An Atlas of Removable Orthodontic Appliances

Second edition

GORDON C. DICKSON
B Ch U (Leeds).F D S, D Orth, R C S (Eng) Orthodontic Consultant to the Portsmouth Hospital Group

ALBERT E. WHEATLY
F B I S T. M O T A Chief Technician, Dental Wing, Royal Portsmouth Hospital

Turkish Power
OrTHoTaMiNe Tarafından Yeniden Düzenlenmiştir

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CONTENTS

Preface 8 The Materials 10 The Tools 12 Anodic Polishing Apparatus 14 Wire Bending 16 Construction of the Adams Clasp 24 Variations of the Adams Clasp 38 The Adams Clasp f o r Extraoral Traction 40 Alternative Clasps 42 The Effect of a Fingerspring 44 Resistance to Displacement 46 Resistance to T o o t h Movement (Anchorage) 50 T h e Simple Cantilever Spring 56 Boxing-in 62 Paired Cantilever Springs 64 Double Cantilever Springs 66 The Kinked Cantilever Spring 68 Premolar Retraction Springs 70

Palatal Movement of Premolars and Molars 72 Mesial and Distal Movement of Incisors 74 Lateral Movement of Canutes 76 Labial Movement of Canines 78 Distal Movement of Canines 80 The Labial Canine Retractor 82 Sleeving the Canine Retractor 84 A d j u s t i n g the Retractor 86 The Cut-and-bend Spring 88 Palatal Movement of Lateral Incisors 90 The Sved Bile Plate 92 The Effect of a Bite Plane 94 The Labial A r c h 96 The Labial A r c h as a Retainer 98 The Roberts Retractor 100 Construction o f the Roberts Retractor 102 A p r o n Springs 104

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Variations of, and Additions t o , Labial Arches 106 More Variations of the Labial A r c h 108 The Inverted Labial A r c h 110 Space-maintainers 112 Expansion Screws 114 Asymmetrical Radial Expansion 120 Distal Movement of Buccal Segment (Schwarz) 122

Labial Movement of Upper Incisors (Schwarz) 124 R o t a t i o n of a Single T o o t h 126 R o t a t i o n by Contra-acting Springs 132 Extraoral Traction 134 Extraoral Anchorage 138 Buccal Movement of Premolars 144 Incisor Elongation 146 T h e Andresen Appliance 150 The Oral Screen 156

Acrylic resin C L E A R acrylic denture base is used for the construction of all appliances. and also because it shows more clearly when f o o d debris has collected around the springs. It is usually specified by internal diameter only. POLISHED ONE S I D E . 3507 (1962)] Hard drawn. the thickness of the tube wall being appropriate for orthodontic purposes. tape is supplied S O F T . unpolished wire is inferior and should not be used. chiefly as it allows blanching of the tissues over pressure areas to be detected visually. Stainless steel tube Tubing may be H A R D P O L I S H E D or B R I G H T A N N E A L E D . 10 . It is specified in metric diameter measurement and the correct sizes for each appliance will be f o u n d on the text-page opposite each appliance. the other side being m a t t to facilitate adhesion of cement.by OrTHoTaMiNe THE M A T E R I A L S Stainless steel wire This must be H A R D POLISHED [ B r i t i s h Standard No. Stainless steel tape As used in orthodontics.

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They may also be used for increasing the bend in the labial canine retraction spring shown on page 82. 2. Wire cutters The diagonal type of wire cutter is used and must have hardened blades. 6 m m wire can be passed between them at the base when the pliers are closed. these pliers have one beak round and the other h o l l o w e d so as to wrap round its opponent. Loop-forming pliers These have r o u n d . When the pliers become worn they should be resharpened. 1.by OrTHoTaMiNe THE TOOLS For the vast m a j o r i t y of removable appliances l o u r instruments o n l y are required. The beaks are s t o u t . tapered beaks around which loops or coils of various sizes may be f o r m e d . and meet o n l y at the tips. tapered and rectangular in section. 3. Hollow-chop pliers Used for making bends in wires which are already anchored at b o t h ends in an appliance. Universal pliers These are used for all wire bending w i t h the exception of the f o r m a t i o n of loops or coils. They therefore exert pressure simultaneously at three points on the wire. Beaks which are in contact throughout their length tend to eject a large diameter wire (Inset A ) . 4. maintaining a beak size of 1 mm square at each t i p and c u t t i n g back so that a 0 . The beaks of Universal pliers are parallel when gripping the wire (Inset B). 12 .

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the cathode. A current of 8 amps at 20 volts is suitable for most purposes. The cathode (negative pole) is f o r m e d of a stainless steel plate.by OrTHoTaMiNe ANODIC POLISHING APPARATUS The anodic polishing bath illustrated is used for reducing the diameter of stainless steel wire where a variation in thickness is required. A variable resistance is unnecessary as the current can be varied by moving the anode nearer t o . 14 . In use the positive pole is connected to the wire to be thinned using a crocodile c l i p and so f o r m i n g the anode. or further f r o m .

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creating a smooth curve of large radius. Avoidance of the use of pliers will ensure a bend without kinks.by OrTHoTaMiNe WIRE BENDING. Repeating the process will increase the curve to any desired extent. smooth curves are formed by holding one end of the wire firmly on one hand and forming a curve with the thumb of the other hand. 16 . 1 Soft curves For labial arches of all kinds. The thumb is then drawn firmly along the wire.

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) 18 . (For clarity in the illustration the t h u m b is shown a little too fat back. 2 Right angle bends H o l d i n g ihc wire at right angles to the long axis of the pliers the wire is held against the t h u m b and the bend made by pressing the t h u m b f i r m l y on the wire as closely as possible to the plier beak.by OrTHoTaMiNe WIRE BENDING.

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20 . 3 Acute bends These are formed by holding the wire along the beaks of the pliers and bending firmly back with the forefinger.by OrTHoTaMiNe WIRE BENDING.

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by OrTHoTaMiNe WIRE BENDING. 4 Small radius bends H o l d i n g the wire at right angles to the plier beak the wire is bent with the t h u m b placed a short distance away f r o m the bend. 22 .

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24 .by OrTHoTaMiNe CONSTRUCTION OF THE ADAMS CLASP. 1 If desired the clasp may be pre-lightened by t r i m m i n g the plaster t o o t h as shown.

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A piece of 0.by OrTHoTaMiNe CONSTRUCTION OF THE ADAMS CLASP. are pushed backwards as far as the plier beaks will permit. 2 Forming the bridge A careful estimate is made by eye of the mesiodistal width of the tooth.7mm wire about 12cm (5in) long is held at right angles to the pliers at a point where the width of their beaks is equal to about twothirds of the tooth-width. A 26 . which should be of equal length. The tips of the beaks are then used to increase these bends to slightly less than a right angle so that the ends of the wire cross each other. Using the thumb and forefinger the two ends.

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by OrTHoTaMiNe CONSTRUCTION OF THE ADAMS CLASP. This is made in two stages. this is first estimated and a bend made in a position which will place the bridge about half-way up the crown. First stage: a right angle bend as shown opposite. 28 . 3 Forming the first arrowhead As the length of the arrowhead will vary according to the height of the crown of the tooth to be clasped.

