REMOVABLE APPLIANCES Part I /cosmetic dentistry courses

REMOVABLE APPLIANCESREMOVABLE APPLIANCES
Part IPart I
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing DentalLeader in continuing Dental
EducationEducation
www.indiandentalacademy.comwww.indiandentalacademy.com

ContentsContents
 INTRODUCTIONINTRODUCTION
 DEVELOPMENT OF REMOVABLE APPLIANCESDEVELOPMENT OF REMOVABLE APPLIANCES
 METHODS OF WIRE FORMINGMETHODS OF WIRE FORMING
 PLIERSPLIERS
 PRINCIPLES OF WIRE BENDINGPRINCIPLES OF WIRE BENDING
 CLASSIFICATION OF REMOVABLE APPLIANCESCLASSIFICATION OF REMOVABLE APPLIANCES
 ADAVANTAGES AND DISADVANTAGESADAVANTAGES AND DISADVANTAGES
 INDICATIONS OF REMOVABLE APPLIANCESINDICATIONS OF REMOVABLE APPLIANCES
 ACTION OF REMOVABLE APPLIANCESACTION OF REMOVABLE APPLIANCES
 DESIGN OF THE REMOVABLE APPLIANCEDESIGN OF THE REMOVABLE APPLIANCE
 BASE PLATEBASE PLATE
 APPLIANCE RETENTION AND CLASPSAPPLIANCE RETENTION AND CLASPS
 PATIENT AND APPLIANCE MANAGEMENTPATIENT AND APPLIANCE MANAGEMENT
 CONCLUSIONCONCLUSION
 REFERENCESREFERENCES

Definition:Definition:
Orthodontic appliances that can be easilyOrthodontic appliances that can be easily
inserted & removed by patient.inserted & removed by patient.

Development of removableDevelopment of removable
appliancesappliances 22
Fredriech Christoph Kniesel was one of the
first ones to give removable plate in 1836

Coffin plate by C. R. Coffin (1881)Coffin plate by C. R. Coffin (1881)

 Victor H. Jackson (1850-1929) gave theVictor H. Jackson (1850-1929) gave the
wire crib in 1887wire crib in 1887
 His technique became known as theHis technique became known as the
“Jackson System”.“Jackson System”.

Baker’s vulcanite retainer.

Crozats Appliance (1928)Crozats Appliance (1928)

 Removable appliance development still continuedRemovable appliance development still continued
in Europe despite the neglect in U.S. This wasin Europe despite the neglect in U.S. This was
mainly because of three reasons:mainly because of three reasons:
 Angle’s approach to occlusion had less impact inAngle’s approach to occlusion had less impact in
Europe.Europe.
 Social welfare systems development in Europe.Social welfare systems development in Europe.
 Precious metal for fixed appliance was lessPrecious metal for fixed appliance was less
available in Europe.available in Europe.

METHODS OF WIREMETHODS OF WIRE
FORMINGFORMING

PliersPliers
 There are two basic pliers which can beThere are two basic pliers which can be
used for wire bendingused for wire bending
1. Adams plier1. Adams plier
2. young’s universal plier2. young’s universal plier

Adams plierAdams plier
 Adams’ Universal pliers and principles ofAdams’ Universal pliers and principles of
their use were conceived in 1946.their use were conceived in 1946.
 Their specification and fundamentalTheir specification and fundamental
principles of wire forming using theseprinciples of wire forming using these
pliers were published in 1950.pliers were published in 1950.
 In due course a full specification wasIn due course a full specification was
published in 1955published in 1955

Essential features:-Essential features:-
1.1. Adams’ UniversalAdams’ Universal
pliers are made ofpliers are made of
stainless steel that isstainless steel that is
harder than wiresharder than wires
that they will bethat they will be
used to formused to form
5.25 inches
48 mm

3. The handles are wide3. The handles are wide
and comfortable toand comfortable to
hold.hold.
 The handle curvesThe handle curves
smoothly andsmoothly and
prolonged use as inprolonged use as in
the lab, does notthe lab, does not
fatigue or hurt thefatigue or hurt the
palm.palm.
4. Side of beak must be4. Side of beak must be
flatflat

5. The edges of the5. The edges of the
grasping surfaces ofgrasping surfaces of
the beak must bethe beak must be
sharp not rounded orsharp not rounded or
beveledbeveled
6. The grasping6. The grasping
surfaces must besurfaces must be
textured and musttextured and must
not be polished butnot be polished but
also must not bealso must not be
serrated or grooved.serrated or grooved.

