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REMOVABLE
APPLIANCE
Dr. Mohammad Khursheed Alam
BDS, PGT, PhD (Japan)
First Published August 2012
ISBN: 978-967-5547-99-7
Correspondance:
Orthodontic Unit
Email:
dralam@gmail.com
dralam@kk.usm.my
Published by:
PPSP Publication
Jabatan Pendidikan Perubatan, Pusat Pengajian Sains Perubatan,
Published in Malaysia
1
Contents
1. Orthodontic appliance............................................3
2. Types……………………… .................................3-4
3. Ideal requirements.……………………………...4-5
5. Component parts………..….……………….......6-9
2
Orthodontic appliance:
within the bone and other tooth supporting tissues, to allow tooth
movement”
A. Removable appliance:
Orthodontist.
These appliances can be taken out of the mouth by patient when required.
1. Space maintainer
2. Retention appliances
3. Tongue guard
3
modifying muscle forces to the teeth and their supporting tissues.
removed by the patient and other parts remain fixed on the teeth.
consists of:
4
3. It should not interfere with normal function and growth
6. It should be unbreakable
possible.
APPLIANCE DESIGN
(1) The frame work – This consist of the base plate in removable appliance,
5
(2) Means of retention – This consists of ‘clasp’ crib in removable appliance
and ‘band’ or cast caps” in fixed appliance. Mesh brackets may however be
(3) The active components – Active components may be in the form of:
(d) Muscle force some appliances rely on occlusal force (anterior bite plat
retain the plate in the mouth. However, the “frame work” and the “means of
anchorage.
a. Slow
5. When the forces are in physiologic limits, the resorbtion is seen in the
6
A. Retentive component- This part of removable orthodontic appliance
about the actual tooth movement. The active tooth movement cab be
(b) Springs
(d) Elastics.
C. Base Plate- This unit of removable orthodontic appliance carries all the
resin is the material generally used for fabricating the base plate,
sometimes heat curing acrylic resins can also be used. The acrylic base
can be modified to have bite planes which serve special functions such as
7
A. Passive Components (Attachments):- These are Bands, Brackets,
Buccal tube, Lingual cleats, Lingual buttons, Lingual hooks, eyelets, Lock
Arch wires: Different types of readymade and other plain arch wires, Twist
Springs: Different types of springs used with arch wires such as uprighting,
bonding.
1. Bite Plane.
2. Oral Screen.
3. Activator.
Andresen appliance
8
5. Habit Breaking Appliance.
6. Tooth Positioner.
complex.
malocclusions.
10. They can be removed by patient for brushing teeth and appliance
maintenance.
9
12. If there is any damage or problem, the appliance can be removed by
the patient.
difficult to manage.
7. If they are not adjusted carefully, they bring about uncontrolled tipping of
teeth.
9. Appliances can be easily broken or damaged, if they are not worn and
10
10. Cannot be given in high or low FMA angle cases. Cannot be given to
Definition:
embrasures.
11
4. Triangular Clasp.
a. Interdentally clasp.
6. Southend clasp.
7. Duyzing Clasp.
8. Schwarz Clasp.
9. Eyelet Clasp.
Synonym –
• Universal clasp.
Parts –
a. Two arrowheads
b. Bridge.
Modification –
12
1. Adam’s clasp i J hook.
7. Addam’s on incisor.
Active components
1. Bows.
2. Spring.
3. Screw.
4. Elastics.
Bows
5. Robert’s retractor.
6. Mills retractor
13
8. Fitted labial bow.
Springs
1. Helical springs.
2. Looped spring
4. Supported springs.
7. T spring.
Canine retractor
Spring
Retentive arm.
14
Diameter of helix – 3mm
15
the point of
application of force.
8. Coffin 1.2mm Shape- U. Expansion of
spring Onega denotable lar arch `
diamond.
Position mid
polak.
Activation 1-
2mm at a
time.
Name Function
Up righting spring Move root in a mesial or distal direction.
Torquing spring Move root in lingual on palatal direction.
Open coil spring Springs are compressed b/w tow teeth to open
up space b/w them.
Closed coil spring They are stretched b/w teeth to close space.
Definition
retracting and retaining the anterior teeth and also contributes for retention
of the appliances.
2. Vertical loops
3. Retentive arms.
16
4. Used for reinforcement.
Labial bow
17
Active component: Springs.
Definition
Type of springs
The different types of springs which can be used to bring about the
1. Finger spring.
4. “T” spring
6. Flapper spring.
7. Apron spring.
8. Coffin spring.
Bite plane:
18
Definition:
Classification:
a. Flat
b. Inclined
19
1. Anterior inclined plane or Catalans appliance.
It is an extension of acrylic base plate covering the region behind the upper
flat and should be parallel to the occlusion plane. The bite plane should be
Indication:
1. Deep bite
2. Cuspal interferences
Contra indication:
Construction:
20
The patients cast should be preferably articulated to assess the amount the
acrylic base plate the thickness in the anterior region is increased to form a
flat bite plane. The bite plane extends from canine to canine lingual to the
anterior teeth. The bite plane should disocclude the posterior teeth by
about 2 to 3 mms. After fabrication the height can be checked and adjusted
anterior bite plane. The bite plane is inclined downwards and forwards at
retroclined, a flat anterior bite plane cannot be given as the forces will no
longer be transmitted along the long axis of the teeth and therefore an
anterior inclined bite plane should be used. The lower incisors engage the
bite plane when the patient closes the mouth and the mandible is guided to
3. Reduction of overbite.
21
INFORMATION AND INSTRUCTIONS FOR THE PATIENT AND
Its effects:
It should be explained to the patient that, initially the appliance will feel
sore for about 3-5 days each time the brace is adjusted. If necessary, pain
killers would take for a headache may help. If there is an obvious area of
reasonably possible. If possible, do not stop wearing the brace. Speech will
be different. Practice speaking with the brace in place e.g. read out aloud at
home on your own, and in this way your speech will return to normal within
a couple of days.