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30 I . 4 Forming the first arrowhead (contd.) Second stage: this bend is increased by bending thc wire backwards over the beak-lips (as on page 21).by OrTHoTaMiNe CONSTRUCTION OF THE ADAMS CLASP.

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the second arrowhead is formed in the same way as the first (Inset D). Each arrowhead is then squeezed lightly between the plier beaks (Inset E) to increase the sharpness of the arrowheads.by OrTHoTaMiNe CONSTRUCTION OF THE ADAMS CLASP. This should not be carried to excess or the wire will later break at this point. 32 . 5 Forming the second arrowhead Holding the clasp in the position shown.

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by OrTHoTaMiNe CONSTRUCTION OF THE ADAMS CLASP. 34 . 6 Aligning the arrowheads Each arrowhead in turn is held in the pliers as shown and bent until the plane of the arrowhead lies at about 45° to the bridge.

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36 . The tags should lie out of contact with the plaster so that they will later be completely surrounded by acrylic material. Over the contact point of the t o o t h a second. It is essential that the bridge should not lie in contact w i t h the buccal surface of the t o o t h and these last bends should be increased if necessary to achieve this. When the clasp has become slack in wear it is lightened by increasing the bend in the tag at a point immediately overlying the contact point of the t o o t h . shallow bend is f o r m e d and the clasp presented to the t o o t h .by OrTHoTaMiNe C O N S T R U C T I O N OF T H E A D A M S C L A S P . 7 Forming the togs A right angle bend is formed at a level slightly below the bridge by holding the arrowhead as shown (the t h u m b has been w i t h d r a w n for c l a r i t y ) . Finally the tags are completed by bending over the palate and the ends turned under and forced i n t o the plaster (page 25).

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The auxiliary clasp A second arrowhead is formed as shown and united to the bridge of the main clasp using hard solder and stainless steel flux. Materials All clasps are made with 0. The incisor clasp B. otherwise it will be removed entirely from the surface and will have no mechanical hold. C. A single incisor can be clasped as shown in the left-hand diagram.7mm wire. Two central incisors can be clasped as shown. Soldering may be carried out either on the model or after processing.by OrTHoTaMiNe VARIATIONS OF THE ADAMS CLASP A. . the arrowheads resting against the mesiolabial and distolabial aspects of the tooth. The minimum amount of heat should be used and the solder should not be heavily polished.

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7mm stainless steel wire 1.25mm wire 1.1 mm stainless steel tape or binding with soft wire and soldering 40 . Construction Adams clasps Extraoral arch: Tubing. ii is convenient to offset the tubing in which the arch fits as shown in diagrams B and C. Attachment of tubing 0. A variation is to place arrowheads on the mesial of the second premolar and the distal of the molar as in diagram A This form of retention is of value in extraoraI anchorage (page 138) but for convenience of accommodating adjustment loops of friction stops.by OrTHoTaMiNe THE ADAMS CLASP FOR EXTRAORAL TRACTION Where upper first premolars have been extracted an auxiliary arrowhead may be used (page 38) but this is not easy to adjust.25 internal diameter stainless steel Strapping with 2.0 x 0.

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The Duyzings clasp C.by OrTHoTaMiNe A L T E R N A T I V E CLASPS B o t h the clasps illustrated use the same principle as the Adams clasp i. T w o stainless steel wires are bent over the m a x i m u m c o n t o u r of t h e t o o t h f r o m mesial and distal aspects and then curved back u p o n themselves so that the lower part lies below the m a x i m u m c o n t o u r a n d the ends are sprung i n t o the undercuts. retention f r o m the undercut areas present on the mesiobuccal and distobuccal corners of the molar teeth. 42 .e. Alternatively. 7 m m stainless steel wire. Materials B o t h clasps are made f r o m 0 . The A. B. ball-ended clasp Prefabricated ball-ended wires are bent in the f o r m shown a n d sprung i n t o the angular undercuts. closed curve a n d c u t o f f short to replace the balls. stainless steel wire may be bent i n t o a sharp.

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it acts as an inclined plane and the horizontal forward thrust of a fingerspring is convened into an upward and forward thrust. the tooth exerts a backward and downward force on the spring. into an upward component of two units and a forward com ponent of three units B. In the case illustrated in diagram A the palatal surface is at 60 c to the horizontal and the thrust may be divided.by OrTHoTaMiNe THE EFFECT OF A FINGERSPRING A. It follows that the clasps on such an appliance must be placed. as represented in diagram B. as shown by the length of the lines. in accordance with Newton's Third Law of Motion. On the tooth Owing to the tact that the palatal surface of an upper incisor tooth has a downward and forward slope. not only to resist the backward thrust of the tooth. but also to resist a considerable downward displacing force. 44 . On the appliance Reciprocally.

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In diagram B a palatally placed spring is m o v i n g the incisors forward. 1 Downward displacement of an upper appliance In diagram A a labial arch is used to retract upper incisors. Only the f o r w a r d force is resisted by the clasped molar t o o t h (black) while the palate acts as a f u l c r u m and receives the u p w a r d force. 46 . which would pivot on the clasped first molar (black).by OrTHoTaMiNe R E S I S T A N C E TO D I S P L A C E M E N T . The inclined plane of the t o o t h here exerts a backward and d o w n w a r d force on the anterior part of the appliance. There is a backward force on t h e incisor c o m bined w i t h a downward force due to the inclined plane effect. A d d i t i o n a l clasps must be placed on the first premolars (black) to produce an upward c o m ponent and prevent displacement. Reciprocally a forward and upward force is exerted on the appliance.

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so giving an upward thrust and stabilizing the appliance. The d o w n w a r d thrust is countered by placing an occlusal rest on the second molar t o o t h (black). t i l l i n g the posterior end downwards.by OrTHoTaMiNe RESISTANCE TO DISPLACEMENT. (If the second molar is uncrupted the occlusal rest may be placed on the distal p o r t i o n of the first molar ) 48 . 2 A lingually placed spring exerts a forward force on the sloping surfaces of the lower incisors and consequently receives an upward and backward thrust f r o m the teeth. A clasp placed on the first premolar (black) acts as a f u l c r u m about w h i c h the appliance w i l l pivot.

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an appliance designed to retract only the four incisors can utilize all the six remaining teeth as anchorage. B. so producing a major movement of the incisors with little further forward movement of these teeth. It may be expected. When the canines alone are retracted the incisors take part in the anchorage. The canines now being in the fully corrected positions. this will be small compared with the distal movement of the canines. an attempt is made to retract the entire labial segment at once. Although these will inevitably undergo some slight forward movement. following extraction of first premolars. 50 .by OrTHoTaMiNe RESISTANCE TO TOOTH MOVEMENT (ANCHORAGE). that the forward movement of these teeth will exceed the backward movement of the incisors and canines. the only teeth resisting this movement are the four remaining posterior teeth. C. therefore. If. Only two teeth are being moved against an anchorage of eight teeth. 1 Retraction of labial segment A.

