ORTHODONTIC

TECHNOLOGY II
(DNT 506)
DENTAL TECHNOLOGY

LECTURE MATERIAL

COMPILED BY
COURSE LECTURE
 ORTHODONTICS TECHNOLOGY II

SCREWS:

Screws are active component that can be incorporated in a removable appliance.

Screw can be activated by the patient at regular intervals using a key. Removable

appliances having a screw usually consist of split acrylic plate and Adams clasps

on the posterior teeth. The screw is placed connecting the split acrylic plate.

They are active components that are used to provide intermittent forces in

removable appliances. Screws can be used to bring about various kinds of tooth

movements. Screw consists of a rod with left and right threads at both ends and a

nut in the center, which is turned for activation, the threads turn in metal blocks

that are embedded in the baseplate, which is split at right angles to the screw. The

appliance is retained with adam‟s clasps on posterior teeth. When the screw is
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turned, the two parts of the baseplate separate and apply pressure on the teeth. This

causes the teeth to be displaced slightly and overtime the teeth move to new

positions by remodeling of the overlying bone.

Wide variety of tooth movement is possible with the screws based on the location

of the screw, number of screws and location of the split in the plate. Removable

orthodontic appliances have been grouped or divided under (a) activators or

functional appliances which modify growth (b) active plate‟s use in moving teeth.

The frame work of active plates is a baseplate made of acrylic resin. It is also

serves as a base to which both clasps, springs, screws are attached. The baseplate is

also used to control anchorage by preventing the unwanted movement of some

teeth. When screws are embedded in a baseplate, the baseplate becomes an active

part of the appliance.

Uses of screws

1. For anterior expansion of maxillary incisors: One of the simplest uses of screw

expansion is to correct maxillary anterior crossbite. When there is room to

accommodate the teeth in their appropriate position within the arch. In this

circumstance, the baseplate is usually brought up over the occlusal surface of

the teeth, creating a posterior bite plane that separate the teeth vertically and

allows clearance for upper incisors to move out of crossbite. The bite plane

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 must be supported by the teeth, not underlying soft tissues. Retention for this

type of plate can be obtained by allowing acrylic material to flow slightly into

buccal and lingual undercuts. Alternatively and more typically, clasps are

incorporated, which extends into buccal undercuts of posterior teeth. A labial

bow behind the incisors completes the appliance.

2. Transverse expansion of the arches: this is another common case in which arch

expansion (screw) can be used. Constricted maxillary arch with a tendency

towards cross-bite requires an arch expansion plate. The split arch expansion

appliance will expand the arch by tipping the posterior teeth buccally, not by

opening the midpalatal suture and widening the maxilla itself. For this reason,

removable plates are not indicated for skeletal crossbites or for dental expansion

of more than 4 to 5mm. retention is obtained by engaging mesio-buccal and

mesiolingual undercuts of the maxillary posterior teeth.

Active component is the screw placed in the midline so that it holds the two part

of the plate together. Activating the screw with a key separates the two halves

of the plate widening the arch and tipping the teeth buccally.

Advantages:

 The amount of movement is controlled.

 The baseplate remains rigid despite being cut into two.

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Disadvantages

 Rather than providing a light but continuous force, activation of the screw

produces a heavy force that decays rapidly.

3. Simultaneous anterior and posterior expansion: this type of expansion appliance

has a baseplate that is divided into three segments rather than two. This design

is based on schwartz‟s original Y-plate which is used to simultaneously expand

the maxillary posterior teeth laterally and the incisors anteriorly. If the plate is

activated slowly and carefully, it can be quite effective in arch expansion in

children. A variant of the Y-plate divided the plate into two sections, one large

and one small section. This approach is not recommended because too much

force is produced by activation if it is concentrated against a single tooth and

the practical limit for the number of teeth in a small segment is two or three.

Indication:

 Correction of unilateral crossbites

 Correction of V- shaped arches as in thumb suckers

 Preparation for bone graft in cleft cases

 Minimal crowding in the upper arch (1-2mm)

 Elimination of a displacement.

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 Contra-indication:

 Arch expansion of more than 4-5mm

 Skeletal crossbites

 Intra arch movement

 Bodily movement of the teeth.

PRINCIPLES OF SCREW EXPANSION

Screw usually comes with a key which is used in activation of the expansion

appliance. The two ends of the screw are embedded in the baseplate leaving the

center where the nut is positioned exposed (not embedded in the baseplate). It is

into this nut that the key is slotted after construction. When the screw is turned

with the key, the two halves of the baseplate separate and apply pressure on the

teeth engaged.

