0-atlas Dentaurum-The ultimate reference work on removable appliances.pdf

o-atlas Dentaurum UT0

T0U

The ultimate reference work on removable appliances

Atlas of orthodontic and orofacial orthopedic technique

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Foreword Ursula Wirtz: The idea to compile an atlas of orthodontic and orthopedic technique emerged after hearing the same questions over and over from students, dental technicians from private practices and technician students. This widely illustrated atlas with short explanations will provide a quick help to technicians and students during their practice. It provides guidelines for the construction of orthodontic and orthopedic appliances and explains the techniques for bending wire more easily with the use of pliers. It illustrates il lustrates orthodontists the use of alternative appliances and serves as instruction for patients. In this atlas, the construction of removable and fixed orthodontic and orthopedic appliances is described. But as the single appliances vary considerably depending on the region or practitioner, this atlas should mainly be a stimulus stimulus to make the construction of orthodontic orthodontic appliances using wire, screws and acrylic as simple as possible. Whether the desired treatment goal is always achieved with the orthodontic appliance depends mainly on the treatment method and the corresponding treatment appliance. The effectiveness of the active and passive plates depends on their adequate retention and support. The competence and teamwork of the practitioner, technician and patient are necessary for the treatment result and the effectiveness of an appliance. Because the technician is responsible for the perfect execution of the appliance, it must be designed and constructed with the greatest care. This is the only way to guarantee that an appliance is accepted by the patient and is worn with pleasure. The therapeutic grinding and activating of the appliances is not dealt with in this atlas since it is the task of the practitioner and not of the technician. Prof Dr. Dr. Diedrich:

The actual level of orthodontic technique is determined through an extensive spectrum of removable and laboratory made fixed appliances with a wide therapeutic indication. In past time, known and proven base appliances have undergone many modifications through ideas and empirical understanding so that there are inexhaustible possibilities for the individual appliance design. Mrs. Ursula Wirtz, collaborator of many years´ standing in my clinic, has set herself the task to show this variety of appliances in a color atlas. This successful synoptic depiction starts with the detailed description of the passive and active basic elements of removable appliances. Based on this, the construction of all common plates, functional orthopedic appliances, and combined combined fixed / removable devices as well as active and passive fixed special appliances is compared. This atlas is outstanding for its it s competence, systematology, love for details and endeavors to provide the reader with the actual available therapeutic range. The atlas is a treasure trove for everyone, practitioner or specialist technician, who is connected to the discipline of orthodontics and orofacial orthopedics. I wish this work a wide acceptance.



Foreword Ursula Wirtz: The idea to compile an atlas of orthodontic and orthopedic technique emerged after hearing the same questions over and over from students, dental technicians from private practices and technician students. This widely illustrated atlas with short explanations will provide a quick help to technicians and students during their practice. It provides guidelines for the construction of orthodontic and orthopedic appliances and explains the techniques for bending wire more easily with the use of pliers. It illustrates il lustrates orthodontists the use of alternative appliances and serves as instruction for patients. In this atlas, the construction of removable and fixed orthodontic and orthopedic appliances is described. But as the single appliances vary considerably depending on the region or practitioner, this atlas should mainly be a stimulus stimulus to make the construction of orthodontic orthodontic appliances using wire, screws and acrylic as simple as possible. Whether the desired treatment goal is always achieved with the orthodontic appliance depends mainly on the treatment method and the corresponding treatment appliance. The effectiveness of the active and passive plates depends on their adequate retention and support. The competence and teamwork of the practitioner, technician and patient are necessary for the treatment result and the effectiveness of an appliance. Because the technician is responsible for the perfect execution of the appliance, it must be designed and constructed with the greatest care. This is the only way to guarantee that an appliance is accepted by the patient and is worn with pleasure. The therapeutic grinding and activating of the appliances is not dealt with in this atlas since it is the task of the practitioner and not of the technician. Prof Dr. Dr. Diedrich:

The actual level of orthodontic technique is determined through an extensive spectrum of removable and laboratory made fixed appliances with a wide therapeutic indication. In past time, known and proven base appliances have undergone many modifications through ideas and empirical understanding so that there are inexhaustible possibilities for the individual appliance design. Mrs. Ursula Wirtz, collaborator of many years´ standing in my clinic, has set herself the task to show this variety of appliances in a color atlas. This successful synoptic depiction starts with the detailed description of the passive and active basic elements of removable appliances. Based on this, the construction of all common plates, functional orthopedic appliances, and combined combined fixed / removable devices as well as active and passive fixed special appliances is compared. This atlas is outstanding for its it s competence, systematology, love for details and endeavors to provide the reader with the actual available therapeutic range. The atlas is a treasure trove for everyone, practitioner or specialist technician, who is connected to the discipline of orthodontics and orofacial orthopedics. I wish this work a wide acceptance.



Author

Dental Technician Ursula Wirtz 1967 - 1971 1972 - 1982 1982 - 1984 Since 1984 Dental Technician Apprenticeship, Nickel Dental Laboratory, Stolberg, Germany KuAcrylic Re sto rati on s Technician (Orthodontics), Jacobs Laboratory, Würselen, Germany Technician at Graef Laboratory for Orthodontics, Würselen, Germany Technician for orthodontics at the Aachen University Clinic for Orthodontics (Principal: Prof. Dr. Dr. P. Diedrich) Key aspects of activity: Publications: As a speaker: Lingual-technique, autonomous apparatus, development of innovative treatment appliances. Quintessence Publishing: Quintessence Dental Technology Laboratory Fabrication of the pendulum appliance, laboratory production of mandible fìxed linguai bar apparatus. Urban and Fischer Publishers: PDZ Orthodontics III Book contribution Orthodontie Technique Dentaurum: o-atlas of orthodontie techniques Courses and lectures for Dentaurum, the Gesellschaft fur Kieferorthopâdische Zahntechnik e.V., and for the Aachen Vocational School II. Further éducation in the pendulum appliance for Dentaurum since 2003



Acknowledgements Acknowledgemen ts This atlas was created while working at the clinic cli nic of the University of Aachen. Therefore, I want to express my special gratitude to Prof. Dr. med., Dr. med. dent. P. Diedrich, chief of orthodontics of the clinic of the t he University of Aachen. He enabled me to put my ideas into practice and supported me generously in all areas. Dr. W. Bauer made the professional orthodontic corrections in many hours of her time. Dr. T. Hetz translated this reference r eference work into English and Spanish, so that it can be understood "in the whole world". Dr. G. Kinzinger collaborated mainly in i n the Pendulum appliances section. The idea and title of this atlas resulted together with Prof. Dr. med., Dr. med. dent H. Wehrbein. Mrs. I. Sous worked tirelessly finding and correcting errors with a trained eye, detailed the draft, supported me with ideas and valued advice and in this way sacrificed many hours for me. My husband Heinz supported me in every way, accepting restrictions of our free time activities in common. I owe them all a debt of gratitude. I would like to thank the Dentaurum Company sincerely for our fri endly and good cooperation, as well as the extensive promotion which made possible the making of this project. Ursula Ursula Wirtz T2