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by OrTHoTaMiNe RESISTANCE TO TOOTH MOVEMENT (ANCHORAGE). 52 . Distal movement of a buccal segment Following extraction of an upper second molar the first molar and both premolars of that side may be moved distally. The labially displaced canine is not included in either part of the appliance. three teeth moving against an anchorage of nine teeth. 2 D.

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RESISTANCE TO TOOTH MOVEMENT (ANCHORAGE), 3

The proper A

application

of

extraoral

traction

At the commencement of extraoral traction designed to move ail the upper teeth posteriorly f o l l o w i n g e x t r a c t i o n of second molars, the labial arch is bent away f r o m the labial segment. A l l the extraoral force is then directed against the cheek teeth, which w i l l move distally. At the completion of distal movement of the cheek teeth the labial arch is bent back to rest against the labial segment, not to press against it. When the extraoral force is applied the labial segment will move posteriorly. At the next visit the labial arch w i l l be seen to stand away f r o m the incisors Until the extraoral force is applied. It can then once more be adjusted to rest against the anterior teeth. If the labial arch is adjusted (via the U-loops) to press against the incisors, application of t h e extraoral force will increase pressure on the incisors, but w i l l not release the forward force on the cheek teeth produced by the tension in the U-loops. The anchorage problem generated within the appliance is not removed by the application of extraoral force.

B.

C.

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THE SIMPLE C A N T I L E V E R SPRING. 1

Parrs of the spring A, A simple cantilever spring consists of three parts. The tag is embedded in the acrylic resin of the supporting baseplate. The coil is the active part of the spring and is normally made so that it tends to open, rather than close, in use. The arm of the spring undergoes only slight bending and may be regarded as a rigid lever. Direction B. of pressure

As friction between the spring and the t o o t h can be ignored, the direction of pressure will always be at right angles to the a r m of the spring and, if the spring has to work over a l o n g angular range, this will change considerably during t o o t h movement. The path traced by the t i p of the spring is k n o w n as the Path of A c t i o n . C. The longer the arm of a spring the greater will be its range of action. A short spring not o n l y has a short range of action but, as it moves, its tip describes an arc of a small circle. As its length increases so this arc becomes straightened and its path of action is nearer to a straight line. As length increases, so the spring must be made of thicker wire to exert the same force,

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exaggerated for clarity in diagram B.by OrTHoTaMiNe ACTIVATING THE CANTlLEVER SPRING A small. This produces a slight flattening of the curve. controlled and accurate amount of tension can bo given to cantilever springs by squeezing the coil in the tips of the universal pliers as in diagram A. 58 .

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5mm boxed-in Retention: Adams clasps on 64/46 Bite-raiser: 10 mm wire or acrylic capping Baseplate: Full palate 60 . Inset B shows the same spring adapted to move two teeth Construction Springs: 0. This is used where the thickness of acrylic capping (see Inset A) would be too little to stand the bite without fracture. as shown here. by a single wire passing over the occlusal surfaces of the cheek teeth. Ihe coil is set as far away as possible from the tooth to be moved The tag is short and well within the thickness of the acrylic. The arm of the spring is set at right angles to the intended path of the tooth to be moved and is lelt long so as not to lose contact with the tooth towards the end of its movement. The bite is raised on the cheek teeth either by a thickness of acrylic resin or.by OrTHoTaMiNe THE SIMPLE CANTILEVER SPRING The spring illustrated is moving .in upper incisor 'over the bite'.

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by OrTHoTaMiNe BOXING-IN The purpose of boxing-in is to protect the spring from damage and to act as a guide along which the arm can slide. At the time the spring is constructed and tacked to the plaster model with wax. A check should then be made to ensure that the spring has free travel without Fouling any projection of the baseplate. It should extend beyond the tip of the spring and should have a smooth outline. 62 . 2. flat upper surface. 3. It should continue this smooth. As the teeth move forward so the control excited by the capping is lost. It should have a smooth. It is possible lo use instead a guide wire. flat surface right in between the teeth 4. 1. care being taken to note the following points. This can be advanced as the teeth move by squeezing the sides with pliers. The guide is made of 0. it is covered with a small amount of thin plaster which is shaped up with a knife. as illustrated.7mm soft stainless steel wire After appropriate protection the plaster is covered evenly with baseplate wax and processing completed.

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5mm boxed-in 0. Construction Springs: Clasps: Retention: Baseplate: Inset A This lateral view shows boxed-in spring and just sufficient clearance to allow the upper incisors to move f o r w a r d w i t h o u t f o u l i n g the lowers.7mm Adams clasps on 64/46 Continued over all check teeth as capping Inset B A double cantilever spring may be used as an alternative for the same t o o t h movement ( 0 . 6 m m wire). 0. 64 . b u t this requires a greater degree of skill in adjusting. each spring moves the central and lateral incisor nearest the e n d of the spring.by OrTHoTaMiNe P A I R E D C A N T I L E V E R SPRINGS Where four incisors are to be moved over the bite.

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may be carried out by means of two small double cantilever springs which can be used to vary the direction of movement.by OrTHoTaMiNe DOUBLE CANTILEVER SPRINGS Forward movement of two upper lateral incisors.5 mm boxed-in Clasps: Adams clasps on 64/46 Baseplate. or where space for the spring is confined. Full palate (capping on cheek teeth if the lateral incisors must pass over the bite) Inset A Lateral movement is produced by opening the right-hand coil Inset B Forward movement is produced by opening the left hand coil 66 . Construction Springs. 0.

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This is overcome by kinking the spring.7mm boxed-in Clasps: A d a m s clasps on 6 4 / 6 Baseplate: Full palate (capping on cheek teeth if the canine must pass over the bite) Inset The position of the spring at completion of tooth movement 68 . Construction Spring: 0.6 or 0.by OrTHoTaMiNe THE KINKED CANTILEVER SPRING Interference with the movement of the spring by the palatal surface of a premolar may prevent a simple spring moving a palatally displaced canine into the arch. which still behaves as a lever pivoting on the coil.

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one incorporating a guide wire and one boxed-in.6mm 0. . both moving the first premolar distally into an extraction space. Construction Left side Right side Springs: 0.by OrTHoTaMiNe PREMOLAR RETRACTION SPRINGS TWO alternative springs are shown. cut away to expose spring Inset The spring must follow as closely as possible over the contact point.6mm with guide wire boxed in Clasps: Adams clasps Adams clasps on 6/6 on 6/6 Baseplate Full palate Full palate.

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72 . both using a buccally placed c o i l . Materials Clasp: 0. cut away to allow palatal movement of teeth Inset This shows the level of the a r m of the spring and the large coil in an alternative design where the spring is attached to the molar clasp.7mm Spring: 0. On the left an upper molar is being m o v e d .6mm Tape: 2 . 0 x 0 . 1 mm Solder and flux Construction Springs: Clasps: Baseplate: 0. on the right t w o premolars are being moved.by OrTHoTaMiNe P A L A T A L MOVEMENT OF PREMOLARS A N D MOLARS Buccally displaced teeth may be moved palatally by means of springs passing between the teeth.6mm Adams clasps on any cheek teeth not being moved Full palate.

