METHODS OF GAINING
SPACE.
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.ind...
Key-stoning procedureHarry G.Barrer JCO Aug 1975

A. Malposed incisors

B. interproximal relationship after key stoning

R...
Key-stoning procedure:

www.indiandentalacademy.com

3
Nonsurgical rapid maxillary alveolar
expansion in adults:a clinical evaluation.
Chester S. Handelman, Angle Orthodontist, ...
• 5 adults with transverse deficiency- treated
nonsurgically using Haas appliance.
•RMAE- expansion centered in the alveol...
Displaces the alveolus with the teeth rather than
expanding the teeth through the alveolus.

www.indiandentalacademy.com

...
bilateral

www.indiandentalacademy.com

7
Unilateral
crossbite –
left

www.indiandentalacademy.com

8
www.indiandentalacademy.com

9
www.indiandentalacademy.com

10
RMAE acceptable alternative to SA-RME in adults for maxi deficiency.
www.indiandentalacademy.com

11
Nickel-Titanium Palatal expander.
2 properties: Shape memory & superelasticity.
Exists in more than 1 crystal structure.
L...
MOLAR DISTALIZATION

www.indiandentalacademy.com

13
Indications for Molar distalization
1. In a growing child
- to relieve mild crowding
- causes permanent increase in arch
l...
Indications for Molar distalization
3. Non-growing patient
-

To regain lost arch length

-

Blocking out of canines

4. U...
Indications for Molar distalization




Class I malocclusion- with highly placed canine/impacted
canine
Lack of space fo...
Indications for Molar distalization



Good soft tissue profile



Borderline cases



Mild to moderate space discrepan...
Case selection
1. Normal or near normal mandibular arch
2. Late mixed dentition-ideal
- Early permanent dentition-growth s...
Classification
1.

Location of appliance


Extra-oral



Intra-oral

2. Position of appliance in mouth


Buccal



Pal...
Classification
4. Compliance needed from patient
 Maximum compliance
 Minimum or No compliance
5. Type of appliance


R...
Various appliances used for
Molar Distalization :











Head gears
Pendulum appliance.
Coil springs Niti an...
Various appliances used for Molar
Distalization











ACCO
Crozat appliance
Crickett appliance
Modified Nan...
Distalization using Headgears


Very efficient



Reciprocal forces are not transmitted to other teeth



Molar movemen...
Biomechanics of Headgears:



C Res



Moments

www.indiandentalacademy.com

24
Cervical Headgear






Short face Class II
maxillary protrusive
cases with low MPA
& Deepbites
Extrusive & distalizing...
High pull Headgear








Produces intrusive &
Posterior direction of pull
Long face class II
patients with high MPA
...
Straight pull headgear


Class II Malocclusion with
no vertical problems



Prevent anterior
migration of maxillary
teet...
Modification of the Bimetric arch


Class II correction- Distalization + expands caninepremolar area- unlocks the occlusi...
Modification of the Bimetric arch
Archwire design:
 .016”premium wire
 Premolars bonded if
expansion is
required
 Teard...
Elastic load reduction principle:


Class II elastics – used sequentially
T.P Green – 1st week
Pink - 2nd week
Yellow – n...
K-Loop molar distalizing
appliance Valrun Kalra – JCO 1995


K-loop – forces - .017 x .025 TMA



Nance button – anchora...