Each turning/activation produces heavy intermittent forces which are acceptable

for tooth movement provided adequate time is allowed for remodeling and repair

after activation. Heavy force and damage could result from activating the screw too

rapidly.

In bilateral expansion of the maxillary arch, however, the force from the screw is

distributed over a number of teeth, thereby reducing the amount of forces felt by

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individual tooth. And even with the best clasps, if the force level becomes too high,

the appliance will be displaced before any damage is done (this is one of the

disadvantages of screw appliance).

Most screws open 1mm per complete revolution, so that a single quarter turn

produces 0.25mm of tooth movement. The rate of active tooth movement should

not exceed 1mm per mouth. A screw used for expansion of the maxillary arch

should not under any circumstances, be activated more than twice a week, a rate

which produces 1mm per mouth bilaterally. It is usually preferable to place the

appliance in the mouth, turn the screw with the appliance held firmly in position

and not activated outside the mouth, or remove it for several hours after activation.

If it is desired to expand the maxillary arch more anteriorly that posteriorly, a wire

can be placed holding the posterior parts of the split plate together, the screw itself

allows a certain amount of twisting and up to 4mm of opening anteriorly can be

achieved with an ordinary screw in a plate that is wired posteriorly.

Advantages of screws over springs

1. Can be managed easily by less skillful patient

2. Screws are activated by the patient at regular interval using a key, therefore

screw appliances are more valuable for patients who cannot visit the Dentist

frequently.

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 3. Less displacement tendencies

4. Controlled forces based on the amount of activation done.

SPRINGS

Springs are the active component of removable orthodontic appliance that is used

to effect various tooth movements.

Classification of springs:

1. Based on the presence or absence of helix: they can be classified as: (a.) simple-

without helix and (b.) compound with helix.

2. Based on the presence of loop or helix; they can be classified as (a.) helical

spring – have helix and (b.) looped springs – have a loop.

3. Based on the nature of stability of the springs they can be classified as: (a.) self-

supported spring = made of thicker gauge wire, can support themselves. (b.)

supported springs = made of thinner gauge wire and thus lack adequate

stability, springs are encased in metallic tube to give adequate support.

Ideal requisites of spring

(a.) The spring should be simple to fabricate

(b.) It should be easily adjustable

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(c.) It should fit into the available space without discomfort to the patient.

(d.) It should be easy to clean

(e.) It should apply force of required magnitude and direction

(f.) It should not slip or dislodge when placed over a sloping tooth surface.

(g.) It should be roust

(h.) It should remain active over a long period of time.

Factors to be considered in designing a spring:

1. Diameter of wire: flexibility of the spring to a large extent depends upon

diameter of wire, F = D4/L3, where; F = force applied by spring, D = Diameter

of wire and L = Length of wire.

2. Length of wire: force can be decreased by increasing the length of wire. Thus

springs are longer are more flexible and remains active for long duration of

time. By doubling the length of wire force can be reduced by eight times.

3. Patient comfort: springs should be comfortable to patient in design, shape, size

or force generation. The patient should be able to insert the appliance with

spring in proper position.

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4. Direction of tooth movement: the direction of tooth movement is determined by

the point of contact between the spring and tooth. Palatally placed spring is

used for labial and mesio-distal tooth movement. Buccally placed spring is used

when the tooth is to be moved palatally and in a mesio-distal distal direction.

Finger spring: is also called single cantilever spring as one end is fixed in acrylic

and the other end is free. It is constructed using 0.6mm wire. It consists of active

arm of 12 – 15mm length, helix of 3mm internal diameter and retentive arm of 4 –

5mm length. It is used for mesio-distal tooth movement when teeth are located

correctly in bucco lingual direction. It is activated by moving active arm toward

the teeth intended to be moved.

Cranked single cantilever spring: It is constructed with 0.5mm. The spring

consists of coil, close to its emergence from base plate. The spring is cranked to

keep it clear of the other teeth. It is used to move teeth labially.

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Z spring: the „Z‟ spring is also called double cantilever spring. It is made up of

0.5mm wire. The springs consist of two coil of very small internal diameter. It

should be placed perpendicular to palatal surface of tooth. The spring can be made

for movement of single incisor or two incisor. It is activated by opening helices by

2-3mm at a time.

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T SPRING: it is made of 0.5mm wire. The spring consist of T shaped arm whose

arm are embedded in acrylic. It is used for buccal movement of premolar and some

canine. It is activated by pulling the free end of the T towards the intended

direction of tooth movement.

