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An Atlas of Removable

Orthodontic Appliances

Second edition

GORDON C. DICKSON
B Ch U (Leeds).F D S, D Orth, R C S (Eng)
Orthodontic Consultant to the
Portsmouth Hospital Group

ALBERT E. WHEATLY
F B I S T. M O T A
Chief Technician, Dental Wing, Royal
Portsmouth Hospital

Turkish Power

OrTHoTaMiNe Tarafından
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CONTENTS

Preface 8 Palatal Movement of


The Materials 10 Premolars and Molars
The Tools 12 72
Anodic Polishing Mesial and Distal Move-
Apparatus 14 ment of Incisors 74
Wire Bending 16 Lateral Movement of
Construction of the Adams Canutes 76
Clasp 24 Labial Movement of
Variations of the Adams Canines 78
Clasp 38 Distal Movement of
The Adams Clasp f o r Canines 80
Extraoral Traction The Labial Canine
40 Retractor 82
Alternative Clasps Sleeving the Canine
42 Retractor 84
The Effect of a Finger- A d j u s t i n g the Retractor
spring 44 86
Resistance to Displacement The Cut-and-bend Spring
46 88
Resistance to T o o t h Move- Palatal Movement of
ment (Anchorage) Lateral Incisors 90
50 The Sved Bile Plate 92
T h e Simple Cantilever The Effect of a Bite Plane
Spring 56 94
Boxing-in 62 The Labial A r c h 96
Paired Cantilever Springs The Labial A r c h as a
64 Retainer 98
Double Cantilever Springs The Roberts Retractor
66 100
The Kinked Cantilever Construction o f the
Spring 68 Roberts Retractor
Premolar Retraction 102
Springs 70 A p r o n Springs 104
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Variations of, and Labial Movement of Upper


Incisors (Schwarz)
Additions t o , Labial
124
Arches 106
R o t a t i o n of a Single T o o t h
More Variations of the
126
Labial A r c h 108 R o t a t i o n by Contra-acting
The Inverted Labial A r c h Springs 132
110
Space-maintainers 112 Extraoral Traction 134
Expansion Screws 114 Extraoral Anchorage 138
Asymmetrical Radial Buccal Movement of
Expansion 120 Premolars 144
Distal Movement of Incisor Elongation 146
Buccal Segment T h e Andresen Appliance 150
(Schwarz) 122 The Oral Screen 156
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THE M A T E R I A L S

Stainless steel wire


This must be H A R D POLISHED [ B r i t i s h Standard
No. 3507 (1962)] Hard drawn, unpolished wire is
inferior and should not be used. It is specified in metric
diameter measurement and the correct sizes for each
appliance will be f o u n d on the text-page opposite each
appliance.

Stainless steel tube


Tubing may be H A R D P O L I S H E D or B R I G H T
A N N E A L E D . It is usually specified by internal diameter
only, the thickness of the tube wall being appropriate for
orthodontic purposes.

Stainless steel tape


As used in orthodontics, tape is supplied S O F T ,
POLISHED ONE S I D E , the other side being m a t t to
facilitate adhesion of cement.

Acrylic resin
C L E A R acrylic denture base is used for the construction
of all appliances, chiefly as it allows blanching of the tissues
over pressure areas to be detected visually, and also
because it shows more clearly when f o o d debris has
collected around the springs.

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THE TOOLS

For the vast m a j o r i t y of removable appliances l o u r


instruments o n l y are required.

1. Universal pliers
These are used for all wire bending w i t h the exception of
the f o r m a t i o n of loops or coils. The beaks are s t o u t ,
tapered and rectangular in section, and meet o n l y at the
tips. Beaks which are in contact throughout their length
tend to eject a large diameter wire (Inset A ) . The beaks
of Universal pliers are parallel when gripping the wire
(Inset B). When the pliers become worn they should be
resharpened, maintaining a beak size of 1 mm square at
each t i p and c u t t i n g back so that a 0 . 6 m m wire can be
passed between them at the base when the pliers are
closed.

2. Loop-forming pliers
These have r o u n d , tapered beaks around which loops or
coils of various sizes may be f o r m e d .

3. Wire cutters
The diagonal type of wire cutter is used and must have
hardened blades.

4. Hollow-chop pliers
Used for making bends in wires which are already
anchored at b o t h ends in an appliance, these pliers have
one beak round and the other h o l l o w e d so as to wrap
round its opponent. They therefore exert pressure
simultaneously at three points on the wire. They may
also be used for increasing the bend in the labial canine
retraction spring shown on page 82.

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ANODIC POLISHING APPARATUS

The anodic polishing bath illustrated is used for


reducing the diameter of stainless steel wire where a
variation in thickness is required.
In use the positive pole is connected to the wire to be
thinned using a crocodile c l i p and so f o r m i n g the anode.
The cathode (negative pole) is f o r m e d of a stainless steel
plate.
A current of 8 amps at 20 volts is suitable for most
purposes. A variable resistance is unnecessary as the
current can be varied by moving the anode nearer t o , or
further f r o m , the cathode.

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WIRE BENDING, 1

Soft curves
For labial arches of all kinds, smooth curves are formed
by holding one end of the wire firmly on one hand and
forming a curve with the thumb of the other hand. The
thumb is then drawn firmly along the wire, creating a
smooth curve of large radius. Repeating the process will
increase the curve to any desired extent. Avoidance of
the use of pliers will ensure a bend without kinks.

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WIRE BENDING, 2

Right angle bends


H o l d i n g ihc wire at right angles to the long axis of the
pliers the wire is held against the t h u m b and the bend
made by pressing the t h u m b f i r m l y on the wire as
closely as possible to the plier beak. (For clarity in the
illustration the t h u m b is shown a little too fat back.)

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WIRE BENDING, 3

Acute bends
These are formed by holding the wire along the beaks of
the pliers and bending firmly back with the forefinger.

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WIRE BENDING, 4

Small radius bends


H o l d i n g the wire at right angles to the plier beak the
wire is bent with the t h u m b placed a short distance
away f r o m the bend.

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CONSTRUCTION OF THE ADAMS CLASP, 1

If desired the clasp may be pre-lightened by t r i m m i n g


the plaster t o o t h as shown.

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CONSTRUCTION OF THE ADAMS CLASP, 2

Forming the bridge


A careful estimate is made by eye of the mesiodistal
width of the tooth. A piece of 0.7mm wire about 12cm
(5in) long is held at right angles to the pliers at a point
where the width of their beaks is equal to about two-
thirds of the tooth-width.
Using the thumb and forefinger the two ends, which
should be of equal length, are pushed backwards as far
as the plier beaks will permit. The tips of the beaks are
then used to increase these bends to slightly less than a
right angle so that the ends of the wire cross each other.

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CONSTRUCTION OF THE ADAMS CLASP, 3

Forming the first arrowhead


As the length of the arrowhead will vary according to
the height of the crown of the tooth to be clasped, this
is first estimated and a bend made in a position which
will place the bridge about half-way up the crown. This
is made in two stages.
First stage: a right angle bend as shown opposite.