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Here the springs are boxed-in. This diagram shows mesial movement. but here the path of movement of the teeth is not o n l y dictated by the position of the coils of the springs but is guided by a labial arch and a palatally placed guide wire which prevents them 'wandering' in an anteroposterior plane.6mm Adams clasps on 6 / 6 Full palate in A Full palate cut away in B B. This diagram shows distal movement.by OrTHoTaMiNe MESIAL A N D D I S T A L MOVEMENTS OF INCISORS A. The springs are n o t covered by the baseplate. Tour palatally plated fingersprings are used.6mm 0. Construction Springs: Labial arch: Guide wire: Clasps: Baseplate: 0.7mm 0. the position of the coil of each spring being carefully placed to carry the t o o t h in the desired direction. 74 .

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by OrTHoTaMiNe LATERAL MOVEMENT OF CANINES Simple cantilever springs are illustrated. this facilitating insertion of the appliance by the patient. the positioning of the coil being dictated by the direction of t o o t h movement. 7 m m Guide wires: 0 . Construction Springs: 0. cut away to expose springs and if necessary carrying bite platforms on all the cheek teeth to allow the canines to move over the b i t e 76 .6 or 0 . B o t h springs are uncovered and c o n t r o l l e d by guide wires. 7 m m Clasps: Adams clasps on 6/6 Baseplate: Full palate.

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by OrTHoTaMiNe LABIAL MOVEMENT OF CANINES A covered canine spring is d i f f i c u l t for the patient to insert if any degree of activation is a p p l i e d : in this appliance (designed by R. 6 m m boxed-in Adams clasps on 6 / 4 6 Space-holding clasps on 4 2 / : 0 . 6 m m Full palate. The spring thus has the protective advantages of boxing-in yet the patient can engage the kink w i t h a fingernail and so compress the spring to facilitate insertion of the appliance. Hanney) the spring is kinked in the middle of the arm and the baseplate is correspondingly cut away. Construction Spring: Clasps: Baseplate: 0 . with cut-away in cover for spring. Bile platforms where necessary 78 .

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7 m m boxed-in Adams clasps on 6 / 6 Full palate 80 . Once movement has begun it can be m o d i f i e d to fit r o u n d the neck of the t o o t h . Inset To avoid sliding d o w n the mesial slope of the canine the spring is carefully bent so as to f i t between the lateral incisor and canine and to take advantage of the flat mesial surface of the t o o t h . their coils being placed so as to give movement of the canines along the arch w i t h o u t displacing them either lingually or buccally. Construction Springs: Clasps: Baseplate: 0 .by OrTHoTaMiNe D I S T A L M O V E M E N T OF CANINES Palatally placed cantilever springs are used.

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THE L A B I A L CANINE RETRACTOR

This is one of the few springs in which the c o i l is made to close rather t h a n to o p e n in action. The c o i l lies in the labial sulcus. Points to note

1. The end of the spring should be bent at a r i g h t angle before being shaped to the curve of the t o o t h , like a golf-club. 2. The loop should lie as high as possible in the sulcus w i t h o u t interfering with any f o l d of soft tissue c o m m o n l y f o u n d in this area. 3. The tag should lie as close as possible to the second premolar, and the posterior arm should not cut across the first premolar position where it would interfere w i t h retraction of the canine. Construction Spring: Retention: Baseplate: 0 . 7 m m wire or 0 . 6 m m sleeved (see page 84) Adams clasps on 6 / 6 Full palate, cut away to allow movement of canines

Inset A Shows (1) Posterior arm in contact w i t h second premolar and passing over the contact point of this t o o t h . (2) Golf-club end of anterior a r m , sharpened at tip.

Inset B
Shows (1) Path of action. (2) Clear area behind the canine, unobstructed by the spring.

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Sleeved portion bent over to complete the posterior arm and form the tag. Sleeve passed over the posterior arm. 3. Sleeve prepared (upper end chamfered).by OrTHoTaMiNe SLEEVING THE CANINE RETRACTOR 1.6mm internal diameter soft (annealed} stainless steel tube 84 .6mm hard polished stainless steel 0. 2. Materials Spring: Sleeve: 0.

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Position of the plier beaks on the posterior arm. Coil and anterior arm raised. This must be followed by a downward bend of ihe anterior arm as in A and B. 2. B. Increased tension is produced by bending the anterior arm using 'hollow-chop' pliers such as Marthews' or Andresen's. Position of the plier beaks on the anterior arm. F. Increasing the tension As the coil is in the reverse direction to that of the fingerspring it cannot be adjusted In the same way. 3. D. 86 . Position of the plier beaks on the posterior arm.by OrTHoTaMiNe ADJUSTING THE RETRACTOR 1. Raising the coil E. A. Resultant bend. Coil and anterior arm lowered. Lowering the spring on the tooth C.

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B E N D SPRING A l t h o u g h the spring requires frequent adjustment. When the t o o t h has moved by this a m o u n t . it can be used where a low labial sulcus prevents the use of the labial retractor described on pages 82 and 84. yet where a palatal component of movement is needed. The spring may touch the labial surface of the canine for palatal movement (as on left of illustration) bul is well clear of the t o o t h anteriorly except where the l i p touches the mesial aspect of the l o o t h .by OrTHoTaMiNe T H E C U T .A N D . Construct ion 0. 1 mm is cut off the t i p of the spring and the bend remade so that the shape of the spring is maintained (Inset B). It is also useful in lower appliances where there is rarely any depth of sulcus.6mm Adams on 6/6 Full palate Spring: Clasps: Baseplate: 88 . To activate the spring the tip is bent back about 1 m m .

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Pressure should be exerted as near to the tip of the t o o t h as possible and the springs are activated w i t h hollow-chop pliers. w o u l d f o u l the central incisors. Construction Springs: Retention: Baseplate: 1. Each spring is flattened at the t i p on an anvil.6mrn anodically Adams clasps on 6/6 Full plate.0mm wire thinned to 0. tapered in the anodic polishing bath and bent to a golf-club and before adapting it to the t o o t h .by OrTHoTaMiNe PALATAL MOVEMENT OP LATERAL INCISORS Individual springs are preferred to a full labial arch w h i c h . c u t a w a y b e h i n d 2/2 90 .

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Pressure on the bite plane by the lower incisors is transferred to the upper incisors instead of to the soft tissues.6mm sleeved Adams clasps on 6 / 6 Pull palate and covering tips of upper incisors. the plane should be lowered. thickened to f o r m bite plane Inset A This shows relationship of lower incisors to bite plane which must be extended sufficiently to make it impossible for the lower incisors to bite behind it. It is necessary to m o u n t the models on an articulator for this purpose Inset B Should this open the bite on the check teeth by more than 3 or 4 m m . though it may be used alone. Construction Springs: Retention: Baseplate: 0. and later in treatment it can be raised by adding c o l d c u r i n g acrylic resin.by OrTHoTaMiNe T H E SVED B I T E P L A T E This is illustrated in c o m b i n a t i o n w i t h canine retractors. 92 .

