Download - Appliances in Pediatric Dentistry

A. VAMSI KRISHNA

I M D S

APPLIANCES IN PEDIATRIC DENTISTRY

Space maintainers

Habit breaking appliances

Removable appliances

Myofunctional appliances

Orthopaedic appliances

Conclusion

References

Contents

SPACE MAINTAINERS

DEFINITION

This term was coined by JC Brauer in 1941. It is defined as the process of maintaining a space in a given arch previously occupied by a tooth or a group of teeth

Boucher: it is a fixed or removable appliance designed to preserve the space created by the premature loss of a primary tooth or a group of teeth

If a child loses a primary tooth early through decay or injury, the child's other teeth could shift and begin to fill the vacant space.

When the child's permanent teeth emerge, there's not enough room for them.

The result is crooked or crowded teeth and difficulties with chewing or speaking.

This is a ideal case where a space maintainer would have helped

INDICATIONS

1. If the space shows signs of closing.

2. If the use of space maintainer will make the future orthodontics less complicated.

3. If the need for treatment of malocclusion at a later date is not indicated.

4. When the space should be maintained for two year or more.

5. To avoid supra eruption of opposing tooth.

6. To improve the masticatory system and restore dental health.

CONTRAINDICATIONS

1. If the radiograph shows that the succedant tooth will erupt soon.

2. When the space left is greater than the needed for the permanent as indicated from radiographically.

3. If the space shows no signs of closing.

4. When the succedenous tooth is congenitally absent.

Requirements

• It should maintain the entire space created by the tooth

• It must restore function

• Prevent supraeruption of opposing tooth

• It should be simple in construction

• It should be strong enough to withstand occlusal forces

• Should permit maintenance of oral hygiene

• Must not restrict the growth of jaws

• It should not exert undue forces of its own

CLASSIFICATION OF SPACE MAINTAINERS

Commonly used Space maintainers

BAND & LOOP CROWN & LOOP LINGUAL ARCH HOLDING DEVICE NANCE’S PALATAL HOLDING

DEVICE TRANS PALTAL DISTAL SHOE REMOVABLE SPACE MAINTAINER

Missing Tooth

Treatment Treatment

Unilateral loss of primary 1st molar

Band / crown and loop Band/crown and loop

Unilateral loss of primary 2nd molar

No treatment until eruption of 1st permanent molar, later transpalatal arch

Distal shoe until eruption of 1st permanent molars and permanent incisors, then lower lingual holding arch

Bilateral loss of primary 1st molars

Bilateral bands/crowns and loops.

Bilateral bands/crowns and loop

Bilateral loss of primary 2nd molars

No treatment until eruption of 1st permanent molars, later Nance palatal arch.

Bilateral distal shoes until eruption of 1st permanent molars and incisors, then lingual arch

Multiple bilateral primary molars loss

Saddle appliance until 1st permanent molars are erupted, later Nance.

Saddle appliance until 1s permanent molars and incisors are erupted, later lingual arch.

Primary Dentition Maxilla Mandible

Missing Tooth

Treatment Treatment


No treatment unless leeway space is to be preserved



Transpalatal Band and loop until eruption of permanent incisors, then lower lingual holding arch





Nance Bilateral bands and loops until eruption of permanent incisors, then lower lingual arch


Nance Saddle appliance until eruption of permanent incisors, then lower lingual holding arch

Early Mixed dentition Maxillary Mandibular

Missing Tooth Treatment Treatment





Transpalatal Lower lingual holding arch





Nance Lower lingual holding arch


Nance Lower lingual holding arch

Late Mixed Dentition Maxilla Mandible

They are unilateral, fixed, nonfunctional and passive

Used when single tooth is missing in the posterior segment.

Can also be given in bilateral posterior tooth loss

Band and Loop space maintainers

Indication:1. Premature loss of one tooth.

Contraindication:1. Long span.2. Space lost3. Severe malocclusion.4. Abutment tooth mobile

Advantages:1. Simple and easy constructed.2. Moderate chair time.3. Give room for erupting permanent tooth.4. Easy to clean.5. Inexpensive.