Content Chapter 1 Models, labial bows, appliance retaining elements, support elements

Chapter 2 Spring elements

Chapter 3 Shield elements, different orthodontic plates

Chapter 4 Double plates, bimaxillar appliances

Chapter 5 Bimaxillar appliances, activators, bionators, function regulator appliances

Chapter 6 Wire appliances, rapid palatal expansion (RPE) appliances

Chapter 7 Nance and pendulum appliance, space maintainer, cleft and stimulation plate

Chapter 8 Retention appliances, splints, snoring appliance

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CHAPTRR 1

The ultimate reference work on removable appliances



•

The dental models U

U

Function: Basis for treatment planning Description: Plaster models are the most important records for diagnosis, treatment planning and the working basis for removable and fixed appliances in the laboratory

It does not matter if the models have round, square or rubber form bases; they always have to be fixed in habitual occlusion. In all procedures the general guidelines are: 1. Midpalatal raphe 2. Tuber plane 3. Occlusal plane As study models could be considered the presentation card of every orthodontist, they should be prepared very accurately.

The midpalatal raphe (1) corresponds to the midsagittal line. It should be right angled to the tuber plane (2) and the model base should be trimmed parallel to the occlusal plane (3). When putting the models on their heel or back surface they should always stand in habitual occlusion. The lateral surfaces can be trimmed in a round or square shape or be cast in plastic forms.

After shaping the models, they are smoothed out with wet sandpaper, all bubbles, positive or negative, have to be removed and the surface is polished and sealed with talcum powder, soap or shine liquid. This way models can be stored dustfree for years.

•

The simple labial bow U

U

Function: Additional retention The labial bow is bent as usual. Then some zigzag inflections must be bent into the incisal part of the wire as retention means for the acrylic.



In order to scatter the acrylic better, it is useful to frame the labial bow with wax. This wax frame should be shaped in a dimension that later corresponds to the thickness of the acrylic shield.

On this occasion attention, should be paid on the counter bite. In order to avoid occlusal interferences, occasionally, the labial bow has to be adapted deeper .

•

The acrylic covered labial bow U

U

Function: Additional retention The labial bow is bent as usual. Then some zigzag inflections must be bent into the incisal part of the wire as retention means for the acrylic.

In order to scatter the acrylic better, it is useful to frame the labial bow with wax. This wax frame should be shaped in a dimension that later corresponds to the thickness of the acrylic shield .



On this occasion attention, should be paid on the counter bite. In order to avoid occlusal interferences, occasionally, the labial bow has to be adapted deeper

•

The labial bow with vertical M-loop U

U

Function: Alignment of the canine, if it is labially positioned or partially erupted The M-loop moves the tooth primarily in a lingual direction. Depending on the location of the centre part of the loop, the tooth can also be rotated.

The loop should only lie on the most prominent part of the crown, avoiding contact with the gingival tissue.

The tag, bent over from the labial to the lingual side (transversal tag), should lie as close as possible to the premolar if the gap distal of the canine is to be closed.



•

The labial bow with retractive canine loop U

U

Function: Alignment of labially rotated canines To optimize the point of force application, the loop should embrace the tooth surface as far as possible. This loop can tip the canine distally as well as lingually.

In order to avoid interference with the occlusion, the labial bow and the transversal tag should not lie too high. If the tooth should be moved distally, there has to be some space between the distal surface of the canine and the transversal tag.

If the loop is bent the other way around, the canine can be moved mesially.

•

The labial bow with canine loop U

U

Function: Stabilization of the incisor segment The labial bow is led to the end of the canine gap and there it is bent back 180°. Then distal of the lateral incisor it is bent into the transversal tag.



If the four incisors have to be stabilized, the transversal tag should contact the lateral incisor. Because of the loop design, the canine can not migrate labially during its eruption.

Because of the transversal tag distal of the lateral incisor, this labial bow maintains open the space for the canine.

•

The labial bow with Andresen loop U

U

Function: Retrusion of the canines The loop should embrace the canine completely but should not contact the gingival tissue.

The transversal tag between the canine and the first premolar should be placed in a way that the wire does not hinder the alignment of the canine

.



The labial bow with Andresen loop plays a rather subordinate role in orthodontics; it is often used in technical school as a bending exercise.

•

The labial bow with intrusion hooks U

U

Function: Vertical movement of incisors The loops are bent as usual. The horizontal part of the labial bow runs along the centre of the crown up to the teeth which are to be moved. There, the wire is bent in a right angle to form a loop over the incisors and afterwards bent back to the normal course of the labial bow.

The transversal tag is covered by a wax layer so that the hooks can be activated.



•

The modified labial bow U

U

Function: Engagement of elastics and soldering of springs

For the application of elastics, different hooks can be attached by laser or conventional welding, or can also be bent in. Force is applied on the anterior segment by the elastics and consequently the incisors are tipped lingually

Elastics can also be installed vertically. They allow the extrusion of retained teeth. The elastics are engaged on soldered or bent-in devices of the labial bow, on to a bonded attachment on the tooth.

For tooth movements in different directions, springs can be soldered on.

Two loops integrated into the labial bow allow the engagement of vertical elastics to align incisors.



A hook is soldered on the loop of the labial bow to engage vertical elastics for the alignment of canines.

Two hooks are soldered in opposite directions on the labial bow to rotate an incisor with elastics.

The partial labial bow embraces only a section of anterior teeth corresponding to the specific oral circumstances

The individual labial bow is contoured along the gingival margin contacting the anterior teeth cervically and is led by a canine loop into the retention.

A labial bow bent circularly, combined with Adams clasps and a base plate, to form a retainer involving the whole arch.



•

The intermaxillary bow U

Function:

U

nfluence of the lower jaw in a posterior direction

In certain cases the labial bow of the upper jaw can be extended to influence the lower jaw. Normally, the horizontal part runs along the lower teeth in centric occlusion. At canine level the wire is bent 90° forming the loops and then is anchored in the upper jaw.

It is also possible to solder or laser a separately bent intermaxillary bow onto a standard labial bow on the upper jaw. It is important to remember that conventional or laser weldable wire has to be used for both bows.

A variation of the intermaxillary bow is a labial bow with an additional helix in the loops in order to increase the elasticity of the bow.