The appliance should be removed and cleaned when cleaning the teeth
Every time after the insertion of the appliance, the patient must check that
out the appliance for eating coarse or hard food to avoid distortion or
22
damage to the appliance and for convenience of the patient. In certain
For your orthodontic treatment to work well and in the shortest possible
time it is important you take care of your teeth and brace. In order to avoid
• Hard food which might damage the brace such as crunchy apples,
Hard foods can be eaten with care if your cut them up first.
Tooth brushing:
It is important you brush well three times per day and use fluoride
toothpaste. If possible carry a brush with you for use after lunch. Take to
brace out to clean your teeth. You should also gently brush the brace,
taking care not to damage the wires. A daily fluoride mouth rinse should
also be used last thing at night, after tooth brushing. Failure to keep your
teeth and brace clean will lead to permanent scarring of your teeth.
Brace can be removed but you should only remove it for cleaning.
23
Duration of the treatment:
It usually takes 6-24 months but will vary according to how severe your
brace will increase the length of time the treatment will take.
Frequency of appointment:
You will need regular appointments during treatment for the brace to be
adjusted.
It will be important you still have check-ups with your regular dentist
decay.
for your next routine appointment as the breakage may slow your
Retainers
Retainers are designed to keep the teeth straight after the active treatment
and can either be removable or fixed to the teeth. Once the teeth are
corrected, if the retainer is not used where it is necessary, the teeth are
24
likely to drift towards their original positions. If this happens it may be
This will vary according to how your teeth originally looked, before the
may mean wearing it all the time at first, before going on the just night-time
Its effects:
Your speech will be different. Practice speaking with the brace in place e.g.
read out aloud at home on your own, and in this way your speech will
You may also find yourself swallowing a lot to being with. This is quite
If you have a fixed retainer then you will need to take extra care to keep it
clean.
2. All traces of wax and plaster has been removed from the appliance
25
3. The thickness of the plate is uniform
1. Appliance should he worn at all times even during sleeping and eating
4. Clean the appliance using tooth brush and soap in the m and before
going to bed
6. Avoid eating coarse or hard food while wearing the appliance or remove
7. Every time after insertion of the appliance check that the springs and
8. Initially the appliance will feel strange and the patient will feel-
a. Discomfort
b. Plastic taste
c. Excessive salivation
26
d. Mild pain
e. Difficulty in swallowing
f. Difficulty in speech
These will disappear within 48 hours if the patients wear the appliance
regularly
a. Severe pain
Report to your Orthodontist at once and do not wait for the next
appointment
27
Base plate preparation
28
Bibilography:
1. Bhalajhi SI. Orthodontics – The art and science. 4th edition. 2009
4. Iida J. Lecture/class notes. Professor and chairman, Dept. of Orthodontics, School of dental
science, Hokkaido University, Japan.
7. McNamara JA, Brudon, WI. Orthodontics and Dentofacial Orthopedics. 1st edition, Needham
Press, Ann Arbor, MI, USA, 2001
9. Mohammad EH. Essentials of Orthodontics for dental students. 3rd edition, 2002
10. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4th edition, Mosby Inc., St.Louis,
MO, USA, 2007
11. Sarver DM, Proffit WR. In TM Graber et al., eds., Orthodontics: Current Principles and
Techniques, 4th ed., St. Louis: Elsevier Mosby, 2005
13. T. M. Graber, R.L. Vanarsdall, Orthodontics, Current Principles and Techniques, "Diagnosis and
Treatment Planning in Orthodontics", D. M. Sarver, W.R. Proffit, J. L. Ackerman, Mosby, 2000
14. Thomas M. Graber, Katherine W. L. Vig, Robert L. Vanarsdall Jr. Orthodontics: Current Principles
and Techniques. Mosby 9780323026215, 2005
15. William R. Proffit, Raymond P. White, David M. Sarver. Contemporary treatment of dentofacial
deformity. Mosby 978-0323016971, 2002
16. William R. Proffit, Henry W. Fields, and David M. Sarver. Contemporary Orthodontics. Mosby
978-0323040464, 2006
17. Yoshiaki S. Lecture/class notes. Associate Professor and chairman, Dept. of Orthodontics, School
of dental science, Hokkaido University, Japan.
18. Zakir H. Lecture/class notes. Professor and chairman, Dept. of Orthodontics, Dhaka Dental
College and hospital.
29
Dedicated To
30
Acknowledgments
I wish to acknowledge the expertise and efforts of the various
teachers for their help and inspiration:
31
Dr. Mohammad Khursheed Alam
has obtained his PhD degree in Orthodontics from Japan in 2008.
He worked as Asst. Professor and Head, Orthodontics
department, Bangladesh Dental College for 3 years. At the same
time he worked as consultant Orthodontist in the Dental office
named ‘‘Sapporo Dental square’’. Since then he has worked in
several international projects in the field of Orthodontics. He is
the author of more than 50 articles published in reputed journals.
He is now working as Senior lecturer in Orthodontic unit, School
of Dental Science, Universiti Sains Malaysia.
32