
8 mm spring hardLabialbogen 0. originally called Monobloc.8 mm spring hard. The retention thorns only anchor the molars maximally.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. or it can be grinded free in order to achieve a passive opening of the vertical dimension. The transitions are smoothed with additional acrylic. With the inclusion of a screw an additional transversal expansion is possible. not the appliance.• U The activator U Elements: Function: Description: Labial bow and retention thorns 0. After the models are prepared this way and hydrated. It can also be used for the lateral side shifting of the lower jaw. This base appliance can include interocclusal acrylic. is characteristic for this appliance . Labial bows and retention thorns are fixed with wax onto the model. they are set together in the fixator. For the acrylic base. • U The Herren activator U Elements: Function: Description: Labial bow 0. acrylic can be added on each one individually and before its polymerization. the model can be blocked out additionally in order to accelerate the grinding and finishing. This appliance.8 mm fh. whose ideal function is as an exercise device.Haltedorne 0. which is intended to alter the muscular activity. retention thorns 0.8 mm fh Modification of the muscular effect through an over dimensional opening of the occlusion The over dimensional vertical opening of the occlusion. does not have any elements that can be activated and is designed as delicate as possible.
The design of the appliance of the finished activator does not differ from the classic activator. The elements are bent as in the traditional activator and a wax collar is fixed for the limitation of the acrylic. determined by the construction bite and then set in the fixator. It is important to observe that the fixator does not hinder the application of the acrylic. • 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 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.
the models are covered with wax for the acrylic base. The lateral bite plane reaches to the centre of the occlusal surfaces. 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 upper base plate is kept small. In the premolar region. • U The headgear activator according to van Beek U Elements: Function: Description: Headgear 1. in the lower jaw the lingual surface.When the retentive parts are blocked out. The upper incisors are also grasped in acrylic. The lingual surfaces remain free. 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 position of the mandible is achieved through the long lingual wings of the lower base. In combination with a high pull headgear.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 connection of the upper buccal shield to the lower lingual shield serves also as occlusal support and stabilizer for the appliance. The lower incisal edges are also mounted into acrylic in order to prevent the lower incisors from tipping. the lower base is extended as far as possible downwards. In the posterior area the interocclusal acrylic is removed in order to allow the premolars to erupt. The palatal area of the upper anterior teeth is blocked out with wax in order to allow a retrusion.
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. 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. 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. . 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. Then the wire is bent distally and between the first and second premolar it is bent into the retention. and under influence of the masticatory muscles.8 mm spring hard Retraction of the upper jaw with simultaneous distal movement of the upper teeth Retraction of the upper jaw. The screw is fixed in the upper jaw and the base plate is limited with wax stripes.• U The activator according to Pfeiffer and Grobety U Elements: Function: Description: Modified labial bow with soldered triangular clasp 0.
from the mesial third of 33 to the mesial third of 43. from the mesial third of 13 to the mesial third of 23.8 mm spring hard. Class III Treatment: When the labial wire adapts on the lower front teeth. triangular clasp 0. • U The Functionator according to Eschler U Elements: Function: Description: Labial wire 0. 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.7 mm hard Treatment of class II-1 or class III Depending on the position of the labial wire. Adams clasp 0. 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. This way. • This is a lateral view of the activator with its pronounced lower wings. This way.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. . then it is bent with distance to the upper incisor area. the lower front teeth which are blocked out with wax can be retruded and the upper lip can be maintained off the upper incisors. then it is bent with distance to the lower incisor area.
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.
The activator with spring bows according to Schwarz
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).
The open bite activator with tongue crib
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.
The SKEL activator according to Ruhland type II-1
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.
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.
The SKEL activator according to Ruhland type II-2
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.
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.
1 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. With a construction bite. both parts.9 mm spring hard. Through activation of the intermaxillary bow and both spring bows the lower jaw is retruded. are finished separately.8 mm spring hard.7 mm spring hard.9 mm spring hard. . Interocclusal acrylic is not necessary.• U The SKEL activator according to Ruhland type III-a U Elements: Function: Description: For class II-1 – II-2: Labial arch 0.9 mm spring hard. occlusal rests canine 0.9 mm spring hard. Two distal spring bows connect the upper and lower part. occlusal molar rests 0. the upper and lower parts are connected in the articulator through spring bows in the distal part of the plates. protrusion spring 0. upper and lower. Coffin spring 0. lingual bow 0. First. connection spring 0. The upper jaw consists of protrusion springs. an intermaxillary bow and a Coffin spring. Coffin spring 1. II-2 and III A reduced elastic activator Type III-a The appliance for class III is horizontally divided. 2T 2T The elements in the lower jaw are two holding thorns and a connecting bow.
Coffin spring 0. The intermaxillary bow makes a distal movement of the mandible possible .9 mm spring hard A reduced elastic activator with different tasks for class II-1.8 mm spring hard. 2T 2T The appliance is also divided horizontally and is activated through the far distally fixed spring bows.9 mm spring hard. the same type can be replenished with a tongue crib which simultaneously serves as a connecting bow. occlusal molar rests 0.7 mm spring hard. connection spring 0. View of the finished appliance type III b. The tongue crib prevents a negative influence of the tongue. II-2 and III A reduced elastic activator Type III-b In the lower part.9 mm spring hard.9 mm spring hard.1 mm spring hard.9 mm spring hard. protrusion spring 0. Coffin spring 1. Support thorns can also be placed before the molars if needed.• U The SKEL activator according to Ruhland type III-b U Elements: Function: Description: For class II-1 – II-2: Labial arch 0. lingual bow 0.7 mm spring hard For class III: Labial arch 0. . occlusal rests canine 0.
9 mm spring hard.1 mm spring hard.9 mm spring hard.7 mm spring hard. In order to install the prognathism screw parallel. . protrusion spring 0. a metal pattern is needed for their installation.9 mm spring hard A reduced elastic activator with different tasks for class II-1. occlusal molar rests 0.• U The SKEL activator according to Ruhland type III-c U Elements: Function: Description: For class II-1 – II-2: Labial arch 0. connection spring 0.9 mm spring hard. lingual bow 0. Through this screw a more uniform distal activation of the lower part is possible. occlusal rests canine 0. Coffin spring 0. II-2 and III A reduced elastic activator Type III-c Instead of the spring bows between the upper and lower jaw.9 mm spring hard. a prognathism screw (LS-Duobloc.7 mm spring hard For class III: Labial arch 0.8 mm spring hard. Coffin spring 1. 2T 2T The acrylic is added in one process by means of a dividing metal plate.Screw) was installed. 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.
labial bow 0. a wax spacer is placed to ensure adequate clearance for tissue comfort. From there.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 acrylic shares lay orally from the canines to the last molars forming a small band contacting teeth and gingiva.• U The elastic open activator according to Klammt (EOA) U Elements: Function: Description: Palatal bow 1.2 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. . Under the palatal bow. the models are blocked out with wax. For an ergonomic finish and material saving. The occlusal surfaces are not covered with acrylic and a vertical support by the acrylic is left only in the canine area.
as delicate as possible with interocclusal acrylic.8 mm spring hard. 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.9 mm hard. supporting thorns 0.• U The rigid open activator (SOA) U Elements: Function: Description: Connecting bow 1. Because of the rigid connecting bow. with this appliance expansion of the jaws is not possible . The acrylic base is designed as in the EOA. The rigid connecting bow gives the body of the appliance certain stability. labial bow 0.5 mm hard. protrusion spring 0.7 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.