•

The triangular clasp U

U

Function: Simple retention for removable appliances of all types



The horizontally lying triangle continues into a vertical part, then into the transversal tag and finally ends in the retention portion. In order to protect the cheek, the open part of the triangle should face distally.

The tag should be bent exactly over the triangle to avoid disturbing the occlusion.

If the triangular clasp is used as an additional retention in the front, the transversal tag has to run over the labial bow.

•

The triangular clasp according to Zimmer U

U

Function: Simple hold for removable appliances of all types

The triangular clasp according to Zimmer varies in a way that the triangle closes interdentally. The buccal part is not bent over the triangle, but directly back into the transversal tag.



The buccal component should not be overdimensioned in direction of the cheek. It is formed directly into the transversal tag and then into the retention.

The transversal tag should be adjusted as deep as possible into the interdental space so that the occlusion is not disturbed.

•

The triangular clasp according to Tränkmann U

U

Function: Simple retention for removable appliances

The triangular clasp is characterized by the fact that the open part of the triangle is located buccally. This open end has to be rounded off with a rubber polisher so that the cheek is not injured by a sharp end of the wire.

After unifying the triangle in the middle of the buccal part, the wire is bent towards occlusal into the transversal tag. The tag should be bent as close as possible to the occlusal surface of the teeth to avoid disturbing the counter jaw in occlusion.



This variation of the triangular clasp allows a good activation

. •

The double triangular clasp U

U

Function: Retention for the first molar if the second molar is missing

The double triangular clasp consists of two triangles which are interconnected as in the Adams clasp.

The triangles should be aligned to the occlusal plane in order to make activation possible.

In the mixed dentition, this clasp is fitted appropriately on the first permanent molar but it can also serve as a retention element on other teeth.



•

The Adams clasp according to Adams U

U

Function: Anchorage, usually used on molars

It consists of a horizontal part and two U-shaped loops that merge from the transversal clasp parts to the retention. The clinical crown determines the height of the loops. These loops should have such height that the horizontal part of the clasp runs 1 - 2 mm below the cusps.

The bridge portion of the clasp should keep a distance of approximately 1 mm to the buccal surface of the tooth so that the clasp can be activated.

Seen from occlusal, the angle between the loops, the bridge portion and the transversal part is approximately 45°. Therefore the loops find retention in the undercuts of the crown in the transition from buccal to interproximal.

•

The Adams clasp according to Tenti U

U

Function: Improved retention in comparison to the original Adams clasp

Depending on the tooth width, a 9 cm long wire is marked parting from the middle at precisely 3.5 mm to the left and to the right so that a 7 mm long piece is marked in the centre of the wire. This part forms the buccal bridge portion between the two loops. The square part of the angle wire bending pliers (for example Dentaurum REF 004-139-00) is positioned from the inside at the markings and the wire is bent downward slightly over 90°.



Now two marks are made on the vertical parts, each 0.3 mm from the buccal bridge portion including the wire diameter. With the round tip of the pliers, the wire is bent upward by 180° at the markings on both sides.

Holding the pliers horizontally, the mesial loop is bent 75° to the bridge. The corresponding angles for the distal loop are 60° for the upper and 55° for the lower jaw.

The square part of the angle wire bending pliers (for example Dentaurum REF 004-139-00) is positioned 2 mm mesially and distally of the curve of the loop and the wire is bent lingually 90° to the axis of the loop.

According to the central groove, the transversal tag can be bent gingivally in a V-shape to avoid occlusal interferences.

A small V-shaped bend towards the gingival tissue at the central groove of the molar can be adapted to minimize occlusal interferences

.



Function: Verbesserter Halt gegenüber der Adamsklammer nach C. P. Adams

At the level of the lingual cusps the wire is bent around the square part of the angle wire bending pliers (for example Dentaurum REF 004-139-00) 60° towards the gingival tissue. Now both wire ends run parallel to the buccal axis of the loop.

According to the crown length, the wire is bent afterwards 60° from the marginal gum. Now the wire end runs parallel to the occlusal surface. Directly after this bend, the tag is bent again gingivally, parallel to the gingival tissue in a distance of 1 - 2 mm.

Afterwards, the two wire ends are bent to form the retention.

•

Six modifications of the Adams clasp U

U

Function: Anchorage of individually standing teeth and molars

Adams clasp with an S-shaped loop bent in a vertical direction.



Adams clasp with horizontally proceeding U-loop.

Adams clasp with only one mesial loop because of unfavorable gingival architecture on the last molar

If the Adams clasp should serve as a retention element for two teeth, a V-shaped bend between both teeth is appropriate.

An Adams clasp, also embracing two separated teeth. The clasp is activated contracting the centered U-loop.

Another variation is the Adams clasp over two teeth with a centered arrow for additional hold.



•

The Adams clasp with anchorage for extraoral traction U

U

Function: Anchorage for headgear

The Adams clasp is bent over two teeth. In the centre, exactly between both teeth, the wire is bent into a coil in order to anchor the extraoral traction.

The bridge portion with the coil should not contact the teeth and should match the height of the coil on the opposite side. This way, the headgear can be inserted without any problems into the Adams clasps.

As shown here, in an upper twin block appliance the labial bow can be laid under the Adams clasp

•

The Adams delta clasp U

U

Function: Good retention if the Adams clasp is the only retentive component (in an incomplete tooth row)



The Adams delta clasp is the combination of an Adams clasp and a triangular clasp.

The centrally localized triangle offers additional retention.

Both loops are bent in the same way as in the simple Adams clasp

. •

The arrowhead clasp U

Function:

U

nchorage for removable appliances in the deciduous, mixed and especially in the permanent dentition

To achieve optimal hold, the arrows have to be adapted to the anatomical details.



The arrowhead is bent downward with the arrow bending pliers and laid horizontally into the interdental area.

If the contiguous teeth have not erupted yet, it can be bent with one arrow and the sides fit tightly mesially and distally as shown here.

•

The modified arrowhead clasp U

U

Function: Anchorage for removable appliances in the deciduous, mixed and especially in the permanent dentition

An arrowhead clasp bent with two arrows in which its mesial tag can be used with an additional bend for the movement of canines.

To avoid occlusal interference, the mesial end can be bent in a retrograde way.



Forming an additional loop on the distal tag, a buccally positioned tooth can be aligned into the tooth row.

•

The eyelet clasp according to Groth U

U

Function: Retention for removable appliances in the deciduous dentition

First, a V-shaped loop is bent which adjusts interdentally between the two anchor teeth.

Then the clasp leads loop shaped towards occlusal.

and is continued into the retention.



•

The eyelet clasp according to Stahl U

U

Function: Retention in the deciduous and mixed dentition

The size of the eyelet depends on the width of the interdental area of both anchor teeth.

