basic removable appliance design

IntroductionIntroduction HistoryHistory Properties of Orthodontic wiresProperties of Orthodontic wires ClassificationClassification IndicationsIndications AdvantagesAdvantages DisadvantagesDisadvantages Design ComponentsDesign Components Commonly Used AppliancesCommonly Used Appliances Soldering and WeldingSoldering and Welding ConclusionConclusion

Weinstein has saidWeinstein has said

““There is only one disease that is There is only one disease that is malocclusion.malocclusion.

The medicine is force and there are The medicine is force and there are number of number of

ways of applying this force”ways of applying this force”

HISTORYHISTORY

Victor Hugo JacksonVictor Hugo Jackson chief proponent of removable appliances in the USchief proponent of removable appliances in the US

Charles Hawley Introduced Hawley’s appliance in 1908Introduced Hawley’s appliance in 1908

Martin SchwartzMartin Schwartz In mid 20In mid 20thth century developed a variety of split plate century developed a variety of split plate

appliancesappliances

Philip AdamsPhilip Adams Modified arrowhead clasp into ‘Adams Crib’Modified arrowhead clasp into ‘Adams Crib’ Became the basis for English removable appliancesBecame the basis for English removable appliances Still the most effective clasp for orthodontic purposeStill the most effective clasp for orthodontic purposeGeorge CrozatGeorge Crozat In early 1900s developed a removable appliance In early 1900s developed a removable appliance

entirely in precious metal entirely in precious metal Effective clasps on I molars modified from Jackson’s Effective clasps on I molars modified from Jackson’s

design design Heavy gold wires as frameworkHeavy gold wires as framework Lighter gold finger springs for desired tooth movementLighter gold finger springs for desired tooth movement

At the beginning of the twentieth centuryAt the beginning of the twentieth century

• vulcanite baseplate that covered the palate vulcanite baseplate that covered the palate • molars and premolars capped for retention.molars and premolars capped for retention.• Although the materials changed, removable Although the materials changed, removable

appliances remained the principal appliance for appliances remained the principal appliance for orthodontic treatment in UK and Europe for the next orthodontic treatment in UK and Europe for the next 70 years70 years..

• In contrast, it had little impact on American In contrast, it had little impact on American orthodontics, which at that time was dominated by orthodontics, which at that time was dominated by Edward AngleEdward Angle..

Development of Removable Appliances Development of Removable Appliances in Europein Europe

1.1. Angle’s dogmatic approach to occlusion, with its Angle’s dogmatic approach to occlusion, with its emphasis on precise positioning of each teeth had emphasis on precise positioning of each teeth had less impact on Europeless impact on Europe

2.2. Social welfare systems developed much more Social welfare systems developed much more rapidly in Europe- providing limited treatment for rapidly in Europe- providing limited treatment for large number of patientslarge number of patients

3.3. Precious metals for fixed appliances were less Precious metals for fixed appliances were less available in Europeavailable in Europe

In the UK, the establishment of the National Health In the UK, the establishment of the National Health Service in 1948 favoured use of removable Service in 1948 favoured use of removable appliances. appliances.

• only ten specialist orthodontists only ten specialist orthodontists • so the vast majority of orthodontic treatment was so the vast majority of orthodontic treatment was

provided by general dental practitioners.provided by general dental practitioners.• Department of Health, and the then Dental Estimates Department of Health, and the then Dental Estimates

Board, were of the view that the near exclusive use of Board, were of the view that the near exclusive use of removable appliances was the most cost effective way removable appliances was the most cost effective way of providing UK orthodontic care.of providing UK orthodontic care.

1970s: 1970s: The length of postgraduate orthodontic training The length of postgraduate orthodontic training increased from one to two yearsincreased from one to two years

1980s: 1980s: to three years. to three years. Postgraduates were able to complete supervised Postgraduates were able to complete supervised

treatment of multibanded cases before they qualified. treatment of multibanded cases before they qualified. A series of technical advances A series of technical advances • Prewelded, preformed orthodontic bands Prewelded, preformed orthodontic bands • Directly bonded attachments Directly bonded attachments • Pre-adjusted edgewise bracket reduced the need Pre-adjusted edgewise bracket reduced the need for complex individually formed archwires.for complex individually formed archwires.

Measurements of treatment outcomeMeasurements of treatment outcome

The quality of outcome not as high as with fixed The quality of outcome not as high as with fixed appliances appliances

Higher discontinuation of treatment associated with Higher discontinuation of treatment associated with the use of removable appliancesthe use of removable appliances

Dental practitioners now refer their patients on to Dental practitioners now refer their patients on to specialist orthodontists. specialist orthodontists.

Specialist orthodontists favour the use of fixed Specialist orthodontists favour the use of fixed appliances due to the ability to precisely position appliances due to the ability to precisely position teethteeth

Scope of removable appliancesScope of removable appliances

The use of removable appliances still varies widely The use of removable appliances still varies widely between clinicians, but it is possible to achieve between clinicians, but it is possible to achieve adequate occlusal improvement with these adequate occlusal improvement with these appliances, provided suitable cases are chosen.appliances, provided suitable cases are chosen.

It is vital to emphasize that cases suitable for removable It is vital to emphasize that cases suitable for removable appliance treatment are those that require simple appliance treatment are those that require simple tipping movements only, and surprisingly few tipping movements only, and surprisingly few malocclusions will fall into this category. malocclusions will fall into this category.

Properties of Orthodontic wiresProperties of Orthodontic wires1)1) Esthetics Kusy, AO 1997Esthetics Kusy, AO 19972)2) StiffnessStiffness3)3) StrengthStrength4)4) RangeRange5)5) SpringbackSpringback6)6) FormabilityFormability7)7) ResiliencyResiliency8)8) FrictionFriction9)9) BiohostabilityBiohostability10)10) BiocompatibilityBiocompatibility11)11) WeldabilityWeldability

1) Esthetics:1) Esthetics:-desirable property -no compromise on mechanical -desirable property -no compromise on mechanical

propertiesproperties-composite wires-composite wires

2) Stiffness/Load deflection rate:2) Stiffness/Load deflection rate: -Magnitude of force delivered by the appliance for a -Magnitude of force delivered by the appliance for a

particular amount of deflection.particular amount of deflection. LDR=Load/DeflectionLDR=Load/Deflection

FFαα EdrEdr44 d d αα l l33

ll3 3 rr44

E- Modulus of elasticityE- Modulus of elasticity d- Deflectiond- Deflection r- Radiusr- Radius l- Lengthl- Length

Doubling radius = Increases force 16 foldDoubling radius = Increases force 16 foldDoubling length = Reduces force 8 foldDoubling length = Reduces force 8 fold