Reactivated by 2mm 6-8 weeks later.



molars move by 4mm, premolars by 1mm



Anchorage can be reinforced by headgea...
K- loop Appliance

www.indiandentalacademy.com

33
Distalization of Molars with
Repelling Magnets Gianelley etal JCO 1988


Anchorage – Modified Nance
appliance



Wire ex...
Distalization of Molars with
Repelling Magnets


Incisor brackets – passive
sectional wire- maintain incisor
alignment

...
Molar distalization with Superelastic
NiTi wire
Gianelly JCO 1992


100gm Neosentalloy upper
archwire



3 markings



...
Molar distalization with
Superelastic NiTi wire
Case report :


12 yr / F



Unilateral class II



Class II elastic ag...
NiTi Double Loop system for simultaneous
distalization of first and second molars
Giancotti JCO 1998


Mandibular molars ...
NiTi Double Loop system for
simultaneous distalization of first and
second molars


2 Sectional NiTi archwires
– crimp st...
24yr/f, class II div I
5months- overcorrected
www.indiandentalacademy.com

40
NiTi Double Loop system for simultaneous
distalization of first and second molars


Useful technique – Class II div I


...
NiTi Open Coil Springs

Dia 0.012”
Lumen 0.030

www.indiandentalacademy.com

42
Pendulum Appliance for class II noncompliance therapy
JAMES J.HILGERS,JCO 1992


Nance button for anchorage



.032” sTM...
Pendulum Appliance
Fabrication :
Pendulum springs
consist
Recurved molar insertion
wire
1.
Horizontal adjustment
loop
2.
C...
Springs close to center of
palatal button:to maxi range
of action, easy insertion.
Retaining wire is soldered to
the U4 an...
Pendulum Appliance


Nance button- extend to about 5mm
from teeth



Anterior retention loops fixed on
model, later sold...
Pendulum Appliance
Pend-X
Expansion needed:
Jack-screw-One-quarter turn
every 3 days

www.indiandentalacademy.com

47
Pre activation and placement
After cementation,before
activation:
Springs prefabricated to lie
parallel to midsagittal pla...
Intra oral reactivation:
Center of helix held with bird
beak plier while, spring is
pushed distally & reinsert.

Stabiliza...
Pendulum Appliance


Unilateral correction

www.indiandentalacademy.com

50
Pendulum Appliance
Conclusion :


Excellent patient tolerance



Upto 5mm distalization in 4 months



Distalization + ...
Franzulum appliance
Friedrich Byloff et al


Anterior anchorage : acrylic
button-5mm wide



Rests on canine and
premola...
Franzulum appliance:
Niti spring over J shaped
wire
Inserted into tube of anterior
anchorage unit
•Anchor unit bonded
with...
Case report

11yrs 10mts / M













end on molar relationship
Space deficiency in both the
arches
Premolars ...
Distal jet Appliance
Aldo Carano, Mauro Testa JCO 1996



Lingual molar distalizing
appliance



Appliance design :
Wire...
Distal jet Appliance



Reactivation- sliding clamp
closer to first molar,once a
month.



After distalization –
- clamp...
Distal jet Appliance
Case report

18/F, Class II div I

No skeletal abnormalities

Non-extraction therapy (3rd molars
r...
Distal jet Appliance
Advantages :
 Bodily movement
 Easy insertion
 Well tolerated
 Esthetic
 Unilateral, Bilateral
...
Open Coil Jig
Jones, White –JCO 1992 Oct
NiTi springs 70-75g
Nance button attached to
U5

Assembly tied in place

www.indi...
Open Coil Jig
3
1.

Fixed Sheath

4.

Hook

5.

Sliding Sheath

6.

5

Light wire

3.

6

Heavy round wire

2.

4

1

Open...
Conclusion






Borderline cases
Space gaining procedures
Simplicity
Clinical effectiveness
Patient compliance facto...
Distraction Osteogenesis:










New bone formation b/w the surfaces of bone
segments gradually separated by incre...
Mandibular Sympyseal distraction.