8 mm spring hard. acrylic is added and the plate is finished.0-1. labial shields or pads can be added for functional enhancement. protrusion loop 0. an additional M or U-loop can be bent into the labial wire.1 mm spring hard wire with simple or triple loop Treatment of skeletal open bites and rehabilitation after TMJ injuries Special springs of 1. the retentions have to be bent according to this situation being anchored into this acrylic segment. a special spring system according to Sander: 1.7 mm hard. an expansion screw can be incorporated and in the anterior region paired guiding wires can be added. Adams clasps 0. If the canines should be influenced separately (in this example an EOA). triangular clasps 0.1.• U Modifications of the EOA and the SOA U Instead of the palatal bow.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. The highest part of the palate is covered with a tin foil which is 1 . In order to distract the tongue from the incisors the Coffin spring can be replenished with a small movable plastic pearl.0 x 1.8 mm spring hard. As the acrylic base of the upper jaw is reduced. palatal bow 3.7 mm spring hard. With corresponding carving of the models (in this example an EOA). • U The spring activator according to Sander U Elements: Function: Description: Labial bow 0.0-1. .5 mm thick to guarantee an even distance of the palatal bow and to avoid pressure areas. The finished elements are fixed onto the model.5 mm half round steel 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 decision on whether to incorporate one or three loops into the spring design depends on the oral space availability. After polishing both individually made plates and the bite blocks lay even on each other. the height has to be checked in the fixator according to the construction bite. While occluding firmly with the spring activator there should not be any interfering contacts in the anterior area. 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 bite block can be set onto the polymerizing lower plate. . Isolated with a thick wax layer. the spring activator can also be fitted with a transversal expansion screw or headgear tubes. which means it is activated (safety pin principle). The springs should be incorporated into the plate without strain. The loops have to be bent in such a way that while closing the wire is pushed into the loop. the springs should be made out of 1. Because of the extremely high load on the wire. The retentions of the springs have to be anchored as far as possible into the distal area of the acrylic segments. If the headgear tubes are incorporated in the area of the first premolars the triangular clasps cease to apply. 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. The upper plate is finished and polished completely in order to allow an even adjustment of the upper and lower bite blocks.The base of the upper plate should extend palatally as much as to guarantee sufficient retention and stability for the special spring. Instead of the palatal bow.
While the acrylic is still malleable the fixator is closed. after bending the elements.8 mm spring hard Separate expansion of the maxilla In this horizontally divided bimaxillar appliance. Therefore. finished and polished separately. The wax layer in the retention area of the screw prevents the union of the upper and lower plate. The area of retention in the lower jaw is blocked out with wax. .Dehnschraube im Unterkiefer verankert The elements are bent following the design. the screw is centered and fixed with wax so that the retentions of the screw stick out into the lower jaw. The extension of the acrylic base is limited with wax. That is the reason why this area is covered with wax to this height. additionally with two protrusion springs. in this case. In this horizontally divided appliance. In the upper jaw. The fixator should be able to open and close without interference. in the anterior region. the upper and lower bite blocks of the divided activator show a separation of almost one millimeter. the upper expansion screw is anchored in the lower jawin diesem horizontal geteilten bimaxillären Gerät ist die Oberkiefer. the lower jaw is finished separately and polished. Now acrylic is added on the upper jaw.• U The divided activator with screw for the upper jaw U Elements: Function: Description: Labial bow and retention thorns 0. two notches have to be grinded into the lower base plate. In the interocclusal area. This way the upper plate can be sawed.
The upper part of this activator can be expanded without the lower jaw. • U The Prognathism activator according to Wunderer with screw according to Weise U Elements: Function: Description: Labial bow 0.After this. the division and the interocclusal area close to the screw are covered with wax. The bow extends orally over the acrylic base. Only the retention part of the screw is grasped in the acrylic. 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. both separately produced plates are unified to one appliance. The sagittal divided screw lets the upper plate glide over the lower plate . Now the retentions of the screw are polymerized into the lower plate and therefore both plates are unified to one bimaxillar appliance.8 mm spring hard Continuous retropositioning of the mandible with simultaneous advancement of the upper jaw In this horizontally divided activator.8 mm spring hard. For this purpose. retention thorns 0.
The parts of the upper and lower jaw are finished and polished separately. It is important that the occlusal and interdental tooth surfaces are grasped with acrylic. . 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. Through the continuous activation of the sagittal screw spindle a retropositioning of the lower jaw and an advancement of the upper jaw are possible. In the finished activator. The retention thorns are bent as usual. 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. The finished acrylic base has to be designed as delicately as possible.The labial bow for the upper jaw normally does not contact the incisors while in the lower jaw it contacts the incisors passively. acrylic can be added on the upper part of the activator. Nevertheless the screw can also be activated from the oral side with a screwdriver. After this preparation of the lower base plate. 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. only the retentions of the screw . The retention part of the screw has to be well covered with acrylic. in the upper part of the base plate a small opening can be grinded from the palatal side in order to activate the screw.
If screws are added into the plates. 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.2 mm spring hard. the upper short arm shows distally. In this type I distal activator the arms of the U-bow point anteriorly. which are anchored into the acrylic in the region of the first molars. The long arms are situated in the lower plate as seen here .• U The U-bow activator according to Karwetzky U Elements: Function: Description: U-bow 1. Type III-a Pan activator In this type III-a two different bows are built in.8 mm spring hard Movement of the mandible in different directions. they only have effect on that specific jaw. both plates are joined to a bimaxillar appliance. The long arm of the U-bow is always fixed into the lower jaw. labial bow 0. the short arm into the upper jaw. When activating the U-loops a panning movement to the right is produced. on the left side. On the right side. according to the specific type (type I-III) Through the addition of different U-bows into the elastic activator. Type I distal activator Through both U-loops. the short upper arm shows mesially. Type II prognathism activator In type II both anchored arms of the U-bow are directed posteriorly. .
It is bent away slightly to avoid contact with the rest of the clinical crown. 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). The interocclusal area should be high enough to allow a good anchorage of the retentions of the headgear tubes in the acrylic. on the left side the short upper arm shows distally. a panning movement to the left is the result. 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. On the right side. • U The Teuscher activator U Elements: Function: Description: Headgear tubes. Coffin spring 1. torque springs 0.2 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. This way. the short upper arm shows mesially. The headgear tubes lie between both tooth rows in the area of the deciduous molars.5 mm spring hard. when activating. .Type III-b Pan activator In the type III-b the U-bows are incorporated opposite as in type III-a. The retention is in the interocclusal area.
Therefore the limit of the vestibule has to be erased before making the appliance. 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 d) Lip bumper Also. a lip bumper can be attached directly to the appliance in order to support a protrusion of the lower incisors. It has to be positioned in height of the gingival margin in front of the lower incisors in a distance of approximately 1 mm.The acrylic base has to cover one third of the lower incisors. only to the incisal edge. • 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. 2T 2T . lip pads for the development of the lower jaw can be attached as in the function regulator according to Fränkel. and the upper incisors should be covered on the palatal side up to one half and on the labial side. 2T 2T c) Labial pads On the Teuscher activator.
the retention finishes in the area of the interocclusal opening. distalizing springs 0.9 mm spring hard. 2T 2T • U The Harvold-Woodside activator for class II-1 U Elements: Function: Description: Labial bow 0. 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. 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 . 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 activator has to be liberated in the area of the molar tubes and the palate.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.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.
is added in the lower jaw. In order to guide the anterior movement in the posterior region. 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. The labial bow only contacts the upper incisors. only the retention of the distalizing springs is covered with acrylic. The labial shield covers the incisors over one third of their clinical crown. The retention of the labial bow lies in the interocclusal acrylic right behind the upper incisors. the main purpose is to create plane surfaces for the acrylic platforms. 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. a thin wax plane is added in the upper jaw and a high wax plane. The characterizing feature of this appliance is the large vertical opening in the buccal sections which is determined by a construction bite. for their proper activation. so that the lateral bite plane presents enough stability. 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 distal limitation of the appliance is the A-line. higher than half of the vertical opening. . The models prepared this way can be covered with acrylic and put into the pressure vessel for its polymerization.
The acrylic shield of this appliance only covers the lower incisal area and is correspondingly framed with a wax limitation. its task in the upper jaw is to shield off the lips through loops bent as labial pads. the acrylic in the interocclusal area should show a thickness of one millimeter.9 mm spring hard. The big vertical opening corresponds to the one in type-II. Despite its location. in the anterior area of the vertical opening. the labial bow in the lower jaw is bent as an intermaxillary bow. As before.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. distalizing spring 0. from canine to canine. the loop and the distal cantilever of the distalizing spring are also covered with wax.• U The Harvold-Woodside activator for class III U Elements: Function: Description: Labial bow 0. For its proper stability. In this case. Before adding the acrylic both models have to be hydrated. the wax is concavely shaped. the distalizing spring is bent with a big loop in the molar region. a wax plane that reaches over the half of the vertical opening is added onto the upper jaw. In the lower jaw. . the wax coverage is very important. the posterior teeth are slightly covered with wax and in the incisal area. Also. a sufficient anchorage has to be guaranteed for the retention of the labial bow. the retention ends in the anterior palatal area. The retention lies as in the class II appliance. Although in this appliance the distal cantilevers are located behind the first molars.