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CONSTRUCTION OF THE ADAMS CLASP, 4

Forming the first arrowhead (contd.)


Second stage: this bend is increased by bending thc wire
backwards over the beak-lips (as on page 21).

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CONSTRUCTION OF THE ADAMS CLASP, 5

Forming the second arrowhead


Holding the clasp in the position shown, the second
arrowhead is formed in the same way as the first (Inset
D). Each arrowhead is then squeezed lightly between the
plier beaks (Inset E) to increase the sharpness of the
arrowheads. This should not be carried to excess or the
wire will later break at this point.

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CONSTRUCTION OF THE ADAMS CLASP, 6

Aligning the arrowheads


Each arrowhead in turn is held in the pliers as shown and
bent until the plane of the arrowhead lies at about 45°
to the bridge.

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C O N S T R U C T I O N OF T H E A D A M S C L A S P , 7

Forming the togs


A right angle bend is formed at a level slightly below the
bridge by holding the arrowhead as shown (the t h u m b
has been w i t h d r a w n for c l a r i t y ) .
Over the contact point of the t o o t h a second, shallow
bend is f o r m e d and the clasp presented to the t o o t h . It
is essential that the bridge should not lie in contact w i t h
the buccal surface of the t o o t h and these last bends
should be increased if necessary to achieve this.
Finally the tags are completed by bending over the
palate and the ends turned under and forced i n t o the
plaster (page 25). The tags should lie out of contact with
the plaster so that they will later be completely
surrounded by acrylic material.
When the clasp has become slack in wear it is
lightened by increasing the bend in the tag at a point
immediately overlying the contact point of the t o o t h .

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VARIATIONS OF THE ADAMS CLASP

The auxiliary clasp


A. A second arrowhead is formed as shown and united to
the bridge of the main clasp using hard solder and stain-
less steel flux. The minimum amount of heat should be
used and the solder should not be heavily polished,
otherwise it will be removed entirely from the surface
and will have no mechanical hold. Soldering may be
carried out either on the model or after processing.

The incisor clasp


B. A single incisor can be clasped as shown in the left-hand
diagram, the arrowheads resting against the mesiolabial
and distolabial aspects of the tooth.
C. Two central incisors can be clasped as shown.

Materials
All clasps are made with 0.7mm wire.
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THE ADAMS CLASP FOR EXTRAORAL TRACTION

Where upper first premolars have been extracted an


auxiliary arrowhead may be used (page 38) but this is
not easy to adjust. A variation is to place arrowheads on
the mesial of the second premolar and the distal of the
molar as in diagram A
This form of retention is of value in extraoraI
anchorage (page 138) but for convenience of accom-
modating adjustment loops of friction stops, ii is con-
venient to offset the tubing in which the arch fits as
shown in diagrams B and C.

Construction
Adams clasps 0.7mm stainless steel wire
Extraoral arch: 1.25mm wire
Tubing. 1.25 internal diameter stain-
less steel
Attachment of tubing Strapping with 2.0 x 0.1 mm
stainless steel tape or binding
with soft wire and soldering

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A L T E R N A T I V E CLASPS

B o t h the clasps illustrated use the same principle as the


Adams clasp i.e. retention f r o m the undercut areas
present on the mesiobuccal and distobuccal corners of
the molar teeth.

The ball-ended clasp


A, B. Prefabricated ball-ended wires are bent in the f o r m
shown a n d sprung i n t o the angular undercuts. Alterna-
tively, stainless steel wire may be bent i n t o a sharp,
closed curve a n d c u t o f f short to replace the balls.

The Duyzings clasp


C. T w o stainless steel wires are bent over the m a x i m u m
c o n t o u r of t h e t o o t h f r o m mesial and distal aspects and
then curved back u p o n themselves so that the lower part
lies below the m a x i m u m c o n t o u r a n d the ends are
sprung i n t o the undercuts.

Materials
B o t h clasps are made f r o m 0 . 7 m m stainless steel wire.

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THE EFFECT OF A FINGERSPRING

A. On the tooth
Owing to the tact that the palatal surface of an upper
incisor tooth has a downward and forward slope, it acts
as an inclined plane and the horizontal forward thrust of
a fingerspring is convened into an upward and forward
thrust. In the case illustrated in diagram A the palatal
surface is at 60 c to the horizontal and the thrust may be
divided, as shown by the length of the lines, into an
upward component of two units and a forward com
ponent of three units

B. On the appliance
Reciprocally, in accordance with Newton's Third Law of
Motion, the tooth exerts a backward and downward
force on the spring, as represented in diagram B. It
follows that the clasps on such an appliance must be
placed, not only to resist the backward thrust of the
tooth, but also to resist a considerable downward dis-
placing force.

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R E S I S T A N C E TO D I S P L A C E M E N T , 1

Downward displacement of an upper appliance


In diagram A a labial arch is used to retract upper
incisors. There is a backward force on t h e incisor c o m -
bined w i t h a downward force due to the inclined plane
effect. Reciprocally a forward and upward force is
exerted on the appliance. Only the f o r w a r d force is
resisted by the clasped molar t o o t h (black) while the
palate acts as a f u l c r u m and receives the u p w a r d force.
In diagram B a palatally placed spring is m o v i n g the
incisors forward. The inclined plane of the t o o t h here
exerts a backward and d o w n w a r d force on the anterior
part of the appliance, which would pivot on the clasped
first molar (black). A d d i t i o n a l clasps must be placed on
the first premolars (black) to produce an upward c o m -
ponent and prevent displacement.

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RESISTANCE TO DISPLACEMENT, 2

A lingually placed spring exerts a forward force on the


sloping surfaces of the lower incisors and consequently
receives an upward and backward thrust f r o m the teeth.
A clasp placed on the first premolar (black) acts as a
f u l c r u m about w h i c h the appliance w i l l pivot, t i l l i n g the
posterior end downwards.
The d o w n w a r d thrust is countered by placing an
occlusal rest on the second molar t o o t h (black), so giving
an upward thrust and stabilizing the appliance. (If the
second molar is uncrupted the occlusal rest may be
placed on the distal p o r t i o n of the first molar )

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RESISTANCE TO TOOTH MOVEMENT


(ANCHORAGE), 1

Retraction of labial segment


A. If, following extraction of first premolars, an attempt is
made to retract the entire labial segment at once, the
only teeth resisting this movement are the four
remaining posterior teeth. It may be expected, therefore,
that the forward movement of these teeth will exceed
the backward movement of the incisors and canines.
B. When the canines alone are retracted the incisors take
part in the anchorage. Only two teeth are being moved
against an anchorage of eight teeth. Although these will
inevitably undergo some slight forward movement, this
will be small compared with the distal movement of the
canines.
C. The canines now being in the fully corrected positions,
an appliance designed to retract only the four incisors
can utilize all the six remaining teeth as anchorage, so
producing a major movement of the incisors with little
further forward movement of these teeth.