Mandibular symphyseal distraction- space gaining.
Intra oral mandibul...
Thank you
For more details please visit
www.indiandentalacademy.com
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Methods of gaining space 1. /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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Methods of gaining space 1. /certified fixed orthodontic courses by Indian dental academy

  1. 1. METHODS OF GAINING SPACE. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com 1
  2. 2. Key-stoning procedureHarry G.Barrer JCO Aug 1975 A. Malposed incisors B. interproximal relationship after key stoning Rounded surfaces slip and rotate. www.indiandentalacademy.com 2
  3. 3. Key-stoning procedure: www.indiandentalacademy.com 3
  4. 4. Nonsurgical rapid maxillary alveolar expansion in adults:a clinical evaluation. Chester S. Handelman, Angle Orthodontist, 1997 vol 67 •Late teens and early 20’s questionable. •Sutures: rigid and fuse. •SA-RME. Non Surgical Maxillary expansion: Pain, swelling, ulceration, flared posterior teeth, bite opening, gingival recession, and perforation of the buccal alveolus. Vanarsdall: in children, gingival recession and dehiscence of bone www.indiandentalacademy.com 4
  5. 5. • 5 adults with transverse deficiency- treated nonsurgically using Haas appliance. •RMAE- expansion centered in the alveolar process of maxilla rather than the body.(lateral walls of the palate) •Bilateral/unilateral crossbites, arch constriction. 2 quarter turns/day Haas appliance Later 1 quarter turn/day U 1 no separation. 12 weeks retention. www.indiandentalacademy.com 5
  6. 6. Displaces the alveolus with the teeth rather than expanding the teeth through the alveolus. www.indiandentalacademy.com 6
  7. 7. bilateral www.indiandentalacademy.com 7
  8. 8. Unilateral crossbite – left www.indiandentalacademy.com 8
  9. 9. www.indiandentalacademy.com 9
  10. 10. www.indiandentalacademy.com 10
  11. 11. RMAE acceptable alternative to SA-RME in adults for maxi deficiency. www.indiandentalacademy.com 11
  12. 12. Nickel-Titanium Palatal expander. 2 properties: Shape memory & superelasticity. Exists in more than 1 crystal structure. Lower temp-martensite. temp:94degree Transition Higher temp-austenite {phase transition} www.indiandentalacademy.com 12
  13. 13. MOLAR DISTALIZATION www.indiandentalacademy.com 13
  14. 14. Indications for Molar distalization 1. In a growing child - to relieve mild crowding - causes permanent increase in arch length of about 2mm on each side. 2. Late mixed dentition - When lower E space –utilized for relief of anterior crowding, - Upper molars distalized to get a class I relation www.indiandentalacademy.com 14
  15. 15. Indications for Molar distalization 3. Non-growing patient - To regain lost arch length - Blocking out of canines 4. Upper second molar extraction - Lower arch normal www.indiandentalacademy.com 15
  16. 16. Indications for Molar distalization   Class I malocclusion- with highly placed canine/impacted canine Lack of space for eruption of premolars due to mesial migration of permanent first molars www.indiandentalacademy.com 16
  17. 17. Indications for Molar distalization  Good soft tissue profile  Borderline cases  Mild to moderate space discrepancy with missing 3 rd molars/2 nd molars not yet erupted  End on molar relation with mild to moderate space requirement.  Cases with less than full cusp class II molar relation. www.indiandentalacademy.com 17
  18. 18. Case selection 1. Normal or near normal mandibular arch 2. Late mixed dentition-ideal - Early permanent dentition-growth still left in maxillary tuberosity area.- 16-17 yrs-males 14-15 yrs-females 3. Molars placed normally- buccopalatally. 4. 3rd molars-absent –stacking of upper molars – unsuitable 5. Profile considerations- well developed nose & chin 6. High MPA- contraindicated-wedging effect www.indiandentalacademy.com 18
