❞ كتاب Removable Orthodontic Appliances ❝ ⏤ K Vijayalakshmi

التعويضات السنية Prosthodontics وتشمل
الجسور الثابتة Fixed bridges والزرعات Implants
الطقوم الكاملة المتحركة removable complete denture
الطقوم الجزئية المتحركة removable partial denture
معالجة و إصلاح الأسنان Operative Dentistry وتشمل:
تشخيص تسوس الأسنان caries diagnosis
الوقايه والحد من انتشار تسوس الاسنان management of dental caries
تبييض الأسنان Dentalbleaching
تجميل الأسنان cosmetic dentistry
حشوات الأسنان Dental Fillings
معالجة لب الأسنان Endodontics
معالجة الأسنان المجهرية microscopic endodontics
طب الأسنان الوقائي Preventive Dentistry
تقويم الأسنان Orthodontics
جراحة الفم والوجه والفكين Oral and Maxillofacial Surgery
طب أسنان الأطفال Pedodontics
أمراض اللثة
أمراض الأنسجة المحيطة بالأسنان Periodontics
زراعة الأسنان Dental Implantology
أشعة الأسنان Dental Radiology
طب الأسنان الشرعي Forensic Dentistry
طب الفم Oral Medicine
أمراض الفم Oral Pathology
أنسجة الفم والأسنان Oral Histology
المادة السنية Dental material
تشريح الأسنانDental anatomy
مواضيع متعلقة بطب الأسنان
طب الأسنان للرضع
جراحة الأسنان
أسنان
طقم أسنان
طب الاسنان في الاردن
طب الأسنان في جميع أنحاء العالم

e
Orthodontic
Appliances

Dedicated to
My parents SR Kuppuswamy and
K Krishnaveny
My husband G Ravindran
My children Arun Jai Kumar and
Pradeep Kumar

PREFACE
Removable appliances are fabricated in the laboratory rather than
directly in the patient’s mouth, reducing the dentist chair time and
they can be made almost invisible if fabricated from clear plastic
materials. This makes them more acceptable to especially adult
patients. These advantages for both the patient and the dentist have
ensured a continuing interest in removable appliance. With a few
limitations, removable appliances are most useful for the first 2
phases of treatment and contemporary comprehensive treatment is
dominated by fixed appliance. However, removable appliances
remain to stay as retention appliance.
Major part of malocclusion need either removable appliances or
with combination of semi-fixed removable appliance. Moreover,
the most of simple removable appliances are delivered by general
clinicians than orthodontic specialists. One, who is handling with
an understanding of how appliances function, is able to rationally
design, select and use orthodontic appliances in an efficient manner
for the patient.
In view of this, I present this book useful for the undergraduates
and clinicians in designing and construction of the removable
appliances. I have listed the various designs and modifications of
components of appliances.
K Vijayalakshmi

CONTENTS
1. Introduction ............................................................................. 1
2. Labial Wire .............................................................................. 7
3. Clasp ....................................................................................... 23
4. Springs ................................................................................... 47
5. Bite Planes ............................................................................. 65
6. Expansion Appliance ........................................................... 73
7. Clinical Adjustments ........................................................... 87
Index ........................................................................................ 93