In the upper jaw, the vertical part of the clasp which continues into the transversal tag should be long enough to allow a good activation.

For the eyelet clasp in the lower jaw, one has to pay attention to avoid causing any interference with the buccal cusps of the upper jaw. Therefore, a small bent has to be made into the ascending part of the clasp.

•

The double eyelet clasp U

Function:

U

nchorage of one or more teeth in removable appliancesa

The eyelets are bent lying in the cervical area of the tooth and can be activated with movements towards lingual.



The eyelets are to be located in the undercut area.

Image of a completed appliance with a continuous eyelet clasp over several teeth.

•

The universal clasp U

U

Function: Retention of removable appliances with incompletely erupted molars

The universal clasp is a retaining element which can be activated for better hold with a loop.

The eyelets, mesial and distal of the tooth, have to fit preferably close to the gingiva. As the eruption continues, the undercut areas of the tooth will expose. Then the fit of the clasp can be optimized activating the loop.



In order to avoid irritation the loop should not touch the gingival tissue.

•

The ball clasp U

U

Function: Anchorage of removable appliances, frequently applied on incisors and small posterior teeth

The ball clasp can be bent in different manners under the condition that the ball is always inserted gingivally in the interdental area.

Its application is normally with short clinical crowns or with teeth that don’t have retentive undercuts (for example lower incisors).

It should lie in the interdental area, gingival of the contact point. For this, it is necessary to slightly carve the papila.



•

The Lorenz spring U

U

unction: Especially strong anchorage of removable appliances

The plaster casts are carved interdentally on the oral and buccal side so that the holding springs can be inserted deep into the retentive area. The first and lower part of the spring is bent from labial to occlusal and then towards lingual into the retention.

The second and upper part of the spring is bent from lingual to occlusal above the contact points into the undercut beside the first part. On the occlusal surface, the wire is bent 180° and then back on the other side of the first part in order to be bent into the retention.

Because the Lorenz spring consists of two separately bent parts, it can reach far into the undercuts and is therefore a very strong retaining element

•

The occlusal rest U

U

Function: Stabilization of lower appliances against vertical forces

Without the use of occlusal rests, appliances could sink into the floor of the mouth because of blocking out the undercuts. The occlusal rest is laid into the lingual groove of the molar and should not interfere with the occlusion.



One can bend the occlusal rest to an eyelet.

or can leave it ending in a simple wire.

•

The incisal rest U

U

Function: Stabilization of removable appliances

If vertical support is needed in the front, teeth can be held by short wires with an eyelet bent over the incisal edge.

A wax layer should be applied to the upper third of the incisors before the polymerization of the base plate. Therefore it is possible to activate the incisal rests for intrusion of the teeth.



The incisal rests fixed in this manner prevent tipping of the incisors and tilting of the appliance.

CHAPTRR 2

Spring E lements



•

The active circumferential clasp U

U

Function: Mesial or distal tooth movement

It is bent exactly like a normal circumferential clasp used in general dental technique; the only difference is the free end which is bent into a small loop so that it can be introduced into the area of the papilla.

As clinical crowns in adolescents are mostly short, the clasp should lie at the gingival margin on the buccal side in order to give enough retention to the appliance.

If the circumferential clasp is to be activated, the active part has to be waxed out before the retention.

The circumferential clasp for a first molar is usually placed from distal; hereby, the final loop is bent mostly in a vertical direction.



Equally, the final loop can be bent in a horizontal direction. On this occasion the loop reaches deep into the interdental area at the cervical margin.

When the first molar is banded, the circumferential clasp can be anchored between the tubes of the band.

•

The canine retracting spring U

U

Function: lignment of teeth into the arch It attacks the tooth from buccal. The resilient part of the retracting spring is bent U-shaped and at the end continued into the transversal tag which prevents the posterior teeth to migrate mesially. The transversal tag continues into the retention.

The transversal tag should lie as close as possible to the bicuspid and should not project too far buccally in order to allow enough space for the transversal tag of the labial bow and to avoid disturbing the occlusion.



The loop has to be designed to neither contact the gingival tissue nor disturb the labial bow which afterwards is laid over it.

•

Modifications of the canine retracting spring U

Function:

U

lignment of canines into the arch

First, the loop at the canine is bent, and afterwards the space maintaining part which simultaneously serves as a distal guiding rail for the canine.

The canine retracting spring can also be bent V-shaped and with a helix.

If the wire for the V-shaped helical spring is bent over a greater distance, the space maintaining part can be extended (analogous to the spring on the top of this side) as a guiding rail.



Canine retracting spring with a long cantilever and helix. The end of the loop is bent overlying the cantilever into the transversal tag as a guide to hold the spring in proper position.

In smaller gaps, the retracting spring can be bent oval shaped and led back exactly over the starting point into the acrylic.

Usually the retracting spring is anchored in the base plate. However it can also be soldered directly onto the labial bow.

•

The helical finger spring U

U

Function: Mesial or distal movement of single teeth The finger spring is placed in the interdental area of the teeth with a small loop.



The helix is positioned directly under the tooth crown and covered with wax together with the active portion.

The helix lies always opposite to the direction dir ection to which the tooth should be moved (safety pin principle). View of the lower lower side of the mandibular mandibular plate

.

•

The finger spring The

U

U

Function: Tooth movement in sagittal s agittal and transversal direction

The spring contacts the tooth being moved interdentally and therefore, is also called interdental spring, intermediate spring, mesial or distal spring.

The entire resilient portion of the spring is covered with wax in order to make activation possible. The whole active portion, as well as the retention, should maintain a distance of approximately 1 mm to the gingival tissue.



When the spring is covered properly with wax and the appliance is finished there is enough free play to activate the spring.

•

The protrusion spring The

U

U

Function: Movement of a single si ngle tooth or entire tooth too th groups The free end protrusion spring for single tooth movement (0.5 mm spring hard) is exactly as wide as the tooth being moved. It is fixed with wax as deep as possible at the tooth crown, crown, so that the tooth tips as less as possible.

The active portion is bent flat in i n a right angle to the tooth axis and is completely covered with wax before sprinkling the acrylic. The retention is bent according to the anatomy of the upper jaw in a distance of 1 mm.

Because of the wax cover, the active portion remains freely movable for activation.



•

The T he free end protrusion spring with retaining function

U

U

Function: Protrusion of teeth with simultaneous retaining ret aining function and diastema closing The multifunctional protrusion spring serves as a retaining element because of the bent over of the free end; through corresponding activation it can also als o function as a mesial spring.

Accordingly, the parts being activated have to be covered with wax to make activation possible.

In this example only the retention is anchored in the acrylic. The remaining parts of the spring are freely fr eely movable for activation.