Disadvantages:1. Not restore the function.2. Not prevent the extrusion of opposing tooth.3. Has to be replaced if the tooth anterior to

space exfoliated.

DesignIt consists of a band fabricated from 0.005’’

steel band and a loop that extends from the band to the distal surface of the anterior abutment tooth.

Loop is placed 1mm from the gingival surface.

ConstructionBand two types- Preformed, Custom made

Custom made bands are made by taking the required amount of band material from the spool and pinching them to form the band.

Fabricated using various pliers- Beak pliers, band adaptor and how’s plier.

Band pinchingFestooningTrimmingFolded flap method

Band is adapted on to the tooth

Impression of the archCast is obtained with the

band secure on the toothLoop is prepared with 0.9

mm hard round stainless steel wire.

Loop soldered to the band Cemented to the tooth

Modifications

Loop made only on one side

Occlusal rest

Occlusal stop

Crown loop

Reverse

Controversy:

Recently a study has shown that space changes with regard to arch width or arch perimeter 6 months following premature loss of a primary maxillary first molar was minimal.

The early space changes in the maxillary dental arch consist mainly of palatal migration of the maxillary incisors indicating that the mesial movement of permanent molars might not occur as a consequence of the tooth extraction.

There was statistically significant 1 mm of space loss detected; however, it is not likely to be of enough clinical significance for the use of a space maintainer. If palatal movement seems to be needed, a palatal arch was suggested instead of band and loop space maintainer.

JADA 2007 vol 138:362-8

Lingual arch space maintainer

Bilateral, fixed or semifixed, nonfunctional passive

Indications1. Bilateral loss of primary first or second

molars after the eruption of permanent mandibular incisors,

2. If there is multiple loss of primary teeth.3. In late mixed dentition stage, may be

used to hold leeway space to allow sufficient space for permanent canines & premolars to erupt or to preserve space for later alignment of crowded incisors.

Advantages:

Used with uncooperative patient.Used in children with bad oral hygiene.Can maintain the space through period of mixed

dentition.Preserve the integrity of the whole arch.There is no breakage problem or retention problem.It allows free individual movement of teeth while

maintaining space.It is easily removed, adjusted and replaced.

Disadvantages:Not restore masticatory function.Not prevent over eruption of opposing teeth.

Construction

The wire should be made to contact the cingula of the mandibular incisors

In the edentulous ridge region wire curved down to the lingual 1 mm away from the soft tissue

Should maintain 3-4 mm contact with the lingual surface of the band

Konstantinos et al (1998) have suggested that in the canine region 2 omega bends need to be given ???

Bilateral, fixed, passive and nonfunctional space maintainer

Indicated when there is bilateral missing deciduous molars in the upper arch

The first permanent molars are banded

The arch wire extends from the palatal surface of one molar band to the other, anteriorly it extends upto the rugae area and is embedded in an acrylic button.

Nance Palatal Arch

Can be made active-

The acrylic button may irritate

Bilateral, fixed, passive and nonfunctional

Used when there is unilateral loss deciduous molars

The first permanent molars are bandedThe wire component extends from the

palatal aspects of the bands to cross..It prevents the mesiolingual rotation of

the molars around..It can be used in bilateral loss of

posterior teeth !!! PEDIATRIC DENTISTRY V 29 / NO 3 MAY / JUNE

2007

Transpalatal arch

Early version of distal shoe – Willet’s distal shoePresent version – Roche’s modified distal shoe

applianceUnilateral, fixed, nonfunctional and passiveAn intraalveolar appliance

INDICATIONThe distal shoe appliance is used to maintain the

space of a primary second molar that has been lost before the eruption of the permanent first molar.

The result of this mesial drift is loss of arch length and possible impaction of the second premolar

DISTAL SHOE SPACE MAINTAINER

Contraindication:

1. Medically compromised pt. (because no complete epithelization around alveolare bone) lead to (subacute bact endocarditis).