  19. 19. Classification 1. Location of appliance  Extra-oral  Intra-oral 2. Position of appliance in mouth  Buccal  Palatal 3. Type of tooth movement  Bodily movement  Tipping movement www.indiandentalacademy.com 19
  20. 20. Classification 4. Compliance needed from patient  Maximum compliance  Minimum or No compliance 5. Type of appliance  Removable  Fixed 6. Arches involved Intra-arch Inter-arch www.indiandentalacademy.com 20
  21. 21. Various appliances used for Molar Distalization :           Head gears Pendulum appliance. Coil springs Niti and S.Steel Distal jet K loop Jones Jig Magnet Wilson’s Bimetric loop Use of super elastic NiTi Franzulum appliance. www.indiandentalacademy.com 21
  22. 22. Various appliances used for Molar Distalization           ACCO Crozat appliance Crickett appliance Modified Nance lingual appliance Schmuth and Muller double plates Claspring Removable molar distalization splint Fixed piston appliance Using implants Fixed functional appliance www.indiandentalacademy.com 22
  23. 23. Distalization using Headgears  Very efficient  Reciprocal forces are not transmitted to other teeth  Molar movements depends on direction of force in relation to the C Res of the molar & magnitude of force www.indiandentalacademy.com 23
  24. 24. Biomechanics of Headgears:  C Res  Moments www.indiandentalacademy.com 24
  25. 25. Cervical Headgear    Short face Class II maxillary protrusive cases with low MPA & Deepbites Extrusive & distalizing effect Lower anterior facial height is less. www.indiandentalacademy.com 25
  26. 26. High pull Headgear     Produces intrusive & Posterior direction of pull Long face class II patients with high MPA Force through C Res – Intrusion & distal movement of molar 6-8 months – class IIclass I www.indiandentalacademy.com 26
  27. 27. Straight pull headgear  Class II Malocclusion with no vertical problems  Prevent anterior migration of maxillary teeth, translate them posteriorly Adv-effective, no reciprocal forces Disadv- Patient compliance www.indiandentalacademy.com 27
  28. 28. Modification of the Bimetric arch  Class II correction- Distalization + expands caninepremolar area- unlocks the occlusion  A mild-moderate class II div 2 with normal mandibular arch-easily corrected www.indiandentalacademy.com 28
  29. 29. Modification of the Bimetric arch Archwire design:  .016”premium wire  Premolars bonded if expansion is required  Teardrop shaped loop  Bite opening bend  Mild toe-in  2mm activation www.indiandentalacademy.com 29
  30. 30. Elastic load reduction principle:  Class II elastics – used sequentially T.P Green – 1st week Pink - 2nd week Yellow – next 2-3 weeks  Initial heavy force- to resist forward pushing force of new wire- force transferred distally  Later Molar uprights-mesially directed archwire force decreases- support with light forces.  Extrusive component of class II- kept to a minimum www.indiandentalacademy.com  1mm/month.wire activated for 3 visits.  Borderline cases –Non Ext 30
  31. 31. K-Loop molar distalizing appliance Valrun Kalra – JCO 1995  K-loop – forces - .017 x .025 TMA  Nance button – anchorage  8mm long , 1.5 mm wide  Legs- 20 degree bend  Inserted into molar and first premolar tube, marked  Stops bent 1mm distal , 1mm mesial  Stops- 1.5mm long www.indiandentalacademy.com 31
  32. 32.  Reactivated by 2mm 6-8 weeks later.  molars move by 4mm, premolars by 1mm  Anchorage can be reinforced by headgear www.indiandentalacademy.com 32
  33. 33. K- loop Appliance www.indiandentalacademy.com 33
  34. 34. Distalization of Molars with Repelling Magnets Gianelley etal JCO 1988  Anchorage – Modified Nance appliance  Wire extending from 1st premolars  Acrylic button anteriorly contacting the incisors  Auxiliary wire with a loop at its end soldered - premolars bands www.indiandentalacademy.com 34