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RESISTANCE TO TOOTH MOVEMENT


(ANCHORAGE), 2

D. Distal movement of a buccal segment


Following extraction of an upper second molar the first
molar and both premolars of that side may be moved
distally, three teeth moving against an anchorage of nine
teeth. The labially displaced canine is not included in
either part of the appliance.

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RESISTANCE TO TOOTH MOVEMENT


(ANCHORAGE), 3

The proper application of extraoral traction


A At the commencement of extraoral traction designed to
move ail the upper teeth posteriorly f o l l o w i n g e x t r a c t i o n
of second molars, the labial arch is bent away f r o m the
labial segment. A l l the extraoral force is then directed
against the cheek teeth, which w i l l move distally.
B. At the completion of distal movement of the cheek
teeth the labial arch is bent back to rest against the
labial segment, not to press against it. When the extra-
oral force is applied the labial segment will move
posteriorly. At the next visit the labial arch w i l l be seen
to stand away f r o m the incisors Until the extraoral force
is applied. It can then once more be adjusted to rest
against the anterior teeth.
C. If the labial arch is adjusted (via the U-loops) to press
against the incisors, application of t h e extraoral force
will increase pressure on the incisors, but w i l l not release
the forward force on the cheek teeth produced by the
tension in the U-loops. The anchorage problem
generated within the appliance is not removed by the
application of extraoral force.

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THE SIMPLE C A N T I L E V E R SPRING. 1

Parrs of the spring


A, A simple cantilever spring consists of three parts. The
tag is embedded in the acrylic resin of the supporting
baseplate. The coil is the active part of the spring and is
normally made so that it tends to open, rather than
close, in use. The arm of the spring undergoes only slight
bending and may be regarded as a rigid lever.

Direction of pressure
B. As friction between the spring and the t o o t h can be
ignored, the direction of pressure will always be at right
angles to the a r m of the spring and, if the spring has to
work over a l o n g angular range, this will change con-
siderably during t o o t h movement. The path traced by
the t i p of the spring is k n o w n as the Path of A c t i o n .
C. The longer the arm of a spring the greater will be its
range of action. A short spring not o n l y has a short
range of action but, as it moves, its tip describes an arc
of a small circle. As its length increases so this arc
becomes straightened and its path of action is nearer to
a straight line. As length increases, so the spring must be
made of thicker wire to exert the same force,
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ACTIVATING THE CANTlLEVER SPRING

A small, controlled and accurate amount of tension can


bo given to cantilever springs by squeezing the coil in the
tips of the universal pliers as in diagram A. This
produces a slight flattening of the curve, exaggerated for
clarity in diagram B.

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THE SIMPLE CANTILEVER SPRING

The spring illustrated is moving .in upper incisor 'over


the bite'.
The arm of the spring is set at right angles to the
intended path of the tooth to be moved and is lelt long
so as not to lose contact with the tooth towards the end
of its movement.
Ihe coil is set as far away as possible from the tooth
to be moved
The tag is short and well within the thickness of the
acrylic.
The bite is raised on the cheek teeth either by a
thickness of acrylic resin or, as shown here, by a single
wire passing over the occlusal surfaces of the cheek
teeth. This is used where the thickness of acrylic capping
(see Inset A) would be too little to stand the bite with-
out fracture;
Inset B shows the same spring adapted to move two
teeth
Construction
Springs: 0.5mm boxed-in
Retention: Adams clasps on 64/46
Bite-raiser: 10 mm wire or acrylic capping
Baseplate: Full palate

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BOXING-IN

The purpose of boxing-in is to protect the spring from


damage and to act as a guide along which the arm can
slide. At the time the spring is constructed and tacked
to the plaster model with wax, it is covered with a small
amount of thin plaster which is shaped up with a knife,
care being taken to note the following points.
1. It should extend beyond the tip of the spring and
should have a smooth outline,
2. It should have a smooth, flat upper surface.
3. It should continue this smooth, flat surface right in
between the teeth
4. As the teeth move forward so the control excited by
the capping is lost, It is possible lo use instead a guide
wire, as illustrated. This can be advanced as the teeth
move by squeezing the sides with pliers. The guide is
made of 0.7mm soft stainless steel wire
After appropriate protection the plaster is covered
evenly with baseplate wax and processing completed. A
check should then be made to ensure that the spring has
free travel without Fouling any projection of the base-
plate.

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P A I R E D C A N T I L E V E R SPRINGS

Where four incisors are to be moved over the bite, each


spring moves the central and lateral incisor nearest the
e n d of the spring.

Construction
Springs: 0.5mm boxed-in
Clasps: 0.7mm
Retention: Adams clasps on 64/46
Baseplate: Continued over all check teeth as capping

Inset A
This lateral view shows boxed-in spring and just
sufficient clearance to allow the upper incisors to move
f o r w a r d w i t h o u t f o u l i n g the lowers.

Inset B
A double cantilever spring may be used as an alternative
for the same t o o t h movement ( 0 . 6 m m wire), b u t this
requires a greater degree of skill in adjusting.

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DOUBLE CANTILEVER SPRINGS

Forward movement of two upper lateral incisors, may be


carried out by means of two small double cantilever
springs which can be used to vary the direction of move-
ment, or where space for the spring is confined.

Construction
Springs; 0.5 mm boxed-in
Clasps: Adams clasps on 64/46
Baseplate. Full palate (capping on cheek teeth if
the lateral incisors must pass over the
bite)
Inset A
Lateral movement is produced by opening the right-hand
coil
Inset B
Forward movement is produced by opening the left hand
coil

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THE KINKED CANTILEVER SPRING

Interference with the movement of the spring by the


palatal surface of a premolar may prevent a simple spring
moving a palatally displaced canine into the arch. This is
overcome by kinking the spring, which still behaves as a
lever pivoting on the coil.

Construction
Spring: 0.6 or 0.7mm boxed-in
Clasps: A d a m s clasps on 6 4 / 6
Baseplate: Full palate (capping on cheek teeth if
the canine must pass over the bite)

Inset
The position of the spring at completion of tooth move-
ment

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PREMOLAR RETRACTION SPRINGS

TWO alternative springs are shown, one incorporating a


guide wire and one boxed-in, both moving the first pre-
molar distally into an extraction space.

Construction
Left side Right side
Springs: 0.6mm 0,6mm with guide wire
boxed in
Clasps: Adams clasps Adams clasps on 6/6
on 6/6
Baseplate Full palate Full palate, cut away
to expose spring

Inset
The spring must follow as closely as possible over the
contact point.
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P A L A T A L MOVEMENT OF PREMOLARS A N D
MOLARS

Buccally displaced teeth may be moved palatally by


means of springs passing between the teeth. On the left
an upper molar is being m o v e d ; on the right t w o pre-
molars are being moved, both using a buccally placed c o i l .

Materials
Clasp: 0.7mm
Spring: 0.6mm
Tape: 2 . 0 x 0 . 1 mm
Solder and flux

Construction
Springs: 0.6mm
Clasps: Adams clasps on any cheek teeth not
being moved
Baseplate: Full palate, cut away to allow palatal
movement of teeth

Inset
This shows the level of the a r m of the spring and the
large coil in an alternative design where the spring is
attached to the molar clasp.