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A plane at 30° to the horizontal would divide a similar force i n t o 56. B. It should be noted that the appliance itself receives equal a n d opposite pressures to those exerted on the opposing teeth. A horizontal plane exerts all its force downwards.5g(1.by OrTHoTaMiNe T H E EFFECT OF A BITE PLANE A. 94 . a force of 85g (3oz) is divided i n t o t w o forces each of 42.3g (1oz) horizontally. A bite plane such as that used in the Sved plate exerts a variable force on the lower incisors depending on its inclination. C.5oz). A plane at 4 5 ° exerts as m u c h f o r w a r d force on the opposing teeth as it exerts d o w n w a r d — for example.7g (2oz) d o w n w a r d a n d 28.

by OrTHoTaMiNe

by OrTHoTaMiNe

THE L A B I A L ARCH

This, the simplest f o r m of incisor retraction, is f i r m and positive in action but works over o n l y a short range and consequently requires frequent adjustment. The arch itself should make contact w i t h the incisors about half-way up the crowns; the U-loops lie over the canines and should be tall enough to facilitate adjustment. This is carried o u t by closing the loops w i t h h o l l o w chop pliers. The baseplate is cut away a l i t t l e at a l i m e b e h i n d the incisors, keeping slightly in advance of their movement. Construction Labial arch: Retention: Baseplate: 0 . 7 m m wire Adams clasps on 6/6 Full palate

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It is here shown w i t h a s h o r t steep bite plane to maintain the position of the lower incisors after they have been depressed (Inset B). 7 m m wire Adams clasps on 6 / 6 Full palate. Inset A shows the reverse loops which may be e m p l o y e d w i t h this arch or w i t h t h e plain labial arch when it is desired to c o n t r o l the position of the canines.by OrTHoTaMiNe THE L A B I A L ARCH AS A RETAINER The fitted labial arch This is used to secure the incisors f i r m l y after they have been rotated. thickened a n t e r i o r l y to f o r m bite plane 98 . Construction Labial a r c h : Retention: Baseplate: 0 .

by OrTHoTaMiNe .

5mm internal diameter soft stainless steel tubing 0. It is suitable only for retraction of the four upper incisors following previous retraction of the canines. The baseplate is cut away in advance of tooth movement in the manner shown in Inset B.5mm wire sleeved in 0. Forward relapse of the canines is prevented by spurs on their anterior surfaces. Roberts consists of two sleeved Canine retractors joined to form an apron spring. Construction Retractor: Spurs: Retention: Baseplate: 0.by OrTHoTaMiNe THE ROBERTS RETRACTOR This adaptation of the labial arch designed by G. H.6mm wire Adams clasps on 6/6 Full palate 100 . contoured to pass incisally to the contact point. The arch should lie half-way up the crowns of the teeth (Inset A) and should extend only two-thirds of the width of the lateral incisors. otherwise adjustment becomes difficult towards the end of tooth movement.

by OrTHoTaMiNe .

Materials 0.by OrTHoTaMiNe CONSTRUCTION OF THE ROBERTS RETRACTOR.5mm hard polished stainless steel wire 0.5mm internal diameter bright annealed stainless steel tubing 102 . The diagram shows how chamfered annealed stainless steel tubing is slipped over the ends of the Spring before bending the posterior arms to form tags as in the construction of the canine retractors.

by OrTHoTaMiNe .

104 . The spring is w o u n d r o u n d the high labial arch on both sides of the strap and again. at the opposite end of the apron spring. loosely.0mm wire A p r o n spring: 0. If the incisors arc spaced it is i m p o r t a n t n o t to carry the arch t o o far across the lateral incisors. The palate is cut away in advance of the t o o t h m o v e m e n t . Construction High labial arch: 1. After bending the spring i n t o shape it is attached by winding r o u n d the labial arch close to one of the angles. t w o or three turns being taken r o u n d each of the horizontal and vertical arms (Inset A ) . Here the spring is strapped on to the arch by stainless steel tape which is welded tightly r o u n d both wires.by OrTHoTaMiNe APRON SPRINGS A high labial arch i n c o r p o r a t i n g a step in each vertical arm carries a light wire spring w h i c h lies half-way down the crowns of the incisors. It is activated by bending the upright arms of the a p r o n spring w i t h hollow-chop pliers.35mm Retention: Adams clasps on 6/6 w i t h ancillary arrowheads on 5/5 Baseplate: Full palate Inset B Shows an individual apron spring to retract a central incisor.

by OrTHoTaMiNe .

AND ADDITIONS TO.by OrTHoTaMiNe VARIATIONS OF.7mm arch as at diagrams A and C or simply wound on as shown at diagram B.0 x0. The 'bridge spring' illustrated can be taped on to a 0.35mm extra hard stainless steel 2.7mm 0. after the upper incisors have been retracted. it is found that the canine stands too far labially. LABIAL ARCHES Sometimes.1mm 106 . Materials Labial arch: Bridge spring: Tape: 0.

by OrTHoTaMiNe .

108 .7mm labial arch with bends to c o n l r o l the canines. Flexible 0. B.7mm labial arches designed by J. . Flexible 0. They are activated mainly w i t h the fingers. Flexible 0.by OrTHoTaMiNe MORE V A R I A T I O N S O F THE L A B I A L A R C H A. Mills. D. E.7mm labial arch with extended labial section to control canines. These may also be extended to c o n t r o l canines. R.

by OrTHoTaMiNe .

8mm wire or sleeved as shown in Inset C Palatal springs: 0.5mm wire boxed-in Retention: Adams clasps on 64/46 Baseplate: Full palate and covering all cheek teeth sufficiently for upper incisors to clear lowers 110 . The arch is activated by bending back slightly with the thumbs until the lower incisors will only just pass behind it. additional backward movement of the lower incisors with an inverted labial arch greatly shortens treatment time. The bite is propped open on all the cheek teeth. It is essential that a retrusive bite in the slightly open position is taken and the models placed on an articulator before bending the arch. Construction Inverted labial arch: 1. As the mandible closes it swings forward (Inset B) so that the arch is slightly flexed. This arch exerts Class III intermaxillary traction. The palatal springs are simultaneously brought into action.25mm wire anodically thinned to 0. the vertical arm of which should lie well clear of the lower canine and premolar (Inset A).by OrTHoTaMiNe THE INVERTED L A B I A L ARCH Whilst lingually occluding upper incisors may be moved 'over the bite' by means of palatal cantilever springs alone.

by OrTHoTaMiNe .

by OrTHoTaMiNe SPACE-MAINTAINERS The appliance s h o w n is to maintain the space for any unerupted canine f o l l o w i n g e x t r a c t i o n of first premolars. HaIf clasps around the teeth adjacent to the space prevent movement of the lateral incisors and second premolars. The baseplate is cut away well clear of the e r u p t i n g canine and the lags of the half-clasps are placed so as to allow further c u t t i n g of the baseplate if necessary. 6 m m stainless steel wire Adams clasps on 6/6 Pull palate 112 . Construction Half-clasps: Retention: Baseplate: 0 .

by OrTHoTaMiNe .

should be used and its length should be adequate Adams clasps on 6 4 / 4 6 Full palate. as deep in the palate as possible. this is one quarter-turn per d a y . Correct placing of the screw is of the u t m o s t i m p o r t a n c e a n d the f o l l o w i n g p o i n t s should be carefully observed. divided d o w n the centre after processing Retention: Baseplate: 114 . 4. A f t e r plastering the screw according to the maker's instructions it should be placed: 1. between the first premolars. Rate of activation Using a screw w i t h one end threaded. occluding upper molars and premolars i n t o normal relationship w i t h their opponents. Construction Screw. 2. w i t h guide pins i n t a c t . w i t h its long axis parallel to the occlusal plane. 1 Direct lateral expansion The appliance shown is to move lingually. at right angles to the median raphe. A screw of hard metal such as stainless steel. a screw w i t h both ends threaded. one quarter-turn every other day. 3.by OrTHoTaMiNe E X P A N S I O N SCREWS.

by OrTHoTaMiNe .