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. only the retention of the distalizing springs is grasped in acrylic. The lateral bite plane allows more vertical eruption for the upper 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. 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.9 mm spring hard. Once again. • U The bionator according to Balters U Elements: Function: Description: Buccinator loop 0. it is bent back along the upper teeth. From this point on.In this class III appliance. 2T 2T . Coffin spring 1. From there the wire is bent diagonal downwards and then in a distance of 2 mm from the posterior teeth. it is led distally as a buccinator loop up to the mesial cusp of the first molar. In the upper jaw. the distal limitation is also marked by the A-line.
This area can be blocked out with wax before the application of the acrylic. 3) In the reverse appliance. The appliance can be designed with an acrylic overhang for the lower incisors. it is then led distally up to the centre of the first molars and from there. The bionator is a rigid appliance with a delicate design of its acrylic base.The Coffin spring is bent distally closed. . The position of the tongue is influenced by the Coffin spring. 2) The shield appliance has a similar labial bow as the base appliance. Because of the open bite. Between the canines and the first premolars in the upper jaw the labial bow is bent orally into the retention. the labial bow only contacts the lower front teeth. This bow hinders the introduction of the lower lip between the arches. The shape of the Coffin spring is opposite to the shape in the base and shield 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. the labial wire is located in the middle between the upper and lower incisors. or be trimmed free after its finishing. for example in patients with tongue dysfunction. back over the upper molars.
d) Labial pads in the upper jaw: It is also possible to add labial pads in the upper jaw. 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. 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. Before this. a high labial bow can be added onto the labial arch. 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 HGtubes can be integrated into the interocclusal acrylic during its polymerization or they can be incorporated afterwards. A precondition is a sufficient vertical opening which should be considered during the realization of the construction bite. here in a reverse appliance. In order to avoid the interposition of the cheek. . the loops are covered with acrylic. The high labial bow is bent depending on the modification high into the vestibule and soldered onto the buccinator loop. the buccinator loops can present a longer distance than 1 cm. as with an inclined plane. 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. c) Lateral shields: If the vertical opening is wide. This bite plane serves as protrusion element for the maxillary anterior teeth.
2 mm spring hard. Whether the lateral bite plane contains interdigitations. . all kinds of springs. the labial pads can also be incorporated in the mandible.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. has to be decided depending on each patient. retention thorns and if necessary.e) Labial pads in the lower jaw: To achieve an anterior-posterior development. The Coffin spring ends in the molar area. or if it is plain. labial bow and retention thorns 0. • U The kybernator U Elements: Function: Description: Coffin spring 1. The design can incorporate a labial bow in the upper jaw and an acrylic overhang in the lower jaw. or is removed totally. It is also possible to add two labial bows.
• 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. labial bow 0.8 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. A labial bow is added both in the upper and lower jaw. Additionally.• U The bite restrainer according to van Thiel U Elements: Function: Description: Arrow clasps 0.7 mm spring hard. transversal or segmental screws can be added to this appliance. in this example arrow clasps.
and should be 3 mm in the area of the teeth and 2.9 mm. it is bent completely around the canine and ends buccally in the lateral shield between the canine and the first premolar. Components: 2 vestibular shields. 2 canine loops in the upper jaw and the support or connecting wires of the pads and shields. 2 lower labial pads. The thickness of the wax relief is measured with a probing instrument.0 mm wire In the lower jaw. It is also used in the class II-1 without an increased overbite and without a notorious mesial migration of the lateral segments. Normally the orthodontist should carve the model himself during the appointment. the support wires between the labial pads and the vestibular shields as well as the connecting wire for the pads are 0.9 mm strong. . he has to give the technician exact measurements which have to be transported onto the model.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.9 mm) starts in the distobuccal aspect of the canine. 1 palatal wire with occlusal rests. 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. The palatal wire with rest is bent out of 1. 1 lingual shield with lingual bow. 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.5 mm in the vestibular sulcus.General prerequisites for the FR I . In the FR I the wire diameter for the labial bow in the upper jaw is 0. The canine loop (wire diameter 0. If not.
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.
CHAPTER 6 Wire appliances. rapid palatal expansion (RPE) appliances .
2 mm.8 mm. putters 0. The retention period starts after the third phase.8 mm The Crozat appliance can perform all functions of an active plate In this appliance.7 mm.8 mm. distal extensions 0.3 mm. using the basic appliance. precurved auxiliaries 0.3 mm. the wire elements are not anchored in an acrylic base. expansion of the molars and premolars is induced and also derotation of the first molars if necessary. buccal extension 1. cuspid hooks 0. mesial or distal.• 0TU The Crozat appliance U0T Elements: Function: Description: Crib (Jackson clasp) 0. Therefore the basic appliance has to be adapted passively on the cast and then the corresponding springs are soldered on. elastic hooks 1. In the second phase.0 mm.8 mm. In the third phase the following tasks are achieved: Movement of single teeth or tooth segments towards buccal palatal.8 mm. crescent (retention thorn) 0. elastic hooks 0. canines and second molars are aligned or rotated. lingual arm 1. body wire 1.7-0. pins. occlusal rest 1. .0 mm.0 mm. extrusion or intrusion of teeth. rotations of incisors or premolars and transverse expansion in case of relapse. basic high labial arches 1.8 mm. but lasered or soldered together The treatment sequence of Crozat appliances takes place in three phases: In the first phase.
This small piece of band is pushed along the buccal surface of the molar behind the clasps. For the later soldering the crescent on the buccal side has to lie exactly along the crib. exactly onto the buccal contour of the molar and the extremes have to lie in the holes. The erasing has to be done parallel to the occlusal plane. The unpolished side of the band shows outwards.8 mm drill into the mesial and distal area of the cast. the cast is now duplicated to make a soldering cast. has to be adapted very precisely to the shape of the tooth. The gingival triangles. 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. small holes are made with a 0.The preparation of the cast First. 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. mesially and distally of the molar. These holes allow a better fitting of the crescents onto the soldering cast. The crib The crib is the most important clasp of the entire appliance. A careful erasement guarantees a good support even when a stronger strain is applied. It fits tightly on the first molar and has to grasp the tooth interproximally in such a way that even its rotation is possible. . the crescent has to be shortened according to the holes drilled. are removed from the plaster cast. so that once inserted. The curve of the crescent has to lie mesio-distally. If necessary. underneath has to be enough distance to the gingival margin in the buccal area for the crescent. The horizontal buccal part of the clasp lies over the equator. thin band material such as the one used in banding technique for the anterior teeth is employed. For this purpose. The crescent In the interdental space on the buccal side of the first molar. After the laser or conventional soldering. It is important not to erase too deep. the crescent does not crush the papilla. and therefore.
The bent between the first molar and the second premolar has to be located in the interdental space. the U or W-loop is adapted onto the model. The endings of the palatal rest lie along the horizontal parts of the crib. without compromising the solder union of the crib or crescent. the rest of the entire arm can either contact in one point or can be curved and also reach into the interproximal area. After the soldering. It is important to keep an even distance of 1 mm to the gingival tissue. The buccal extension simultaneously makes the removing of the appliance easier for the patient without deforming the crib. The wire is bent in a 90 degree angle.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 palatal rest has to be bent slightly inwards according to the shape of the palate. In the upper jaw The body wire First. the rest has to end shortly before the central fossa. The lingualarm Continuing exactly with the occlusal rest. it can serve for the buccal expansion of the appliance (e. a corresponding shortening is possible. The length of the bow should not exceed 12 mm. Later on.g. the lingualarm is bent adapting up to the first premolar. high labial arch). The end of the wire is bent concavely to ensure a sufficient distance to the gingiva.
The wire has to have an even distance to the cast and assure symmetry in the horizontal plane. it lies flat contacting the second premolars in one point. The remaining elements are bent according to those in the upper jaw. In the centre of both molars a right angle is bent towards occlusal and in height of the crescent. the lingual arch can first be adapted manually into U-shape in the approximate size of the sublingual space. Precurved auxiliaries In the upper as well as in the lower jaw. In this case. another bend is made mesially.In the lower jaw The body wire When the crib and crescent for the lower jaw are finished. for the protrusion of the incisors auxiliaries are soldered or lasered onto the lingual or palatal arms. If the lingualpalatal arm is activated. Concerning the lingual arm and the palatal arm. The Pin The single springs can be bent in different shapes and serve different purposes. it has to be bent bow shaped onto the premolars. A Uloop is incorporated in the area of the premolars which extends over the gingival tissue. a simple pin is soldered or lasered onto the labial arch for moving the canine. it is important that the bent between the first molar and the second premolar reaches into the interproximal space. The active part of the spring arm should contact the incisors. When the lingual arm is not activated. .