•

The free end protrusion spring with mesial arm The

U

U

Function: Combined labial and mesial m esial movement This versatile protrusion spring can be applied both in the front, for single tooth movements, and in the posterior section. Here, it is recommended recommended to use larger wires. The spring can move the tooth labially and simultaneously mesially or distally. The end of the spring is bent into a small loop as usual. The protrusion spring comprises the entire entire tooth width. Correction of rotation is possible if the tooth is only comprised part wisely. To make activation possible, the resilient portion is covered with wax as usual.

The finished spring consists of a mesial arm which embraces the tooth being moved extensively and a protrusive portion. As far as the retention, the spring lies exposed over the acrylic.

•

The double loop spring The

U

U

Function: Protrusion The spring consists of two loops which run parallel to the occlusal plane.



It is fixed in the lower third of the clinical crown and is covered with wax.

he spring does not finish in a free end, instead, both wire ends are anchored in the acrylic; therefore the spring is less resilient.

•

The double helical spring U

U

Function: Maximizing the elasticity of the protrusion spring First, a small loop is bent which contacts distally on the tooth in order to prevent a distal migration; then two helixes are bent opposite and horizontally to the occlusal plane.

The spring is prepared in such a way that the entire active part is covered with wax.

Only the retention is anchored in the acrylic, the remaining part is freely movable and through the wax cover easily accessible.



•

The helical protrusion spring for the anterior segment U

U

Function: Protrusion of the entire anterior segment The loops are bent opposite and horizontally to the incisal plane over the entire width of the anterior segment. The retention tags are parallel to the palatal gingival tissue.

The active portion should be blocked out completely with wax so that the spring can be activated easily.

The retention has to be anchored properly in the acrylic to be able to resist the high strain.

•

The closed protrusion spring for incisors U

U

Function: Alignment of the dental arch The closed protrusion spring can be used in conjunction with the labial bow to align the dental arch. This spring is bent lying on the most prominent parts of the lingual tooth arch.



It proceeds horizontally to the occlusal surface and is covered with wax in the usual manner.

Both retention tags are anchored in the acrylic base, the rest of the spring lies free for activation.

•

The buccal box spring U

U

Function: Oral movement of buccally standing single teeth, preferably in the activator The buccal box spring emerges out of the interocclusal acrylic in a distance of approximately 1 - 2 mm to the tooth being moved; it encloses the tooth lying buccally at the gingival margin.

In order to create a counter base, the activators whole interocclusal acrylic is preserved. The area where the teeth are being moved is excluded. This area has to be covered with wax during the preparation; therefore, the activator is stable guaranteeing the proper function of the spring.



The acrylic of the activator has to be removed in such a way that the tooth is not hindered in its movement. The buccal box spring is mainly used in activators.

•

The paddle spring U

Function:

U

rotrusion of incisors with triangular shaped palatal surfaces

The paddle spring has a wider base in comparison to the lingual protrusion spring. The spring should lie as extensive and precise as possible on the lingual surface.

The active part has to be covered with wax and both ends of the wire have to be anchored in the acrylic base.

It can also be used for buccal movement of posterior teeth.



•

The paddle spring over several teeth U

U

Function: Buccal movement of several teeth

A paddle spring over several teeth is often used in the making of bionators for the anterior and also for the posterior areas.

As with all other springs, after its bending it is covered with wax to allow space for its activation.

In the posterior area, the paddle spring is frequently bent using larger wire than in the front.

•

The intrusion hook U

U

Function: Intrusion of single anterior teeth The wire for the intrusion hook is bent in the centre by 180° so it is led double from labial across the incisal edge towards lingual. If the appliance design includes protrusion springs, the intrusion hooks have to be adapted.



The entire spring area has to be covered with wax and the screw has to be fixed before finishing the appliance.

In the finished appliance, the springs and the intrusion hooks have to lie freely so that they can be activated without any effort.

•

The sheet spring U

U

Function: Protrusion of single teeth First, according to the mesiodistal diameter of the tooth the matching sheet spring is chosen. Then depending on the crown length the spring is bent together in an S-shape.

The retention portion is carved with a disc; the active portion is covered with wax.



The sheet spring has to emerge sufficiently out of the acrylic to allow enough free play for its activation.

•

The beam spring U

U

Function: Buccal movement of bicuspids and molars The spring is placed underneath the equator at the lingual/palatal surface of the tooth being moved. The cantilever proceeds straight (like a beam) and is then bent into the retention. The spring presents advantages in restricted areas, for example in steep palates.

The beam shaped cantilever of the spring is covered with wax in such a way that the spring is freely movable in direction of the base plate. For space opening additional C-clamps and expansion screws are used.

The space opening and spring activation take place simultaneously.



•

The buccal spring U

U

Function: Uprighting of lingually tipped teeth The spring has a loop that is directed distally, this means the open side shows towards mesial.

After the loop, the spring is bent approximately 3 - 4 mm downwards and then turned again upwards 180° to finish into the retention.

For achieving an optimal effect with this spring, the wire portion contacting the tooth should be positioned under the equator of the tooth.

•

The buccal spring according to Schneemann U

U

Function: Lingual or palatal movement of two teeth The buccal spring is bent out of one piece of wire embracing two teeth. Both teeth are moved simultaneously. The spring has only one retention portion.



In order to make the oral movement of those teeth possible, they are covered with wax on their lingual or palatal surface, or the according acrylic on the base plate is removed.

The buccal spring lies close to the teeth, so that the wire end which lies in the centre does not irritate the cheek tissue.

•

The pressure spring U

U

Function: Oral movement of bicuspids and molars The pressure spring, which attacks from buccal and resembles the Bonyhard clasp, is predominantly used on bicuspids but can also be applied on molars as shown here.

The bridge portion that leads to the retention should be bent in such a way that the tooth is not disturbed in its oral movement.



The exposed loop makes activation easy.

•

The T-loop spring U

U

Function: Lingual or palatal movement of posterior teeth The spring is bent in the same way as the T-loop in the fixed appliance technique. Both ends of the wire are narrowly adjusted to the contour of the teeth being moved and then bent into the retention.

The base plate is either covered with wax or trimmed free in the direction of the movement.

The T-loop is activated narrowing both T-loop tags and bending the “T” towards lingual.



•

The lingual or palatal spring U

U

Function: Lingual or palatal movement in the posterior area The tip of the clasp is bent over and the tooth is completely embraced from buccal. The activation loops are bent in an S-shape in a distance of 2 mm to the lingual or palatal area of the tooth crown.

This active portion has to be covered with wax as usual. In this case, the lingual or palatal surface of the tooth should also be covered with wax so that the acrylic does not lie directly on the tooth and its oral movement is not hindered.