  35. 35. Distalization of Molars with Repelling Magnets  Incisor brackets – passive sectional wire- maintain incisor alignment  Repelling surfaces of magnets brought into contact by passing an .014 ligature through the loop, then tying back a washer anterior to the magnets  Force- 200-225 gms , dropped as space opened  3mm in 7 weeks  Anchor loss – 1mm www.indiandentalacademy.com 35
  36. 36. Molar distalization with Superelastic NiTi wire Gianelly JCO 1992  100gm Neosentalloy upper archwire  3 markings  Stops crimped, hook added  Insert wire such that posterior stop abuts mesial end of molar tube, anterior stop abuts distal of premolar.Xs wire deflected gi  Anchorage reinforced by class II, or Nance appliance www.indiandentalacademy.com 100g 36
  37. 37. Molar distalization with Superelastic NiTi wire Case report :  12 yr / F  Unilateral class II  Class II elastic against upper 1st premolar  Overcorrected- 4 months www.indiandentalacademy.com 37
  38. 38. NiTi Double Loop system for simultaneous distalization of first and second molars Giancotti JCO 1998  Mandibular molars and 2nd premolars banded, other teeth bonded  Lip bumper- prevent extrusion  Maxillary molars and bicuspids – banded, aligned  80 gm Neosentalloy – maxillary archwire placed – marked 1. Distal to 1st premolar 2. 5mm distal to 1st molar tube  Stops crimped on markings www.indiandentalacademy.com 38
  39. 39. NiTi Double Loop system for simultaneous distalization of first and second molars  2 Sectional NiTi archwires – crimp stops 1. Mesial and distal to 2nd premolar 2. 5mm distal to 2nd molar tube  Uprighting springs on 1st bicuspids  Class II elastics  Simultaneous, bodily movement www.indiandentalacademy.com 39
  40. 40. 24yr/f, class II div I 5months- overcorrected www.indiandentalacademy.com 40
  41. 41. NiTi Double Loop system for simultaneous distalization of first and second molars  Useful technique – Class II div I  Minimal patient co-operation  Ideal for simultaneous distalization U7 easier ‘.’ anatomy.  Due to stretching of transeptal fibers, 1 st molars can be distalized using lighter 80 gm force  Anchorage easily controlled , without need for TPA/Nance’.’light forces www.indiandentalacademy.com 41
  42. 42. NiTi Open Coil Springs Dia 0.012” Lumen 0.030 www.indiandentalacademy.com 42
  43. 43. Pendulum Appliance for class II noncompliance therapy JAMES J.HILGERS,JCO 1992  Nance button for anchorage  .032” sTMA springs-light continuous forces  Broad swinging arc (Pendulum) of force from midline of palate to upper molars www.indiandentalacademy.com 43
  44. 44. Pendulum Appliance Fabrication : Pendulum springs consist Recurved molar insertion wire 1. Horizontal adjustment loop 2. Closed helix 3. Loop for retention in acrylic button  Springs- close to center of Nance button www.indiandentalacademy.com 44
  45. 45. Springs close to center of palatal button:to maxi range of action, easy insertion. Retaining wire is soldered to the U4 and extended into acrylic. www.indiandentalacademy.com 45
  46. 46. Pendulum Appliance  Nance button- extend to about 5mm from teeth  Anterior retention loops fixed on model, later soldered to bicuspid bands  Acrylic pressed against the palatal vault  Pendulum springs inserted www.indiandentalacademy.com 46
  47. 47. Pendulum Appliance Pend-X Expansion needed: Jack-screw-One-quarter turn every 3 days www.indiandentalacademy.com 47
  48. 48. Pre activation and placement After cementation,before activation: Springs prefabricated to lie parallel to midsagittal plane, Which produces 60* of activation after insertion. As the molar distalizes it moves on an arc towards midline-counteracted by opening horizontal loop www.indiandentalacademy.com 48
