in minor tooth movemant is the proper removable oppita ‘hele manlputarion with ra: Gord te mognitede, direction, end duration of farce REMOVABLE ‘ ORTHODONTIC APPLIANCES SPIRO J. GHACONAS, DDS, Ms* eee eee APPLIANCE DESIGN AND CONSTRUCTION ‘The design and construction of any removable orthodontic appli- ance must begin with a detailed plan of the tooth movement that fe to bbe carried out in the course of the treatment of a particular case. If the {treatment is at all of a complicated nature. it is important to consider how many movements can be carried out with one appliance alone or. if necessary, to break down the treatment plan to a series of simple tooth movements, using a separate appliance for each. ACRYLIC AND WIRE APPLIANCES ‘A removable orthodontic appliance is one which is easily removed for cleaning, but which is firmly attached to the supporting structures so that controlled pressure is brought to bear an the teeth to be moved. ‘The most common removable appliances «sed for minor tooth movement are the acrylic and wire appliances. The design of a removable appli- Volume ¥ Number 7 263 64Removable Orthodontic Appliances ance will be considered to be composed of three parts (Figure 1): 1) the acrylic base plate that covers the palate, 2). the retentive clasps around the premolar and molar teeth, and 3). the active force or element. BASEPLATE ‘The greatest portion of a removable orthodontic appliance is com- posed of the base plate. It is usually made of acrylic and has three main purposes. The first purpose is to act as a vehicle dnd carry all working parts and active elements such as the clasps and finger springs. The second purpose is to serve as anchorage or retention. It must be remembered that these are primarily tissue-bearing appliances, and close adaptation is essential. The third purpose of the base plate is to become an active element of the appliance itself, as indicated by the specific orthodontic problem. An example of the third purpose is an anterior bite plate that is built into the base plate (Figure 2). Another example 2k Acre Someat ty ome 65 SSOUDETETETTTTTTTTCTTTUCT OCT TTC C UOC CUCU UCUO UO OUUOS1g aS an active element is when i is uti the maxilary arch.(Figure 3). Differentiai diagnosis is extremeng Drlant in these eases in order to determine w : striction isdue to 2 collapsed dental arch ot to insufficient manila, growth, The difference between orthodontic and ortho 2 the importance of the extra such cases correctly. a} mascle forces In the maxillary removable orthodontic appliance, it is usually better {© cover the entire palate to the distal ofthe first molar (Figure 4). This is accomplished for twa reasons: fist, this type of design is intrinsically sionger than the so-called “horseshoe” or partially covered palate, thie Providing more anchorage: and secondly, the tongue is lew likely catch under a complete acrylic palate and dislodge the appliance 66 . . . . tot J CULO CODCOOC RitesRemovable Orthodontic Appliances ‘The lower base plate presents special problems (Figure 5). Due to hallowness of the lingual sulcus, itis necessary 10 make the lower plate sufficiently shallow also, and thus some extra thiekness is oft needed for strength. Also, there is usually a deep lingual undercut in the molar area. and iis usually necessary to ease the base plate in this region (Figure 6) PLANNING OF ANCHORAGE Since every action causes a reaction of the same magnitude, every pring pressing against the tooth develops force in the same quantity dpainst the base plate. For every action, there is an equal end opposite reaction. After the directions of the tooth movement are carefully fanalyzed, itis necessary to assess the reaction which will be produced land to make plans on suitable teeth to resist itChaconas CLASP DESIGN AND CONSTRUCTION Most of the retention aspect of a removable appliance is accom: plithed by adequate tissue adgptation ofthe base plate. However, most appliances usually require some form of wie clasps to provide the billzation needed during orthodontic treatment (Figure 7). There are several types of clasps that help serve ths retention purpose by istibut- ing the active force through the base plate inta the sot tissues, Circumferenti 1 clasp ‘The circumferential clasp is ont of the most commonly used in emistry. I should especially be designed to take advantage of the undercuts found mesially and distally on the buceal aspect of the perma- rent molars. Accordingly, when a simple molar clssp is used, 8 maxi rum length of wite should lie along the gingival area of the tooth in order to