LL3 3 αα d (2l) d (2l)3 3 αα 8d 8d 11αα d d 1 1 αα 16d 16d rr44 (r/2) (r/2)44

Low stiffness or LDR impliesLow stiffness or LDR impliesi.i. Low forces will be appliedLow forces will be appliedii.ii. Forces more constant as appliance deactivatesForces more constant as appliance deactivatesiii.iii. Greater ease & accuracy in applying a given forceGreater ease & accuracy in applying a given force

-For active components low LDR -For active components low LDR -For retentive components high LDR-For retentive components high LDR

‘‘Variable Cross-section Orthodontics’-BurstoneVariable Cross-section Orthodontics’-Burstone‘‘Variable Modulus Orthodontics’Variable Modulus Orthodontics’NiTi ≤ TMA ≤ ss wireNiTi ≤ TMA ≤ ss wire

3)3) Strength: Force required to activate an archwire to a Strength: Force required to activate an archwire to a specific distance- Kusyspecific distance- Kusy

Shape and cross-section of wire have an effect Shape and cross-section of wire have an effect

4)4) Range: Distance to which an archwire bends Range: Distance to which an archwire bends elastically, before permanent deformation occurs- elastically, before permanent deformation occurs- ProffitProffit

5)5) Springback: The extent to which the wire reverses its Springback: The extent to which the wire reverses its shape after permanent deformation.shape after permanent deformation.

Wire can be activated to a large extent hence fewer Wire can be activated to a large extent hence fewer activations will be neededactivations will be needed

6)6) Formability: Ability to bend wire in desired Formability: Ability to bend wire in desired configuration.configuration.

7)7) Resiliency: Amount of energy stored in a body.Resiliency: Amount of energy stored in a body.

9)9) Friction: While closing spaces in continuous archwire Friction: While closing spaces in continuous archwire technique, involves relative motion of bracket over wire.technique, involves relative motion of bracket over wire.

Excess friction- loss of anchorExcess friction- loss of anchor - binding- binding Least amount of friction desiredLeast amount of friction desired

9)9) Biohostability: Ability of a wire to accumulate, or be a site of Biohostability: Ability of a wire to accumulate, or be a site of accumulation of bacteria, spores or virusesaccumulation of bacteria, spores or viruses

10)10) Biocompatibility: Resistance to corrosion and tissue Biocompatibility: Resistance to corrosion and tissue tolerance to elements in the wire.tolerance to elements in the wire.

11)11) Weldability: Ease by which a wire can be joined to other Weldability: Ease by which a wire can be joined to other metals by actually melting the 2 metals in the area of the metals by actually melting the 2 metals in the area of the bond bond

1meter = 39.37in1meter = 39.37in1.0mm = 0.3937in1.0mm = 0.3937in1mm = 40 1mm = 40

thousandths of an thousandths of an inchinch

1mm = 0.040in1mm = 0.040in

mmmm inchinch thou of thou of an inchan inch

gaugegauge

1.51.51.251.251.01.00.90.90.80.80.70.70.60.60.50.5

0.0590.0590.0490.0490.0390.0390.0350.0350.0320.0320.0280.0280.0240.0240.0200.020

60605050404036363232282824242020

----

191920202121222223232424

Definition:Definition:

Mechanical Orthodontic Appliances are instruments Mechanical Orthodontic Appliances are instruments which apply pressure or offer resistance to the teeth which apply pressure or offer resistance to the teeth for the purpose of stimulating alveolar bone change for the purpose of stimulating alveolar bone change bringing about changes in the position of teeth. bringing about changes in the position of teeth.

ClassificationClassification

Appliances that affect actual tooth movement Appliances that affect actual tooth movement through adjustment of springs or attachments within through adjustment of springs or attachments within the appliance- the appliance- ACTIVE PLATEACTIVE PLATE

Appliances that stimulate reflex muscle activity Appliances that stimulate reflex muscle activity which in turn produces desired tooth movement- which in turn produces desired tooth movement- FUNCTIONAL APPLIANCESFUNCTIONAL APPLIANCES

II.II. According to site of appliance placementAccording to site of appliance placement1.1. ExtraoralExtraoral2.2. IntraoralIntraoral3.3. CombinationCombination

III.III. According to plane of movementAccording to plane of movement1.1. Transverse Transverse 2.2. SaggitalSaggital3.3. VerticalVertical

IV.IV. Based on method of curingBased on method of curing1.1. Heat cureHeat cure2.2. Self cureSelf cure3.3. Light cureLight cure

Minor tooth movement technique may be consideredMinor tooth movement technique may be consideredo Malposition limited to relatively few teethMalposition limited to relatively few teetho Desired movement not more than few mmDesired movement not more than few mmo Adequate space between adjacent teeth to permit Adequate space between adjacent teeth to permit

entry of teeth to be movedentry of teeth to be movedo Allowable axial inclination corrected by tipping Allowable axial inclination corrected by tipping

forcesforceso Correctable etiologic factorsCorrectable etiologic factorso Favorable periodontal and periapical prognosisFavorable periodontal and periapical prognosiso Absence of contraindicationsAbsence of contraindications

IndicationsIndications

• Excessive flaring of maxillary anterior teethExcessive flaring of maxillary anterior teeth• Diastima closureDiastima closure• Crossbite correctionCrossbite correction• Anterior crowding Anterior crowding

PreprostheticPreprosthetic• Closing of spacesClosing of spaces• Uprighting of teethUprighting of teeth

Preventive PeriodonticPreventive Periodontic• Migration of mandibular incisorsMigration of mandibular incisors

Correction of Speech DefectsCorrection of Speech Defects Facilitation of Oral Surgical ProceduresFacilitation of Oral Surgical Procedures Retention after corrected malocclusionRetention after corrected malocclusion•

ProceduralProcedural• To gain spaceTo gain space

Preventive and interceptive orthodonticsPreventive and interceptive orthodontics

1.Tipping movement 2.Can be removed -for cleaning of teeth & appliance -if in pain -on socially sensitive occasion 3.Less conspicuous 4.Can be undertaken by general practitioner with adequate training 5.Manufactured in lab -less chair side time -more patients can be treated 6.Inexpensive

1.Only simple malocclusion can be corrected 2.Multiple rotations cannot be corrected 3.Uncooperative patients may leave out the appliance- prolongs treatment 4.Multiple tooth movement - one at a time- prolongs Rx duration 5.Lower appliance not well tolerated 6.Cases other than I premolar extraction cannot be treated easily

AdvantagesAdvantages DisadvantagesDisadvantages

Components of removable appliancesComponents of removable appliances

Retentive ComponentsRetentive Components Baseplate Baseplate Active componentsActive components

Retentive ComponentsRetentive Components

Retention: Means whereby displacement of appliance is Retention: Means whereby displacement of appliance is resisted.resisted.