Faults of pliersFaults of pliers
1.1. Metal of the pliers is not hard enough. It isMetal of the pliers is not hard enough. It is
impossible to hold wire tightly with suchimpossible to hold wire tightly with such
pliers.pliers.
2.2. The construction is slender and wires ofThe construction is slender and wires of
thicker gauges cannot be grasped andthicker gauges cannot be grasped and
formed.formed.
3.3. Some manufacturers put a high polish onSome manufacturers put a high polish on
the pliers.the pliers.

4. The edges of the grasping surfaces are4. The edges of the grasping surfaces are
rounded or beveled. These edges shouldrounded or beveled. These edges should
be square and sharp so that wire can bebe square and sharp so that wire can be
held firmly and formed precisely.held firmly and formed precisely.
5. The tips of the beaks are too large or too5. The tips of the beaks are too large or too
small.small.
6. Handles are not of proper shape and size6. Handles are not of proper shape and size
and cause fatigue and hurt the palm inand cause fatigue and hurt the palm in
daily usedaily use

Young’s universal plierYoung’s universal plier

General Principles of wire formingGeneral Principles of wire forming
 Pliers are meant for holding the wire onlyPliers are meant for holding the wire only
not for the bending. Finger pressure isnot for the bending. Finger pressure is
used for bendingused for bending
 Hold the plier in a palm graspHold the plier in a palm grasp
 Before bending the wire establish a firmBefore bending the wire establish a firm
grip on the wiregrip on the wire
 Easier to bend the wire by pushing theEasier to bend the wire by pushing the
wire than pulling itwire than pulling it

 Precise marking should be done where toPrecise marking should be done where to
bendbend
 Use the proper beak of the plier forUse the proper beak of the plier for
bendingbending
 Care should be taken to apply pressure atCare should be taken to apply pressure at
909000 to the long axis of the wire.to the long axis of the wire.

CLASSIFICATIONCLASSIFICATION
Appliance can beAppliance can be
ActiveActive PassivePassive

According to skeletal or dentalAccording to skeletal or dental
changeschanges
Orthopedic changes Orthodontic ChangesOrthopedic changes Orthodontic Changes

 Appliances forAppliances for
 Arch expansionArch expansion
 Repositioning of individual teethRepositioning of individual teeth

AdvantagesAdvantages
 Can be removed on socially sensitiveCan be removed on socially sensitive
occasions.occasions.
 Fabricated in the laboratory.Fabricated in the laboratory.
 There is better maintenance of the oralThere is better maintenance of the oral
hygiene.hygiene.
 Does not cause tooth demineralization.Does not cause tooth demineralization.
 Less conspicuousLess conspicuous
 Less expensiveLess expensive

DisadvantagesDisadvantages
 Heavily dependant on patient complianceHeavily dependant on patient compliance
 Limited possibility of treatment
 They affect speech
 They are inefficient for multiple tooth
movements
 Lower removable appliances are more
difficult to tolerate

 Multiple rotations are difficult to treat usingMultiple rotations are difficult to treat using
removable appliances.removable appliances.
 Requiring extraction, it is very difficult toRequiring extraction, it is very difficult to
close residual space by forward movementclose residual space by forward movement
of posterior teeth.of posterior teeth.

 Appliances are removable, there is aAppliances are removable, there is a
greater chance of patient misplacing orgreater chance of patient misplacing or
damaging them.damaging them.
 Patients should exhibit enough skill toPatients should exhibit enough skill to
remove and replace the appliance withoutremove and replace the appliance without
distorting them.distorting them.