2. Poor oral hygiene.3. Long span.4. Damaged abutment.

Construction• The crown/band is adapted on the first deciduous

molar and impression is taken…

• An IOPA is taken..

• On the cast position of the mesial surface of the first permanent molar is marked, then V shaped notch is made

• Loop is fabricated

Loop is soldered to the crown, appliance is sterilized..

Extract the tooth just before cementation..Appliance tried in patient’s mouth and IOPA

taken to confirm…Final cementation.

REMOVABLE SPACE MAINTAINERS

a. Non-functional types b. Functional types

It is like a removable partial denture, Not only Mesiodistal space but also the vertical space is maintained.

Masticatory Function is restored in functional type

Esthetics & speech improvement

removable unilateral space maintainersThey are too small and present

swallowing and choking dangers for children.

The esthetic and hygienic EZretainer maintains the mesiodistal dimension of an extraction space and can also be used to regain slightly closed spaces, according to Dr. Güray.

The appliances are color-coded for each quadrant and are available in boxes of four.

EZ retainer

Gajanan et al.concluded that ribbond space maintainer as well as repaired ribbond space maintainer are comparable to the conventional band and loop in terms of physical strength.

McDonald and Avery suggested that the band and loop space maintainer should be removed once a year to inspect, clean and apply fluoride to the tooth. FRC loop space maintainer seems to eliminate these annual maintenance steps.

Contemporary Clinical Dentistry | April 2012 | Vol 3 | Supplement 1

FRC

These space maintainers are available with stainless steel crowns or stainless steel bands with an assortment of attachments. There is no welding or soldering required and they are fully adjustable to different edentulous spans.

Preformed space maintainers

Oral habit breaking appliances

Oral screenNewell in 1912

Principle Both on principle of force elimination and force

application

IndicationsMostly to intercept mouth breathing; thumb

sucking, tongue thrusting , lip biting and cheek biting

Flaccid hypotonic upper lipCorrection of mild anterior proclination

Mechanism of action

When patient closes the lips or swallows

All muscle forces transmitted to anterior teeth

Retraction of the proclined teeth

ModificationsHotz modification

Kraus modification

Rehak modificationCommercially available polyamide or

thermoplastic appliance

Lip bumperSynonymsLip plumper

PrincipleBoth on principle of force elimination and

force application

IndicationsHyperactive mentalisLip sucking habit

Mode of action- Lip bumper will prohibit lip from exerting excessive force on the mandibular incisors and reposition the lip away from the lingual aspect of the maxillary incisors

Types RemovableFixedDenholtz modification

The Palatal Crib is designed to reduce the comfort of thumb sucking by placing a metal crib over the most anterior portion of the palate, preventing the thumb from resting along or contacting the palate.

The Blue Grass appliance is designed to prevent the patient from sucking their thumb or tongue thrusting. This fixed appliance uses a spinning roller to help break the patient's habit and allow the anterior teeth to return to their normal position

Modified blue grass appliance was used using 3 mm acrylic beads as recommended by Baker.

It encourages neuromuscular stimulations by using multiple beads.

Between 4–6-year-old children can be instructed to play with the beads with the tongue immediately after placement.

Since Teflon rollers are not in contact with palatal tissues, children can roll them with their tongues. Within few days, the tongue establishes new non-harmful habit of playing with roller.

Hence, this appliance works through counter

conditioning response to the original conditioned stimulus for thumb sucking.

Case Reports in Dentistry Volume 2013, Article ID 537120

The Quad Helix appliance is designed to achieve arch development by providing a light, continuous force to both anterior and posterior segments. Fabricated as either fixed or removable (MIA), this appliance can also be used for molar rotation

Four helixes

Anterior bridge

Outer arms

Expansion and rotation

PURPOSE About one third of people brux (grind or clench) their teeth.