Clasp: any hook or band attached to a natural tooth and Clasp: any hook or band attached to a natural tooth and used to anchor a partial denture or an orthodontic used to anchor a partial denture or an orthodontic appliance.appliance.

Circumferential ClaspCircumferential Clasp

• Fabricated using wire 0.9mmFabricated using wire 0.9mm• -Also known as ‘C’ clasp or Three Quarter Clasp-Also known as ‘C’ clasp or Three Quarter Clasp Simple clasp used to engage buccocervical undercutSimple clasp used to engage buccocervical undercut Cannot be used in partially erupted teethCannot be used in partially erupted teeth

Jackson’s ClaspJackson’s Clasp

- Fabricated using 0.9mm wire- Fabricated using 0.9mm wire - Also known as Full clasp or ‘U’ clasp- Also known as Full clasp or ‘U’ clasp - Engages both buccocervical undercuts- Engages both buccocervical undercuts Simple design Simple design Offers adequate retentionOffers adequate retention Inadequate retention in partially erupted teethInadequate retention in partially erupted teeth

Triangular ClaspTriangular Clasp

-Fabricated using 0.6mm wire-Fabricated using 0.6mm wire -used between adjacent posterior teeth-used between adjacent posterior teeth -Indicated for additional retention-Indicated for additional retention

Adam’s ClaspAdam’s Clasp -Also known as Liverpool Clasp,-Also known as Liverpool Clasp, Universal Clasp,Universal Clasp, Modified Arrowhead ClaspModified Arrowhead Clasp

PartsParts BridgeBridge ArrowheadArrowhead Retentive armsRetentive arms

Advantages:Advantages: Small, neat, unobtrusive, occupies minimum spaceSmall, neat, unobtrusive, occupies minimum space Rigid, offers excellent retentionRigid, offers excellent retention Used on any tooth in the archUsed on any tooth in the arch If broken can be repaired by solderingIf broken can be repaired by soldering Permits modifications in design Permits modifications in design Extensive wire bending incorporates stresses in the Extensive wire bending incorporates stresses in the

wirewire

ModificationsModifications

Adams clasp with single arrowhead: Adams clasp with single arrowhead: Adams clasp with J hook Adams clasp with J hook

Adams clasp with helixAdams clasp with helix Adams clasp with additional arrowheadAdams clasp with additional arrowhead Adams clasp with soldered buccal tubeAdams clasp with soldered buccal tube

Adams clasp with distal extensionAdams clasp with distal extension

Double clasp on maxillary central incisorsDouble clasp on maxillary central incisors

Schwarz ClaspSchwarz Clasp

Designed by C. M. SchwarzDesigned by C. M. SchwarzOldest & for a considerable amount of time most Oldest & for a considerable amount of time most

generally usedgenerally usedAdj: Arrowhead bent towards papilla to engage Adj: Arrowhead bent towards papilla to engage

undercutsundercuts Can be used in deciduous or permanent teethCan be used in deciduous or permanent teeth Skill to fabricateSkill to fabricate Can be used only on posterior teethCan be used only on posterior teeth

Duyzings ClaspDuyzings Clasp

-Simple design-Simple design-engages buccal undercut of molars-engages buccal undercut of molars-half clasp can also be constructed-half clasp can also be constructedAdj: Bending towards the tooth or undercut areaAdj: Bending towards the tooth or undercut area

Eyelet ClaspEyelet Clasp

-similar to triangular clasp-similar to triangular clasp-used as single eyelet or multiple eyelet clasp-used as single eyelet or multiple eyelet clasp-eyelets placed in embrasures-eyelets placed in embrasuresAdj: Bending eyelet interdentally towards the toothAdj: Bending eyelet interdentally towards the tooth No sharp bends, breakage unlikelyNo sharp bends, breakage unlikely Does not interfere with eruption of teethDoes not interfere with eruption of teeth On single tooth does not have firm gripOn single tooth does not have firm grip

Delta ClaspDelta Clasp

• Designed by William J. ClarkDesigned by William J. Clark• Similar to Adams clasp in principleSimilar to Adams clasp in principle• Engage interdental undercutsEngage interdental undercutsAdj: -hold retentive loop and twist inwardsAdj: -hold retentive loop and twist inwards -bending towards interdental undercut as it -bending towards interdental undercut as it

emerges from acrylicemerges from acrylic

Southend ClaspSouthend Clasp

-0.7 mm wire-0.7 mm wire-spans two adjacent margins of anterior teeth-spans two adjacent margins of anterior teethAdj: readapting into interdental areaAdj: readapting into interdental area Esthetically more pleasingEsthetically more pleasing

Ballend ClaspBallend Clasp

• Wire having a knob or ball like structure on one endWire having a knob or ball like structure on one end• utilizes interdental undercutsutilizes interdental undercuts• Indicated when additional retention requiredIndicated when additional retention required

BaseplateBaseplate

Greatest portion of removable applianceGreatest portion of removable appliance1-2mm thick1-2mm thick3 main purposes3 main purposes1.1. Act as vehicle to carry all parts of the applianceAct as vehicle to carry all parts of the appliance2.2. Serve as anchorageServe as anchorage3.3. Become an active part of appliance itself Become an active part of appliance itself

ANCHORAGEANCHORAGE

AnchorageAnchorage resists forces of reaction generated by active resists forces of reaction generated by active components. Thus, sites of anchorage must be equal incomponents. Thus, sites of anchorage must be equal in magnitude but opposite in direction to those generated magnitude but opposite in direction to those generated by active components. by active components. Simple AnchorageSimple Anchorage: Teeth which offer greater resistance : Teeth which offer greater resistance

to movement, used as anchorage for movement of to movement, used as anchorage for movement of lesser resistancelesser resistance

• Usually made of AcrylicUsually made of Acrylic• As thin as possible(1-2mm)As thin as possible(1-2mm)• Closely adaptedClosely adapted• Extend as far as necessary to obtain anchorageExtend as far as necessary to obtain anchorage• Lower baseplate- U shaped, relatively thickerLower baseplate- U shaped, relatively thicker• Shallow lingual sulcus reinforced with ss wire or barShallow lingual sulcus reinforced with ss wire or barHeat cureHeat cureSelf cureSelf cureLight cureLight cureBiocryl: Biostar pressure molding machineBiocryl: Biostar pressure molding machine

BASEPLATE

Anterior

Posterior

Upper

Lower

Parallel to occ plane

Inclined to occ plane

Anterior biteplaneAnterior biteplane

-Platform behind upper incisor teeth-Platform behind upper incisor teeth-Height enough to separate -Height enough to separate posterior teeth by 1.5-2mmposterior teeth by 1.5-2mm-Reduce overbite of anterior teeth-Reduce overbite of anterior teeth-‘opening the bite’-‘opening the bite’-Height of plane gradually increased-Height of plane gradually increasedProclination of upper incisorsProclination of upper incisors *Placement of labial bow*Placement of labial bow *Sved biteplane*Sved biteplane