The retention should be anchored sufficiently in the acrylic so that the spring is not torn off because of the resulting forces.

•

The oral spring U

U

Function: Lingual or palatal movement of buccally erupted teeth The tooth is embraced with a precisely adapted one armed clasp. After crossing the contact point, the wire continues 5 to 7 mm horizontally to the occlusal plane and straight towards oral, and is then bent in a right angle into the retention.



The active portion of the clasp is covered with wax on the lingual side in order to avoid damaging the wire while trimming the base plate.

With the oral spring, not only the tooth crown can be tipped lingually, also alveolar remodeling takes place in oral direction as a result of the bone remodeling during tooth movement.

•

The crossed over mesial springs U

U

Function: Diastema or space closure at incisors The endings of the clasps are bent into small loops; the palatal portions of the clasp are bent parallel over each other.

The entire clasps are covered with wax as far as their retention portions.

The springs can only be applied in combination with a transversal screw. Through the opening of the screw both spring parts are pulled together.



•

The closed intermediate spring with loop U

U

Function: Diastema closure Here, the closed intermediate spring has a loop on the labial side. Through activating the loop (see below) the central incisors can be moved together in an optimal way.

On the palatal side, the wire ends cross over so that the centered lying screw which expands the upper jaw in a transverse direction pulls together the springs simultaneously and therefore moves both teeth together. Both clasps have to be covered with wax as far as their retention.

This way, the spring anchored in the acrylic base can be activated properly. The consistent mesial pressure from labial and palatal sides moves both teeth towards one another guided by the acrylic.



CHAPTRR 3

Shields elements, different orthodontie plates



•

The tongue guard U

U

Elements: The tongue guard runs inside along the tooth rows in the area of the open bite. Function: Abhalten der Zunge von den Frontzähnen Description: mäanderförmig gebogenes Gitter

Das Zungengitter verläuft innerhalb der Zahnreihen im Bereich des offenen Bisses.

It consists of multiple loops which are bent in a distance of 3 to 4 mm and shield the open area of the bite from the tongue.

The tongue guard is often combined with an oral screen, but can also be integrated into an active plate.

•

The lip activator according to Dass U

U

Elements: Stimulation spring 1.2 mm spring hard Function: Closing stimulation of the lips Description: Appliance which follows the safety pin principle and represents exercise for the lips



The spring, which also serves as a grip, is bent once around the loop forming pliers. The following zigzag bent is used for activation if the tension decreases. The retention works simultaneously as reinforcement for the acrylic shield.

The wire end and the retention are underlaid with a wax plate and framed with a wax stripe.

The acrylic shield is finished concave to the labial surface, corresponding with the shape of the lip.

•

The lip bumper U

lements: Function: escription:

U

ip bumper 1.0 mm spring hard Separating the lip from the incisors bow in the shape of the arch with zigzag bents for retention of the lip pads

The lip bumper, which in this example is made individually, is anchored in the buccal tubes of the molar bands.



In order to have the lip pads in a certain distance from the gingival tissue, the bent lip bumper wire is underlaid with wax. The distance between the wire and the wax layer is about 1 mm.

When the finished lip bumper is in place, the distance from the gingival tissue should be 1 - 3 mm.

•

Lip pads with an engaged labial bow U

Elements: Function: Description:

U

Modified wire of the lip pads, engaged labial bow 0.7 mm spring hard Protection from the upper lip (combination with the engaged labial bow) The lip pads wire contains a closed loop in order to be able to engage the labial bow

In this case of special lip pads, the wire between the canine and the bicuspid is bent into a loop to allow the engagement of the labial bow.

The area in which the lip pads should keep away the lip has to be underlaid with wax.



Depending on the desired function, the labial bow can be either engaged or not.

•

The inclined plane U


U

Simple retention elements and labial bow 0.7 mm spring hard ovement of single teeth or tooth groups Simple appliance for the correction of the position of single teeth or tooth groups in anterior cross-bites and for the anterior movement of the mandible

For the inclined plane, simple retention elements and a labial bow are bent. Special care should be taken with the retention elements to guarantee a good anchorage because of the load.

For the making of a fixed inclined plane, first the retentive parts of the teeth have to be blocked out with wax and the model has to be articulated in reference to the construction bite.



The inclined plane in the anterior area of a maxillary plate can be used to move the mandibular teeth forward, or to advance the mandible from a distal bite into a neutral occlusion.

•

The active plate U


U

ccording to the planned design ifferent purposes, depending on the design n combination with resilient wire elements and pressure or traction screws, active plates can serve many different purposes

For the making of an active plate the models are prepared in such a way that all blisters have to be eliminated and the undergoing parts have to be covered with wax. The chosen clasps are bent according to the planned design, the active parts are covered with wax and the screws are positioned on the model.

The prepared model can be watered. The model should not to be isolated if the plaster is not synthetic. The acrylic can be scattered on and can be polymerized in the pressure vessel for around 10 minutes.

Afterwards, the plate is detailed, the screw sections are sawed and the active elements are uncovered. The basis plate is only polished on the upper side. On the lower side, only coarse details have to be eliminated. Otherwise, the lower side remains untreated in order to adjust as precise as possible onto the model.



•

The Cetlin appliance U


U

istal spring 0.7 mm spring hard, modified labial bow 17 x 24 rectangular stainless steel wire istal movement of the last molars using a headgear Simple plate to move the last molars distally with fixed bands for extra oral traction

The labial bow is only laid over the four incisors and an acrylic shield is adapted. Adams clasps are bent over the first bicuspids. In order to adjust the distal springs between the bicuspid and the molar, the plaster model has to be slightly erased in this area.

The springs and the acrylic shield are blocked out with wax and covered with acrylic.

The distal limit of the acrylic base reaches the A-line. The acrylic does not contact the last molars. Therefore they can be banded without any problems and the teeth can glide distally along the acrylic.



•

Upper and lower plate with pressure-traction screw according to Heller U

U


ccording to the planned design ovement of single teeth mesially or distally This screw moves single teeth in anterior-posterior direction using the anchorage of all other teeth which are not to be moved

While designing and bending the elements, one has to pay attention in order that the retentions of the clasps do not reach into the sawing area.

The acrylic base has to be sawed or grinded free in all the extension of the gap. The acrylic underneath the screw can continue in order to make the appliance more stable.

A view of the plate with a completely open screw: The Adams clasps for the bicuspids which are to be moved lie on the distal end of the gap.



•

Appliance with open screw U


U

ccording to the planned design Gap closure The screw creates a continuous force used for gap closure

The open screw is available in different sizes depending on the size of the gap. The retention should be bent again in such a way that it does not invade the later sawing area.

n the area of the gap, the acrylic edges are grinded off parallel so that the screw can be closed without any obstacles.