It follows that the screw must open on a curve.by OrTHoTaMiNe E X P A N S I O N SCREWS. 3. 2 Radial expansion Lateral movement of the premolars and canines is achieved by uniting the t w o halves of the appliance across the posterior border w i t h a tie-wire so that the appliance hinges at the back and opens fanwise. Construction Screw: Tie. Special screws have been manufactured to permit this to take place. w i t h its l o n g axis parallel to the occlusal plane. Labial arch: Retention: Baseplate.7mm stainless steel wire Adams clasps on 6 / 6 Full palate. as far f o r w a r d as possible. 2. Soft metal w i t h guide pin removed 0 . softmetal screw such as the Badcock screw w i t h the guide pin cut o f f (Inset B). divided through the midline after processing 116 . The screw must be positioned as f o l l o w s : 1. 4. at right angles to the median raphe. as high in the palate as possible (Inset A ) . but it is q u i t e satisfactory to use a loose. Rate of activation The screw is given one quarter-turn twice a week. 9 m m stainless steel wire 0.

by OrTHoTaMiNe .

3 Asymmetrical expansion Correction of unilateral lingual occlusion of the cheek teeth (and sometimes a canine and a lateral incisor) presents problems in anchorage due to the tendency of the lingually occluding side to resist movement more than the normal side. A short stainless steel screw should be used. Rate of activation The screw is usually turned at the rate of t w o quarterturns per week. stainless steel Adams clasps on 6 4 / 4 6 Full palate. to engage w i t h the lower cheek teeth and so to add them to the anchorage. Construction Spurs: Screw: Retention: Baseplate: 0.6mm stainless steel wire Short. divided as shown and carrying a smoolhed-off b i t i n g section on the small segment and a b i t i n g section indented by the lower teeth and w i t h a lingual flange on the ' f i x e d ' side 118 .by OrTHoTaMiNe E X P A N S I O N SCREWS. Spurs or half-clasps engage 21/. The appliance illustrated raises the bite on the cheek teeth on b o t h sides and carries a lingual flange on the normal side. placed near to the centre of the segment to be moved. w i t h its long axis parallel to the occlusal plane and at right angles to the line of the cheek teeth.

by OrTHoTaMiNe .

6mm on 3 1 / . Construction Screw: Soft metal (Badcock type) Tie: 0. divided as shown 120 . it must lie parallel w i t h the occlusal plane.9mm stainless steel wire Spurs: 0. As the appliance is joined by a tie at the posterior border a soft metal screw is used. The guide p i n is removed and the screw angulated so as to lie along the circumference of a circle w h i c h has t h e tie as i t s centre. Rate of activation The screw is turned at the rate of t w o quarter-turns per week.by OrTHoTaMiNe A S Y M M E T R I C A L R A D I A L EXPANSION The illustration shows an appliance to regain space loss in the region of a labially displaced lateral incisor. Retention: Adams clasps on 6 4 / 4 6 Baseplate: Full palate. As w i t h all other screws.

by OrTHoTaMiNe .

Rate of activation The screw is turned at the rate of one quarter-turn per week.6mm stainless steel wire Adams clasps on 64/46 Full palate with anterior inclined plane. A hard metal screw is placed with its long axis parallel to the line of the segment to be moved and to the occlusal plane. A short.by OrTHoTaMiNe DISTAL MOVEMENT OF BUCCAL SEGMENT (SCHWARZ} Distal movement of an upper buccal segment after extraction of the second molar can be accomplished by means of the appliance illustrated. one across the screw and the other exactly parallel with the buccal segment to be moved and with the long axis of the screw 122 . steep inclined plane is incorporated to assist anchorage by applying some forward pressure to the lower incisors (Inset). A spur or half-clasp on the left lateral incisor prevents this tooth drifting distally. divided by two cuts. Construction Screw: Spur: Retention: Baseplate: Hard metal (stainless steel) with guide pin 0.

by OrTHoTaMiNe .

The screw should be placed as close as possible to the incisors and as low as possible without tilting and while retaining parallelism with the occlusal plane (Inset). Construction Screw: Spurs: Retention: Baseplate: Stainless steel. divided transversely as shown 124 . Spurs or half-clasps arc placed distally on 2/2 and mesially on 3/3. with capping over molars and premolars. The bite is raised on all the cheek teeth so as to clear the overlap of the incisors. the slower rate being used if the appliance tends to slip off the teeth. minimum bulk 0.6mm on 32/23 Adams clasps on 64/46 Full palate.by OrTHoTaMiNe LABIAL MOVEMENT OF UPPER INCISORS (SCHWARZ) Although this appliance is somewhat bulky it has the merit that the screw can be adjusted by the patient. Rule of activation The screw is turned at a rate of one or two quarter-turns per week.

by OrTHoTaMiNe .

When first made. Subsequently the spring may be k i n k e d outwards to continue the movement and over-rotate the t o o t h .a pair of springs exerting pressure in opposite directions on the mesial and distal corners of an incisor tooth.0 x 0 .0 x 0 . 1 m m ) stainless steel tape OR 3. so reducing the retention period. for those who do not possess a welder.7mm stainless steel wire A d a m s clasps on 6 / 6 (or o t h e r available teeth) Full palate. U n f o r t u n a t e l y . which will usually c o m plete the alignment of the t o o t h w i t h o u t further adjustment. 1 Rotation may. The l o n g ' w h i p ' or 'capstan' spring i l l u s t r a t e d is attached to a standard twin-wire channel or W-lock as shown in Inset C. 1 m m soft stainless steel tape OR 3. this frequently results in shortening of the t o o t h a n d is not applicable to canines which are of unsuitable shape. Construction Incisor b a n d : Channel: 3. be carried o u t by using a 'couple' . 7 m m soft stainless steel wire 0. in w h i t e gold alloy which is soldered. C o n s t r u c t i o n of the band a n d channel may be in welded stainless steel o r .0 x 0 . In this case the retaining spur may be welded or soldered to the arch.0 x 0 .0 x 0 . 1 5 m m white gold tape 3. 1 m m (OR 2. 3 5 m m extra hard stainless steel wire 0 . cut away f r o m t o o t h to be rotated Spring: Retaining spur: Labial a r c h : Retention: Baseplate: 126 .0 x 0 . 1 5 m m ) w h i t e g o l d tape 0 . 1 5 m m ( O R 2.by OrTHoTaMiNe R O T A T I O N OF A S I N G L E T O O T H . This over-rotation usually results in labial displacement of the t o o t h and if this is expected a labial arch may be incorporated (Inset B). the spring will project f r o m the mouth and is held down by a projection from a separate removable appliance (Inset A ) . w i t h d i f f i c u l t y .