Sved BiteplaneSved Biteplane

-Introduced by Sved in 1944-Introduced by Sved in 1944-Covers incisal edges of upper anteriors-Covers incisal edges of upper anteriors-Pressure transmitted axially-Pressure transmitted axially-Retention questionable-Retention questionable-Ideal in growing individuals-Ideal in growing individuals

Posterior BiteplanePosterior Biteplane

• displacing activity of mandibledisplacing activity of mandible• unilateral posterior crossbiteunilateral posterior crossbite

• wide enough to contact buccal & palatal cuspswide enough to contact buccal & palatal cusps• occlusion disengagedocclusion disengaged• equal on both sidesequal on both sides• after correction appliance acts as retainerafter correction appliance acts as retainer

Lower Inclined PlaneLower Inclined Plane• Catlan more than 200 yrs agoCatlan more than 200 yrs ago• Anterior crossbiteAnterior crossbite• 45 degrees to occ plane45 degrees to occ plane• Upper incisors guided into Upper incisors guided into correct position labiallycorrect position labially• indicated when incisors are in indicated when incisors are in early stage of eruptionearly stage of eruption If used for more than 6wks-If used for more than 6wks- anterior open bite resultsanterior open bite results May need frequent cementationMay need frequent cementation

Pre-treatment Post-treatmentPre-treatment Post-treatment

Active componentsActive components

LabialbowLabialbow SpringsSprings ElasticsElastics ScrewsScrews

LABIAL BOWSLABIAL BOWS

May have 2 functionsMay have 2 functions1)1) Serve as active element for movement of teethServe as active element for movement of teeth2)2) Hold the plate in place & retain the teethHold the plate in place & retain the teeth

Labial Bow with ‘U’ loop Labial Bow with ‘U’ loop

• 0.7 mm wire0.7 mm wire• flexibility depends on vertical height of ‘U’ loopsflexibility depends on vertical height of ‘U’ loops• Only minor overjet reduction or incisor alignment Only minor overjet reduction or incisor alignment

requiredrequired

Adj: Compressing of ‘U’ loopAdj: Compressing of ‘U’ loop Displaced palatally by only 1mmDisplaced palatally by only 1mm

Long Labial BowLong Labial Bow

• Used to close space between canine and premolarUsed to close space between canine and premolar• Can control the canineCan control the canine• Used for retentionUsed for retention

Split Labial BowSplit Labial Bow

• flexibility increasedflexibility increased• incisor retractionincisor retractionAdj: at the ‘U’ loopAdj: at the ‘U’ loop

Labial Bow with Reverse LoopLabial Bow with Reverse Loop

• Prevents buccal drifting of caninePrevents buccal drifting of canineAdj: Done in 2 stagesAdj: Done in 2 stages1)1) Vertical loop opened by compressing with plierVertical loop opened by compressing with plier2)2) This lowers the bow in incisor regionThis lowers the bow in incisor region compensating bends at the base of the loopcompensating bends at the base of the loop

Mills Bow /Extended Labial BowMills Bow /Extended Labial Bow

• Made of 0.7mm wireMade of 0.7mm wire• Extensive loopsflexibility greatly increasedExtensive loopsflexibility greatly increasedIndications -Reducing large overbitesIndications -Reducing large overbites -Alignment of irregular incisors-Alignment of irregular incisors Flexible, lighter forces, long range of actionFlexible, lighter forces, long range of action In mixed dentition when canines not eruptedIn mixed dentition when canines not erupted Due to extensive loops less comfortableDue to extensive loops less comfortable

High Labial Bow with Apron SpringHigh Labial Bow with Apron Spring• Heavy base arch of 0.9mm wireHeavy base arch of 0.9mm wire• Apron spring 0.3-0.4mmApron spring 0.3-0.4mmAdj: Bent towards the teethAdj: Bent towards the teeth

Retraction of teeth with severe proclinationRetraction of teeth with severe proclination Light forces Light forces Longer range of actionLonger range of action Not well tolerated by the patientNot well tolerated by the patient Time consuming to fabricateTime consuming to fabricate Cannot be used in patients with shallow sulcusCannot be used in patients with shallow sulcus

Roberts RetractorRoberts Retractor

• Flexible bow constructed of 0.5mm wireFlexible bow constructed of 0.5mm wire• Steel tubing to give supportSteel tubing to give support• Coil placed at the point of emergence from the tubingCoil placed at the point of emergence from the tubing• Ajd: Vertical limb below the coilAjd: Vertical limb below the coil

Fitted Labial BowFitted Labial Bow• 0.7 mm wire0.7 mm wire• Adapted closely to labial surface of anterior teethAdapted closely to labial surface of anterior teeth• Used for retentionUsed for retention Time consumingTime consuming

Beggs Retenton BowBeggs Retenton Bow

• 0.7mm wire extends till last erupted molar0.7mm wire extends till last erupted molar• ’’U’ loops made between I & II premolarsU’ loops made between I & II premolars Allows settling of occlusionAllows settling of occlusion If not constructed well retention may not be goodIf not constructed well retention may not be good

SPRINGSSPRINGSMost commonly used active elementsMost commonly used active elementsRequirements:Requirements: springs should deliver optimum forcesprings should deliver optimum force should possess high degree of elasticityshould possess high degree of elasticity should have long range of actionshould have long range of action

Force systems delivered depend onForce systems delivered depend onIntrinsic properties-Intrinsic properties- cannot be altered by operator cannot be altered by operator -modulus of elasticity-modulus of elasticity-yield strength-yield strengthExtrinsic properties-Extrinsic properties- operator can exercise control operator can exercise control-length of wire -length of wire -thickness of wire-thickness of wire

Small changes in diameter and length have a profound Small changes in diameter and length have a profound impact on the force deliveredimpact on the force delivered

Effect of wire diameter on force deliveredEffect of wire diameter on force delivered-amount of activation-amount of activation0.5mm- 3mm activation0.5mm- 3mm activation0.7mm- 1mm activation- little margin of error0.7mm- 1mm activation- little margin of error

Effect of wire lengthEffect of wire lengthCoil- increase length of springCoil- increase length of springLower force with same amount of activationLower force with same amount of activation

Classification of SpringsClassification of Springs

II. . Based on direction of tooth movementBased on direction of tooth movement1.1. Springs for mesio-distal tooth movement Springs for mesio-distal tooth movement2. 2. Spring for labio-lingual tooth movementSpring for labio-lingual tooth movement3. 3. Springs for expansion of archesSprings for expansion of archesII. II. Based on nature of supportBased on nature of support1. 1. Self supported springs Self supported springs 2. 2. Guided springsGuided springs3. 3. Auxiliary springsAuxiliary springsIII. III. Based on presence of loop or helixBased on presence of loop or helix

Single Cantilever SpringSingle Cantilever Spring active armactive armParts coil Parts coil retentive armretentive arm• 0.5-0.6mm wire0.5-0.6mm wire• coil with internal diameter of 3mmcoil with internal diameter of 3mm• used to move teeth labio-lingually or mesio-diatallyused to move teeth labio-lingually or mesio-diatally

Double Cantilever Spring / Z springDouble Cantilever Spring / Z spring

• Constructed using 0.5 or 0.6 mm wireConstructed using 0.5 or 0.6 mm wire• Spring perpendicular to palatal surface of toothSpring perpendicular to palatal surface of tooth• Indicated where incisors are to be proclinedIndicated where incisors are to be proclinedActivation: Opening both coilsActivation: Opening both coils If not perpendicular to palatial surface of teeth, it If not perpendicular to palatial surface of teeth, it

tends to intrude teeth.tends to intrude teeth.