take full advantage ofall the existing undercuts on the mesial, dist and buccal surfaces ofthe tooth (Figure 8). ICONTINUED ON NEXT PAGE) 7, Sy yin eedSOSMUPSSSESESESSSSSSSSS USS SOSE SSS SVS SST SST T SESS Tey Removable Orthodontic Appliances Adams clasp ‘One of the most efficient clasps is the modified Arrowhead or ‘Adams clasp (Figure 9). The Adams type of clasp brought to the re ‘movable appliance technique the great advantages of extreme security land relisbility of retention on semerupted teeth, features which could not always be achieved withthe circumferential clasp. There are several important points to remember about the Arrowhead clasp. The Arrow head should not touch the adjacent teeth, the bridge of the clasp should lie approximately 2 millimetets elear of the buccal surface of the tooth, the Arrowhead should be in contact with the tooth only at the extreme fends and there is nothing to be gained by making the bends excessively sharp, as this will only weaken the wire ACTION OF REMOVABLE ORTHODONTIC APPLIANCES. ‘The action of a removable appliance is from the action of the auail lary springs that are used on them. In planning the design of the funiliary springs, itis important to design & spring that will exert suit ahle pressure over an adequate distance, Springs may be divided into Uhree different pes 1. Labia! wire he first type isthe spring that is attached at both ends to the base plate, ab im the Havsley labial wire, The labial wite should be bent in progressive stages with extreme attention to accurate fit at each step 69Chaconas ensure a well-formed arch (Figure 10), ‘The Hawiey wite is probably the most common spring used in removable appliances. The Hawley appliance can be utilized in both the maxillary and mandibulat arch for the purpose of palatal or lingual tipping of the incisor teeth (Figuse 11). ‘The indication for its use is generalized anterior spacing caused by ex cessive labial tipping of anterior teeth. lower Hawley appliance often is used to fulfill the objective of procedural movement which was dis. cussed previously. Often, mandibular anterior teeth must be retracted first in order to make possible the palatal movement of the maxillary anterior teeth 2. Froe-ended spring “The free-ended spring is the second type used in appliance construcSRVUNUMENEBEDESESERERESSESSUSSVSSSES EEUU USS VVIII IIE ETS Removable Orthedontic Appliances tion, An esample of this is the matress spring (Figure 12). The mat toes spring is vtilized for labial movement of teeth in Fossiteis not a symptom ofa general malocclusion, i Space inthe arch atte site ofthe erssbite, and ifthe roth in pment (Figure 13), ‘The helical coi! spring is another example of a free-ended spring Figure 14). is purpose is for mesial or distal tooth movement after teeth have drifted into an edentulous area. The prosthetic reasons fo his type of movement were discussed previously (Figure 15 «sufficiently complete in its dev 3. Accessory spring The third and. last type of epring is the accessory spring attached ‘ech of element. Usually, an a ccomplsh very minor tooth movement along with the primary ie procedures (Figure 16),PSUSSESSESESSSSSOS SSS SOSTOS SES SESE SSE SE DEUS ED RE DDD DEY Removable Orthodentic Appliances PHYSICAL PROPERTIES OF WIRE The properties of the free-ended and accessory springs are those of hard poished stainless steel round wire. Within certain limits, the sams force may be exerted by a thick wire as a thin one. The difference fs the degree of deflection needed to produce the force (Figure 17). Also, due to the greater range of action, a longer spring will move a {ooth a greater distance than a short spring, In orthodontic therapy. the properties required are generally those of « long spring, but thi is frequently inconvenient because of the limited space that is available This disadvantage is overcome by disposing of some of the surplus length im the form of 2 coil (Figure 18). MECHANICS Thete are certain points to remember when using finger springs of removable appliances for limited ofthodontic treatment: 3Chaconas 1}. cis almost impossible to grasp a tooth with the arm of the spring ‘The direction in which a tooth is pushed i, therefore, determined by the point at which the spring contacts the tooth (Figure 19) 2). Movement of the arm of the spring will always be radial and move- ‘meni on any point on it will be part of a curve with its center at the coi, ‘The longer the arm, the straighter the vector of force (Figure 20). (CONTINUED ON NEXT PAGED 74Removable Orthodontic Appliances ACUTE TCT ECCT e teeta terest