Removable orthodontic
appliances
Assistant Professor
Moh’d R.Jaradat
BDS,MSc ( ortho ),Jord board ( ortho),Pal Board (Ortho)
[email protected]
Removable orthodontic appliance
Tipping movement
Simplest form of tooth movement
Produced when orthodontic force is applied
on the crown of the tooth which rotates
around its centre of resistance
Centre of resistance:
Centroid at 40 % from apex for single rooted teeth
At trifurcation of 1st permanent molar
Tipping movement
force
Definition
• Defined as the orthodontic appliances which
can be inserted into and removed from the
mouth by the patient.
:Removable appliances are three types
1. Passive appliances: These appliances remain passive in the mouth
and exert no active pressure. Example as Retention appliances
2. Mechanical appliances: These appliances carry some active
components which are activated to exert active forces.
3. Growth modification appliances: designed to modify
mandibular and maxillary growth.
Passive removable appliances
Hawley retainer
Mechanical appliance
Growth modification appliances
• functional appliance by definition is one that
changes the posture of the mandible, holding
it open or open and forward.
• Pressures created by stretch of the muscles
and soft tissues are transmitted to the dental
and skeletal structures, moving teeth and
modifying growth.
Advantages of Removable Appliances
1. The removable nature of the appliance,
allows the patient to maintain more oral
hygiene.
2. Easy fabrication in the laboratory.
3. Takes less chair side time.
4. Cost-effective.
Disadvantages of Removable Appliances
1. Success depends on patient compliance.
2. Treats minor cases of malocclusion.
3. Capable of tipping the teeth only
4. Moves only few teeth at a time.
5. Lower removable appliances are not well
tolerated.
Components
1. Active components
2. Retention components.
3. Anchorage
4. Base plate
Example on removable ortho appliance
Retention components
Retention Components -1
• These are the components that keep the
appliance in its place restricting its
displacement.
• Usually achieved by engaging the wires
( clasps) into the tooth undercuts.
C-Clasp
South end clasp
Requirement of ideal clasp
1. Should offer good retention
2. Shouldn’t impinge on soft tissues
3. Shouldn’t apply active force on the teeth
4. Shouldn’t interfere with normal occlusion
5. Should allow usage on fully and partially
erupted teeth.
Adams clasp
• Was first described by professor phillip Adams
• are constructed from 0.7-mm stainless steel
wire
• most commonly used on the first molars,
although they can be used on premolars and
anterior teeth.
It is made up of three parts:
1. Two arrowheads
2. Bridge
3. Two retentive arms.
• The arrowheads of the clasp engage undercuts at the mesial
and distal corners of the buccal tooth surface and can easily
be adjusted at the chairside to increase retention.
• The bridge of an Adams clasp can also be used by the patient
to remove the appliance from the mouth.
Advantages
• Rigid and offers excellent retention
• Can be fabricated on primary and permanent
teeth
• Can be fabricated on molars, premolars and
on incisors
• Modifications are available
Circumferential clasp
• Also known as three quarter or C-clasp
• Made from 0.7 mm s.s wire
• Designed to engage bucco-cervical undercut
Disadvantages
• Not used on semi-erupted teeth
• May cause gingival irritation
• There is a risk of decalcification on the cervical
margin of the crown buccaly
Southend clasp
• constructed in 0.7-mm stainless steel wire
• it is used for retention on the incisor teeth
• This clasp is activated by bending the U-loop
towards the baseplate, which carries the clasp
back into the labial undercut of the tooth.
Ball end clasp
• Ball-ended clasps engage into interproximal
undercuts between the teeth and are
activated by bending the ball towards the
contact point.
Active Components -2
This part of removable orthodontic appliance
which brings about the actual tooth
movement.
1. Bows
2. Springs
3. Screws
A- Bows
• Bows are active components that are mostly
used for incisor retraction.
Short Labial Bow
• Constructed using 0.7 mm round stainless steel wire
• Consists of bow that makes contact with the most
prominent labial teeth and two U loops that ends as
retentive arms distal to the canine
uses
• Retraction of incisors
• Closure of anterior spacing
Robert’s Retractor
Robert’s Retractor
This is a labial bow made from thin guage S.S
wire having a coil of 3 mm internal diameter
mesial to the canine
Used for incisor retraction and overjet reduction
B- Springs
• These are the active component of removable
orthodontic appliance that are used to effect
various tooth movements
Z - Spring
• Also called double cantilever spring
• Made up of 0.5 mm s.s wire
• Consist of two coils
• Placed perpindicular to the palatal surface of
the tooth
• Activated by opening the helices by about 2-3
mm at a time.
Double cantilever spring
• Parts:
– Active arm
– Coils
– Retentive arm
:Used for
1. Moving the incisors labially
2. Minor derotation of the incisors
De-rotation of flat teeth
Spring design
• It must be
perpendicular to the
palatal surface of the
tooth
– Otherwise it will tend to
slide down and to
intrude the tooth.