‘‘T’ SpringT’ Spring• Constructed using 0.5 mm wireConstructed using 0.5 mm wire• Buccal movement of premolars and molarsBuccal movement of premolars and molarsActivation: Pulling spring away from the baseplateActivation: Pulling spring away from the baseplate

Coffin Spring Coffin Spring

• Described by Walter.H.Coffin in 1881Described by Walter.H.Coffin in 1881• Made in 2 segments, large enough to make contact Made in 2 segments, large enough to make contact

with all teeth to be movedwith all teeth to be moved• Made of 1.25 mm wireMade of 1.25 mm wire• Spring stands 1 mm away from the soft tissuesSpring stands 1 mm away from the soft tissues

Indications:Indications: Transverse arch expansion – Unilateral crossbite with Transverse arch expansion – Unilateral crossbite with

lateral mandibular displacementlateral mandibular displacement

Advantage over screw – Differential expansion can be Advantage over screw – Differential expansion can be obtained.obtained.

Unless expertly made and adjusted, tends to be rater Unless expertly made and adjusted, tends to be rater unstable.unstable.

ActivationActivation

Canine RetractorsCanine Retractors• Type of springType of spring• used to move canine in distal directionused to move canine in distal direction

CLASSIFICATIONCLASSIFICATIONI.I. Based on location -buccalBased on location -buccal -palatal-palatalII.II. Based on presence of helix or loopBased on presence of helix or loopIII.III. Based on mode of action -push typeBased on mode of action -push type -pull type-pull type

Buccal Self Sopported Canine RetractorBuccal Self Sopported Canine Retractor

• 0.7 mm wire0.7 mm wire• buccally placed canine is to be moved palatally and buccally placed canine is to be moved palatally and

distallydistally• coil just distal to long axis of toothcoil just distal to long axis of tooth

Activation:Activation: by 1mmby 1mm Distal -closing the loopDistal -closing the loop Palatal -anterior limb is bent towards the tooth Palatal -anterior limb is bent towards the tooth after it emerges from the coilafter it emerges from the coil

Uncomfortable to patientUncomfortable to patient Stability increasedflexibility compromisedStability increasedflexibility compromised

Supported Buccal Canine RetractorSupported Buccal Canine Retractor

• identical in design to self supported retractoridentical in design to self supported retractor• 0.5mm wire supported in tubing0.5mm wire supported in tubingActivation: by 2mmActivation: by 2mm

Reverse Loop Canine RetractorReverse Loop Canine Retractor

• can be used in shallow sulcuscan be used in shallow sulcusActivation: 1mmActivation: 1mmi.i. cut off 1mm from the free end & readapt itcut off 1mm from the free end & readapt itii.ii. opening the coilopening the coil

‘‘U’ Loop Buccal Canine RetractorU’ Loop Buccal Canine Retractor

• can be used in sallow sulcuscan be used in sallow sulcusActivation: free end is cut by 1mm & readaptedActivation: free end is cut by 1mm & readapted Requires frequent adjustmentRequires frequent adjustment

Palatal Canine RetractorPalatal Canine Retractor

-canine placed palatally requiring distal buccal -canine placed palatally requiring distal buccal movementmovement

-coil of 3mm placed between the initial & final position -coil of 3mm placed between the initial & final position of canineof canine

Boxing & GuardingBoxing & Guarding

• Boxing to protect from damageBoxing to protect from damage• Spring lies in the recess between baseplate &mucosaSpring lies in the recess between baseplate &mucosa• Guard to prevent distortion during removalGuard to prevent distortion during removal

-often cranked-often crankedActivation: 1-2mm by opening the coilActivation: 1-2mm by opening the coil -should not be bent where it merges from the baseplate-should not be bent where it merges from the baseplate

Dr.SafeenaDr.Safeena

ScrewsScrews

Used for moving individual teeth or group of teethUsed for moving individual teeth or group of teeth

Types of screwsTypes of screws2 types of expansion screws2 types of expansion screws Skeletal expansion screwSkeletal expansion screw Dental expansion screwDental expansion screw

Types of ScrewsTypes of Screws

Maxillary expansionMaxillary expansion

Mandibular expansionMandibular expansion

Bilateral expansionBilateral expansion

Sectional expansionSectional expansion

Radial expansionRadial expansion

Expansion in three directionsExpansion in three directions

ActivationActivationScrew is turned 90 degreesScrew is turned 90 degreesWill drive the parts of the plate apart by 0.2 mmWill drive the parts of the plate apart by 0.2 mmNarrows periodontal membrane by 0.1 mm on each Narrows periodontal membrane by 0.1 mm on each

sideside

Ideal orthodonticIdeal orthodontic condition for transformation of bonecondition for transformation of bone

Uses :Uses : Baseplate divided into sections driven apart by Baseplate divided into sections driven apart by one or more screwsone or more screws

1)1) Split along midline – Bilateral crossbite and minor Split along midline – Bilateral crossbite and minor crowding of incisorscrowding of incisors

2)2) Split into a larger and a smaller partSplit into a larger and a smaller part

PretreatmentPretreatment

Post-treatmentPost-treatment

3)3) Lingually locked and crowded upper central Lingually locked and crowded upper central incisor tipped forward using springs after incisor tipped forward using springs after space provided by moderate expansionspace provided by moderate expansion

4)4) Expansion and reduction of overjetExpansion and reduction of overjet

5)5) Y-Plates – For alignment of crowded canines by Y-Plates – For alignment of crowded canines by saggital and lateral expansionsaggital and lateral expansion

ElasticsElastics

Resembles rubber bandResembles rubber bandMade of latex rubberMade of latex rubberAvailable in various diameters – force applied depends Available in various diameters – force applied depends

on their diameteron their diameterColour coded for easy identificationColour coded for easy identification