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MESIAL A N D D I S T A L MOVEMENTS OF INCISORS

Tour palatally plated fingersprings are used.


A. This diagram shows distal movement, the position of the
coil of each spring being carefully placed to carry the
t o o t h in the desired direction. Here the springs are
boxed-in.
B. This diagram shows mesial movement, but here the path
of movement of the teeth is not o n l y dictated by the
position of the coils of the springs but is guided by a
labial arch and a palatally placed guide wire which
prevents them 'wandering' in an anteroposterior plane.
The springs are n o t covered by the baseplate.

Construction
Springs: 0.6mm
Labial arch: 0.7mm
Guide wire: 0.6mm
Clasps: Adams clasps on 6 / 6
Baseplate: Full palate in A
Full palate cut away in B

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LATERAL MOVEMENT OF CANINES

Simple cantilever springs are illustrated, the positioning


of the coil being dictated by the direction of t o o t h
movement. B o t h springs are uncovered and c o n t r o l l e d
by guide wires, this facilitating insertion of the appliance
by the patient.

Construction
Springs: 0.6 or 0 . 7 m m
Guide wires: 0 . 7 m m
Clasps: Adams clasps on 6/6
Baseplate: Full palate, cut away to expose springs
and if necessary carrying bite platforms
on all the cheek teeth to allow the
canines to move over the b i t e

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LABIAL MOVEMENT OF CANINES

A covered canine spring is d i f f i c u l t for the patient to


insert if any degree of activation is a p p l i e d : in this
appliance (designed by R. Hanney) the spring is kinked
in the middle of the arm and the baseplate is corre-
spondingly cut away. The spring thus has the protective
advantages of boxing-in yet the patient can engage the
kink w i t h a fingernail and so compress the spring to
facilitate insertion of the appliance.

Construction
Spring: 0 . 6 m m boxed-in
Clasps: Adams clasps on 6 / 4 6
Space-holding clasps on 4 2 / : 0 . 6 m m
Baseplate: Full palate, with cut-away in cover for
spring. Bile platforms where necessary

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D I S T A L M O V E M E N T OF CANINES

Palatally placed cantilever springs are used, their coils


being placed so as to give movement of the canines along
the arch w i t h o u t displacing them either lingually or
buccally.

Inset
To avoid sliding d o w n the mesial slope of the canine the
spring is carefully bent so as to f i t between the lateral
incisor and canine and to take advantage of the flat
mesial surface of the t o o t h . Once movement has begun
it can be m o d i f i e d to fit r o u n d the neck of the t o o t h .

Construction
Springs: 0 . 7 m m boxed-in
Clasps: Adams clasps on 6 / 6
Baseplate: Full palate

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THE L A B I A L CANINE RETRACTOR

This is one of the few springs in which the c o i l is made


to close rather t h a n to o p e n in action. The c o i l lies in
the labial sulcus.

Points to note
1. The end of the spring should be bent at a r i g h t angle
before being shaped to the curve of the t o o t h , like a
golf-club.
2. The loop should lie as high as possible in the sulcus
w i t h o u t interfering with any f o l d of soft tissue
c o m m o n l y f o u n d in this area.
3. The tag should lie as close as possible to the second
premolar, and the posterior arm should not cut across
the first premolar position where it would interfere
w i t h retraction of the canine.

Construction
Spring: 0 . 7 m m wire or 0 . 6 m m sleeved (see page 84)
Retention: Adams clasps on 6 / 6
Baseplate: Full palate, cut away to allow movement
of canines

Inset A
Shows (1) Posterior arm in contact w i t h second pre-
molar and passing over the contact point of
this t o o t h .
(2) Golf-club end of anterior a r m , sharpened at
tip.

Inset B
Shows (1) Path of action.
(2) Clear area behind the canine, unobstructed by
the spring.

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SLEEVING THE CANINE RETRACTOR

1. Sleeve prepared (upper end chamfered).


2. Sleeve passed over the posterior arm.
3. Sleeved portion bent over to complete the posterior
arm and form the tag.

Materials
Spring: 0.6mm hard polished stainless steel
Sleeve: 0.6mm internal diameter soft (annealed}
stainless steel tube

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ADJUSTING THE RETRACTOR

1. Increasing the tension


As the coil is in the reverse direction to that of the
fingerspring it cannot be adjusted In the same way.
Increased tension is produced by bending the anterior
arm using 'hollow-chop' pliers such as Marthews' or
Andresen's.
A. Position of the plier beaks on the anterior arm.
B. Resultant bend.

2. Lowering the spring on the tooth


C. Position of the plier beaks on the posterior arm,
D. Coil and anterior arm lowered.

3. Raising the coil


E. Position of the plier beaks on the posterior arm.
F. Coil and anterior arm raised. This must be followed
by a downward bend of ihe anterior arm as in A and
B.

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T H E C U T - A N D - B E N D SPRING

A l t h o u g h the spring requires frequent adjustment, it can


be used where a low labial sulcus prevents the use of the
labial retractor described on pages 82 and 84, yet where
a palatal component of movement is needed. It is also
useful in lower appliances where there is rarely any
depth of sulcus.
The spring may touch the labial surface of the canine
for palatal movement (as on left of illustration) bul is
well clear of the t o o t h anteriorly except where the l i p
touches the mesial aspect of the l o o t h .
To activate the spring the tip is bent back about 1 m m .
When the t o o t h has moved by this a m o u n t , 1 mm is cut
off the t i p of the spring and the bend remade so that the
shape of the spring is maintained (Inset B).

Construct ion
Spring: 0.6mm
Clasps: Adams on 6/6
Baseplate: Full palate

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PALATAL MOVEMENT OP LATERAL INCISORS

Individual springs are preferred to a full labial arch w h i c h ,


w o u l d f o u l the central incisors. Each spring is flattened
at the t i p on an anvil, tapered in the anodic polishing
bath and bent to a golf-club and before adapting it to
the t o o t h . Pressure should be exerted as near to the tip
of the t o o t h as possible and the springs are activated
w i t h hollow-chop pliers.

Construction
Springs: 1.0mm wire thinned to 0.6mrn
anodically
Retention: Adams clasps on 6/6
Baseplate: Full plate, c u t a w a y b e h i n d 2/2

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T H E SVED B I T E P L A T E

This is illustrated in c o m b i n a t i o n w i t h canine retractors,


though it may be used alone. Pressure on the bite plane
by the lower incisors is transferred to the upper incisors
instead of to the soft tissues.

Construction
Springs: 0.6mm sleeved
Retention: Adams clasps on 6 / 6
Baseplate: Pull palate and covering tips of upper
incisors, thickened to f o r m bite plane

Inset A
This shows relationship of lower incisors to bite plane
which must be extended sufficiently to make it
impossible for the lower incisors to bite behind it. It is
necessary to m o u n t the models on an articulator for this
purpose

Inset B
Should this open the bite on the check teeth by more
than 3 or 4 m m , the plane should be lowered, and later
in treatment it can be raised by adding c o l d c u r i n g
acrylic resin.