One has to pay attention to avoid the labial and lateral frenum. in the vestibule and then soldered or lasered buccally onto the crib. Elastic hooks The elastic hooks for the intermaxillary elastics are soldered in the area of the canine onto the labial arch. The putters For the mesial movement of teeth. the point of force application should come from a distal wire ending.The basic high labial The basic high labial is located. the buccal hooks are soldered or lasered onto the crib. Buccal hooks In the lower jaw. as its name suggests. These hooks serve for engaging class II elastics. . A distal movement takes place through springs adapted mesially.
The completetly soldered or lasered appliance is finished with small grindstones and smoothed out with rubber polishers. Looking at the crib from the inside. the smooth inner surface of the small soldered metal plate can be seen. all wax areas are covered with soldering plaster.For the soldering or lasering. The exceeding parts of this metal plate have to be worked out according to the shape of the wires. In order to stabilize the single wire elements sufficiently for the soldering. 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 elements have to be fixed with thermal wax onto the cast in order to check the exact fitting of the single components once again. .
lingual basic bow 1. It embraces the incisor area buccally like a normal labial arch with two U-loops in the canine region. • 0TU The wire appliance according to Meyer. In a distance of 1-2 mm the transpalatal arch follows the shape of the palate and its function is to stabilize.0 mm.0 mm. 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. The mandibular basic bow follows the lingual surfaces of the lower premolars until distally. 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.A finished third phase lower Crozat appliance. transpalatal arch with molar rests 1. it is bent orally along the premolars and molars and is then bent towards the palate. From there. anterior vertical support 0.8 mm (remaloy® wire) Functional orthopedic appliance for anterior-posterior problems. bite plane appliance. shielding appliance and braces appliance U0T Elements: Function: Description: Basic bow 1. then it is bent towards the upper jaw to form a soldering union with the transpalatal and the upper basic bow. .
The doubled casts are set into the fixator according to the construction bite. the use of a handpiece is recommended because the danger of distortion is greater on the lathe. The construction bite is taken with a 2 mm overjet. In the posterior region. which can be used by class II patients with increased overbite or for TMJ therapies. For the final polishing. An acrylic pad is incorporated into the appliance for its support. the acrylic covers the lower incisal edges so that these are grasped 1-2 mm. the wires can be fixed with either sticky wax or soldering plaster. The wires should all lie side by side and should be soldered without tension in the assembled fixator. the wax bite should be bitten through. It is favorable to use a Laser soldering unit because a higher deformation and corrosion resistance can be achieved. makes a construction bite of 2-3 mm sagital/vertical step without joint sounds necessary. The anterior bite plane exceeds the lower incisors horizontally. For the soldering process. or can be pointed by a Spot Welding Unit. additional vertical wires are soldered in the premolar region. Anterior vertical supports are soldered in the height of the first premolars between the upper and lower jaw for stabilization. a lingual shield which reaches from the lower lingual arch up into the upper incisor area should be added. To shield off the tongue. hypotonic big tongue (M. In case of lateral or partially lateral open bites. . The shielding appliance (AB) is effective in patients with lateral or anterior open bites. Down) or sucking habits. as well as visceral swallow pattern. When the lower Incisors are protruded. The bite plane appliance (AUF). The finishing of the appliance is done as usual.
The lingual bow has an even distance from the gingival tissue of approximately 1-2 mm. 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. • 0TU The Frozat appliance according to Mayes U0T Elements: Function: Description: Lingual arch and lingual arms 1. The labial arch is bent without U-loops and is placed incisally of the brackets. 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. in later dentitions. angulation or rotation.0 mm remaloy® Depending on the activation: compression or expansion of the arch. In the area of the premolars a slight bend is bent lingually.The braces appliance (MB) is used parallel to fixed appliances. front protrusion. The addition of a moving pearl onto the transpalatal arch can also be realized to achieve stimulation according to Castillo Morales. In anterior open bites the labial arch is located with its U-loops gingivally of the brackets in order to use vertical elastics. . for example. The lingual arms adapt in the region of the equator or cingulum of the teeth.
Once the appliance. the molars can be uprighted and a transversal expansion or compression can be achieved. The wire should contact the molar band on its total lingual surface to ensure a wide and solid soldered joint. bent out of one piece of wire.0 mm remaloy® Unilateral molar distalisation Fixed appliance for the sagital arch expansion in the lower jaw After taking an impression with adapted bands. it is point welded with the Spot Welding Unit and then soldered. a working cast is made. lies fitting passively with the anterior springs on the incisors and the lingual bow has the necessary distance.2 mm with a small lingual bent in the premolar area. . • 0TU The manufacture of an appliance with lingual cantilever according to Kinzinger U0T Elements: Function: Description: Lingual arch and unilateral anterior spring 1. With the corresponding activation the incisors can be protruded. The lingual arch is bent assuring an even distance from the gingiva of 1.
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 precisely adapted Frozat appliance is fixed onto the bands with a Spot Welding Unit. It is extended up to the lateral incisor of the counter lateral side. The prepared appliance can finally be soldered to the bands. When the solder used does not contain flux. separate flux has to be applied on the soldered joint. .
• 0TU The Lizat appliance (Lip bumper and Frozat) according to Kinzinger U0T Elements: Function: Description: Lingual arch and anterior spring 1. Special attention should be paid to avoid hindering the lingual frenum when determining the position of the lingual arch.0 mm remaloy®.0 mm Molar distalisation with simultaneous anchorage through the lower lip The lip bumper is mainly used to enhance anchorage. The finished lip bumper has to be inserted easily and without tension into the corresponding buccal tubes by the patient. but can also support the distalisation of the molars The lingual Frozat appliance is bent as usual. . Buccal tubes are soldered onto the molar bands to receive the individually made lip bumper. This lip bumper has a wider and thicker acrylic shield than the preformed ones. lip bumper 1.
The gingival anchorage has to have some tension to engage underneath the vertical lock into the concavely grinded nut. Besides.8 mm spring hard. The double bent lock pin has to be bent together tightly. The rest of the shape has to be adapted to the molar band exactly according to the illustration. for single tooth movements.4 mm spring hard Expansion of the arch Through continuous force of the bow and possible auxiliary springs. auxiliary springs 0.2-0. small springs can be added to the lingual bow. smooth tooth movement is possible The lock. which is vertically soldered onto the molar band. . has to be grinded concavely to receive the anchorage of the Mershon bow.• 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 TPA and the occlusal rests can be bent out of one piece of wire and then be 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. 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. In this construction. made with the one piece casting method. 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. In the upper jaw. the attachments for the anchorage of the guiding telescopes are soldered. In the lower jaw. In the Herbst® appliance. . the TPA in the upper jaw is not absolutely necessary.• 0TU The Herbst® appliance U0T Elements: Function: Description: Occlusal rests.
Through uniform pressure of the tweezers from gingival and occlusal.5 mm) gingivally onto the impression and then poured with dental stone. upper connecting bow and connecting bow in the lower jaw. Now the impression for the working casts is taken together with the other bands on molars and premolars. The bands are fixed with a small piece of wire (0. both bands are carefully assembled up to the solder point. the bands are pushed together. Therefore. .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. Afterwards. This way a stable band for the lower canines is made. the practitioner has to place a band two sizes bigger over the first band. The soldered canine bands are adapted again in the patient’s mouth.• 0TU The Herbst® appliance with soldered bands U0T Elements: Function: Description: Bands for soldering. 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. 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. one holds the first bands mesio-aproximally with tweezers and puts solder around it. lingual and buccal 0.
. In the upper jaw. the connecting wires from the first premolar to the first molar contain a U-loop. Now the connecting wires can be bent and fixed with thermal wax. For this purpose. a lingual bow is bent from molar to molar out of one piece. In the lower jaw. On the buccal side. with the help of a fixing instrument. or directly soldered with the bands. The connecting wires are fixed either with thermal wax or with the Spot Welding Unit. the Herbst® appliance pivots are held onto the bands then pointed with a Spot Welding Unit.The casts are mounted on the articulator with a construction bite. a continuous palatal bow is bent again from molar to molar. 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. a simple “openclose” articulator (articulator according to Körner) can be used. In the articulator.