Uses :Uses :For movement of singe teeth and groups of teethFor movement of singe teeth and groups of teethFor intermaxillary tractionFor intermaxillary traction

Molar intrusion with removable a applianceMolar intrusion with removable a appliance Giuilio Alessandri Bonatti, Daniela GiuntaGiuilio Alessandri Bonatti, Daniela Giunta

JCO Aug 1996 JCO Aug 1996

CASE 1CASE 1

After 4 months Prosthetic replacementAfter 4 months Prosthetic replacement

CASE 1CASE 1

CASE 2CASE 2

SolderingSoldering

Soldering is the joining of two metals by the use of filler Soldering is the joining of two metals by the use of filler metal which has a substantially low fusion metal which has a substantially low fusion temperature than that of the metal parts being joinedtemperature than that of the metal parts being joined

Fusion temperature of filler metal ≤ 450Fusion temperature of filler metal ≤ 450°°

BrazingBrazingFusion temperature of filler metal ≥ 450° Fusion temperature of filler metal ≥ 450°

Dental soldersDental soldersDental solders are alloys used as intermediary or filler Dental solders are alloys used as intermediary or filler

metals to join two or more metallic parts.metals to join two or more metallic parts.Composed of gold, silver, copper, zinc, tin, nickelComposed of gold, silver, copper, zinc, tin, nickelRequisites of a solderRequisites of a solder1.1. Good tarnish & corrosion resistanceGood tarnish & corrosion resistance2.2. Fusion temperature should be lower than that of Fusion temperature should be lower than that of

parts being joined. (50parts being joined. (50°°-100-100°° less) less)3.3. Should be free flowing and adequately wet the metal Should be free flowing and adequately wet the metal

parts for good adhesionparts for good adhesion4.4. Strength of solder comparable to metals being Strength of solder comparable to metals being

joinedjoined5.5. Colour of solder should match with parts being Colour of solder should match with parts being

solderedsoldered

Flux:Flux: in Latin means ‘flow’in Latin means ‘flow’• Removes oxide coating to increase flow of the molten Removes oxide coating to increase flow of the molten

soldersolder• Dissolves any surface impuritiesDissolves any surface impurities• Prevents oxidation of metalsPrevents oxidation of metals• Reduces melting point of dental solderReduces melting point of dental solder

Flux used commonlyFlux used commonlyBorax Glass- 55%Borax Glass- 55%Boric acid- 35%Boric acid- 35%Silica- 10%Silica- 10%Fluoride fluxes- Boric acid : Potassium fluoride(1:1)Fluoride fluxes- Boric acid : Potassium fluoride(1:1)

AntifluxAntifluxMaterial used to confine the flow of molten solder over Material used to confine the flow of molten solder over

metals being joinedmetals being joinedGraphiteGraphite

Stainless steel is difficult to solderStainless steel is difficult to solder1)1) No union between solder & steel No union between solder & steel

under conditions of stress & strain in the mouth- under conditions of stress & strain in the mouth- Joint failureJoint failure

2)2) Heating to temperature required for soldering Heating to temperature required for soldering anneals- useless for spring purposeanneals- useless for spring purpose

3)3) Passive surface film of chromium protects it from Passive surface film of chromium protects it from further oxidation- inhibits flow of solderfurther oxidation- inhibits flow of solder

Good designGood design Accurate control of heat distributionAccurate control of heat distribution Use of fluoride containing fluxUse of fluoride containing flux

Soldering techniqueSoldering technique

• Miniature butane blow lampMiniature butane blow lamp • Jet of fine needle flame 1cm longJet of fine needle flame 1cm long• Reducing zone of flameReducing zone of flame• Twisting one wire around the otherTwisting one wire around the other• Overheating-burning of wire and solder –rough pitted Overheating-burning of wire and solder –rough pitted

surface on soldering.surface on soldering.• Soldering to be performed in one heating if possible.Soldering to be performed in one heating if possible.• Localization of heat to the site of solder.Localization of heat to the site of solder.

WeldingWelding

Welding is process by which surfaces of metal are Welding is process by which surfaces of metal are joined by mixing, with or without use of heatjoined by mixing, with or without use of heat

Design of welder for orthodontic purposeDesign of welder for orthodontic purposeFred in 1938Fred in 1938Mc Keag in 1939Mc Keag in 1939Principle design features- speed & powerPrinciple design features- speed & power

Cold welding- done by hammering or pressure. Cold welding- done by hammering or pressure. Hot welding- Heat of sufficient intensity to melt metals Hot welding- Heat of sufficient intensity to melt metals

being joined.being joined.3 methods of welding used in dentistry3 methods of welding used in dentistry1)1) Spot weldingSpot welding2)2) Pressure weldingPressure welding3)3) Laser welding Laser welding

Spot weldingSpot weldingConvenient method of uniting pieces of metal of the Convenient method of uniting pieces of metal of the

same kindsame kindClean, Quick, produces joints that are strong & reliableClean, Quick, produces joints that are strong & reliableBasic Principles- Heat & pressureBasic Principles- Heat & pressureElectric current conducted through 2 copper electrodesElectric current conducted through 2 copper electrodesResistance offered generates very high temperature Resistance offered generates very high temperature Copper electrodes simultaneously apply pressure on Copper electrodes simultaneously apply pressure on

metalsmetalsMetal melts at contact points and pressure squeezes Metal melts at contact points and pressure squeezes

metal into each othermetal into each other

Circuite diagram:Circuite diagram:

Spot WelderSpot Welder

Pressure WeldingPressure WeldingMetal parts placed togetherMetal parts placed togetherSufficiently large force applied perpendicular to the Sufficiently large force applied perpendicular to the

surface- welding occurssurface- welding occursForce applied should be sufficiently largeForce applied should be sufficiently large

Laser WeldingLaser WeldingHigh intensity pulse of light that can be focusedHigh intensity pulse of light that can be focusedSelect duration & intensity of pulse- metal melts in Select duration & intensity of pulse- metal melts in

small region without micro structural damage to small region without micro structural damage to surrounding areassurrounding areas

APPLIANCESAPPLIANCES

ClassificationClassification1.1. RetentionRetention2.2. Preventive & InterceptivePreventive & Interceptive3.3. Active tooth movementActive tooth movement TransverseTransverse SaggitalSaggital VerticalVertical

Hawley’s ApplianceHawley’s Appliance

Designed by Charles Hawley in 1908Designed by Charles Hawley in 1908Most frequently used retainerMost frequently used retainerShort labial bowShort labial bowAdams Clasp on molarsAdams Clasp on molars