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T H E EFFECT OF A BITE PLANE

A bite plane such as that used in the Sved plate exerts a


variable force on the lower incisors depending on its
inclination.
A. A plane at 4 5 ° exerts as m u c h f o r w a r d force on the
opposing teeth as it exerts d o w n w a r d — for example, a
force of 85g (3oz) is divided i n t o t w o forces each of
42.5g(1.5oz).
B. A plane at 30° to the horizontal would divide a similar
force i n t o 56.7g (2oz) d o w n w a r d a n d 28.3g (1oz)
horizontally.
C. A horizontal plane exerts all its force downwards.
It should be noted that the appliance itself receives
equal a n d opposite pressures to those exerted on the
opposing teeth.

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THE L A B I A L ARCH

This, the simplest f o r m of incisor retraction, is f i r m and


positive in action but works over o n l y a short range and
consequently requires frequent adjustment.
The arch itself should make contact w i t h the incisors
about half-way up the crowns; the U-loops lie over the
canines and should be tall enough to facilitate adjustment.
This is carried o u t by closing the loops w i t h h o l l o w chop
pliers.
The baseplate is cut away a l i t t l e at a l i m e b e h i n d the
incisors, keeping slightly in advance of their movement.

Construction
Labial arch: 0 . 7 m m wire
Retention: Adams clasps on 6/6
Baseplate: Full palate

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THE L A B I A L ARCH AS A RETAINER

The fitted labial arch


This is used to secure the incisors f i r m l y after they have
been rotated. It is here shown w i t h a s h o r t steep bite
plane to maintain the position of the lower incisors
after they have been depressed (Inset B).
Inset A shows the reverse loops which may be
e m p l o y e d w i t h this arch or w i t h t h e plain labial arch
when it is desired to c o n t r o l the position of the canines.

Construction
Labial a r c h : 0 . 7 m m wire
Retention: Adams clasps on 6 / 6
Baseplate: Full palate, thickened a n t e r i o r l y to
f o r m bite plane

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THE ROBERTS RETRACTOR

This adaptation of the labial arch designed by G. H.


Roberts consists of two sleeved Canine retractors joined
to form an apron spring. It is suitable only for retraction
of the four upper incisors following previous retraction
of the canines. Forward relapse of the canines is
prevented by spurs on their anterior surfaces, contoured
to pass incisally to the contact point.
The arch should lie half-way up the crowns of the
teeth (Inset A) and should extend only two-thirds of the
width of the lateral incisors; otherwise adjustment
becomes difficult towards the end of tooth movement.
The baseplate is cut away in advance of tooth move-
ment in the manner shown in Inset B.

Construction
Retractor: 0.5mm wire sleeved in 0.5mm internal
diameter soft stainless steel tubing
Spurs: 0.6mm wire
Retention: Adams clasps on 6/6
Baseplate: Full palate

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CONSTRUCTION OF THE ROBERTS RETRACTOR.

The diagram shows how chamfered annealed stainless


steel tubing is slipped over the ends of the Spring before
bending the posterior arms to form tags as in the con-
struction of the canine retractors.

Materials
0.5mm hard polished stainless steel wire
0.5mm internal diameter bright annealed
stainless steel tubing

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APRON SPRINGS

A high labial arch i n c o r p o r a t i n g a step in each vertical


arm carries a light wire spring w h i c h lies half-way down
the crowns of the incisors. If the incisors arc spaced it is
i m p o r t a n t n o t to carry the arch t o o far across the lateral
incisors.
After bending the spring i n t o shape it is attached by
winding r o u n d the labial arch close to one of the angles,
t w o or three turns being taken r o u n d each of the
horizontal and vertical arms (Inset A ) . It is activated by
bending the upright arms of the a p r o n spring w i t h
hollow-chop pliers. The palate is cut away in advance of
the t o o t h m o v e m e n t .

Construction
High labial arch: 1.0mm wire
A p r o n spring: 0.35mm
Retention: Adams clasps on 6/6 w i t h
ancillary arrowheads on 5/5
Baseplate: Full palate

Inset B
Shows an individual apron spring to retract a central
incisor. Here the spring is strapped on to the arch by
stainless steel tape which is welded tightly r o u n d both
wires. The spring is w o u n d r o u n d the high labial arch
on both sides of the strap and again, loosely, at the
opposite end of the apron spring.

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VARIATIONS OF, AND ADDITIONS TO, LABIAL


ARCHES

Sometimes, after the upper incisors have been retracted,


it is found that the canine stands too far labially. The
'bridge spring' illustrated can be taped on to a 0.7mm
arch as at diagrams A and C or simply wound on as
shown at diagram B.
Materials
Labial arch: 0.7mm
Bridge spring: 0.35mm extra hard stainless steel
Tape: 2.0 x0.1mm

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MORE V A R I A T I O N S O F THE L A B I A L A R C H

A. Flexible 0.7mm labial arch with bends to c o n l r o l the


canines.

B. Flexible 0.7mm labial arch with extended labial section


to control canines.

, D. Flexible 0.7mm labial arches designed by J. R. E. Mills.


These may also be extended to c o n t r o l canines. They
are activated mainly w i t h the fingers.

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THE INVERTED L A B I A L ARCH

Whilst lingually occluding upper incisors may be moved


'over the bite' by means of palatal cantilever springs
alone, additional backward movement of the lower
incisors with an inverted labial arch greatly shortens
treatment time. This arch exerts Class III intermaxillary
traction.
The bite is propped open on all the cheek teeth. It is
essential that a retrusive bite in the slightly open position
is taken and the models placed on an articulator before
bending the arch, the vertical arm of which should lie
well clear of the lower canine and premolar (Inset A).
The arch is activated by bending back slightly with
the thumbs until the lower incisors will only just pass
behind it. As the mandible closes it swings forward
(Inset B) so that the arch is slightly flexed. The palatal
springs are simultaneously brought into action.

Construction
Inverted labial arch: 1,25mm wire anodically
thinned to 0.8mm wire or
sleeved as shown in Inset C
Palatal springs: 0.5mm wire boxed-in
Retention: Adams clasps on 64/46
Baseplate: Full palate and covering all
cheek teeth sufficiently for
upper incisors to clear lowers

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SPACE-MAINTAINERS

The appliance s h o w n is to maintain the space for any


unerupted canine f o l l o w i n g e x t r a c t i o n of first premolars.
HaIf clasps around the teeth adjacent to the space prevent
movement of the lateral incisors and second premolars.
The baseplate is cut away well clear of the e r u p t i n g
canine and the lags of the half-clasps are placed so as to
allow further c u t t i n g of the baseplate if necessary.