After fixing all elements. Now the appliance can be soldered. the thermal wax is covered with solder plaster or the wires are pointed with a Spot Welding Unit. . Retentions are soldered onto the attachments and then heated to be pressed into the splints for their fixation. Finished Herbst® appliance with soldered bands. • 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 Herbst® appliance can be integrated into splints and therefore be removable The working casts are mounted onto the fixator with the construction bite. The vacuum formed foils are made out of 1 mm material and are finished like normal splints. finished and polished.
0 mm hard.The length of the guiding hinges has to be checked and if necessary. Now the splints can be built up with acrylic in the molar area for the definitive fixation and stabilization. In order to achieve corresponding planes in the upper and lower jaw.0. the upper jaw is built up with acrylic and set together in the fixator.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.8 . modified. afterwards. The number of spikes is variable. • 0TU Appliances with spikes U0T Elements: Function: Description: Connecting bow 1. first. Then only the exceeding acrylic material has to be removed. polished and isolated. the lower splint is finished. spikes 0. .
The spikes can also be designed as a removable appliance. The tongue guard is bent according to the transversal width of the arch. the molars are moved mesially The bands once fixed in the alginate impression are slightly waxed out before the pouring. • 0TU The tongue shield for mesialisation U0T Elements: Function: Description: Tongue shield 1.0 mm hard Mesialisation of the molars Through the permanent pressure of the tongue.The spikes are fixed horizontal to the occlusal surface in order to hinder the tongue from pressing against the incisors. with the MIA-System (with bent locks). in this example. .
It is important to maintain enough distance from the tongue shield to the gingival tissue in order to allow the molar movement. it is fixed with the Spot Welding Unit to the bands and then soldered. There.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. Neither the screw nor the connecting wires should contact the gingival tissue. . On this cast the Hyrax® screw is adapted to the palate.
The connecting wires are led towards the bands. everything is lasered or soldered together. and afterwards. • 0TU The rapid palatal expansion appliance (RPE) according to McNamara U0T Elements: Function: Description: Circular clasp 0. A clinical view of a patient with an activated Hyrax® screw. finally.8 mm hard.The screw should lie as deep as possible in the centre of the palate. Then the four wire extensions of the Hyrax® screw are bent in a distance of 1 mm from the palate to the circulating clasp. united between the first premolars and the first molars in order to achieve a maximum stability of the appliance. Hyrax® expansion screw Rapid palatal expansion Appliance with acrylic coverage of the occlusal surface for a better retention of the anchorage teeth First. The open diastema makes the rapid palatal expansion evident. 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. the circular clasp is bent approximately 1 mm underneath the occlusal surfaces and the incisal edges. . then bent.
032” rectangular stainless steel wire. Before. Hyrax® screw Correction of extreme cross-bites When the expansion capacity of a single screw is not sufficient. . The bands should be blocked out with a very thin layer of wax. the vertical opening should correspond to the height of the construction bite. • 0TU The rapid palatal expansion appliance (RPE) with an interchangeable Hyrax® screw U0T Elements: Function: Description: 0.Once the appliance is polished. they can be removed easily from the cast after finishing. Small perforations are grinded into the finished bite blocks to allow the cement to flow while inserting the appliance. acrylic is added on the occlusal surfaces up to slightly under the circulating clasp. The bite block should not be too voluminous. 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. the bands should be replenished with brackets on the palatal side.8 mm / 0. so that although they are fixed well on the cast.
After a couple of weeks. the appliance is removed and an impression is taken. Now on this prepared cast. Before making the second appliance. . a second appliance can be made. In this impression. transmission brackets are set in. slightly waxed out. Special attention should be paid that this rectangular wire is ligated passively into these brackets. when the end of the screw spindle is reached. 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. the screw has to be opened 3 or 4 turns and then be adapted to the palate. then it is inserted again. and then poured. 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.The rectangular wire should be adapted on both sides from the first premolar to the first molar into these brackets.
After this. The Nardella screw can be fixed with wax onto the model to guide the wire along both bands to the retention of the screw.0 mm soldable wire (remaloy®) Asymmetric rapid palatal expansion The Nardella screw. If the dimension of the planned expansion makes it necessary. • 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. a third appliance can be inserted. After preparing both sides. The appliance can be made using the cast prepared this way. 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. . a direct replacement can take place in the patient’s mouth. While inserting the appliance. the screw is unscrewed to get past the brackets and then is opened up again immediately.
the wires are definitely lasered or soldered. one anterior and one posterior which can be activated symmetric or asymmetrically.After the provisional fixing. The screw contains two threads. The hooks for the face mask are usually bent into a loop in height of the centre of the canine and then rounded off. hooks 1. They unify the premolar and molar bands from buccally. • 0TU The rapid palatal expansion appliance (RPE) with hooks for the Delaire face mask U 0T 0T Elements: Function: Description: Hyrax® screw. .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.2 mm spring hard (occlusal rests 0.
If vertical opening is desired. the Hyrax® screw is adapted to the palate and soldered as usual. 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. Instead. The fixed elements are lasered or soldered and then polished. only molar bands are used. • 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. the premolar bands are not needed.To ensure a good oral hygiene. .
The casts should be set into the fixator to guarantee a better adaptation. In the area of the bite blocks a wax stripe can be attached to limit the acrylic to achieve a faster finishing. 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 order to simultaneously open the bite vertically with this appliance. acrylic bite blocks are attached. the space availability and the height of the vertical opening depend on the design. 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. . In this case.
The screw is fixed on the working cast and the acrylic base limited by wax stripes. . For this purpose 4 bands are recommended. In this case. 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. Additional bands and wires can be attached in an asymmetric RPE appliance. a Nardella screw was used again.The RPE appliance can also include a buccally lasered or soldered reinforcement wire.
The vertical bite opening is determined by a construction bite in a fixator. 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. .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. 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 RPE Screw can be incorporated horizontally.
the screw is screwed back and the appliance can be inserted without any problems. 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. the screw has to be opened 3 to 6 turns before its fixation. In situations where the premaxilla is inclined in such a way that for the insertion the retentive area is very extensive. The screw body lies close to the palate in height of the second premolars.The retentive spots of the cleft are blocked out and the extension of the acrylic base is limited with wax. the extensions are soldered or welded onto the molar bands and contact up to the first premolar. a fast expander is bent with the RPE compact screw. . After finishing.
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. The bracket bases are bonded intraorally simultaneously with the bands. the extensions are soldered on the bands of the first premolars and to increase the stability. The loop is placed distally of the tooth to be rotated and should. brackets are fixed in the molar area.7 mm spring hard. the screw body is located directly behind the incisors. The connecting part of the wire serves as retention. in no case. contact the gingival tissue.When the lower arch is to be expanded. . To position the elements. the wire is pointed on and lasered or soldered either before or after the polymerization. a passive double TPA made of 1 mm SS wire is soldered onto the molar bands. • 0TU Hilgers Palatal Expander (HPE) U0T Elements: Function: Description: Rotation bow with occlusal rest 0. For stabilization after a successful expansion.
This resin serves to open the bite vertically in order to be able to move the upper molars without occlusal interferences. this expander can be replenished easily with protrusion springs. 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. • 0TU Modified HPE U0T Elements: Function: Description: Rotation bow with occlusal rest 0. 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. .
the anterior and posterior area can be expanded in a different way.With a Nardella screw. then up to the molar bands along the premolars and up to the incisors if necessary. . 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.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. • 0TU The Quad-Helix appliance U0T Elements: Function: Description: 1.
a MIA-System. . The distance between the appliance and the gingival tissue should be approximately 1 mm. • 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. Spikes can also be lasered or soldered without any problems to a Wilson appliance. The corresponding appliance for the lower jaw is the Bi-Helix.The helix has to be bent opposite in the same way and should not contact the palate. here for example.
The Bi-Helix appliance also exists preformed for the MIA or Wilson System. .
space maintained cleft and stimulation plate .CHAPTER 7 Nance and pendulum appliance.
finished and polished from the inside and outside.0 mm soldable wire. It is important that the connecting wires do not touch the palate. In order to achieve a wide extension. The solder union should be clean and also be polished thoroughly to guarantee a good hygiene and avoid irritating the tongue. It should not touch the gingival margin. it can be designed heartshaped. They are bent. .• 0TU The soldered Nance appliance (Nance holding arch) U0T Elements: Function: Description: Soldered extensions 1. The acrylic shield is formed. fixed onto the bands with a Spot Welder and then soldered. 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.