INDICATIONSINDICATIONS55
 Limited tooth movement (tipping)Limited tooth movement (tipping)
 For relief of moderate crowdingFor relief of moderate crowding
 Correction of individual toothCorrection of individual tooth
malpositionmalposition
 Arch expansionArch expansion
 Retention after comprehensiveRetention after comprehensive
orthodontic treatment.orthodontic treatment.

ACTION OF REMOVABLEACTION OF REMOVABLE
APPLIANCESAPPLIANCES11
 Spontaneous movementsSpontaneous movements
1. Uprighting

2. Labiolingual movements

Mesial migrationMesial migration

Active movementsActive movements

25- 50 g
1 mm per month
Christiansen and Burstone 1969
20 g per cm2
of root area
Schwarz (1932)

IntrusionIntrusion

Movements in the plane ofMovements in the plane of
occlusionocclusion

Tissue changes during toothTissue changes during tooth
movementmovement

AREAS OF :AREAS OF :
COMPRESSION TENSION
1. CAPILLARY PRESSURE IS NOT EXCEEDED
2. CAPILLARY PRESSURE IS LOCALLY EXCEEDED

CAPILLARIES REMAIN PATENT
CAPILLARY PRESSURE IS NOT
EXCEEDED
INCREASED PROLIFERATION OF CELLS
RECRUITMENT AND ACTIVATION OF OSTEOCLASTS
ACTIVE RESORPTION

CAPILLARY PRESSURE IS
LOCALLY EXCEEDED
CAPILLARIES OCCLUDED
HYALINIZED
UNDERMINING RESORPTION

AREAS OF TENSIONAREAS OF TENSION
INCREASED WIDTH OF PDL
PROLIFERATION OF FIBROBLASTS ANS OSTEOPROGENITOR CELLS
OSTEOBLAST
OSTEOID

DESIGN OF THE REMOVABLE APPLIANCEDESIGN OF THE REMOVABLE APPLIANCE
Removable appliances are made up of threeRemovable appliances are made up of three
basic components.basic components.
 Base plateBase plate
 Retentive componentsRetentive components
 Active componentsActive components

 Unites all the components both active andUnites all the components both active and
retentive components.retentive components.
 Helps in anchoring the appliance in place.Helps in anchoring the appliance in place.
 It provides support for the wireIt provides support for the wire
componentscomponents
 Distributing the forces over a larger area.Distributing the forces over a larger area.
 Bite planes can be incorporated into plateBite planes can be incorporated into plate
BASE PLATEBASE PLATE

RetentionRetention
 They are components that help in keepingThey are components that help in keeping
the appliance in place and resistthe appliance in place and resist
displacement of the appliance.displacement of the appliance.

Evolution of clasp designEvolution of clasp design
ADAMS 1969ADAMS 1969

Molar claspMolar clasp (Full Clasp, Jackson’s(Full Clasp, Jackson’s
Clasp) 1904Clasp) 1904

CROZAT 1920www.indiandentalacademy.comwww.indiandentalacademy.com

The Visick ClaspThe Visick Clasp
19261926

 Time consumingTime consuming
to make, delicate,to make, delicate,
troublesome totroublesome to
adjust, and likelyadjust, and likely
to causeto cause
discomfortdiscomfort

Arrowhead Clasp SchwarzArrowhead Clasp Schwarz
(1933)(1933)
TischlerTischler

Draw Backs of Arrowhead claspsDraw Backs of Arrowhead clasps
 Needs special arrowhead forming pliers toNeeds special arrowhead forming pliers to
fabricatefabricate
 Occupies a large amount of space in theOccupies a large amount of space in the
buccal vestibulebuccal vestibule
 The arrowheads can injure the interdentalThe arrowheads can injure the interdental
soft tissuesoft tissue
 It is difficult and time consuming procedureIt is difficult and time consuming procedure

Eyelet claspEyelet clasp

Adam’s ClaspAdam’s Clasp (1949 - C.P. Adam’s )(1949 - C.P. Adam’s )
 Modified arrowhead clasp, Liverpool clasp,Modified arrowhead clasp, Liverpool clasp,
universal claspuniversal clasp
19531953