  49. 49. Intra oral reactivation: Center of helix held with bird beak plier while, spring is pushed distally & reinsert. Stabilization: •Nance button •Upper utility arch- anterior segment- anchorage. •Full arch bonding:continuous wire with omega loop. •Head gears ? www.indiandentalacademy.com 49
  50. 50. Pendulum Appliance  Unilateral correction www.indiandentalacademy.com 50
  51. 51. Pendulum Appliance Conclusion :  Excellent patient tolerance  Upto 5mm distalization in 4 months  Distalization + Expansion  Patient compliance not needed www.indiandentalacademy.com 51
  52. 52. Franzulum appliance Friedrich Byloff et al  Anterior anchorage : acrylic button-5mm wide  Rests on canine and premolars - .032”S.Steel wire  Tube from acrylic button to receive active component  NiTi coil springs-100200g/side  JCO2000 sep J-shaped wire inserted into tube www.indiandentalacademy.com 52
  53. 53. Franzulum appliance: Niti spring over J shaped wire Inserted into tube of anterior anchorage unit •Anchor unit bonded with composite. •Close to CR of molarpure bodily movement. compressed Tied into lingual sheath www.indiandentalacademy.com 53
  54. 54. Case report  11yrs 10mts / M        end on molar relationship Space deficiency in both the arches Premolars blocked out Fixed appliance with cervical headgear and Cl II elastics End of treatment; Class I molar relation, no significant change in facial profile U6:3mm,L6:6mm Lower incisors proclined. Extrusion of U&L 6 Long term stability???? www.indiandentalacademy.com 54
  55. 55. Distal jet Appliance Aldo Carano, Mauro Testa JCO 1996  Lingual molar distalizing appliance  Appliance design : Wire extending from acrylic through tube ends in a bayonet bend-inserted into lingual sheath   Coil spring clamped on tube  Clamp  Anchor wire to 2nd premolar www.indiandentalacademy.com .036” int dia 55
  56. 56. Distal jet Appliance  Reactivation- sliding clamp closer to first molar,once a month.  After distalization – - clamp-spring assemblyacrylic, - premolar arms cut off. www.indiandentalacademy.com 56
  57. 57. Distal jet Appliance Case report  18/F, Class II div I  No skeletal abnormalities  Non-extraction therapy (3rd molars removed)  Distal jet  4 months- Class I ,2mm-L, 3mm-R www.indiandentalacademy.com 57
  58. 58. Distal jet Appliance Advantages :  Bodily movement  Easy insertion  Well tolerated  Esthetic  Unilateral, Bilateral  Permits simultaneous use of full bonded appliances. www.indiandentalacademy.com 58
  59. 59. Open Coil Jig Jones, White –JCO 1992 Oct NiTi springs 70-75g Nance button attached to U5 Assembly tied in place www.indiandentalacademy.com 59
  60. 60. Open Coil Jig 3 1. Fixed Sheath 4. Hook 5. Sliding Sheath 6. 5 Light wire 3. 6 Heavy round wire 2. 4 1 Open coil spring 4-5mm of distal movement. 2 www.indiandentalacademy.com 60
  61. 61. Conclusion      Borderline cases Space gaining procedures Simplicity Clinical effectiveness Patient compliance factor www.indiandentalacademy.com 61
  62. 62. Distraction Osteogenesis:      New bone formation b/w the surfaces of bone segments gradually separated by incremental traction. Tension-stimulates new bone parallel to vector of distraction. tension in surrounding soft tissues, initiating a sequence of adaptive changes termed as distraction histogenesis. Skin, fascia, bl vessels, nerves, muscles, cartilage, periosteum. Illizarov. www.indiandentalacademy.com 62
  63. 63. Mandibular Sympyseal distraction.         Mandibular symphyseal distraction- space gaining. Intra oral mandibular distraction device. More stable results. Corticotomy. Latent period.5-7days.(fibro vascular bridge) Activation.optimum rate: 1mm/day(0.5mm-premature ossification,2mm-fibrous CT , ischemia) Consolidation (remodeling) concomitant soft tissue expansion. Retention. www.indiandentalacademy.com 63
  64. 64. Thank you For more details please visit www.indiandentalacademy.com

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