For an easier use. . 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. If additional extension for activation is desired. the MIA System is recommended. If the molars are to be slightly rotated. After this. it is easier to use a preformed lingual arch which can be transformed into the Nance appliance without any problems.• 0TU Modified Nance appliances U0T The Nance appliance can also be designed removable.
the hooks are polymerized into the base of the Nance appliance. . The elastics are engaged from these hooks to the second molars. 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. 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 wax limit is designed according to the acrylic base which extends behind the second molars because of the hooks in the molar area. Finally. The acrylic base is finished. the second molars can be moved through elastics in an oral direction For an easy adaptation of the palatal extension. 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.
.8 mm rematitan® SPECIAL Molar Distalisation Special spring consisting of a part which is bent back for its insertion into the molar lock.8 mm rematitan® SPECIAL wire. Now. The wire is grasped slightly further towards the short end of the wire and carefully bent slightly over 90°.• 0TU The manufacture of the pendulum spring U0T Elements: Function: Description: Pendulum spring out of 0. The extension of the molar lock determines the length of the wire until its bent by 90° with the pointed beak pliers. a U-loop and a closed loop The pendulum spring is bent of 0. the V-shaped wire is set into the guiding grooves of the pointed beak pliers and these are closed carefully. The result is a bent of 180°. 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 pendulum loop is bent around the round extreme of the Young loop bending pliers. this U-loop can be open towards mesial or distal.Afterwards. 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. Depending on the type of the appliance. After the U-loop another 90° bent is made towards the closed pendulum loop.
the wire is bent 180° as carefully as in the beginning of the spring.The end of the wire lies in the centre of the palate.8 mm rematitan® SPECIAL round. and is effective without the compliance of the patient For the intraoral fixation of the pendulum appliance. to finish in a double ended extreme. Then follows a horizontal U-loop (mesially open). a closed loop is bent near the mid palatal suture. For the pendulum spring. • 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. If the pendulum spring is designed removable. occlusal rests are bent over premolars or deciduous molars. This double wire ending is inserted into the palatal locks of the molar bands. 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. occlusal rests 0. .7 mm spring hard Molar distalisation. for example for a dentoalveolar correction of class II malocclusions The pendulum appliance is anchored completely intraorally. points anteriorly and is bent into the retention.
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 springs are fixed with wax distal to the molars and the closed loop is blocked out with wax. The retentions are placed in such a way that they do not interfere with the separation cut. The extension of the palatal plate. which resembles the one in a Nance appliance. The preactivated double ended springs are inserted into the palatal locks of the banded molars. from there.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. occlusal rests 0. can be limited with wax stripes. This force application results in the distal movement of the molars without the need of the patient’s compliance. .
The finished Pend-X appliance should be polished with the handpiece so that the very mobile pendulum springs are not distorted on the lathe. to the palatal locks of the molar bands. connecting wire (palatal plate molar bands) 0.8 mm rematitan® SPECIAL.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.The expansion screw should be laid near the mid palatal suture to be able to design the whole appliance delicately. . connecting wires are soldered onto the molar bands. occlusal rests 0. The transversal screw is regularly activated by the practitioner to achieve transversal expansion. • 0TU The RPE-pendulum appliance according to Snodgrass U0T Elements: Function: Description: Pendulum spring double ended without U-loop out of 0. Additionally. double ended. The pendulum springs with the closed loops lie right and left of the centre of the palate and are bent without loops. The pendulum springs are fixed under the body of the screw and are located mainly distally of the molars to be moved.
double ended retentions which are anchored removable in the acrylic The occlusal rests are located onto the anchorage teeth. The transversal screw is fixed in the centre of the acrylic plate. a pause of one month is made. the U-loop is open towards distal.8 mm rematitan® SPECIAL Removable pendulum springs for their extraoral activation Bayonet shaped. • 0TU The M-pendulum according to Scuzzo U0T Elements: Function: Description: Occlusal rests 0.The soldering of the connecting wires can be done before the scattering of the plate (or afterwards. The transversal expansion screw of this pendulum is activated daily during 14 days. removable pendulum spring out of 0. .7 mm spring hard. afterwards. In this appliance. Then the connecting wires are removed and therefore leave the preactivated pendulum springs free for derotation and distal movement. The pendulum spring lies with its closed loop near the mid palatal suture. cautiously with a small soldering flame).
7 mm spring hard. . 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. and therefore.The double ending bent retentions are wrapped around with ligature wire. The retentions of the springs have to be located beneath the movable part of the distal screw. the pendulum appliance is converted into a quick Nance appliance to stabilize the molars in their new position. This way. Afterwards. After finishing the desired distal movement. and then with a small flame. This way a stop is created. • 0TU The K pendulum type DS (Distal Screw) according to Kinzinger U 0T 0T Elements: Function: Description: Occlusal rests 0. The open part of the U-loop should show mesially. the pendulum springs are taken out and replaced with passive SS bows. 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 with closed loop and mesially open loop Extensive straight distal movement through the activation of the distal screw. they are covered with a very thin layer of wax in order to create a corresponding reception space to anchor the retentions. double ending pendulum spring out of 0.
The extreme can be simple or double ended. including the springs and the active part of the screw. pendulum spring out of 0.7 mm spring hard. this part is previously underlaid with wax. should not surpass the limit of the hard and soft palate. . the loops are placed near the mid palatal suture and the U-loops are bent open mesially. The posterior extension of the appliance.To avoid the contact of the acrylic with the curve of the palate. • 0TU The Bi/Quad pendulum according to Kinzinger U0T Elements: Function: Description: Occlusal rests 0.8 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.
7 mm spring hard. The engaged retentions of the springs and the locks are covered with wax on their surface. the retentions of the pendulum springs are engaged into the Goshgarian locks.8 mm rematitan® SPECIAL. single ended pendulum spring with mesially open U-loop. The small hooks (cleats) on the locks are bent over and serve as retention in the acrylic. 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. while the spring of first molar is activated resulting in distal movement. The U-loop of the pendulum spring is open mesially and the wire ends simple in the molar bands. These have a double tube. segmented arch wire for lingual technique out of 0.To prepare the acrylic application. Through the removable pendulum springs. the second molar is stabilized through deactivation. • 0TU The F-pendulum according to Favero U0T Elements: Function: Description: Occlusal rests 0. One slot serves for receiving the pendulum spring and the other for the later fixation of a TPA after the distal molar movement. . the first molars can be incorporated into the anchorage segment through the passive springs. Afterwards. the second molars can be moved distally activating the springs. simultaneously.
This way the length of the pendulum is notoriously shorter.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. The anterior segmented arch wire should be employed mainly for passive anchorage rather than for leveling the incisors. removable The pendulum springs are bent with big loops which are not placed near the mid palatal suture. pendulum spring out of 0. . or fixed onto the cast for indirect bonding. but fixed sagitally underneath the molars.7 mm spring hard. These can be either already bonded directly in the patient's mouth and be represented well on the working cast.The segmented wire for the lingual technique is fixed passively into the bracket slots. • 0TU The penguin pendulum according to Mayes U0T Elements: Function: Description: Occlusal rests 0.
. the rests are bent as usual. they are slightly blocked out in the retention area. The retentions are shortly bent to find space beneath the Bertoni screw. As Goshgarian locks used in this case are soldered onto the bands. The penguin is Mayes distinguishing mark. In order to guarantee an almost normal swallowing and speaking pattern and to prevent tonguepressing. the end is double bent. To be able to activate the springs extraorally.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. 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. • 0TU The K pendulum type TDS (Transversal Distal Screw) according to Kinzinger U0T Elements: Function: Description: Pendulum spring out of 0.8 mm rematitan® SPECIAL round.The relatively big palatal plate is extended in a mushroom shape behind the loops of the pendulum spring. the acrylic base has to be finished very thin. Each of the pendulum springs contain a loop near the mid palatal suture and a mesially open Uloop. occlusal rests 0.