by OrTHoTaMiNe

by OrTHoTaMiNe

R O T A T I O N OF A S I N G L E T O O T H , 2

A l t h o u g h the appliance shown on page 127 may be m o d i f i e d to suit r o t a t i o n of a premolar t o o t h , the appliance illustrated opposite offers more c o n t r o l as the labial arch is extended distally to an attachment on the molar clasp on one side. Such attachment may be made by welding straps of steel tape over b o t h arch and clasp or by soldering. In this appliance the end of the r o t a t i o n spring is formed i n t o a three-quarter collar a r o u n d the arch as s h o w n in Inset B. The thicker wire of the arch forms a protection f o r the more vulnerable r o t a t i o n spring (Inset A ) . At the completion of treatment by either appliance, cold c u r i n g acrylic resin may be added to the cut-away portion of the baseplate after removing the band and the appliance converted to a retainer.

Construction
Premolar band: Channel: Strap: Spring: Labial a r c h : Retention: Baseplate: 3.0 x 0 . 1 m m stainless steel tape OR 3.0 x 0 . 1 5 m m w h i t e gold tape 2.0 x 0.1 mm stainless steel tape OR 2.0 x 0 . 1 5 m m while gold tape 2.0 x 0.1 mm stainless steel tape 0 . 3 5 m m extra hard stainless steel wire 0 . 8 m m stainless steel wire Adams clasps on 6/6 Full palate, cut away around premolar t o o t h

128

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it has become possible simply to attach a spring to the labial or buccal aspect of a t o o t h (diagrams A and B). The spring may be attached w i t h carding wax to an adjacent t o o t h while the composite sets. 130 . Over-rotation To achieve good final alignment it is c o m m o n practice to over-rotate and to retain in the over-rotated position for six months. To avoid displacing the adjacent t o o t h it is necessary to bend a dog-leg in the spring as in diagrams 3 and 4.by OrTHoTaMiNe R O T A T I O N OF A S I N G L E T O O T H . Construction Spring: Composite: Baseplate. 3 With the development of acid-etch preparation of enamel prior t o b o n d i n g w i t h composite f i l l i n g materials. etc: 0 . 3 5 m m extra hard stainless steel wire A n y composite filling material suitable for acid-etch retention As on page 129.

by OrTHoTaMiNe .

relieved around 2/2 132 . Some ingenuity is required to k i n k the springs and the labial arch so as to f o l l o w the r o t a r y movement of the teeth (Inset). Such an appliance is illustrated and its purpose is to rotate the t w o lateral incisor teeth. such an appliance can be effective.7mm stainless steel wire Adams clasps on 6/6 F u l l palate.A C T I N G SPRINGS When t w o springs act in opposite directions on opposite corners of an incisor t o o t h the force produced is k n o w n as a 'couple'. 5 m m stainless steel wire (boxed-in) 0. provided that slight shortening of the lateral incisor is acceptable. Construction Springs: Labial arch: Retention: Baseplate: 0 . Nevertheless.by OrTHoTaMiNe R O T A T I O N B Y C O N T R A .

by OrTHoTaMiNe .

1 When it is necessary to retract the upper labial segment w i t h o u t exerting any f o r w a r d force on the cheek teeth.by OrTHoTaMiNe E X T R A O R A L FRACTION.25mm stainless steel wire Labial arch: 0. the appliance illustrated may he used. It differs only in its application f r o m that shown in plan view on page 137.9mm stainless steel wire Retention: Adams clasps on 6 4 / 4 6 134 . T h e extraoral 'whiskers' are attached either by strapping and soldering or by banding w i t h soft wire and soldering as shown in the Insets on page 137. taking care not to obstruct any distal movement of these teeth. Several forms of cervical traction can be constructed w i t h webbing and elastic but as ready-made neckbands and neckpads (such as Orthoband) are easily available a n d quite satisfactory it is this w h i c h has been illustrated Construction Extraoral arch: 1. Four clasps provide f i r m retention and a flexible U-loop labial arch is attached distal to the canines. The junction of the labial arch and the extraoral arch is the vulnerable point and it may be reinforced by sliding t u b i n g over the labial arch prior to bending.

by OrTHoTaMiNe .

25mm stainless steel wire 1.0 x 0. Construction C o f f i n spring: Extraoral wires: Labial arch: Retention: Baseplate: Attachment of extraoral arms: 1.1 mm stainless steel wire OR binding w i t h soft wire and soldering 136 . 2 Backward movement of all the upper teeth may now be readily accomplished w i t h removable appliances if the second molars have been e x t r a c t e d . This avoids moving the cheek teeth f o r w a r d again (see page 55).by OrTHoTaMiNe EXTRAORAL TRACTION.9mm stainless steel wire Adams clasps on 6 4 / 4 6 Two sections extending f r o m mesial of 3/3 to distal of 6/6 Strapping w i t h 2.25mm stainless steel wire 0. this applies also if 4/4 have been extracted and the space lost. Movement is in t w o phases. The cheek teeth are moved dislally in Phase I by opening the U-loops and Standing the arch 2 m m away f r o m the incisors. In Phase II (retraction of the labial segment) the labial arch is allowed to rest on the incisors but should not press until the elastic traction is applied. F i r m retention is required and a C o f f i n spring is used to increase upper arch w i d t h and so avoid development of a molar cross-bite.

by OrTHoTaMiNe .

The extraoral traction arch is inserted into molar tubes and stands clear of the incisors. tubing and extraoral arch sttapped and soldered 138 . as shown.7mm stainless steel wire 1.25mm stainless steel wire 1. The appliance illustrated carries a bite plane (Inset A) and palatal canine retractors (boxed-in) with guide wire (Inset B).6mm stainless steel wire 0.6mm stainless steel wire 0. 1 Forward movement of anchor teeth during retraction of anterior teeth may be anticipated and prevented by applying exlraoral traction at night to a removable appliance which is worn during the whole of the 24 hours. Construction Canine retractors: Canine guide wires: Anterior clasp: Adams clasps: Molar tubes: Labial arch: Extraoral arch: Anterior tubing: 0.25mm internal diameter 1.by OrTHoTaMiNe EXTRAORAL ANCHORAGE. It may be reinforced.5mm stainless steel wire 0. Additional retention is provided by Adams clasps on 1/1 (Inset C) (page 38) and modified Adams clasps on 65/56 (page 40).25mm stainless steel wire 1. by stainless steel tubing before attaching the traction wires.25mm internal diameter soft Labial arch.

by OrTHoTaMiNe .