Modifications :Modifications : Long labial bow – Closing space distal to canineLong labial bow – Closing space distal to canine Labial bow soldered to bridge of Adams clasp – Labial bow soldered to bridge of Adams clasp –

avoids risk of space opening due to cross over wireavoids risk of space opening due to cross over wire Fitted labial bow – Offers excellent retentionFitted labial bow – Offers excellent retention Anterior bite plane – To retain or correct deep bite Anterior bite plane – To retain or correct deep bite

casescases Expansion screw with split labial bowExpansion screw with split labial bow With tongue crib.With tongue crib. With Z spring on second molars for lingual With Z spring on second molars for lingual

movement of molarsmovement of molars

Alexander,s RetainerAlexander,s Retainer

• ‘‘C’ clasp on molarsC’ clasp on molars• Anterior labial bowAnterior labial bow

High Labial RetainerHigh Labial Retainer Harvey L. LavittHarvey L. Lavitt JCO Jan1972 JCO Jan1972

• Control over each tooth seperatelyControl over each tooth seperately• Springs for correction of rotation and uprightingSprings for correction of rotation and uprighting• Both active and retentiveBoth active and retentive• More estheticMore esthetic

A Removable CUSPID-TO-CUSPID RetainerA Removable CUSPID-TO-CUSPID Retainer DOUGLAS J. SHILLIDAY (JCO 1973)DOUGLAS J. SHILLIDAY (JCO 1973)

Begg’s Wraparound retainerBegg’s Wraparound retainer

Popularized by P.R.Begg.Popularized by P.R.Begg.Bow extending till last erupted molarBow extending till last erupted molar No crossover wire, eliminates risk of space opening No crossover wire, eliminates risk of space opening

upup

Clip-on RetainerClip-on RetainerWire runs labial to incisors, passes between canine and Wire runs labial to incisors, passes between canine and

premolarpremolarBoth labial and lingual wire segments embedded in Both labial and lingual wire segments embedded in

strips of acrylicstrips of acrylicBrings out correction of rotation in lower anterior Brings out correction of rotation in lower anterior

segmentssegments

Van der Linden RetainerVan der Linden RetainerJCO May2003JCO May2003

Kesling’s Tooth positionerKesling’s Tooth positionerDescribed by H.D.Kesling in 1945Described by H.D.Kesling in 1945Made of thermoplastic rubber like materialMade of thermoplastic rubber like materialSpans interocclusal space and covers clinical crowns Spans interocclusal space and covers clinical crowns

and a small portion of gingivaand a small portion of gingiva No activation neededNo activation needed Difficulty in speech Difficulty in speech Risk of TMJ problemsRisk of TMJ problems

Essix Retainers- Fabrication and supervision for Essix Retainers- Fabrication and supervision for permanent retentionpermanent retention

John. J. Sheridan, Willaim Ledoux, Robert McminJohn. J. Sheridan, Willaim Ledoux, Robert McminJCO Jan 1993JCO Jan 1993

Wraparound cantilever retainerWraparound cantilever retainer Timonthy J. TremontTimonthy J. Tremont JCO Feb- 2003JCO Feb- 2003

•Ideal for a well finished caseIdeal for a well finished case•Cantilever arm- middle of first bicuspid Cantilever arm- middle of first bicuspid soldered to labial bowsoldered to labial bow•Bow adjusted by giving a slight bend in the cantilever armBow adjusted by giving a slight bend in the cantilever arm

• Thermoplastic copolymer retainerThermoplastic copolymer retainer• Thin, yet strong, cuspid-cuspidThin, yet strong, cuspid-cuspid• Low cost & ease of fabricationLow cost & ease of fabrication• Brilliant appearance of teeth caused by light reflectionBrilliant appearance of teeth caused by light reflection • Thickness- .030”Space cut at distogingival margin Thickness- .030”Space cut at distogingival margin to allow removal removalto allow removal removal

•Pontic can be incorporated for missing anterior toothPontic can be incorporated for missing anterior tooth

Habit Breaking/Restraining AppliancesHabit Breaking/Restraining Appliances

Tongue crib applianceTongue crib applianceTongue crib anchored to oral cavity by clasps and labial Tongue crib anchored to oral cavity by clasps and labial

bowbowUsed for interception of habits like tongue thrusting and Used for interception of habits like tongue thrusting and

thumb sucking.thumb sucking.

Oral Screen/Vestibular screenOral Screen/Vestibular screen

• Introduced by Newell in 1912Introduced by Newell in 1912• Shield of acrylic placed in the labial vestibuleShield of acrylic placed in the labial vestibule• Designed to screen oral cavityDesigned to screen oral cavity• Metal ring projecting between upper and lower lipsMetal ring projecting between upper and lower lips• Used to intercept habits like thumb sucking, tongue thrusting Used to intercept habits like thumb sucking, tongue thrusting

and mouth breathing.and mouth breathing.

Modifications Modifications • For interception of tongue thrusting :For interception of tongue thrusting :• Additional screen placed in the lingual aspect, Additional screen placed in the lingual aspect,

attached to the vestibular screen by means of a thick attached to the vestibular screen by means of a thick wirewire

• For mouth breathing- when airways are open For mouth breathing- when airways are open • Fabricated with a number of holes that are gradually Fabricated with a number of holes that are gradually

closed.closed.• Open bite in deciduous & mixed dentitionOpen bite in deciduous & mixed dentition• Mild disto-occlosion with premaxillary protrusionMild disto-occlosion with premaxillary protrusion

Space MaintainersSpace Maintainers

Space maintenance is a process of maintaining the space Space maintenance is a process of maintaining the space previously occupied by a tooth or several teeth before previously occupied by a tooth or several teeth before the eruption of permanent tooth.the eruption of permanent tooth.

ClassificationClassification Functional- teeth incorporated to aid in mastication, Functional- teeth incorporated to aid in mastication,

speech and esthetics.speech and esthetics. Nonfunctional- acrylic extension over edentulous Nonfunctional- acrylic extension over edentulous

area to prevent space closurearea to prevent space closure

Class I: Unilateral maxillary posterior Class I: Unilateral maxillary posterior Class II: Unilateral mandibular posterior Class II: Unilateral mandibular posterior Class III: Bilateral maxillary posterior Class III: Bilateral maxillary posterior Class IV: Bilateral mandibular posterior Class IV: Bilateral mandibular posterior

‘‘C’ Space RegainerC’ Space Regainer

Tongue Blade TherapyTongue Blade Therapy

Lip Bumper/ Lip ShieldLip Bumper/ Lip ShieldExtends into the vestibular sulcus to the labial foldExtends into the vestibular sulcus to the labial foldNo contact made between shield and incisorsNo contact made between shield and incisorsEliminates persistent hyperactivity of mentalis muscleEliminates persistent hyperactivity of mentalis muscleClass II div 1 malocclusionClass II div 1 malocclusionClass I flush terminal plane with large overjetClass I flush terminal plane with large overjetShield the lower lip away- used for interception of lip Shield the lower lip away- used for interception of lip

sucking habitsucking habitTo augment anchorageTo augment anchorageDistallisation of first molarsDistallisation of first molarsAs space regainers- early loss of deciduous molars As space regainers- early loss of deciduous molars