Many of these people do so subconsciously . The purpose of a night guard is to reduce the negative effects

of bruxism. These negative effects can include:

Mobile teeth Drifting teeth Recession or clefting of the gum tissue Wear of teeth “v” shaped erosions in the root surfaces Increased bone loss Muscle soreness or stiffness Joint clicking Joint soreness or stiffness

Mouth guard

Removable Appliances

Called as three quarter clasp

ConstructionThis need 0.8 mm stainless steel wire, extends

from the interproximal embrassure either mesially or distally and passes below the maximum bulge area and above the gingival margin buccally.

AdjustmentThe clasp is adjusted by holding it at the contact

point and bending it towards the tooth.

C clasp

Drawbacks

It cannot be used on deciduous teeth as there is no infra-bulge area.

Only on posterior..Cannot be used in partially erupted teethThick wire..Create space..

Used on premolars and molarsConstruction0.8 mm wire is usedTake apiece of wire of 5 inchesBegin to form the clasp from the buccal

aspect…….

AdjustmentClasp is adjusted by bending the clasp towards

the tooth by holding it at the contact point.

Full clasp or Jackson’s clasp or Circumferential clasp

Used for additional retentionAbout 3 inches of 0.7 mm, stainless steel wire is used

for forming the clasp.A small triangle is made….The triangle should be perpendicular to the tooth

surface…The free end of triangle should be placed distally to

prevent injury to the cheek.

AdjustmentThe clasp is adjusted by bending it towards the tooth

at the contact point.

Triangular Clasp

Introduced by C. P. AdamsModified arrowhead clasp or Liverpool

Clasp or Universal Clasp0.7 mm stainless steel wire is used

Arrowheads should be positioned at …Arrowheads should have a point

contact..The bridge should be located at the

middle third of the toothThe bridge should be 2 mm ..When viewed from the side the bridge…

Advantages

Adam’sClasp

Modifications of Adams clasp

UsesUsed for retraction of anterior teethUsed for retention of teethUsed for reinforcementUsed for the attachment of auxiliary springs

Stainless steel wire 0.6 mm- Retraction 0.7 mm- Retention 0.8 to 1.0 mm-

ReinforcementContra-Indication

Activation

Short Labial Bow

Stainless steel wire of 0.6 mm- Retaction 0.7 mm-

Retention

Activation

Advantage• Can be used to close space between

canine and premolar.• Can control canines• Used for retention

Long Labial Bow

Type a – the labial bow is split in the mid-line and the two halves do not overlap each other

Activation – by closing the U loopsAdvantage – Uses- For minor correction of spaces, to

flatten arch

Type b – the two halves of the split labial bow cross each other at the midline and engage the distal aspect of the central incisor of the opposite side.

Activation

Advantage

Split Labial Bow

0.5 mm stainless steel wire

ActivationBy placing a bend on the vertical limb of wire….

Advantage Can be used for correction of severe protrusion of

teethLight force is appliedRange of action is longer

Robert’s Retactor

Mill’s Retractor High Labial Bow

Reverse Labial Bow

Classification

Based on the direction of tooth movement brought about by the springs

Based on the nature of the support required for the action

1. Self-supporting spring 2. Guided spring 3. Auxiliary spring

Springs

Formula F α Edr4 / l3

Factors to be considered

Wire dimensionForce appliedDeflectionDirection of the tooth movement

Springs

Description of the screw

Pitch of the screw

Expansion Screw

Activation

A key is provided by the manufacturer

In adults one-quarter turn is opened once in a week

In case of children, one-quarter turn is opened once in three days as the periodontal ligament is wider

Advantages• Can be used in many types of tooth movements…Intermittent forces..Controlled force..Activation is simple, can be done by patient or

parentUseful in moving the teeth which are to be clasped

Disadvantages Appliance is bulkySometimes the screw tends to turn backExpensive

For clinical application, the expansion screw appliances are grouped as

Group 1 – Expansion screw appliances used to widen the arch

Group 2 – Expansion screw appliances used to move teeth in labial direction

Group 3 – Expansion screw appliances used to move teeth in mesio-distal direction

Group 4 – expansion screw appliances used to move individual teeth in buccal or labial direction