Note: Normally the extraoral arms should lie in the same plane as the arch but have been bent clear in the illustrations to show details of construction.5mm stainless steel wire Labial arch: Molar tubes: Extraoral whisker: 140 . 6 m m sleeved.25mm internal diameter 1. Roberts retractor 0 . Retention is by Adams clasps on 6/6 w i t h auxiliary arrowheads on 5/5 but the alternative clasp illustrated on page 41 may be used. Construction Retention: Springs: Adams clasps on 6 5 / 5 6 Canine retractor 0 . 2 Class II division 1 treatment may need to be supported by extraoral t r a c t i o n .25mm stainless steel wire 1. The c o m m o n sequence of canine retraction w i t h buccal canine retractors (page 84) and incisor retraction w i t h a Roberts retractor (page 100) is illustrated opposite.by OrTHoTaMiNe EXTRAORAL ANCHORAGE. 5 m m sleeved 1.

by OrTHoTaMiNe .

3 The second stage of Class II division I treatment f o l l o w s in the same way as the canine retraction.5mm stainless steel wire 142 . A Roberts retractor is constructed as described on page 102 and a double Adams clasp made for 6 5 / 5 6 .by OrTHoTaMiNe EXTRAORAL ANCHORAGE.25mm internal diameter stainless steel Extraoral a r c h : 1. However. the bridges of the clasps may have to be contoured so that the buccal tube will accept the extraoral arch. at no time should this arch rest on the teeth: the t o o t h movement is produced by the Roberts retractor. During treatment the baseplate is cut away behind the incisors and it may be necessary to close the extraoral U-loops to bring the arch back and avoid d i s c o m f o r t to the lips.5mm stainless steel wire 0.5mm internal diameter soft tubing Molar tubes: 1.25mm stainless steel wire Extraoral whisker: 1. Some ingenuity is necessary to pass the tags of the retractor and the clasps between canines and first premolars. Tubes are attached to the clasps (page 140) and a labial arch w i t h U-loop stops inserted i n t o t h e m . Construction Retention: Retractor: Sleeve: Double Adams clasps on 6 5 / 5 6 0.

by OrTHoTaMiNe .

The Adams T-spring illustrated falls into the correct place as the appliance is inserted. its initial contact must be near the occlusal surface: it will slide gingivally as the tooth moves. Construction T-spring: 0. the spring usually coming to lie on the occlusal surface of the tooth. So that the T-piece will not slide into the gingiva as the tooth moves.5mm stainless steel Wire 144 .by OrTHoTaMiNe BUCCAL MOVEMENT Of PREMOLARS The disadvantage of simple fingersprings to move palatally placed upper premolars into the arch is that they are extremely difficult for the patient to insert. It is then boxed-in shallowly.

by OrTHoTaMiNe .

a h o o k made of stainless steel tape has been laboratory-welded to a piece of fine stainless steel gauze (BS N o . Diagram D shows the spring resting on the slot. The advent of acid-etch retained composite resins has reversed this situation. On the opposite page is illustrated a simpler technique i n w h i c h a f a i r l y t h i c k b l o b o f c o m p o s i t e . 146 . 1 Without access to bands and welders It has been impossible to exert vertical traction on teeth.by OrTHoTaMiNe INCISOR E L O N G A T I O N . 155) This is cemented to the tooth by the acid-etch technique. T w o methods are s h o w n : on the left. resin is attached to the t o o t h and then grooved by means of a number 1 or 2 fissure bur. This gives a very positive h o l d to the spring.

by OrTHoTaMiNe .

2 A simple removable appliance can be adapted to elongate incisors (or canines) which may have been delayed. by a supernumerary tooth. for example.5mm stainless steel Sleeve: 0. Construction Clasps: Adams on 6/6 Spring 0.by OrTHoTaMiNe INCISOR ELONGATION. A simple sleeved fingerspring is employed but it is important to note the position of the coil so that the arm will follow the tooth without slipping off. It is activated by flattening a section of the coil.5mm internal diameter soft stainless steel 148 .

by OrTHoTaMiNe .

but it is required in only a relatively small p r o p o r t i o n of cases. 1 This appliance consists essentially of an upper and lower baseplate u n i t e d together in such a manner as to h o l d the mandible f o r w a r d . lt is used mainly in the treatment of Class II division I malocclusions. Diagram A The C o f f i n spring. and t o o t h movement is produced by the pull of the muscles of mastication w h i c h t r y t o return the mandible t o its rest p o s i t i o n . This is shown in the large illustrations to show the placing of the extraoral 'whiskers'.by OrTHoTaMiNe T H E ANDRESEN APPLIANCE. I f required the backward pull of the mandible can he reinforced by extraoral t r a c t i o n . 150 .

by OrTHoTaMiNe Diagram B The appliance is shown here in plan view with a C o f f i n spring in position. The appliance overlies the palatal half of the occlusal surfaces of the cheek teeth. c . Diagram C The points of insertion of the labial arch and extraoral wires.

2 Diagram D The baseplate is cut away behind the upper incisors but should not be removed from the tips of the lower incisors. 152 .by OrTHoTaMiNe THE ANDRESEN APPLIANCE. Diagram E Removal of the acrylic material f r o m the occlusal surfaces will allow adjustment of the occlusal level of the cheek teeth.

when cutting away from the occlusal surfaces. causing them to move dislally.by OrTHoTaMiNe Diagram F Full extension of the acrylic resin between the teeth should be allowed. . causing them to move mesially. In the mouth these extensions will bear on the upper teeth as shown. Diagram G When the acrylic is cut away from the occlusal surfaces of the lower teeth the interdental extensions act as shown.

4 m m . Upper as shown in diagram A 1. w i t h o u t straining and open 2 . This is m o u n t e d on an articulator a n d the appliance waxed as s h o w n in diagrams B and C. The appliance is completed in the usual way.by OrTHoTaMiNe THE ANDRESEN APPLIANCE. rising to clear the gingiva and contact o n l y the teeth in the lower incisor region.25mm C o f f i n spring: Labial a r c h : Extraoral wires: 154 . 3 Construct'on A b i t e is taken in the protrusive position. Materials Baseplate: Deeply extended and thickened in lower molar region. 8 m m 1. After t r i m m i n g the models very closely they are flasked together as shown in diagram H. 8 m m sleeved or 1.0mm anodically t h i n n e d to 0 .25mm 0 . The reverse half forms a plug in the palate and a raised bite is impossible.

by OrTHoTaMiNe .

so that these prolrude very slightly through the wax. therefore.by OrTHoTaMiNe THE ORAL SCREEN The oral screen is an active orthodontic appliance worn during sleep and transferring the pressure of the circumoral soft tissues to the upper incisor teeth. It is necessary. After applying a separating medium a double thickness of wax is adapted over the entire area and trimmed away from all mucous folds. A second sheet of wax is applied over the whole area and then scraped away over the tips of the prominent incisors. Wax is added to the areas shown. This is then removed and converted to clear acrylic resin. filling in anteriorly to the lower incisors and into the other hollows indicated. A sheet of baseplate wax is applied to the whole area except the most prominent upper incisors. 156 . 3. to raise the screen away from the dentoalveolar structures except those teeth to he moved. 1. 4. It should extend distally no further back than the middle of the upper first molars. 2. This is known as waxing out and is carried out as follows.

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