Construction of Adam’s ClaspConstruction of Adam’s Clasp
 Preparation of castPreparation of cast

Essential feature of the Adam’sEssential feature of the Adam’s
claspclasp
 Bridge is straight, not curved or bent.Bridge is straight, not curved or bent.
 Bridge stand clear of the tooth and the gumsBridge stand clear of the tooth and the gums
 Bridge is not fitted against the buccal surface ofBridge is not fitted against the buccal surface of
the tooth.the tooth.
 Arrow heads are parallel, do not converge orArrow heads are parallel, do not converge or
diverge.diverge.
 The arrowhead slope to correspond with theThe arrowhead slope to correspond with the
curve of the gum margin into the interdentalcurve of the gum margin into the interdental
papilla.papilla. www.indiandentalacademy.comwww.indiandentalacademy.com

 Advantages of Adams ClaspAdvantages of Adams Clasp
 The bridge provides site to which theThe bridge provides site to which the
patient can apply pressure with finger tipspatient can apply pressure with finger tips
during removal of the appliance.during removal of the appliance.
 Auxiliary springs can be soldered to theAuxiliary springs can be soldered to the
bridge of the claspbridge of the clasp
 Hooks can be soldered to the clasp orHooks can be soldered to the clasp or
bent in during the construction. Tubes canbent in during the construction. Tubes can
be soldered to the bridge of the clasp tobe soldered to the bridge of the clasp to
accommodate a facebow for extraoralaccommodate a facebow for extraoral
traction.traction.

 Strong, simple, easily constructedStrong, simple, easily constructed
 It can be used for deciduous orIt can be used for deciduous or
permanent, anterior or posterior teeth, fullypermanent, anterior or posterior teeth, fully
or partially erupted teeth.or partially erupted teeth.
 It is neat and unobstructive andIt is neat and unobstructive and
comfortable to wearcomfortable to wear

Adjustment of Adams claspAdjustment of Adams clasp
 Adjustment takes but a moment and consists ofAdjustment takes but a moment and consists of
making one slight bend at each tag.making one slight bend at each tag.
 If the tags are not fitted closely in contact withIf the tags are not fitted closely in contact with
the teeth and into the lingual embrasure, thethe teeth and into the lingual embrasure, the
appliance will be most uncomfortable to theappliance will be most uncomfortable to the
patient and will move or bounce.patient and will move or bounce.
 Adams clasps are constructed so that theAdams clasps are constructed so that the
arrowheads fit against the mesial and distalarrowheads fit against the mesial and distal
undercuts on the tooth and does not exert gripundercuts on the tooth and does not exert grip
on the natural teethon the natural teeth

Variants of Adam’s ClaspVariants of Adam’s Clasp

Circumferential claspCircumferential clasp

The Duyzing’s clasp (1969)The Duyzing’s clasp (1969)

Southend claspSouthend clasp
Stephen in 1979

Triangular claspTriangular clasp

Ball-end claspBall-end clasp

Arrow Pin ClaspArrow Pin Clasp

Issuing the applianceIssuing the appliance
 Removable appliance should be placedRemovable appliance should be placed
within two weeks of taking the impression.within two weeks of taking the impression.
 Appliances should be delivered to the clinicAppliances should be delivered to the clinic
on the casts on which they wereon the casts on which they were
constructed.constructed.

Instructions to the patientInstructions to the patient
 With the aid of a mirror the patient should beWith the aid of a mirror the patient should be
shown how to remove and insert the appliance .shown how to remove and insert the appliance .
 The instruction to wear the appliance for 24The instruction to wear the appliance for 24
hours per day .hours per day .
 A high standard of oral hygiene should beA high standard of oral hygiene should be
insistedinsisted
 Removable appliances should be taken out andRemovable appliances should be taken out and
kept clean and the mouth rinsed after everykept clean and the mouth rinsed after every
mealmeal

 Diet should be that required for goodDiet should be that required for good
general health and hard and sticky foodsgeneral health and hard and sticky foods
and sweets avoided completelyand sweets avoided completely
 Patients must be told quite clearly that if anPatients must be told quite clearly that if an
appliances is causing pain or discomfort,appliances is causing pain or discomfort,
they should attend the clinic at oncethey should attend the clinic at once