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COFFIN SPRING: It is made of 1.2mm wire. It consists of a U or omega shaped

wire placed in the mid-palatal region with retentive arm incorporated in base

plates. It is retended by Adams clasp in molar. It is used in slow dento-alveolar

arch expansion in patient with upper arch constriction or in unilateral crossbite.

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ORAL SCREEN

It is a functional appliance fitted in the vestibule which shuts off the ingress of air

through the mouth and directs the contraction of lips against any anterior teeth in

labioversion/protrusion. It can also be said to be a removable appliance placed in

the anterior vestibular region to improve lip position and reduce the overjet. In

patients with a persistent tongue thrust or tongue interposition habit, it can be used

in conjunction with a tongue crib.

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It is an all acrylic appliance which passive in itself and capable of producing tooth

movement. It is inserted between the lips and the teeth and worn during sleep and

hours of relaxation. At insertion and during wear, the muscles of the lips and

cheeks are stretched and apply gentle pressure on the appliance, which is

transmitted to the teeth hence retracting protruded anterior teeth.

The amount of pressure is determined by the thickness of the chin (spacer) which

is preferably two sheets of modeling wax and by the thickness (two sheets of

modeling wax) of the screen overlaying the shin. Oral screen is made in clear

acrylic resin to enable the dentist detect unwanted points of contacts. The clarity of

the resin is affected by moisture which can be from;

 Wet mixing vessel – use dry mixing vessel

 Wet cellophane – use tinfoil.

 Plaster mould – use tinfoil or allow the mould to dry overnight.

Function of oral screen

1. Prevent mouth breathing

2. Corrects protruded maxillary anterior bite.

3. Corrects thumb sucking

4. Use in strengthening lip action and retrain the lips

5. Can be used as retainer on completion of orthodontic treatment.

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Procedure

1. Articulate the models (upper and lower) in usual relationship.

2. Block out deep tissue undercuts if present

3. Adapt a sheet of modeling wax which should extend beyond the first molars

and completely into the sulci.

4. Cut out a window of wax around the incisal halves of the protrusive teeth.

5. Adapt another sheets of modeling wax over the first wax spacer, using a hot

wax knife, uncover the incisal halves of the protrusive teeth

6. Smooth the surface thoroughly because the smoothness of the shim determines

the smoothness of the inside of the screen.

7. Dust the shim liberally with French chalk and apply a two sheet of modeling

wax.

8. Trim around the sulci and relief the muscles of attachment, wax should expand

to the distal of the first molar.

9. The screen must not coverage at the ends.

10.The screen should have very slight depression on the inside showing where the

protrude teeth touch.

11.Remove the screen wax pattern and flask with the ends upwards in the deeper

position of the flask.

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MYOFUNCTIONAL APPLIANCE

These are appliance that utilizes force generated by the orofacial soft tissue in

order to move teeth. They can also be defined as appliances that produce parts or

all their effect by altering the position of the mandible. The purpose of

myofunctional appliance is to modify the pattern of jaw growth by posturing the

mandible away from the rest position with forces generated by resultant soft tissues

stretch, hence modifying facial growth. They are also constructed to utilize forces

generated by orofacial soft tissue to move the teeth.

Functional appliance is normally used at the beginning of growth spurt (girls-10-

12yrs, boys-12-14yrs).

Growth affects the relationship between the mandible and maxilla in three spatial

planes; anteroposteriorly, vertically and transversely. This three-dimensional jaw

relationship is normally affected by growth at;

Base of the skull: the cartilaginuous synchondroses between the bones of the skull

base act as primary growth centres. This includes in the frontoethmoidal,

sphenoethmoidal, spheno-occipital and the basioccipital synchondroses. The

sphenoethmoidal fused by 6yrs and spheno-occipital synchondroses fused by

14yrs. As a result of the growth at these sites, the glenoid fossa and the mandible

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will move backwards with respect to the maxilla. This will affect both

anteroposterior and vertical relationships of the jaws.

Mode of action

Skeletal changes – can be considered in two dimensions. They are:

(a) Additional overall growth of the mandible

(b) Accelerated growth of the mandible, but not necessarily additional growth.

(c) Change in the direction of growth of the mandible.

(d) Change in the position of the mandibular condyle and glenoid fossa.

(e) Restricted growth of the maxilla

Dentoalveolar change –

(a) Retraction of the upper incisors

(b) Proclination of lower incisors

(c) Overbite reduction by reducing lower incisor eruption while permitting buccal

segment tooth eruption.