Denholtz ApplianceDenholtz ApplianceLip bumper for the maxillary archLip bumper for the maxillary archDesign similar to madibular lip bumperDesign similar to madibular lip bumper

Crozat Appliance Treatment of BuccalCrozat Appliance Treatment of Buccal Crossbite Crossbite JCO 2003, JCO 2003, JuneJune Frank MarasaFrank Marasa

ACCOACCO• Acrylic Cervico Occipital anchorageAcrylic Cervico Occipital anchorage• Margolis 1976 & Spengeman 1967Margolis 1976 & Spengeman 1967• Acrylic on labial bowAcrylic on labial bow• Auxiliaries- springs for posterior rotationAuxiliaries- springs for posterior rotation - minimal anterior crowding- minimal anterior crowding - minimal distalization- minimal distalizationJacobson splint- Used phase therapy or prefixed Jacobson splint- Used phase therapy or prefixed

appliance guidance.appliance guidance.Verdon combination appliance-When Verdon combination appliance-When

mandibular protraction desiredmandibular protraction desired

Fixed Removable approach to presurgical Fixed Removable approach to presurgical Orthodontic TreatmentOrthodontic Treatment

H.S.Orton, P.M.NobleH.S.Orton, P.M.NobleLower full edgewise appliance JCO May 1990Lower full edgewise appliance JCO May 1990Upper labial sectional edgewise applianceUpper labial sectional edgewise applianceExpansion plate with dams clasp for fixationExpansion plate with dams clasp for fixation

Design variation for class II div 2 casesDesign variation for class II div 2 casesClasps on I premolar and I molar Clasps on I premolar and I molar Palatal spring to intrude and procline upper incisorsPalatal spring to intrude and procline upper incisors

Bonding for Retention of Removable AppliancesLeonard Gorelick, Arnold Geiger

JCO 1986 JUNEAnatomic factors prevent adequate Anatomic factors prevent adequate retentionretention•Bell shaped posterior teethBell shaped posterior teeth•Teeth with abnormal axial Teeth with abnormal axial inclinationinclination•High palatal vault- poor tissue High palatal vault- poor tissue adaptation of acrylicadaptation of acrylic• Large tori that limit tissue supportLarge tori that limit tissue support Bondable eyeletBondable eyeletComposite bonding materialComposite bonding material

Bonded Composite Button for Removable Bonded Composite Button for Removable Appliances Appliances JCO 2003 JuneJCO 2003 June Stephen Edward Grimm III Stephen Edward Grimm III

• Composite button made on lingual surfaceComposite button made on lingual surface• Undercut made on the gingival side of the buttonUndercut made on the gingival side of the button• Prevents the spring from being displacedPrevents the spring from being displaced• Allows full force to act on the toothAllows full force to act on the tooth

Instructions to patient• DiscomfortDiscomfort• PhoneticsPhonetics• Increased salivationIncreased salivation• Cleaned after eatingCleaned after eating• Initially full time wear except while eating for 6mtsInitially full time wear except while eating for 6mts• Later night time wearLater night time wear

ConclusionConclusion

““All you can do is push, pull or turn a tooth. I have given All you can do is push, pull or turn a tooth. I have given you an appliance and now for God’s sake use it”you an appliance and now for God’s sake use it”

Edward.H.AngleEdward.H.Angle

ReferencesReferences

Orthodontic treatment with removable appliances- W. Orthodontic treatment with removable appliances- W. W.J.B. Houston, K.G. IssacsonW.J.B. Houston, K.G. Issacson

The Design, construction and use or Removable The Design, construction and use or Removable Orthodontic Appliances – C. Philip AdamsOrthodontic Appliances – C. Philip Adams

Removable Orthodontic Appliances- T.M. Graber, Removable Orthodontic Appliances- T.M. Graber, Bedrich NeumannBedrich Neumann

Orthodontics Principles and Practice- T.M. Graber Orthodontics Principles and Practice- T.M. Graber Contemporary Orthodontics- ProffitContemporary Orthodontics- Proffit


Orthodontics. Post graduate dental hand book- Spiro. Orthodontics. Post graduate dental hand book- Spiro. J. ChakonasJ. Chakonas

An Introduction to Orthodontics- Laura MitchellAn Introduction to Orthodontics- Laura Mitchell Removable Partial Prosthodontics - McCracken’sRemovable Partial Prosthodontics - McCracken’s Dentofacial Orthopedics with Functional Appliances, Dentofacial Orthopedics with Functional Appliances,

Thomas. M. Graber, Thomas Rakosi, Alexandre G. Thomas. M. Graber, Thomas Rakosi, Alexandre G. PetrovicPetrovic

Removable Orthodontic Appliances. M.S.Rani Removable Orthodontic Appliances. M.S.Rani


High Labial Retainer Harvey.L.LevittHigh Labial Retainer Harvey.L.LevittJCO Jan1972JCO Jan1972

A Removable cuspid-to-cuspid RetainerA Removable cuspid-to-cuspid RetainerDoglus J. Shilliday JCO 1973Doglus J. Shilliday JCO 1973

Crozat Princilples and Technique. Wendell H. Taylr. JCO Crozat Princilples and Technique. Wendell H. Taylr. JCO June 1985June 1985

Crozat Appliance Treatment of Buccal Crossbite Frank Crozat Appliance Treatment of Buccal Crossbite Frank Marasa. JCO June 2003 Marasa. JCO June 2003

Essix Retainers- Fabrication and supervision for permanent Essix Retainers- Fabrication and supervision for permanent retention John. J. Sheridan, Willaim Ledoux, Robert Mcmin. retention John. J. Sheridan, Willaim Ledoux, Robert Mcmin. JCO Jan 1993JCO Jan 1993

Van der Linden RetainerVan der Linden Retainer JCO May2003JCO May2003


Molar intrusion with removable a applianceMolar intrusion with removable a appliance Giuilio Alessandri Bonatti, Daniela GiuntaGiuilio Alessandri Bonatti, Daniela Giunta JCO Aug 1996 JCO Aug 1996

Wraparound cantilever retainerWraparound cantilever retainerTimonthy J. TremontTimonthy J. Tremont, , JJCO Feb- 2003CO Feb- 2003

Notes & Compilation of Articles. Notes & Compilation of Articles. Dr.Arundhati P. TandurDr.Arundhati P. Tandur

Space maintainers in Pedodontics, Dr.N. Shivakumar, Space maintainers in Pedodontics, Dr.N. Shivakumar, Library thesis, Department of Pedodontics, ManipalLibrary thesis, Department of Pedodontics, Manipal

basic removable appliance design

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