Construction
Half-clasps: 0 . 6 m m stainless steel wire
Retention: Adams clasps on 6/6
Baseplate: Pull palate

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E X P A N S I O N SCREWS, 1

Direct lateral expansion


The appliance shown is to move lingually, occluding
upper molars and premolars i n t o normal relationship
w i t h their opponents.
Correct placing of the screw is of the u t m o s t
i m p o r t a n c e a n d the f o l l o w i n g p o i n t s should be carefully
observed.
A f t e r plastering the screw according to the maker's
instructions it should be placed:
1. as deep in the palate as possible,
2. between the first premolars,
3. w i t h its long axis parallel to the occlusal plane,
4. at right angles to the median raphe.

Rate of activation
Using a screw w i t h one end threaded, this is one
quarter-turn per d a y ; a screw w i t h both ends threaded,
one quarter-turn every other day.

Construction
Screw; A screw of hard metal such as stainless
steel, w i t h guide pins i n t a c t , should be
used and its length should be adequate
Retention: Adams clasps on 6 4 / 4 6
Baseplate: Full palate, divided d o w n the centre
after processing

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E X P A N S I O N SCREWS, 2

Radial expansion
Lateral movement of the premolars and canines is
achieved by uniting the t w o halves of the appliance
across the posterior border w i t h a tie-wire so that the
appliance hinges at the back and opens fanwise. It
follows that the screw must open on a curve. Special
screws have been manufactured to permit this to take
place, but it is q u i t e satisfactory to use a loose, soft-
metal screw such as the Badcock screw w i t h the guide
pin cut o f f (Inset B).
The screw must be positioned as f o l l o w s :
1. as far f o r w a r d as possible,
2. as high in the palate as possible (Inset A ) ,
3. at right angles to the median raphe,
4. w i t h its l o n g axis parallel to the occlusal plane.

Rate of activation
The screw is given one quarter-turn twice a week.

Construction
Screw: Soft metal w i t h guide pin removed
Tie; 0 . 9 m m stainless steel wire
Labial arch: 0.7mm stainless steel wire
Retention: Adams clasps on 6 / 6
Baseplate; Full palate, divided through the mid-
line after processing

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E X P A N S I O N SCREWS, 3

Asymmetrical expansion
Correction of unilateral lingual occlusion of the cheek
teeth (and sometimes a canine and a lateral incisor)
presents problems in anchorage due to the tendency of
the lingually occluding side to resist movement more
than the normal side. The appliance illustrated raises the
bite on the cheek teeth on b o t h sides and carries a lingual
flange on the normal side, to engage w i t h the lower
cheek teeth and so to add them to the anchorage. A
short stainless steel screw should be used, placed near to
the centre of the segment to be moved, w i t h its long
axis parallel to the occlusal plane and at right angles to
the line of the cheek teeth. Spurs or half-clasps engage

21/.
Rate of activation
The screw is usually turned at the rate of t w o quarter-
turns per week.

Construction
Spurs: 0.6mm stainless steel wire
Screw: Short, stainless steel
Retention: Adams clasps on 6 4 / 4 6
Baseplate: Full palate, divided as shown and
carrying a smoolhed-off b i t i n g section
on the small segment and a b i t i n g section
indented by the lower teeth and w i t h a
lingual flange on the ' f i x e d ' side

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A S Y M M E T R I C A L R A D I A L EXPANSION

The illustration shows an appliance to regain space loss


in the region of a labially displaced lateral incisor.
As the appliance is joined by a tie at the posterior
border a soft metal screw is used. The guide p i n is
removed and the screw angulated so as to lie along the
circumference of a circle w h i c h has t h e tie as i t s centre.
As w i t h all other screws, it must lie parallel w i t h the
occlusal plane.

Rate of activation
The screw is turned at the rate of t w o quarter-turns per
week.
Construction
Screw: Soft metal (Badcock type)
Tie: 0.9mm stainless steel wire
Spurs: 0.6mm on 3 1 / .
Retention: Adams clasps on 6 4 / 4 6
Baseplate: Full palate, divided as shown

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DISTAL MOVEMENT OF BUCCAL SEGMENT


(SCHWARZ}

Distal movement of an upper buccal segment after


extraction of the second molar can be accomplished by
means of the appliance illustrated. A hard metal screw
is placed with its long axis parallel to the line of the
segment to be moved and to the occlusal plane. A short,
steep inclined plane is incorporated to assist anchorage
by applying some forward pressure to the lower incisors
(Inset). A spur or half-clasp on the left lateral incisor
prevents this tooth drifting distally.

Rate of activation
The screw is turned at the rate of one quarter-turn per
week.

Construction
Screw: Hard metal (stainless steel) with guide
pin
Spur: 0.6mm stainless steel wire
Retention: Adams clasps on 64/46
Baseplate: Full palate with anterior inclined plane,
divided by two cuts, one across the
screw and the other exactly parallel with
the buccal segment to be moved and
with the long axis of the screw

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LABIAL MOVEMENT OF UPPER INCISORS


(SCHWARZ)

Although this appliance is somewhat bulky it has the


merit that the screw can be adjusted by the patient. The
screw should be placed as close as possible to the
incisors and as low as possible without tilting and while
retaining parallelism with the occlusal plane (Inset).
Spurs or half-clasps arc placed distally on 2/2 and
mesially on 3/3.
The bite is raised on all the cheek teeth so as to clear
the overlap of the incisors.

Rule of activation
The screw is turned at a rate of one or two quarter-turns
per week, the slower rate being used if the appliance
tends to slip off the teeth.

Construction
Screw: Stainless steel, minimum bulk
Spurs: 0.6mm on 32/23
Retention: Adams clasps on 64/46
Baseplate: Full palate, with capping over molars and
premolars, divided transversely as shown

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R O T A T I O N OF A S I N G L E T O O T H , 1

Rotation may, w i t h d i f f i c u l t y , be carried o u t by


using a 'couple' - a pair of springs exerting pressure in
opposite directions on the mesial and distal corners of an
incisor tooth. U n f o r t u n a t e l y , this frequently results in
shortening of the t o o t h a n d is not applicable to canines
which are of unsuitable shape.
The l o n g ' w h i p ' or 'capstan' spring i l l u s t r a t e d is
attached to a standard twin-wire channel or W-lock as
shown in Inset C. C o n s t r u c t i o n of the band a n d channel
may be in welded stainless steel o r , for those who do not
possess a welder, in w h i t e gold alloy which is soldered.
When first made, the spring will project f r o m the
mouth and is held down by a projection from a separate
removable appliance (Inset A ) , which will usually c o m -
plete the alignment of the t o o t h w i t h o u t further adjust-
ment. Subsequently the spring may be k i n k e d outwards
to continue the movement and over-rotate the t o o t h , so
reducing the retention period. This over-rotation usually
results in labial displacement of the t o o t h and if this is
expected a labial arch may be incorporated (Inset B). In
this case the retaining spur may be welded or soldered to
the arch.
Construction
Incisor b a n d : 3.0 x 0 . 1 m m soft stainless steel tape
OR 3.0 x 0 . 1 5 m m white gold tape
Channel: 3.0 x 0 . 1 m m (OR 2.0 x 0 . 1 m m )
stainless steel tape OR 3.0 x 0 . 1 5 m m
( O R 2.0 x 0 . 1 5 m m ) w h i t e g o l d tape
Spring: 0 . 3 5 m m extra hard stainless steel wire
Retaining spur: 0 . 7 m m soft stainless steel wire
Labial a r c h : 0.7mm stainless steel wire
Retention: A d a m s clasps on 6 / 6 (or o t h e r
available teeth)
Baseplate: Full palate, cut away f r o m t o o t h to
be rotated
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R O T A T I O N OF A S I N G L E T O O T H , 2