(d) Mesial movement of the lower buccal segment teeth, occurs because they move

mesially as they continue to erupt

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(e) Distal movement of the upper buccal segment teeth – in combination with

lower buccal segment teeth, the molar relationship can be altered to class I

(f) Expansion of the upper arch.

Soft tissue changes – the possible mode of action of functional appliance is the

long term effect on soft tissues. Example is functional regulator appliance

devices by frankel which combines with lip exercise are said to alter the

position of the lips and cheeks. If these soft tissues are encouraged to be in the

correct position and function normally, it would follow that the teeth will then

move to their correct positions under the influence of soft tissues.

Classification

 According to their components parts

 Whether they are tooth-borne or tissue-borne

 According to malocclusion

 Degree of soft tissue stretch induced when in place.

Generally functional appliances are classified into:

 Myotonic – elastic recoil which stretch soft tissues generates forces tht move

teeth, eg: harvold appliance.

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 Myodynamic – the stimulation of masticatory muscles generates the forces that

move teeth, eg: bionator, twin block.

ANCHORAGE

When force is applied, it produces equal and opposite reactive force. For tooth

movement to occur in the desired direction, the reactive force should be equal or

greater than the applied force. The areas or units that provide the reactive force

thereby preventing undesirable tooth movement are called anchorage units.

Anchorage is therefore the nature and degree of resistance to displacement offered

by an anatomical unit when used for the purpose of affecting tooth movement.

Although, Graber defined anchorage in orthodontics as the nature and degree of

resistance to displacement offered by an anatomic unit for the purpose of effecting

tooth movement. While, White & Gardener defined Anchorage as the site of

delivery from which a force is exerted.”

Types of Anchorage

 Simple anchorage: this is the type of orthodontic anchorage in which larger

teeth or groups of teeth and their locations are used to move teeth of lesser

size.

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  Stationary anchorage: orthodontic anchorage in which the resistance to the

movement of one or more dental units comes from the resistance to bodily

movement of the anchorage unit.

 Reciprocal anchorage: anchorage in which the movement of one or more

dental units is balanced against the movement of one or more opposing

dental units.

 Intra-oral anchorage: anchorage with all resistance units located within the

oral cavity.

 Extra-oral anchorage: orthodontic anchorage in which the resistance unit

is outside the oral cavity such as in cranial occipital(headgear)

 Intermaxillary anchorage: anchorage in which the resistance units situated

in one jaw are used to effect tooth movement in the other jaw. Also called

maxilla-mandibullar arch.

 Multiple or reinforced anchorage: anchorage in which more than one type

of resistance is used.

 Intramaxillary anchorage – Inter-maxillary anchorage is the anchorage in

which the units situated in one jaw are used to affect tooth movement in the

other jaw.

Biomechanics is the study of the effect of force on a body.

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Force can be defined as an act upon a body that changes or tends to change the

state of rest or motion of that body.

Types of tooth movements

(a) Translation – occurs when all points on the tooth move on equal distance in the

direction. Translation occurs when the line of action of an applied force passes

through the centre of resistance of a tooth. This can be seen in extrusion,

intrusion, retraction or protraction of teeth.

(b) Rotation – this takes place when there is movement of points of a tooth along

the arc of circle, with the centre of resistance being the centre of the circle.

Types of rotational movement

 Transverse rotation – the angulation of the long axis of a tooth changes eg:

crown tipping or root torguing

 Long axis rotation – rotation takes place on the long axis of the tooth.

Angulation of the long axis of the tooth remains unaltered. When the line of

action of a force applied do not pass through the centre of resistance, the force

will produce some rotation or tipping depending on the point of application of

the force.

Movement is the measurement of the potential for rotation denoted by;

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 M = F x d: M = Movement, F = magnitude of force, d = perpendicular

distance of the point of application of force from the centre of resistance.

(c) Combined translation and rotation – a couple is two forces of equal magnitude

but opposite in direction with parallel but non-co linear lines of action.

Centre of rotation is the point around which rotation actually occurs when an

object is being moved or rotated.

Types of forces

 Continuous force – this occurs when the magnitude of force does not decrease

appreciably over time. Light continuous force produces the most efficient tooth

movement causing mainly frontal resorption. Eg; fixed ortho-appliance.

 Intermittent force – the magnitude of force declines intermittently when

appliance is removed by the patient or clinician. Intermittent forces are

produced by removable ortho-appliance such as appliance incorporating

screws, labial bow or springs.

