The document discusses removable and fixed orthodontic appliances. Removable appliances can tip teeth but cannot perform complex movements like fixed appliances. Removable appliances are easier to construct and manage, require less chair time, and allow for oral hygiene. However, they rely more on patient compliance and cannot move teeth as precisely as fixed appliances. While removable appliances can address mild to moderate malocclusions, fixed appliances offer better control and are needed for more complicated cases.

1. Department of Orthodontics
North Bengal Dental College & Hospital

3. •Psychological implications of
malocclusions which hampers
the facial appearance causing
low self –esteem and restricted
social activities of the patient.
•Problems with clarity and
articulation of speech.
•Difficulty in mastication due
to certain malocclusions.
•Inability to keep lips closed
which causes discomfort to the
patient.

4. •Pain in the lower anterior teeth or
palate in severe deep bite.
•Hypersensitivity of teeth and
anterior teeth getting worn down.
•Pain in the TMJ.

5.  Orthodontic treatment aims at improving the
aesthetics and function of the oro-facial region.
Jackson’s
Triad
Functional Efficiency
Structural Balance Aesthetic Harmony

6.  Most of these changes are brought about by using
devices that move teeth or modify the growth of jaws,
these devices are called Orthodontic Appliances.
 Orthodontic appliances are devices by means of which
mild pressure may be applied to a group of teeth and
their supporting structures so as to bring about
necessary changes within the bone, which will allow
tooth movement.

10.  Removable appliances as the name suggests are
appliances which can be inserted into and removed
from the oral cavity by the patient at will.

11.  Fixed appliances are those that are fitted onto
the tooth surface and can only be removed by
the operator.

12. Retentive components- various types of clasps
Active components- bows, springs, retractors, screws.
Base plate- acrylic part.

13.  Active components- arch wires, springs, elastics,
separators.
 Passive components- bands, brackets, buccal tubes,
lingual attachments, lock pins, ligature wires

15.  Easy to construct and manage, requires minimum
chair side time.
 Needs less inventory, relatively less expensive than
fixed appliances.
 The removable nature of appliance makes it possible
for the patient to maintain good oral hygiene,
minimum food debris accumulation.
 Patient can wear without fear, if trauma occurs the
patient has the freedom to remove it (damaged
appliances the apply undesirable forces can be
removed by the patient)

16.  Most malocclusions requiring tipping type of tooth
movement can be readily carried out using removable
appliances.
 Lesser forces are required than those needed for bodily
tooth movement. Hence, strain on the anchor teeth is
lesser than in fixed appliance therapy.

17.  Patient cooperation is dispensed, the orthodontist
does not have to depend on the patient for timely wear
and management of the appliance.
 Multiple tooth movements are possible
simultaneously. Therefore, treatment duration is
considerably reduced.
 More precise tooth movements and detailing of
occlusion is possible using fixed appliances.
 Fixed appliances offer better control over anchorage.

18.  Unlike the removable appliances it is possible to bring
about various types of tooth movements such as bodily
tooth movement, rotation, intrusion, extrusion and
even possible simultaneously in the same treatment.

19.  Removable appliances work by applying a single force
onto the crown of the teeth. Thus, removable
appliance acts by tipping the tooth around its centre of
resistance.
 Tipping can be brought about in mesio-distal or
bucco-lingual direction.
 Removable appliances are generally ineffective in
bringing about bodily translation, derotation and
uprighting of teeth due to single point of contact of
the appliance.

21.  Bodily movement-
implies an equal
movement of both
crown as well as the root
in the same direction.

22.  Tipping – the crown
moves in the direction
of force around a
fulcrum in the apical
region of the root, the
root apex moves in the
opposite direction
Torquing- implies
root movement in
the labial or
lingual direction.

23. Uprighting- the crown of certain teeth
will be tipped in the mesio-distal
direction and the roots tipped in the
opposite direction
Rotation- displacement of the
body, produced by a couple,
characterized by centre of
rotation coinciding with the
centre of resistance that is
movement of point of tooth
along the area of circle with
centre of resistance being the
centre of the circle.

24. Intrusion and Extrusion- it refers to the vertical
movements of teeth along their long axis

25.  The major limitation of removable appliances is that
they are capable of only tipping tooth movement
(uncontrolled tipping).
 Patient cooperation is vitally important for the success
of the treatment. It can only be used when less than
4.5 mm of tooth movement is required.
 Multiple tooth movement correction should b e
carried out 1 at a time, therefore, treatment duration is
prolonged.
 In cases of extraction, residual space closure by
forward movement of posterior teeth is very difficult.

26.  The most important disadvantage is oral hygiene
maintenance becomes very difficult (Plaque and food
debris tend to accumulate around the attachments).
 Fixed appliances are time consuming, they take up more
chair side time unlike removable appliances.
 Unless modern tooth colored appliances are used, they are
unaesthetical.
 They require lot of special skill and training of the operator.
Otherwise there is a greater possibility of producing
adverse tooth movements.
 Fixed appliances are by far more expensive than removable.

28.  Correction of mild to moderate
crowding.
 Correction of anterior cross bite.
 Correction of posterior cross bite .
 Correction of deep bite.

37.  Correction of habits such as:
1. Thumb sucking
2. Mouth breathing
3. Toungue thrusting

38.  Use of an anterior bite block which will allow the
passive erruption of the posterior teeth to an extent
causing the correction of deep bite

39. Before Treatment

40. Removable appliances may cause
inappropriate results if used alone.
The upper first premolars have
been extracted and the overjet
reduced by tipping the teeth. Since
tipping alone is not sufficient in
this case the result is poor.

41. The upper model shows the compromised result
produced by use of a removable appliance alone
Inappropriate use of a removable appliance has simply
converted a Class II division 1 maloccusion in an
unaesthetic and unappealing result due to torque
limitation. In other words, even though removable
appliances have varied scope in orthodontics but it
may require an adjunctive use with fixed appliance for
a number of purposes.

43. In total Removable appliances can
be used for all comprehensive
orthodontic treatment but due to
its certain short comings or side
effects they are now rarely used in
expense of fixed appliances.

44.  The main difference between the removable
appliances and fixed appliances lies in their mode of
action.
 Removable appliances work by simple tipping
movements of the crowns of the teeth about a fulcrum
close to the middle of the tooth. They differ from fixed
appliances, which are capable of complex movements
of multiple teeth, including bodily movement, torque
and rotation.