Group 5 – Traction screws used for closure of extraction spaces

Screws

Myofunctional Appliances

1. Tooth borne passive appliances Tooth borne active appliances Tissue borne passive appliances

2. Myotonic appliances Myodynamic appliances

3. Removable functional appliances Fixed functional appliances

4. Group I, II and III appliances

Classification

Inclined planeSynonymsCatalan’s applianceIncisor capping appliance

Principle Designed to have 450 angulation

Forces the maxillary teeth in cross bite to tip labially

Indications

Maxillary anterior teeth in cross bite

Single tooth crossbite Palatally displaced maxillary incisors Segment of upper arch in cross bite

Contraindications

Cross bite due to true manibular prognathism

NOTE- Inclined plane is of value in patients whose

permanent molars have not erupted + loss of

primary molars

Mode of actionWhen appliance cemented contact established

only at anterior region

When patient swallows

No contact posteriorly

All forces transmitted to the region of contact

Teeth guided to erupt in normal position

Duration of treatment2-3 weeks, maximum

Disadvantage SpeechDietary restrictionWorn more than 6 weeks– anterior open biteFrequent re-cementation

Activator

ActivatorSynonyms

Biomechanic working retainerAndersen applianceNocturnal airway patency applianceNorwegian appliance

First removable functional appliance – Viggo Andersen

Indications

Class II, Division 1 malocclusion Class II, Division 2 malocclusion Class III malocclusion Class I open bite malocclusion Class I deep bite malocclusion As a preliminary treatment before major fixed

appliance therapy to improve skeletal jaw relations Children with lack of vertical development in

lower facial height Activators As Retainers [JCO 1980 Aug(529 - 545)]

Contraindications

Class I problems of crowded teeth caused by disharmony between tooth size and jaw size.

In children with excess lower facial height and extreme

vertical mandibular growth.whose lower incisors are severely procumbent.with nasal stenosis caused by structural

problems within the nose or chronic untreated allergy.

Limited application in non-growing individuals.

Two principles Force application —the source is

usually muscular.

Force elimination —the dentition is shielded from normal & abnormal functional and tissue pressures by pads, shields, and wire configurations

Mode of action

Myotactic reflex

Modifications of Activator

Herren Shaye activator :Herren modified the activator in two ways :By over-compensating the ventral position of the

mandible in the construction wax bite.

By seating the appliance firmly against the maxillary dental arch by means of clasps (arrowhead, triangular or Jackson's).

The Bow activator of A.M Schwarz : Horizontally split activator maxillary portion and a mandibular portion

connected together by an elastic bow. allows step wise sagittal advancement of the

mandible by adjustment of the bow.

Wunderers modification This is an activator modification that is mostly

used in treatment of Class III malocclusion.Opening --Anterior screw

Reduced activator or cybernator of Shmuth :

Professor G.P.F. Schmuth.

Resembles a bionator with the acrylic portion of the activator reduced from the maxillary anterior area leaving a small flange of acrylic on the palatal slopes.

The two halves may be connected by an omega shaped palatal wire similar to bionator.

Hyperpropulsor Activator

• Developed - monobloc of Robin

Consists of a bimaxillary block of acrylic made with the bite open and the mandible in a forward position.

Extra oral force used

Appliance worn only during nights

Cut out or Palate free activator

Mandibular portion resembles an activator

Maxillary portion has acrylic covering only the palatal aspect of the buccal teeth

Palate remains free of acrylic -- more convenient to wear the appliance for longer hours.

TMJ dysfunction cases – best in mandibular positioning

Bimler appliance (Bite former, Bimler stimulator)

A modification of the activator by H.P. Bimler. There are three main kinds of Bimler appliance:

Type A for patients with Class II Division 1 malocclusions,

Type B for those with Class II Division 2 and Type C for patients with a Class III malocclusion.

The Bionator—a Modified Activator

Developed by BalterTermed by Kantorowicz

Advantages over activatorConsiderably less bulky than the activator.It lacks the part covering the anterior section of

the palate, which is contiguous to the tongue. Children able to speak normally, though the

appliance fits loosely in the mouth.The bionator can be worn day and night except at

meals.An important feature -- its freedom of movement

in the oral cavity.