After the occlusal rests are bonded intraorally onto the occlusal surfaces the springs can be engaged into the palatal locks of the molars. The Bertoni screw is placed with the anterior part of the screw over the retentions of the spring. The screw is intraorally activated. . transversally and distally.The pendulum spring is first underlaid with wax. a wax stripe can be added to limit the acrylic base. Afterwards. then fixed in its preactivated position onto the cast.
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. 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.• 0TU The Aachener Implant Pendulum (AIP) according to Kinzinger U0T Elements: Function: Description: Anchorage bow 1. The rectangular wire is adapted exactly to this cut.2 mm rectangular SS wire. the retention wire should not contact the palatal tissue. Goshgarian locks.2 mm rectangular SS wire. Besides. pendulum . pendulum spring out of 0. A clean connection of the stainless steel cap and the retentions is achieved through a lasered union. A corresponding cut is made into the stainless steel cap. Elements: Anchorage bow 1. for example because of periodontal damage. The height of the cut corresponds to the thickness of the wire.
The hollow body of the locks is blocked out with wax in order to avoid filling them with acrylic. Therefore. the pendulum springs are taken out after the polymerization and are only inserted back after the completion. the pendulum can always be inserted exactly in the same position. The closed loops are also covered with wax and simultaneously fixed onto the model. the pendulum can be fixed onto an implant placed into the palate The flaps on the Goshgarian locks are bent for retention.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. After this. For an easier finishing and polishing. .Function: Description: spring out of 0. and then double ended. for example because of periodontal damage. As the implant is equipped with an octagonal edge. the springs are removable. the base can be limited with a wax stripe. bent pendulum springs are inserted with a U-loop open towards distal.
modified GrumRax appliances U 0T 0T Elements: Function: Description: RPE screws. This can happen simultaneously or consecutively The shown modifications of the pendulum appliance are partly designed for activation. C: Modified GrumRax appliance To simultaneously rotate the molars. Palatal locks for the pendulum springs are soldered onto the screw body. modified extender Transversal expansion of the upper jaw & symmetric or asymmetric distal molar movement & rotation of the upper first molars. . Afterwards. The distal extender of the Hyrax® screw is removed and soldered on the anterior extender as occlusal rests on premolars or deciduous molars. the pendulum spring is fixed laterally on the posterior part of the RPE screw. Goshgarian locks are soldered underneath the body of the screw in which the pendulum springs with U-loops are engaged. B: GrumRax appliance according to Grummons The GrumRax appliance is used for arch expansion with simultaneous molar distalisation.• 0TU Pendulum GNE Distalizer (PhD) according to Hilgers. The extender is bent to be laid onto the anchorage teeth. GrumRax appliance. bands with palatal/lingual locks. 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. sectional screws.
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. the pendulum appliance is removed and replaced by a Nance appliance. This can happen simultaneously or consecutively The shown modifications of the pendulum appliance are partly designed for activation. . bands with palatal/lingual locks. K type Bi-DS Pendulum according to Kinzinger U0T Elements: Function: Description: RPE screws. E: K pendulum type Bi-DS according to Kinzinger Through the insertion of two distal 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. If the molars are to be rotated slightly more. After achieving the distal movement. horizontal loops are bent in the distal area of the molars. sectional screws. the right and left side can be activated separately so that the molars can be moved distally in different amounts.
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.• 0TU The space mantainer with teeth U0T Elements: Function: Description: Adams clasps 0. As the deciduous crowns are normally quite small. It should be bent with due care and should adapt exactly.6 mm hard Prevention of the mesialization towards the support zones. Eventually they are set onto the cast with small spaces. . The Adams clasp is recommended for this appliance. This way the children’s denture gets good support. the retention elements are bent out of thinner wire than usual. The preformed teeth are grinded in shape if deciduous preformed teeth are not available.
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.
The gap or space mantainer
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.
The cleft plate
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.
Through a movable pearl in the posterior edge of the plate. The working cast is provided with a functional edge. so that with every stimulation change the plate is made interesting again. the stimulus is enhanced notoriously. it is finished retentively. If the plate contains a stimulation button. For securing the plate. it can be bound with floss to the shirt of the child. 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. If this is not exactly impressed. it can be slightly erased. Labially stimulation channels for the lip muscles are grinded in.• 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. . which can also be changed.
snoring appliance .CHAPTER 8 Retention appliances splints.
The acrylic base should be finished as thin as possible in order to avoid interfering with the occlusion. The design of the bent wire elements is small. he retention plate 0TU U0T Elements: Function: Description: Labial bow and retention elements 0. this should be considered while making the wax limitation. . The acrylic base is also designed delicately. 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.7 mm spring hard.
5 mm vacuum formed thermoplastic foil is used. a bur is used to cut the material and contour the limits. The exceeding granules are knocked off over the machine. . 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. When a 0. The splint is vacuum formed and taken out of the machine. 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. When a thicker foil is used.
75 mm thick co-polyester vacuum formed thermoplastic foil is required for the upper and lower jaw. Once again. The thermoplastic foil is vacuum formed as usual and trimmed one millimeter over the cervical tooth margin. transparent retention appliance after treatment with fixed appliances For this retainer a 0. . This retainer can be used in the upper and lower jaw.75 mm Retention Delicate. 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 Through the combination of a rigid and flexible foil this retention appliance has a high mechanical retention capacity reducing the danger of relapse First. The limits are smoothed out with stones or burs. Because of the thin occlusal coverage.5 mm.5 mm silicone foil (for example Bioplast) onto the dental arch. the limit of the retainer is marked 1-2 mm underneath the gingival margin with a pencil. The reduced Bioplast foil is placed again onto the cast and the 0. the upper and lower jaw can occlude without problems. 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. In the same manner. . small tooth movements and corrections can be achieved when a previous set-up is made. The Osamu retainer 0TU U0T Elements: Function: Description: Vacuum formed thermoplastic foil (Bioplast 1. Imprelon S 0. Now the Osamu retainer is cut along the marked line with scissors. During the last 10 seconds of the heating time. Osamu bond is applied on the Bioplast foil for the bonding of both foils. the incisal edges and occlusal surfaces are cut up to the contact points. The vacuum formed Bioplast foil is trimmed with scissors along the base of the cast.75 mm Imprelon “S” foil is heated as indicated. As with the positioner.
The endings of the C-clasps are bent over and should reach as far as possible into the interproximal area.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. . Both C-clasps are bent behind the last molars slightly over the gingival margin. The posterior margin is located in height of the molars or premolars. The base plate is reduced slightly in the posterior region. 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. The van der Linden retainer 0TU U0T Elements: Function: Description: Labial bow with canine loop 0.8 mm spring hard. C-clasps 0. This labial bow has to adapt precisely to serve as retention element for the plate.
the acrylic base is designed as delicate as possible.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. The Hawley retainer 0TU U0T Elements: Function: Description: Circumferential labial bow. between the lateral incisor and the canine. In the area between the first and second premolar a small U-loop is bent in. a small eyelet can be bent to enhance the support of the labial bow. Again. . Additionally.
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.7 mm spring hard Retention Retention plate without retention elements . For this purpose. In the lower jaw occlusal rests can be added on the last molars. in this example. The retention plate with engaged labial bow 0TU U0T Elements: Function: Description: Labial bow and hooks 0. In this case. The base is finished as delicate as possible. the labial bow includes small Uloops in the premolar/canine area.The Hawley retainer can be replenished with Adams clasps. Once again. the Uloops can lie in the premolar/canine area.
The labial bow is bent individually with a slight distance from the teeth and covered with acrylic. 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. No occlusal interferences should exist. The teeth are supported orally from the palatal plate and labially through the covered labial bow. Around the last molar a hook similar to a C-clasp is bent with its retention.
occlusal rests 0. The definitive adaptation of the spurs is done by the practitioner directly on the patient while inserting the appliance.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. The base plate is designed as usual. Additional occlusal rests can be added in the lower jaw.7 mm spring hard. . The labial bow is made as usual. The spurs should be shortened in such a way that they reach 2 mm over the interdental area. The retention plate with interdental spurs 0TU U0T Elements: Function: Description: Simple labial bow and interdental spurs 0. Now simple straight spurs are bent which are laid onto the erased papillae and extend far over the cast.
The spring retainer 0TU U0T Elements: Function: Description: Circumferential labial bow 0. . The retainer is bent out of one piece of wire.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. It contacts the canines again on the oral and labial side. 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. The wire is bent with certain distance on the oral and labial side.
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. . A finished spring retainer.