A l t h o u g h the appliance shown on page 127 may be


m o d i f i e d to suit r o t a t i o n of a premolar t o o t h , the
appliance illustrated opposite offers more c o n t r o l as the
labial arch is extended distally to an attachment on the
molar clasp on one side. Such attachment may be made
by welding straps of steel tape over b o t h arch and clasp
or by soldering. In this appliance the end of the r o t a t i o n
spring is formed i n t o a three-quarter collar a r o u n d the
arch as s h o w n in Inset B. The thicker wire of the arch
forms a protection f o r the more vulnerable r o t a t i o n
spring (Inset A ) .
At the completion of treatment by either appliance,
cold c u r i n g acrylic resin may be added to the cut-away
portion of the baseplate after removing the band and the
appliance converted to a retainer.

Construction
Premolar band: 3.0 x 0 . 1 m m stainless steel tape OR
3.0 x 0 . 1 5 m m w h i t e gold tape
Channel: 2.0 x 0.1 mm stainless steel tape OR
2.0 x 0 . 1 5 m m while gold tape
Strap: 2.0 x 0.1 mm stainless steel tape
Spring: 0 . 3 5 m m extra hard stainless steel wire
Labial a r c h : 0 . 8 m m stainless steel wire
Retention: Adams clasps on 6/6
Baseplate: Full palate, cut away around
premolar t o o t h

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R O T A T I O N OF A S I N G L E T O O T H , 3

With the development of acid-etch preparation of


enamel prior t o b o n d i n g w i t h composite f i l l i n g
materials, it has become possible simply to attach a
spring to the labial or buccal aspect of a t o o t h (diagrams
A and B). The spring may be attached w i t h carding wax
to an adjacent t o o t h while the composite sets.

Over-rotation
To achieve good final alignment it is c o m m o n practice
to over-rotate and to retain in the over-rotated position
for six months. To avoid displacing the adjacent t o o t h
it is necessary to bend a dog-leg in the spring as in
diagrams 3 and 4.

Construction
Spring: 0 . 3 5 m m extra hard stainless steel wire
Composite: A n y composite filling material
suitable for acid-etch retention
Baseplate, etc: As on page 129.

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R O T A T I O N B Y C O N T R A - A C T I N G SPRINGS

When t w o springs act in opposite directions on


opposite corners of an incisor t o o t h the force produced
is k n o w n as a 'couple'. Such an appliance is illustrated
and its purpose is to rotate the t w o lateral incisor teeth.
Some ingenuity is required to k i n k the springs and
the labial arch so as to f o l l o w the r o t a r y movement of
the teeth (Inset). Nevertheless, such an appliance can be
effective, provided that slight shortening of the lateral
incisor is acceptable.

Construction
Springs: 0 , 5 m m stainless steel wire (boxed-in)
Labial arch: 0.7mm stainless steel wire
Retention: Adams clasps on 6/6
Baseplate: F u l l palate, relieved around 2/2

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E X T R A O R A L FRACTION, 1

When it is necessary to retract the upper labial segment


w i t h o u t exerting any f o r w a r d force on the cheek teeth,
the appliance illustrated may he used. It differs only in
its application f r o m that shown in plan view on page
137.
Four clasps provide f i r m retention and a flexible
U-loop labial arch is attached distal to the canines,
taking care not to obstruct any distal movement of these
teeth. T h e extraoral 'whiskers' are attached either by
strapping and soldering or by banding w i t h soft wire and
soldering as shown in the Insets on page 137. The
junction of the labial arch and the extraoral arch is the
vulnerable point and it may be reinforced by sliding
t u b i n g over the labial arch prior to bending.
Several forms of cervical traction can be constructed
w i t h webbing and elastic but as ready-made neckbands
and neckpads (such as Orthoband) are easily available
a n d quite satisfactory it is this w h i c h has been illustrated

Construction
Extraoral arch: 1.25mm stainless steel wire
Labial arch: 0.9mm stainless steel wire
Retention: Adams clasps on 6 4 / 4 6

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EXTRAORAL TRACTION, 2

Backward movement of all the upper teeth may now be


readily accomplished w i t h removable appliances if the
second molars have been e x t r a c t e d ; this applies also if
4/4 have been extracted and the space lost. F i r m reten-
tion is required and a C o f f i n spring is used to increase
upper arch w i d t h and so avoid development of a molar
cross-bite.
Movement is in t w o phases. The cheek teeth are
moved dislally in Phase I by opening the U-loops and
Standing the arch 2 m m away f r o m the incisors. In Phase
II (retraction of the labial segment) the labial arch is
allowed to rest on the incisors but should not press
until the elastic traction is applied. This avoids moving
the cheek teeth f o r w a r d again (see page 55).

Construction
C o f f i n spring: 1.25mm stainless steel wire
Extraoral wires: 1.25mm stainless steel wire
Labial arch: 0.9mm stainless steel wire
Retention: Adams clasps on 6 4 / 4 6
Baseplate: Two sections extending f r o m mesial
of 3/3 to distal of 6/6
Attachment of Strapping w i t h 2.0 x 0.1 mm
extraoral arms: stainless steel wire OR binding w i t h
soft wire and soldering

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EXTRAORAL ANCHORAGE, 1

Forward movement of anchor teeth during retraction of


anterior teeth may be anticipated and prevented by
applying exlraoral traction at night to a removable
appliance which is worn during the whole of the 24
hours.
The appliance illustrated carries a bite plane (Inset A)
and palatal canine retractors (boxed-in) with guide wire
(Inset B). Additional retention is provided by Adams
clasps on 1/1 (Inset C) (page 38) and modified Adams
clasps on 65/56 (page 40). The extraoral traction arch
is inserted into molar tubes and stands clear of the
incisors. It may be reinforced, as shown, by stainless steel
tubing before attaching the traction wires.
Construction
Canine retractors: 0.6mm stainless steel wire
Canine guide wires: 0.5mm stainless steel wire
Anterior clasp: 0.6mm stainless steel wire
Adams clasps: 0.7mm stainless steel wire
Molar tubes: 1.25mm internal diameter
Labial arch: 1.25mm stainless steel wire
Extraoral arch: 1.25mm stainless steel wire
Anterior tubing: 1.25mm internal diameter soft
Labial arch, tubing and extraoral arch sttapped and
soldered

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EXTRAORAL ANCHORAGE, 2

Class II division 1 treatment may need to be supported


by extraoral t r a c t i o n . The c o m m o n sequence of canine
retraction w i t h buccal canine retractors (page 84) and
incisor retraction w i t h a Roberts retractor (page 100) is
illustrated opposite. Retention is by Adams clasps on
6/6 w i t h auxiliary arrowheads on 5/5 but the alternative
clasp illustrated on page 41 may be used.

