May 30, 2002 - Removable Appliances I

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May 30, 2002 - Removable Appliances I

  1. 2. Removable Orthodontic Appliances Gregory Jackson DDS, MSD Preclinical Orthodontics ORTD 323 May 31, 2002
  2. 3. Removable Appliances <ul><ul><li>Advantages & disadvantages </li></ul></ul><ul><ul><li>Brief history & development </li></ul></ul><ul><ul><li>Major uses of removables </li></ul></ul><ul><ul><ul><ul><li>Growth modification </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Limited tooth movement </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Retention </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Adjuncts to treatment </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mild to moderate malocclusions </li></ul></ul></ul></ul>
  3. 4. Advantages <ul><ul><li>Appealing to patients especially adults </li></ul></ul><ul><ul><li>Inexpensive </li></ul></ul><ul><ul><li>Easy to make and adjust </li></ul></ul><ul><ul><li>Initially less chair time </li></ul></ul><ul><ul><li>Allow for some types of growth guidance </li></ul></ul>
  4. 5. Disadvantages <ul><ul><li>Totally cooperation dependant !!! </li></ul></ul><ul><ul><li>Limited to less complex movement </li></ul></ul><ul><ul><li>Limited range of movement </li></ul></ul>
  5. 6. Development of Removables <ul><ul><li>USA- fixed appliances- Edward Angle </li></ul></ul><ul><ul><ul><ul><li>Minimal usage of removable appliances </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Precise positioning of teeth </li></ul></ul></ul></ul><ul><ul><li>Europe-removable appliances </li></ul></ul><ul><ul><ul><ul><li>Geographic separation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Social welfare systems-limited tx. for masses </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Scarcity of precious metals for fixed appliances </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Alterations in function produced by removables give stable correction of malocclusion </li></ul></ul></ul></ul>
  6. 7. Removables in Europe <ul><ul><li>Growth Guidance with Functional Appliances </li></ul></ul><ul><ul><li>Change mandibular posture </li></ul></ul><ul><ul><ul><ul><li>Open & forward </li></ul></ul></ul></ul><ul><ul><li>Pressure from stretch of muscle & soft tissues transmitted to teeth & bone </li></ul></ul><ul><ul><li>moving teeth and modifying growth </li></ul></ul>
  7. 8. Today Dichotomy Disappeared <ul><ul><li>Instantaneous exchange of ideas & info. </li></ul></ul><ul><ul><li>Politics, economics, travel, electronic age </li></ul></ul>
  8. 9. Can We Grow Mandibles? <ul><ul><li>Chapt. 8 Contemporary Orthodontics </li></ul></ul><ul><ul><li>“ An acceleration of (mand) growth often occurs when a functional appliance is used … , but the final size of the mandible is little if any larger than it would have been without treatment.” </li></ul></ul><ul><ul><li>Other functional appliance tx. effects: </li></ul></ul><ul><ul><ul><li>Mand. teeth forward, max.teeth back- Cl. II el. effect </li></ul></ul></ul><ul><ul><ul><li>Restraint of forward growth of maxilla- HG effect </li></ul></ul></ul>
  9. 10. Tooth-borne Functional Appliances <ul><ul><li>Activator </li></ul></ul><ul><ul><li> (Andresen) </li></ul></ul><ul><ul><li>Bionator </li></ul></ul><ul><ul><li>(Balters) </li></ul></ul>
  10. 11. <ul><ul><li>Herbst </li></ul></ul><ul><ul><li>Twin Block </li></ul></ul><ul><ul><li>(Clark) </li></ul></ul>
  11. 12. Tissue-borne Functional Appliances <ul><ul><li>Functional Regulator (Frankel) </li></ul></ul>
  12. 13. Limited Tooth Movement <ul><ul><li>Appliance Design </li></ul></ul><ul><ul><ul><li>Acrylic plate – stability </li></ul></ul></ul><ul><ul><ul><li>Active portion – force application </li></ul></ul></ul><ul><ul><ul><li>Clasps & occlusal rests- retention </li></ul></ul></ul>
  13. 14. Acrylic Plate Maintenance Plate <ul><li>Stabilize </li></ul><ul><li>Space maintenance </li></ul><ul><li>Replace tooth </li></ul><ul><li>Bite Plane </li></ul><ul><li>Posterior overlay </li></ul>
  14. 15. Be Creative!
  15. 16. Active Portion <ul><ul><li>Expansion – screws </li></ul></ul><ul><ul><li>Repositioning teeth – springs </li></ul></ul><ul><ul><li>Space closing – labial bow & springs </li></ul></ul>
  16. 17. Expansion Screws
  17. 18. Springs <ul><ul><li>Anterior Alignment </li></ul></ul>
  18. 19. Anterior Cross-bite Primary Dentition
  19. 20. Anterior Cross-bite Mixed Dentition
  20. 21. Springs <ul><ul><li>Posterior space regaining </li></ul></ul>correct incorrect Spring winding
  21. 22. Springs <ul><ul><li>Space Closure </li></ul></ul>
  22. 23. Adjustable Labial Bow
  23. 24. Clasps & Rests <ul><ul><li>Adams </li></ul></ul><ul><ul><li>C </li></ul></ul><ul><li>Occlusal rest </li></ul><ul><li>Ball </li></ul><ul><li>Arrowhead </li></ul>
  24. 25. Retention <ul><ul><li>Hawley </li></ul></ul><ul><ul><li>Circumferential </li></ul></ul><ul><ul><li>Spring </li></ul></ul><ul><ul><li>Invisible – Essix </li></ul></ul><ul><ul><li>Positioner </li></ul></ul>
  25. 26. Hawley Retainer <ul><ul><li>With or without ant. or post. biteplate </li></ul></ul>
  26. 27. Circumferential Retainer
  27. 28. Spring Retainer
  28. 29. Invisible Essix Retainer <ul><ul><li>Vacupressureformed </li></ul></ul>Biostar Machine
  29. 30. Positioner
  30. 31. Adjuncts to Treatment <ul><ul><li>Biteplate </li></ul></ul>Nightguard
  31. 32. Removable Appliances Used in Mild to Moderate Malocclusion More to come

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