1. Removable Orthodontic Appliances For Tooth Movement Dr. Zuhair Murshid, BDS., Ortho. Cert. M.Phil. Consultant and Assistant Professor of Orthodontics E-Mail: [email protected]
2. Terminology • Removable appliance An appliance that is not fixed to teeth, but can be removed by the patient.
3. History and Development • Victor Hugo Jackson (early 20th century) Vulcanite bases &precious metals • Crozat used precious metal (gold) for expansion appliance
4. Classification Of ROA • Active (produce tooth movement/growth modification) Mechanical appliances Functional appliances (FA s.) • Passive Retainers Space maintainers
5. Tooth movement with removable appliances • Tooth movement with removable appliances almost always falls into one of the following categories: • 1- Increase arch perimeter (arch expansion). • 2- Repositioning of individual teeth within the arch. • 3- Intrusion or Extrusion of teeth.
6. Active Plates for Arch Expansion -Anterior Expansion of maxillary incisors. -Transverse Expansion of the Arches. -Simultaneous Anterior and posterior Expansion
7. Active Plate for Arch Expansion Active plate are most useful when a few millimeters of space are needed (1.5-2 mm side). The active element of expansion plate is a jackscrew placed so that it holds the parts of the plate together. The screw produces a heavy force that decays rapidly. Most screws open 1 mm per complete revolution, so single quarter turn produces 0.25 mm of tooth movement.
8. We should not exceed 1 mm per month i.e. one ¼ turn/week and not more than two ¼ ¼ per week and it should be activated while the appliance is worn (inside the mouth)
9. Anterior expansion of maxillary incisors. The simplest uses of an active plate is to correct a maxillary anterior crossbite. Posterior biteplane is necessary in adult to allow clearance for the upper incisor to move out of crossbite (½ crown or more is covered).
10. Transverse Expansion of the Arches Active plate split in midline will expand constricted maxillary arch almost totally by tipping the posterior teeth buccally Not by opening mid-platal suture. Therefore this appliance is not indicated for skeletal crossbites or dental expansion for more than 2 mm per side.
11. Simultaneous Anterior and posterior Expansion. By dividing the maxillary appliance baseplate into 3 segments. This design was the basis of Schwartz’s original Y plate used to expand the maxillary posterior teeth laterally and the incisors anteriorly. Careful and slow activation can be quite effective in arch expansion. More than two teeth should be moved by this appliance, for a single tooth spring should be used instead.
12. - Removable Appliances with springs for positioning individual teeth. - Spring design for individual teeth. - Clasps: Adams Clasp, Circumferential Clasp, Lingual Extension Clasp - Clinical Adjustment - Combined functional and Active plate Treatment
13. Removable Appliance with Springs for Positioning Individual Teeth Originally, the removable appliances with springs were used to bring about tipping movement anteriorly, labial bow for more than 3-4 mm of flared incisors, but root control is needed (Hawley 1920 used the classical type).
14. spring designs for individual teeth The design of the spring to move the tooth in MD or labio or bucco-lingual, we have to keep in mind two important principles:1) Adequate springiness acceptable strength. and 2)The spring must be guided to direction. range and appropriate
15. The major problem with long flexible spring is that spring can deflect 3-D. The deflection can be overcome in three ways:1) By placing the spring in an undercut area of a tooth. 2) By using a guide which is either a rigid wire or a shelf of baseplate material extended over the top of the spring to prevent its displacement. 3) By bonding an attachment to tooth surface to provide a point of positive attachment for the spring (Bond stop or ledge toward the incisal edge into which the spring can fit securely)
16. Retention of the removable appliance Retention is the means whereby displacement of an appliance is resisted In order to retain the removable appliance in place clasps has to provide that to insure good clinical performance of the appliance. Different type of clasps are available, but the most useful are Adam’s clasp, Circumferential clasp, Ball clasp and lingual extension clasp.
17. Components Of Removable Applaince •Active Components • Retentive Components • Acrylic Base Plate • Anchorage
18. Component of Removable Appliances • Active component – Spring, screw, elastics,…. • Retentive components – Clasps (Adam’s, C-clasp, Ball clasp, Lingual extension clasp) • Acrylic base plate
19. Active component • Screws – Uni-dimensional screws – Bi-dimensional screws • Wire springs – – – – Finger spring Z-spring Canine retractor Short labial arch
20. Active components • Screws – Expansion is 1 mm. per one full turn i.e. 0.25 mm. per quarter turn – May be used for moving one tooth or group of teeth (usually more than one tooth to be moved with a screw) – Have different sizes and range of activation – Useful only when a few millimeters of space is needed – Usually jackscrews been used as active component – Clasps for retention
21. Active components • Expansion screws – For anterior Expn. of Max. incisors – For simultaneous Expn. of maxillary incisors anteriorly and posteriors laterally (Y-plate). – Y-plate can be modified for Tx. Of unilateral x-bite – Maxillary split plate (By post. teeth tipping not by opening mid-palatal suture).
22. Active plate • The simplest uses of an active plate is to correct a maxillary anterior crossbite. • Posterior biteplane is necessary in adult to allow clearance for the upper incisor to move out of crossbite (½ crown or more is covered).
23. Active plate • Active plate split in midline will expand constricted maxillary arch almost totally by tipping the posterior teeth buccally Not by opening mid-palatal suture. Therefore this appliance is not indicated for skeletal crossbites or dental expansion for more than 2 mm per side.
24. Active components • Springs – Provide extra length of wire to increase range of action and resiliency – Extra length can be provided in the form of coil (s), loop (s) or change configuration to provide extra length of the wire
25. Active component • Wire springs – Spring design • Recommended wire is St. St. round wire (0.5mm) in diameter • The design must ensure adequate springiness and range while keeping acceptable strength • The spring must be guided so that its action is exerted only in the appropriate direction by: – Place the spring in an undercut of the tooth so that it does not slip occlusally during activation – Use a guide to hold the spring in its position during activation – Bond an attachment to the tooth surface to engage the spring
26. Active component • Short labial arch – Constructed from 0.030 inch (0.7 OR 0.8) round St. St. wire – It must contact the middle 1/3 of the labial surface of the teeth 21|12 – Loops should be ½ width of the canine, should extend slightly above the gingival margin – Wire must be closely adapted where it cross the occlusal surface – Palatal retentive arms must be adapted to the contour of the palate.

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