Activation
Why should early intervention
????be done
• The aim of early treatment of this type of
malocclusion is to correct anterior crossbite,
as otherwise often can lead to very serious
Class III mallocclusion
The best time to
Treat a crossbite is
When first seen
• Anterior cross-bite may lead to abnormal
enamel abrasion of the incisors, thinning of
labial alveolar plate surrounding the lower
incisors, and/or gingival recession .
• Anterior dental cross-bite requires early and
immediate treatment to prevent anterior
teeth mobility and fracture, periodontal
pathosis, and temporomandibular joint
disturbance
Can we fix this problem with simple
???removable appliance
Finger Spring
Finger Spring
• Constructed using 0.6 mm wire
• Consisted of active arm of 12-15 mm length, a helix
of 3mm internal diameter and retentive arm of 4-5
mm length.
• Used for mesio-distal tooth movement when teeth
are located correctly in bucco-lingual direction
• Activated by moving active arm toward the teeth to
be moved
– The coil should be positioned on the opposite side of the
direction of tooth movement.
Activation
• The finger spring is activated by opening the
coil or by moving the active arm towards the
tooth to be moved.
Buccal canine retractor
indicated in bucally placed canines high in the
vestibule
So used to move the canine distally and palatally
Made of 0.7 mm s.s wire
• Indications
Retraction of buccally displaced canines that are
mesially tipped
• Contra-Indications
Patients with a decreased buccal sulcus depth
Canines are upright or are already distally tipped
• The upper canine should be buccally displaced
and mesially-angulated.
1 2
x
note
• However, the BCR is an exception the coil is made
to close rather than to open in action.
• Should lie just distal to the long axis of the tooth.
Screws
Posterior cross bite
the buccal cusps of the maxillary teeth are in
contact with the central fossae of the
.mandibular teeth
Some studies have suggested a posterior
crossbite prevalence range between 8 to 16%
Screws
• Screws can be embedded into the baseplate of an
appliance and activated by the patient
progressively turning a key.
• Screws can be effective for expansion to correct a
posterior dental crossbite, or for distal movement
of the buccal segments, often supported by
headgear.
• Each quarter turn of the screw activates it by
approximately 0.25mm and, therefore, should be
done by the patient once or twice per week
• By incorporating a midline expansion screw or spring
in an upper removable appliance, the maxillary arch
can be widened. This is effective for the correction of
posterior cross bites in the mixed dentition, but will
produce only tipping of the buccal teeth; the cross
bite should therefore be dental ( due to palataly
tipped upper posterior teeth) not skeletal in origin.
• Activation: twice per week
Maxillary expansion with a screw
• Indicated when there is a narrowing of the
maxillary arch in which the teeth are tipped
palatally.
• Contraindicated when the teeth are buccaly
tipped
• Can separate the maxillae particularly in the
primary and mixed dentition.
• Skeletal change: 16 -30 % and varies with age
Bite Planes
Anterior Posterior
Anterior bite plane
Upper flat anterior bite plane: It is an extension of acrylic base
plate covering the region behind the upper anterior teeth
extending from canine to canine. This extension should be flat
and should be parallel to the occlusion plane. The bite plane
should be high enough to disocclude the posterior teeth by
about 2 to 3 mm.
Indication: Deep bite cases in growing patients
Should be
• Flat
• Not polished
• Touch at lead 3 lower incisors
Changes in overbite
Deep overbite Removable orthodontic
Appliance with anterior bite
plane
incorporating an anterior bite plane on a removable appliance will
increase the vertical dimension and allow differential eruption of the
posterior teeth, which in a growing patient is an effective way to reduce a deep
.overbite
Bite opening using anterior bite plane
Anchorage -3
• The source of resistance to the reaction from
the active components.
• Sources:-
1. Root surface area
2. Palatal vault
Base Plate -4
This unit of removable orthodontic appliance carries
all the other components in one appliance.
Auto polymerizing (self curing) acrylic resin is the
material generally used for fabricating the base
plate, sometimes heat curing acrylic resins can also
be used.
The acrylic base can be modified to have bite planes
which serve special functions such as reduction of
overbite….
Base plate
1. Unites all components of the appliance into
one unit
2. Helps in anchorage
3. Bite planes can be incorporated into the plate
Scope of removable orthodontic appliances
• Tipping of one or few teeth
• De-rotation of flat teeth (incisors)
• Expansion ( transverse and antero-posterior)
• Repositioning of individual teeth within the
arch
• Intrusion or extrusion of teeth
Removable Orthodontic Appliance
Instructions
WEAR: appliance is meant to be worn at all times – 24 hours a day –
7 days/week.
The most difficult time is the first few days,
Talking and eating are difficult at first, but will return to normal
after 2 or 3 days.
Success: depends on patient cooperation (The most common reason
for failure of orthodontic treatment is when patients do not wear their )
CLEANING Your teeth and appliance must be kept perfectly clean.
Thank You
References
• Removable orthodontic appliances: A
textbook of orthodontics, W J B Houston:
second edition: chapter 15