Indications

1. In a class II, div. 1 malocclusion having

- The dental arches are well aligned originally.

- The skeletal discrepancy is not too severe.

- A labial tipping of the upper incisors is evident.

2. Class III malocclusion

3. Open bite cases

Contraindications

1. The Class II relationship is caused by

maxillary prognathism.

2. A vertical growth pattern is present.

3. Labial tipping of the lower incisors is evident.

BIONATOR TYPES

Standard Appliance.

Reversed bionator.

Open-Bite Appliance.

William Clark – 1977

Goal –maximize the growth response to functional mandibular protrusion

Principle Occlusal inclined plane

Use of masticatory forces

Twin block

Indication

Class II Div 1 with a good arch formLower arch uncrowdedUpper arch alignedOverjet 10-12 mm and a deep biteVTO positivePatient actively growing– pubertal growth spurt

Standard appliance design

Midline screw

Occlusal bite blocks

Clasps Maxilla – molars and premolars Mandible – premolars and incisors

Labial bows

Mechanism of action

TYPES

1. STANDARD

2. SAGITTAL

REVERSE TWIN BLOCK

MAGNETIC TWIN BLOCK

FRANKEL FUNCTION REGULATOR

DESIGN:Acrylic + wire componentsBase of operation – VESTIBULEBuccal shields, lower lip pads – restrain

musculature

Maxillary wires

Labial bow

Palatal bow

Upper lingual wire

Canine loop

Mandibular wires

Labial support wire

Lingual cross over wire

Lower lingual springs

Types

FR – IaClass I malocclusion with mild to moderate

crowdingClass I deep bite cases

FR – IbClass II, division 1 malocclusionOverjet does not exceed 5mm

FR – IcClass II division 1Overjet more than 7 mm

FR 2Class II div 1 and 2

FR 3Class III

FR 4Open bite and bimaxillary protrusion

FR 5• Incorporate headger

MECHANISM OF ACTION:

1. Establishing muscular equlibrium• Buccal & vestibular pads – relieve buccinator &

orbicularis oris pressure

• In rest & deglutition

• Lingual shields - decrease outward thrust of

tongue

2. Enhanced & supplementary widening of upper jaw

Shields – depth of vestibule ---- create tension ---- periosteal pull ---- apposition of bone

Stimulate midpalatal suture growth (Stutzman – 1983)

3. Mandibular protrusion:

Normalizing musculature

Not by construction bite

Lip pads - proprioceptive signal for

maintenance of mandibular

protrusion

4. Dental effects:

• Anchored to maxilla positively --- Prevents downward & forward movement of maxillary molars

• Lingual shields ---- decrease outward thrust of tongue ---- allows eruption in more vertical manner

• Buccal shields --- bodily eruption

HERBST APPLIANCE

Indications Mandibular retrusion Prevention of Bruxism Diseases of TMJ

Contraindication

Non growing subject.

Hyperdivergent facial pattern.

Abnormal mid face.

Negative V.T.O.

Diagnostic criteria for selection –

Patients with convex profile ,class II skeletal & class II dental.

Mainly with retrognathic mandible & orthognathic maxilla ( ANB – 50 )

Positive V.T.O

All first molars & permanent lateral incisors should be fully erupted.

Lower incisors should be upright or even slightly lingually positioned.

Design

The appliance can be compared to an artificial joint working between the maxilla and the mandible.

A bilateral telescope mechanism attached to orthodontic bands keeps the mandible mechanically in a continuous anterior jumped position

Each telescopic device consists of 1. A tube ( upper)2. A plunger ( lower)3. Two pivots 4. Two screws.

Plunger

Tube

Pivots

Screws

Types of appliancesBonded Herbst appliance.

Banded Herbst appliance.

DrawbackBanded Herbst appliance- Breakage & loose bands

Bonded Herbst appliance difficult to maintain hygiene, decalcification & decay are commonly seen . can create posterior openbite which needs

correction later.