 Interrupted forces – the force of the appliance declined to zero magnitude

between activation of the force system. There is genuine time lag between

reactivation of the force system. The initial magnitude of force of the appliance

are high but decrease overtime to zero, giving time of the tissue to recover

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 before force system is reactivated. Examples of appliance exerting interrupting

forces include headgear or force mask.

Source of anchorage

(1) Intraoral – alveolar bone, teeth, basal bone and musculature.

 Alveolar bone: provides good resistance otherwise unwanted movement

can occur by bone remodeling.

 Teeth: the amount of resistance obtained from the teeth depends on the

root form, size of the roots number of root, position of teeth, the axial

inclination of the teeth, their intercupation.

 Basal bone: The areas include the hard palate and the lingual surfaces of

the mandible in the region of the roots of basal bones are available

intra-orally as source of anchorage.

 Musculature: Muscle causes flaring and spacing of teeth. Hypertonic

muscles cause collapse of the teeth lingually.

(2) Extra oral - Certain extra oral areas can also be used when adequate resistance

cannot be obtained from intra oral sources for the purpose of anchorage. The

extra oral sources of anchorage include: the cranium, the back of the neck and

the facial bones.

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  Cranium (occipital / parietal anchorage): Using head gears that derive

anchorage from the occipital or parietal region of the cranium. These

devices are used along with a face bow to restrict maxillary growth or to

move the dentition or maxillary bone distally.

 Back of the neck (cervical anchorage): Extra oral anchorage can

alternatively be obtained from the neck or cervical region. Such a type of

head gear is called cervical head gear.

 Facial bones: The frontal bone and the mandibles symphysis offer

anchorage during face mask therapy in order to protract the maxilla. A

maxillary head gear that makes use of anchorage from the forehead and

chin are called reverse headgears.

Planning for anchorage

Planning for anchorage of orthodontic appliance is subject to some factors in the

mouth. These factors include;

(a) The member of teeth to be moved – the greater the number of teeth being

moved, the greater the anchorage required to resist the greater the displacement

force. Moving teeth in segments such as retracting canine separately rather than

retracting the complete anterior teeth together, will decrease the load/force on

the anchored teeth.

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(b) The type of teeth to be moved – teeth with large flat roots and/or more than one

root exert more loads on the anchored teeth. Therefore it is more difficult to

move a canine when compared to incisor, or a molar as compared to a premolar.

(c) Type of tooth movement – bodily movement of teeth required more

force/anchorage than tipping the same teeth.

(d) Periodontal condition – teeth decreased or compromised bone supports are

easier to move than healthy teeth attached to strong periodontium.

(e) Duration of tooth movement – prolonged treatment time places more strain or

load on the anchored teeth. Short-term treatment might bring about neglible

amount of change in the anchor teeth while the anchored teeth may not

withstand the load if the treatment is prolonged.

Causes of loss of anchorage:

1. Not wearing the appliance adequate

2. Too much activation of springs or active components

3. Presence of acrylic or any obstruction on the path of tooth movement

4. Poor retention of appliance.

5. Anterior bite plane: as this withdraws the occusal interlock,

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6. Anchor root area, not sufficiently greater, then the root area of tooth or teeth to

be used.

7. If appliance encourage tipping movement of anchor teeth and bodily movement

of the teeth to be moved.

Means to detect anchorage loss

1. Position of another teeth, in relation to the teeth in the same and opposite arch.

2. Increase in overjet.

3. Fit of the appliance in the mouth.

4. Measurements of the distance of anchor teeth from midline.

5. Measurements from palatal rugae and frenum.

6. Observation of the spacing mesial/distal to the anchor teeth.

7. Inclination of the anchor teeth.

8. Radiological examination.

Means to increase anchorage value:

1. Intermaxillary traction.

2. Inclined anterior bite plane.

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3. Extra oral traction – occipital, occipital-cervical or cervical.

4. Toe in & “Tip back” bends [Anchor bends for posterior anchorage] and

“Apical torque” [for anterior anchorage] on arch wire so that anchor teeth can only

move bodily.

5. Banding or using good number of teeth for anchorage or moving small number

of tooth at a time.

6. Use of palatal and lingual arches.

7. Use of vertical springs on anchor teeth to encourage bodily movement only.

Anchorage loss and signs

Anchorage loss is the movement of the reaction u nit or the anchor unit instead of

the teeth to be moved.

Signs:

1. Mesial movement of molars.

2. Closure of extraction space by movement of posterior teeth.

3. Proclination of anterior teeth.

4. Spacing of teeth.

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5. Increase in overjet.

6. Change in molar relations.

7. Buccal cross bite of upper posteriors

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