Removable orthodontic appliances: new perspectives on capabilities and efficiency

1. Removable orthodontic appliances: new perspectives on capabilities and efficiency European 160 Journal of Paediatric Dentistry vol. 14/2-2013 Group 3-Aishah,Amalina, Anis, Asmat, Fadhila, Fatimah, Hamzi, Laila, Ruhaizan,Zahid

2. 1. Introduction

3. Advantages Disadvantages • affordable • easy adjustable for orthodontists • treatment with fixed appliance may be shortened by a previous treatment with a removable appliance • Bettter control of oral hygiene • socially unacceptable (extraoral appliance) • success of treatment can be very patient-dependent • Tipping movement only

4. Appliance design appliance design has a key role in success 1. location and type of clasps (for better retention and no tissue irritation) the location of finger springs (for maximum range of activation) and their direction (for highest rate of activation)

5. C-clasp has better retention than Adams clasp due to the design of the “C” clasp creates a contact surface with the anchor tooth rather than a two-point contact by Adams clasp C-clasp → less tissue irritation, easier adjustability and fabrication

6. Important points to be considered when using a removable appliance for tooth movement Preferred for a noncompliant patient to an out-of-mouth gadget (i.e. headgear). Oral hygiene maintenance is much less complicated for patients. Sometimes a removable appliance can promote the full growth potential and consequently favour teeth eruption in the proper position. It can be used for cases that require unilateral mechanics. It shortens the fixed orthodontic treatment when used in the preliminary stage of the tx plan. Interceptive method → excess overjet (protruded upper ant teeth) in the middle mixed dentition. It requires simple adjustments at the chairside. It has a lower relapse rate during retention period compared to fixed appliances It is more affordable when used for selected cases requiring specific designs.

7. 2. MATERIALS AND METHODS

8. Case 1 • 14-year-old girl • Problem: buccallyerupting upper right canine • Aim: provide space for the canine • Appliance design: • A removable appliance is fabricated with • 2 ball clasps • a labial bow • finger spring to be placed between second premolar and first molar

10. Case 2 • 13-year-old boy • Problem: upper left canine has no enough space to erupt • Aim: • provide space for the canine • prevent later malposition of canine • Appliance design: • A removable appliance fabricated with a “c” clasp, a ball clasp, and a labial bow. Two finger springs is designated to distalize second and first molars in upper left quadrant

12. Case 3 • 9-year-old boy • Problem: • 12 & 22 have no enough space to erupt • a little space exists between upper central incisors • Aim: • prevent later malposition of lateral incisors • To close space between upper central incisors • Appliance design: • A removable appliance fabricated with four “c” clasps on upper D’s and E’s for full retention, and 2 finger springs are designed to move the upper central incisorstoward midline.

14. Case 4 • 42-year-old female • Problem: • severe attrition due to longtermedge-to-edge incisor relationship with a very unpleasant smile • anterior crowding with labial displacement of centrals and lingual displacement of laterals • rotational displacement of centrals • Aims: • to resolve the lower anterior crowding • moving the lower central incisors lingually and the lateral incisors slightly labially • Appliance design: • A removable appliance is fabricated with • 4 “ball” clasps • a labial bow is designed to force centrals lingually and to retain the appliance • A lingual bow is included to push laterals labially, simultaneously. • Two occlusal rest on 6’s hold the appliance vertically • Finally, the patient underwent aesthetic restoration of the upper and lower incisors

16. Case 5 • 14-year-old girl • Problem: • protruded anterior teeth with excessive overjet • Appliance design: • A Hawley retainer with a circumferential wire was fabricated for maxillary arch. • Gradual tightening of loops and simultaneous acryl reduction on the palatal side of anterior teeth permits gradual lingual tipping of anterior teeth.

18. 3.Discussion

19. Patient would prefer to wear less visible appliance. • Speech disturbance resolves faster in patient comply to the treatment. • 4 factors should be considered when employing springs: • Location of the spring • should be located on the midway of the mesiodistal aspect of the molar • Direction of the spring loop • The loop on the opposite direction of movement • No spring should be placed at the tooth that require passive drifting. • No interdental acrylic extension to allow passive drifting

20. Retainer • The same appliance can be used as retainer for the retention phase within period of time. • “Essix” retainer, has been demanded by many patient, especially socially active adults due to less visible and easy to use. (Sheridan et al., 1993)

21. 4. CONCLUSIONS Intraoral removable appliances are the treatment of choice for youngsters and adult patients. Less compliant patient tend to removable appliances as it is hidden. Finger springs more effective than other devices with complicated design and screws. Cost is affordable. Less oral hygiene complication. Device is simple to adjust. Easy management by patient. It is very dependable treatment option in orthodontics