Subsequent VisitsSubsequent Visits
 Patients wearing active removable appliancesPatients wearing active removable appliances
should be seen at monthly intervals.should be seen at monthly intervals.
 The patient should be asked to remove and insertThe patient should be asked to remove and insert
the appliance. Dexterity is to be expected ifthe appliance. Dexterity is to be expected if
instructions are being carried out correctly.instructions are being carried out correctly.
 Examination of the appliance out of the mouthExamination of the appliance out of the mouth
should reveal a worn appearanceshould reveal a worn appearance
 Intra-oral examination may reveal a lineIntra-oral examination may reveal a line
demarcating the posterior border of thedemarcating the posterior border of the
appliances on the palate and some imprint of theappliances on the palate and some imprint of the
baseplate on the soft tissues.baseplate on the soft tissues.

 Normal speech is to be expected after aNormal speech is to be expected after a
period of continuous wear and theperiod of continuous wear and the
persistence of lisping speech may suggestpersistence of lisping speech may suggest
that the appliance is not being wornthat the appliance is not being worn
continuously.continuously.
 The tooth movement in the mouth can beThe tooth movement in the mouth can be
assessed visually by comparison with theassessed visually by comparison with the
record casts of the original condition.record casts of the original condition.

CONCLUSIONCONCLUSION
 The success of removable appliancesThe success of removable appliances
depends on good design and attention todepends on good design and attention to
detail.detail.
 Removable appliances must be wellRemovable appliances must be well
designed and accurately constructed to thedesigned and accurately constructed to the
specification of the orthodontist who, ifspecification of the orthodontist who, if
necessary, must be able to construct annecessary, must be able to construct an
appliance himself exactly as he wants it.appliance himself exactly as he wants it.

REFERENCESREFERENCES
 K.G. Isaacson, J.D. Muir, R.T. Reed: RemovableK.G. Isaacson, J.D. Muir, R.T. Reed: Removable
orthodontic appliances, 1st ed. Wrightorthodontic appliances, 1st ed. Wright
publication2002: pg 17-34,102-105publication2002: pg 17-34,102-105
 Norman Wahl “Orthodontics In 3 Millenia”Norman Wahl “Orthodontics In 3 Millenia”
American Journal Of Orthodontic Society &American Journal Of Orthodontic Society &
Dentofacial Orthopedics 2005:volume 128(4)535-Dentofacial Orthopedics 2005:volume 128(4)535-
540540
 William R. Proffit: contemporary orthodontics, 4thWilliam R. Proffit: contemporary orthodontics, 4th
ed. elesevier2007: pg 623-625ed. elesevier2007: pg 623-625
 T.M. Graber, B. Neumann: RemovableT.M. Graber, B. Neumann: Removable
orthodontic appliances, 2nd ed. W.B. Saundersorthodontic appliances, 2nd ed. W.B. Saunders
Company 1984: pg 12- 53Company 1984: pg 12- 53

 Adams Removable appliances yesterday andAdams Removable appliances yesterday and
today AJODO Volume 1969 Jun (202 - 218)today AJODO Volume 1969 Jun (202 - 218)
 S. J. Littlewood, A. G. Tait, N. A. Mandall, andS. J. Littlewood, A. G. Tait, N. A. Mandall, and
D. H. Lewis,D. H. Lewis, The role of removable appliances inThe role of removable appliances in
contemporary orthodontics BRITISH DENTAL JOURNALcontemporary orthodontics BRITISH DENTAL JOURNAL
VOLUME 191 NO. 6 SEPTEMBER 2001VOLUME 191 NO. 6 SEPTEMBER 2001
 C.P. Adams, W. JS. Kerr: The design, construction andC.P. Adams, W. JS. Kerr: The design, construction and
use of removable orthodontic appliances, 6th ed.use of removable orthodontic appliances, 6th ed.
Varghese publishing house: 6-9, 42, 150, 163-170Varghese publishing house: 6-9, 42, 150, 163-170

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