Note: Normally the extraoral arms should lie in the


same plane as the arch but have been bent clear in
the illustrations to show details of construction.

Construction
Retention: Adams clasps on 6 5 / 5 6
Springs: Canine retractor 0 . 6 m m sleeved;
Roberts retractor 0 . 5 m m
sleeved
Labial arch: 1.25mm stainless steel wire
Molar tubes: 1.25mm internal diameter
Extraoral whisker: 1.5mm stainless steel wire

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EXTRAORAL ANCHORAGE, 3

The second stage of Class II division I treatment f o l l o w s


in the same way as the canine retraction. A Roberts
retractor is constructed as described on page 102 and a
double Adams clasp made for 6 5 / 5 6 . Some ingenuity is
necessary to pass the tags of the retractor and the clasps
between canines and first premolars. Tubes are attached
to the clasps (page 140) and a labial arch w i t h U-loop
stops inserted i n t o t h e m ; the bridges of the clasps may
have to be contoured so that the buccal tube will accept
the extraoral arch.
During treatment the baseplate is cut away behind
the incisors and it may be necessary to close the extra-
oral U-loops to bring the arch back and avoid d i s c o m f o r t
to the lips. However, at no time should this arch rest on
the teeth: the t o o t h movement is produced by the
Roberts retractor.

Construction
Retention: Double Adams clasps on 6 5 / 5 6
Retractor: 0.5mm stainless steel wire
Sleeve: 0.5mm internal diameter soft
tubing
Molar tubes: 1.25mm internal diameter
stainless steel
Extraoral a r c h : 1.25mm stainless steel wire
Extraoral whisker: 1.5mm stainless steel wire

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BUCCAL MOVEMENT Of PREMOLARS

The disadvantage of simple fingersprings to move


palatally placed upper premolars into the arch is that
they are extremely difficult for the patient to insert, the
spring usually coming to lie on the occlusal surface of the
tooth.
The Adams T-spring illustrated falls into the correct
place as the appliance is inserted.
So that the T-piece will not slide into the gingiva as
the tooth moves, its initial contact must be near the
occlusal surface: it will slide gingivally as the tooth
moves. It is then boxed-in shallowly.

Construction
T-spring: 0.5mm stainless steel Wire

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INCISOR E L O N G A T I O N , 1

Without access to bands and welders It has been


impossible to exert vertical traction on teeth. The advent
of acid-etch retained composite resins has reversed this
situation.
T w o methods are s h o w n : on the left, a h o o k made of
stainless steel tape has been laboratory-welded to a piece
of fine stainless steel gauze (BS N o . 155) This is cemen-
ted to the tooth by the acid-etch technique. This gives
a very positive h o l d to the spring.
On the opposite page is illustrated a simpler
technique i n w h i c h a f a i r l y t h i c k b l o b o f c o m p o s i t e .
resin is attached to the t o o t h and then grooved by means
of a number 1 or 2 fissure bur. Diagram D shows the
spring resting on the slot.

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INCISOR ELONGATION. 2

A simple removable appliance can be adapted to


elongate incisors (or canines) which may have been
delayed, for example, by a supernumerary tooth.
A simple sleeved fingerspring is employed but it is
important to note the position of the coil so that the
arm will follow the tooth without slipping off. It is
activated by flattening a section of the coil.

Construction
Clasps: Adams on 6/6
Spring 0.5mm stainless steel
Sleeve: 0.5mm internal diameter soft stainless steel

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T H E ANDRESEN APPLIANCE. 1

This appliance consists essentially of an upper and lower


baseplate u n i t e d together in such a manner as to h o l d
the mandible f o r w a r d . lt is used mainly in the treatment
of Class II division I malocclusions, and t o o t h movement
is produced by the pull of the muscles of mastication
w h i c h t r y t o return the mandible t o its rest p o s i t i o n . I f
required the backward pull of the mandible can he
reinforced by extraoral t r a c t i o n . This is shown in the
large illustrations to show the placing of the extraoral
'whiskers', but it is required in only a relatively small
p r o p o r t i o n of cases.

Diagram A
The C o f f i n spring.

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Diagram B
The appliance is shown here in plan view with a C o f f i n
spring in position. The appliance overlies the palatal half
of the occlusal surfaces of the cheek teeth.

Diagram C
The points of insertion of the labial arch and extraoral
wires.

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THE ANDRESEN APPLIANCE, 2

Diagram D
The baseplate is cut away behind the upper incisors but
should not be removed from the tips of the lower
incisors.

Diagram E
Removal of the acrylic material f r o m the occlusal
surfaces will allow adjustment of the occlusal level of
the cheek teeth.

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Diagram F
Full extension of the acrylic resin between the teeth
should be allowed, when cutting away from the occlusal
surfaces. In the mouth these extensions will bear on the
upper teeth as shown, causing them to move dislally.

Diagram G
When the acrylic is cut away from the occlusal surfaces
of the lower teeth the interdental extensions act as
shown, causing them to move mesially.
by OrTHoTaMiNe

THE ANDRESEN APPLIANCE, 3

Construct'on
A b i t e is taken in the protrusive position, w i t h o u t
straining and open 2 - 4 m m . This is m o u n t e d on an
articulator a n d the appliance waxed as s h o w n in
diagrams B and C. After t r i m m i n g the models very
closely they are flasked together as shown in diagram H.
The reverse half forms a plug in the palate and a raised
bite is impossible. The appliance is completed in the
usual way.

Materials
Baseplate: Deeply extended and thickened in
lower molar region, rising to clear
the gingiva and contact o n l y the
teeth in the lower incisor region.
Upper as shown in diagram A
C o f f i n spring: 1.25mm
Labial a r c h : 0 . 8 m m sleeved or 1.0mm anodically
t h i n n e d to 0 . 8 m m
Extraoral wires: 1.25mm

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THE ORAL SCREEN

The oral screen is an active orthodontic appliance worn


during sleep and transferring the pressure of the
circumoral soft tissues to the upper incisor teeth. It is
necessary, therefore, to raise the screen away from the
dentoalveolar structures except those teeth to he moved.
This is known as waxing out and is carried out as follows.
1. Wax is added to the areas shown, filling in anteriorly
to the lower incisors and into the other hollows
indicated.
2. A sheet of baseplate wax is applied to the whole area
except the most prominent upper incisors.
3. A second sheet of wax is applied over the whole area
and then scraped away over the tips of the prominent
incisors, so that these prolrude very slightly through
the wax.
4. After applying a separating medium a double thick-
ness of wax is adapted over the entire area and
trimmed away from all mucous folds. It should extend
distally no further back than the middle of the upper
first molars. This is then removed and converted to
clear acrylic resin.

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