After the active phase of treatment. 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. for the finishing. This new situation is fixed with a wax bite with 2 mm of vertical opening and then the casts are duplicated. After setting up all teeth correctly in the arch form. small corrections are possible with a set-up After an occlusal registration on the patient. the brackets have to be erased on the cast. When the impressions are taken in the last appointment before debonding. In this way. Sometimes the brackets are left on the teeth to enhance the retention of the positioner. the positioner has notoriously more retention and single teeth can even be extruded. The impressions can be taken after debonding or shortly before. the casts are set into a semiadjustable articulator. the gingival architecture is modeled harmoniously. 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. . As an alternative the brackets can be left on the teeth.
both casts are reset in the fixator and set under the heating of the vacuum forming machine.On the basis of the new wax bite. The fixator should allow a simple removal and insertion of the casts. The foil is trimmed up to its approximate length with a hot wax knife. a 3 mm Bioplast foil is vacuum formed. a vacuum forming technique with Bioplast was chosen. and over each single jaw. The foils are heated until they slightly stick to the finger when touched. Afterwards.5 mm foil is vacuum formed onto the complete buccal surface. both single foils now stick together as one appliance. the duplicated casts are set into the fixator. The positioner can be manufactured of different flexible silicone types. . The casts are isolated. In this case. For reinforcement a 1. The fixator is set together and the foils are adapted with wet fingers in the areas of contact. The casts are removed from the fixator and set onto their dorsal side in the vacuum former with the foils in place.
The edges are smoothed out with the “blue Jota”. the positioner can be cut neatly with scissors. . the positioner is set onto the casts. The bonded retainer according to Wiechmann 0TU U0T Elements: Function: Description: Retainer wire 0.After the cooling of the material. If the patient has problems breathing through his nose. it is shortly passed through the flame of the Bunsen burner and is again adapted with damp fingers. 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. As a conclusion.7 mm hard Retention Lingual bonded wire to retain the incisor position First. holes can be drilled in the positioner with a sharp drill.45 mm braided or 0.
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. These are light cured again.Afterwards. .g. Flowline/ Kulzer or Tetric-flow) is placed on each of the oral surfaces from canine to canine or first premolar to first premolar. a fluid silicone impression material (of a two phase material e. In the second step. Durafill/Kulzer or Tetric) to form small bonding bases. To manufacture the Transfer tray. Now the bonding is light cured with a UV lamp. another modeling of the bonding spots is made with a more solid light-curing resin (ConTec LC/Dentaurum. Afterwards. Con Tec LCR/Dentaurum.g. LinguSil/Dentaurum) is injected around the wire of the retainer. the previously adapted retainer wire is set into these bonding drops and adapted as closely to the oral tooth surfaces as possible.
Finally. The solid silicone should cover the incisal edges labially.Afterwards. Now the transfer key is removed from the cast. the polimerized fluid silicone material is covered with kneadable silicone (Lutesil/ Bisico) and formed into shape using the fingers. 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. In the area of the wire. After the silicone is cured. the grease of the bonding bases of this silicone key has to be removed with acetone and cotton pellets. .
The incisal edges and the occlusal surfaces have to be totally covered with acrylic. a thin wax strip is laid around the tooth arch and fixed approximately 0. all impressions of the counter jaw in the posterior and front region are reduced in such a way that only slight impressions remain. the models. When working out. Spaces of missing teeth and retentive areas are also blocked out. After a couple of minutes. For this purpose. 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. when the dough does not flow any more. Distally of the canines. an acrylic guiding surface is added for the fixation of the occlusion. The acrylic is not added with the spray-on technique but favorably with the dough technique. This stop should be adjusted in the semiadjustable articulator with articulating tape. it is pressed onto the cast.5 mm over the gingival margin. It is polymerized in a pressure vessel. fixed in a semiadjustable articulator are blocked out with wax. .
In both jaws.8 mm hard.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. The therapeutic occlusal position is previously determined on the patient and transferred with a wax bite. 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. Now the polymerization in the pressure vessel takes place. lower jaw bow 2. . 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. the teeth are limited with a wax stripe shortly over the gingival margin.
the bite block is left even. . ball clasps or Adams clasps can be used. The retentions are positioned parallel to the gingival margin. 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.0 mm x 1. the occlusal impressions are left in place. The reduced splint 0TU U0T Elements: Function: Description: Ball retainer claps 0.5 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. In the lower jaw.8 mm hard. The extremes of the bows are grinded with a separating disc for retention. If the splint is used for the treatment of patients with cranio-mandibular disorders. bow 3. The upper bow is fixed transversally between the premolars and molars with a distance of 1-2 mm to the gingival tissue.
the posterior teeth in the lower jaw are covered up to the occlusal surfaces (1 mm) with wax. both acrylic parts are adapted and finished separately. . In the upper jaw only the occlusal surfaces are limited with wax. After the polymerization of the acrylic. 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 bite opening has to be checked again before adding the acrylic and the wax limits have to be reduced if necessary. The canine guidance in lateral jaw movement is as important in this appliance as in a complete splint.
the retentions of the attachments are heated with a flame and melted down into the foils. acrylic is added onto the retentions.0 mm Duran® foil which was previously underlaid with space maintaining foils. The fixing points of the guiding telescopes in the upper jaw are located buccally and interocclusally in the molar area. For the final fixation. the foil reaches up to 1 mm over the gingival margin. . and in the lower jaw buccally and interocclusally between the canine and the premolar. in the anterior area the incisal edges are covered 2 mm. The Duran® foils are roughed. While finishing the splints. In the posterior area. The IST fixing attachments are set using the positioning aid and the retentions may have to be adapted to the tooth form. The retentive parts on the duplicated casts are blocked out with wax and then vacuum formed with 2. the main casts are set into the fixator with the aid of the measuring instrument according to George. 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 acrylic is added and then polymerized in the pressure vessel without water. If not. it has to be adapted intraorally by grinding or adding acrylic and the lower cast has to be mounted again in this position. then finished and polished. Before continuing the model surgery. Afterwards. the lower cast is mounted using a centric relation record. Only the occlusal surfaces of the casts are hydrated and then isolated. The incisal pin has to be always in “0” position. they are covered with an extremely thin wax layer. 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. First. To avoid the incisal edges from breaking. Afterwards. 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 casts and the base have a smooth surface to be able to draw the orientation scale for the model surgery. Then the articulator pin is increased by 2 mm to give the splint a thickness of approximately 2 mm. The base of the articulator is trimmed together with the cast base. this splint has to be fitted on the patient. the upper cast is mounted on a semiadjustable articulator using a transfer fork (bite fork) in the correct relation to the cranium. Only if the splint adapts correctly reference lines can be drawn.
. The cast is firmly fixed with sticky wax. the third (transparent) splint can be made. the drawing is realized in the area of the central incisors between the canine and the premolar and underneath the first molars. adding the acrylic. not the cast. If plaster surfaces interfere. The reference lines should correspond to the vertical axis of the teeth. When detailing all three splints one must pay attention that the friction is not excessive when they are set onto the casts. 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. In the lower jaw. the upper cast is removed from the mounting ring and repositioned according to the surgical planning and fixed onto the base with sticky wax. 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. 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. The dental arches are once again covered with wax. Definitive splint: Immediately afterwards. After finishing the orientation scale the articulator pin is set back into “0” position. The articulator pin is set again into “0” position and the model surgery of the lower jaw can be started. The articulator pin is raised again by 2 mm and the second (red) splint is made exactly the same as the first.
Between the single teeth in the upper jaw small holes are drilled into the splint to allow the intermaxillary wiring. The acrylic should extend minimally over the dental arch. Small grooves are grinded into the outer surface to receive the wire. the acrylic is added and the splint is finished.Once again. They can be adapted if needed. When all splints are finished. all three are separately tried on before the surgery. Between the teeth a small hook is soldered to be able to wire both jaws together. If a surgical splint is to be made on dental casts without brackets. . the blue splint is made first. Now a circumferential wire splint is bent adapting on all labial surfaces of every tooth. After the fitting on the patient the orientation scale is drawn on the casts and base. After hydrating and isolating. the wax limitation is set around the teeth and the articulator pin is raised 2 mm exactly as with the other two splints.
After bending both splints. the transparent or definite splint is made with the spray-on technique and then finished. With the wire splints in place. the model surgery is realized as usual in the articulator. .