When the screw is totally closed and a gap remains between the teeth, one can proceed gradually; after a new impression, the plate is changed inserting a new screw in order to close the gap completely.

•

The gap closing plate with diastema screw U


U

ccording to the planned design Gap or diastema closing with a screw This is about a sturdy screw with activation extensions which are added to close a gap or a diastema



The elements are bent according to the planned design. The diastema screw is centered with its plastic holder in the middle of the arch. The activation extensions are adapted on the distal surface of the tooth and are eventually shortened.

In the area of activation the extensions have to be covered with wax.

After scattering, finishing and polishing the appliance the proper function of the screw has to be proved.

•

The active plate with rotation screw U


U

ccording to the planned design otation of single teeth through pressure or tension The screw has two extensions with which the tooth is pushed on one side and on the other, pulled into the right position

After bending and fixing all clasps and holding elements the screw is adapted. It has a pressure and a tension extension. First, the pressure extension is adapted on the tooth; then the tension extension is screwed back in order to create a free space in the acrylic for the later activation.



The whole length of the extensions and the slots of the screw are covered with wax.

The active plate is covered with acrylic and finished. At this moment of the making, the retention of the tension extension still lies inside the acrylic. For the insertion of the plate, the tension extension is screwed back the estimated amount and is adapted to the tooth contour.

•

Plate or appliance with piston spring screw U


U

ccording to the planned design Single tooth movement in labial direction The punctual contact point of this screw moves the tooth around its axis

The assembly screw is first screwed into the prepared nut until the tip exposes 0.5 mm. On the point of force application on the tooth, a drop of wax is placed. The screw and the nut have to be heated slightly, pressed onto the wax and positioned in the desired direction.



The acrylic is scattered as usual. Before finishing the appliance, the assembly screw is unscrewed. Possible acrylic or polishing residues are removed and the desired piston spring screw is screwed in. The resilient pin of the screw should only emerge slightly out of the nut.

The piston spring screw is activated with a small screwdriver. There are three different screw lengths (4/6/8 mm) therefore a labial movement up to 7 mm can be achieved.

•

The lever activating screw U


U

ccording to the planned design Labial inclination of lingually inclined molars or molar rotation Lingually inclined teeth are gradually set upright with this screw

The screw consists of a base plate and a pan lever on which a small movable pan plate is fixed. The pan lever is connected to a hinge joint with a spring for a firm adjustment. The small pan plate has to be adjusted on the tooth to be moved and has to be covered with wax together with the hinge joint, the spring and the activation screw.



If the inclination of the tooth is severe, the point of application of the pan plate does not have to lie under the biggest circumference of the tooth in order to avoid interferences when inserting the appliance. In combination with a labial spring, the lever pan screw can also be used to rotate a molar.

The activation screw changes the position of the pan lever and moves the distal part of the molar labially. A labial spring which can be soldered on the Adams clasp serves as counterpart for the rotation and exerts pressure towards lingual on the mesial part of the molar. This force couple results in a rotational movement of the molar.

•

Appliance with Bertoni screw (Y-plate) U


U

ccording to the planned design Simultaneous transversal and anterior-posterior expansion of the arch The three dimensional screw allows a combination of transversal and anterior-posterior expansion of the arch

During the construction of the appliance, it is important to observe that the retentions do not lie in the area of the sawing traces.



The three dimensional screw allows a transversal expansion of the arch with simultaneous protrusion of the incisors. The screw has to be adapted in such a way that it allows an independent activation of all plate sections.

The saw-tracing of the finished appliance forms a Yshape. The retentions of the wire elements lie in the corresponding section according to their function. This way, they can maintain their function even after a strong activation. The Y-plate is often used for anterior-posterior expansion in order to gain space for the alignment of upper canines.

•

Plate with three dimensional, multisectional screw according to Beutelspacher U

U


ccording to the planned design Combined transversal and anterior-posterior expansion of the mandible Combined transversal expansion of the lower arch analogous to the Bertoni screw in the upper arch

After designing the appliance, the wire elements are bent and covered with wax. The retentions have to lie in such a way that they do not hinder the later sawing. In order to define the direction of the protrusion force, the protrusion springs have to be adjusted horizontally and vertically before fixing the screw onto the model.



After the polymerization of the acrylic, the mounting of the screws is removed and the appliance is finished. Afterwards, the sawing is performed.

The function of the multisectional screw according to Beutelspacher is analogous to the function of the Bertoni screw in the maxilla.

•

The fan type expansion plate with different U

screws and application s U


ccording to the planned design nhanced expansion in specific areas nhanced expansion in the maxilla: 1. Anterior expansion, 2. osterior expansion, 3. Eccentric expansion

The fan type expansion screw exists in two designs: As a one piece or two piece expansion screw. Both have the same function, to expand the anterior or posterior region fan shaped. The two piece expansion screw has the advantage that through the separate fixation of the screw and hinge, the lever is longer so that the fan type expansion is enhanced.



1. Anterior expansion Fan type expansion plate with divided screw The divided screw is smaller and is therefore favored in narrow jaws. This way, there is more space for the retentions of the wire elements. The separate joint that forms part of the hinge has to be covered with wax.

T2

T2

The finished appliance shows that the hinge which lies on the dorsal end of the plate is not covered with acrylic. The appliance has to be extended notoriously further into the palate than a simple split plate. It should not stand out over the A-line.

The appliance can be expanded like a fan after its sawing. To assure an opening without interference the hinge should lie uncovered on the posterior limit of the plate.

Fan type split plate with fan type expansion screw in one piece In the same way as in the two piece screw, the hinge of the one piece screw has to be covered with wax.

The finished appliance is also sawed, and the hinge has to be cleared of wax and acrylic residues. The fan type plate is often used for expansion in patients with lip and palate cleft.



The top view of an activated fan type split plate with one piece screw.

2. Posterior expansion Fan type plate with reverse built-in, divided screw The screw can also be adapted in the opposite direction; then its function is the posterior expansion of the maxilla.

The hinge is covered with wax as usual and the sawing cut is widened wedge shaped from the hinge to the front

. The activated screw shows that the wedge shaped cut is closed in the anterior region. If the wedge shaped cut is insufficient for the planned expansion, it can be cut wider.

3. Eccentric expansion Fan type appliance with one piece screw for eccentric expansion An eccentric expansion is achieved by the oblique fixation of the screw. The screw is built in as usual, then it is covered with wax and the plate is sawed.

T2

T2



Because of the oblique position of the screw, the activation results in an eccentric rotation of the arch. This way, space can be gained in specific parts of the arch, as in this example, in the area of the lip and palatal cleft.

•

The Mandibular plate with bow screw according to Müller U

U


ccording to the planned design xpansion in the anterior arch section The anterior arch section is expanded wider, analogous to the an type screw in the upper arch

The wire elements are bent according to the design. The retentions of the clasps should not disturb the area of the screw. Then the screw is fixed on the model.

The mandibular bow screw is adjusted in the same way as a transversal expansion screw into the plate. After finishing and polishing, the appliance is sawed.

The opened bow screw expands the mandible almost fan shaped.



•

Labial spring bow plate according to Bandulet U


U

Adams clasp 0.7 mm hard, labial arch 0.7 mm spring hard Alignment of the incisors The incisors are aligned with a set-up which is transferred with an acrylic covered labial arch

A slight anterior crowding or wrong position of the incisors can be compensated with a set-up from canine to canine. The plaster model has to be duplicated for the making of the appliance.

Adams clasps with soldered tubes are used as retention elements. The distal part of the labial arch, which is covered with acrylic in the anterior region, is inserted into the molar tubes which serve as guide rails.

Both sides of the labial bow have small loops distal of the incisor coverage. From these loops, elastic springs are attached to the distal endings of the labial bow that slide out of the molar tube. This way, a continuous pressure is applied on the incisors which results in their alignment according to the set-up.



•

The Roberts retractor U


U

Labial arch 0.6 mm spring hard, Adams clasp 0.7 mm hard etraction of the incisors Simple appliance for the retraction of incisors

The special part of this appliance is the labial arch. To enhance the transversal mesial tags of the labial arch, small tubes or the needle of a syringe of corresponding size are pulled over the wire. This way the thinner active part of the labial arch, with additional loops in the U-loops, can serve specifically as an active element.

If the labial arch is bent almost completely only resting the retentions, the tubes are pulled over the wire, and with the enforcement in place, the retentions are bent. The tubes start from the loop to the beginning of the retention.

The transversal screw activates the labial bow automatically.



•

The double bite jumping plate (VSD, VD-plate) U


U

ccording to the planned design Protrusive movement of the mandible The incline of the upper guards contacts the inclined plateau of the lower plate and results in a protrusion of the mandible

The double bite jumping plate with preformed guards and integrated screws in the upper and lower jaw The result of the incline of the upper guards contacting the inclined plateau of the lower plate is a protrusion of the mandible. The models are mounted in the fixator according to a construction bite and the retention elements are bent according to the design. The mandibular plate is totally finished. The acrylic plateau in the incisor area is designed 1 mm over the incisal edges. Following the plateau an inclined plane of 60° in relation to the occlusal plane is added as a gliding surface for the guards.

Preformed mandibular expansion screws for double plates can be used when screws are integrated into the double plates. The screw with holder and mounting pattern for the adjustment of the incline is adapted on the lower plaster model, then the acrylic is added and the appliance is finished.

First, the plateau of the finished mandibular plate is covered with a very thin layer of wax and then, the preformed maxillary expansion screw with guards is fixed. After that, the acrylic is scattered on the maxillary plate and both parts of the fixator are set together carefully. Acrylic can be added to the maxillary plate if the expansion screw is not covered adequately.



•

Modifications of the bite jumping guards U

U

Individually bent guards (1.2 mm spring hard): In this case, two wire loops are added into the maxillary plate. While polishing the maxillary plate one has to pay attention not to damage the upper plateau. It is only sanded down and polished. Following these precautions, the contact of the upper and lower plateau is flat and extensive. This is important to distribute the pressure evenly over the appliance and therefore avoid overloading and breaking of the guards.

Bite jumping handle (1.2 mm spring hard): If the double plates do not include an expansion screw, a one piece protrusion wire can be added. In this case, the width of the wire should correspond to the width of the inclined plane on the lower plate. In this variation, the wire should not extend lingually over the mandibular plate.

Lateral guiding spurs (Müller spurs): The guiding spurs can also be applied in the posterior region. For example, when the lingual area is reduced, these prefabricated Müller spurs can be a good solution. Again, the mandibular plate is finished first including guide planes in the area of the first molars. In models of Angle class II patients, these surfaces show towards dorsal. The models have to be mounted in the fixator as mentioned before with a construction bite.

•

The double bite jumping plate system according U

to Schaneng U

A complete fitting set for the double bite jumping plate system according to Schaneng consists of: 3 expansion screws with bridge, 1 adapter (small), 1 adapter (large), 1 mounting pattern and user instructions.



The elements are bent according to the design. After fixing the mandibular screw, the mounting pattern is held parallel to the occlusal plane over the mandibular model. Here, the holder lies between the guiding surfaces of the pattern and these have to adapt closely to the body of the screw. The plastic adapter is fixed over the guiding surface onto the holder of the screw.

The mounting pattern is removed. The gap that results between the body of the screw and the adapter is the space for the acrylic inclined plane. This inclined plane will always be of 60° because of the mounting pattern. This way the mandibular plate can be prepared, hydrated and scattered.

The inclined plane of the mandibular plate which resulted from the use of the mounting pattern is slightly sanded and polished.

Before fixing the guards, the loops have to be covered with wax in order to maintain their elasticity.

The finished lower plate is isolated with a very thin wax layer. The combination of guards and expansion screw is fixed onto the inclined plane.



When closing the fixator the screw should be close to the palate without contacting it. After this, the acrylic can be applied on the maxillary model.

During the finishing the loops have to be uncovered without grinding them. When the transversal screw is expanded widely, tension can be produced on the guards. These can be neutralized by simply bending open the 1.2 mm strong M-loop.

The exact following of the construction principles and the correct adjustment of the angles are the conditions for a proper elastic bite jumping double plate.

•

The class III double plate (RD-plate) U


U

Clasps according to the planned design, Müller thorns (preformed elements) Retrusive movement of the mandible Müller thorns are built in reversed (exchanging left and right)

In appliances of patients which present a class III, the surfaces on which the thorns glide along are directed mesially. Again, the mandibular plate is finished and polished first.



The thorns are fixed with wax as mentioned before onto the lower plate. The finished mandibular plate is covered with wax to avoid sticking on the maxillary plate. Now acrylic can be applied on the upper plate and the fixator has to be closed while the acrylic is not yet polymerized.

View of both finished and polished appliances.

•

The RD-plate with screw according to Sande r U


U

Bending of the clasps according to the planned design Retrusive movement of the mandible The activation of the screws results in a retrusive movement of the mandible

After bending the elements, the screws are fixed on the lower model, the acrylic is scattered and the appliance is finished.

The mounting templates have to be adapted onto the screw holder and for the maxillary appliance the guards are fixed.

The activation of the screws produces a retrusive movement onto the mandible.



CHAPTRR 4

Double plates, bimaxillar appliances



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