Jasper Jumper

Jasper jumper - developed & patented by James.J Jasper in 1987

The term jasper jumper --- combining the surname of its

inventor with the functional concept expounded by Kingsley

in late 19th century (jumping the bite).

The Jasper Jumper has 3 particular features –

It leaves standard oral functions such as mastication & phonetics unimpaired by virtue of its slenderness & flexibility.

It maintains the sense of touch of opposing tooth.

It cannot be removed readily from the mouth.

Indications for Jasper Jumper

They are basically indicated in skeletal Class II maloccusion with maxillary excess and mandibular deficiency.

Dental class II malocclusion.

Deep bite with retroclined mandibular incisors.

Contraindications –

Cases predisposed to root resorption.

Dental & skeletal open bites.

Vertical growth pattern.

High mandibular plane angle & increased lower anterior face height.

Design

The system is composed of two parts

The Force Module and

The Anchor Units.

Force module

It is an open coil, embedded in soft synthetic & is attached through special connecting pieces.

Other accessories supplied are –

A ball stop – placed on a continuous or segmented orthodontic archwire, forming a ventral stop for the appliance.

A ball pin – with which the appliance is attached to the upper head gear tube.

Attachment to the main arch wire

Orthopaedic AppliancesBasis for orthopaedic appliances

Forces applied to the teeth have the potential to radiate outwards and affect the nearby skeletal structures. For such skeletal changes to occur, the forces employed should be over 400 grams.

Thus the orthopaedic appliances utilize the teeth as handles to transmit the forces to the adjacent structures.

Amount of force

Duration of force

Head gear

Uses

Orthopaedic effect

Anchorage augmentation

Distalization of molars

Molar rotation

Space maintenence

Face mask

Indications

It can be used in a growing patient having a prognathic mandible and retrusive maxilla.

It can be used for bending the condylar neck for stimulating Tmj.

Selective rearrangement of the of the palatal shelves in cleft patients.

Correction of postsurgical relapse after osteotomies.

Chin Cup

A modified RPE appliance in conjunction with a facemask can be used in growing Class III patients to correct transverse and sagittal discrepancies.

IJO VOL. 21 NO. 3 FALL 2010

Cephalometric analysis showed a forward and downward movement of the maxilla, backward and downward rotation of the mandible, proclination of the maxillary incisors, and slight retroclination of the madibular incisors. The mandibular plane angle remained stable

The patient’s facial profile improved. The nasolabial angle became more acute and the upper lip and nose came forward in relation to the chin

IJO VOL. 21 NO. 3 FALL

2010

In many studies, it was shown that cervical headgear significantly restrained maxillary forward growth. However, with cervical headgear, many experienced the undesirable backward rotation of the palatal plane, the opening of the mandibular plane and maxillary molar extrusion

A maxillary splint design that provided a much larger base area

than merely maxillary first molars for the high-pull headgear force application

Due to application of extra oral force to the maxilla with maxillary traction splint appliance there was restriction of downward and forward growth of the maxilla and maxillary dentition

Retraction and intrusion of the maxillary incisors and retraction and inhibition of vertical development of the maxillary molars were significant.

The mandibular plane angle showed a significant reduction in the treated group as compared to control group.

Orthodontic Waves, March 2010

The Tandem Appliance comprises three separate components, one fixed and two removable.

The upper section is a fixed Hyrax appliance with buccal arms soldered for attachment of protraction elastics.

The lower section is similar to a removable retainer, with posterior occlusal coverage and buccal headgear tubes embedded in the lower first-molar regions

Tandam Appliance

The Tandem Appliance provides a toothborne anchorage system that combines skeletal and dentoalveolar movement.

The increased level of patient cooperation with the Tandem Appliance, combined with the ability to control the vertical dimension, protract the maxilla, and benefit from the Class III elastic dentoalveolar effect, makes this appliance extremely valuable in nonsurgical Class III treatment.

JCO vol 14, issue 6, 2011

CONCLUSION Catch them young

Watch them grow

REFERENCES

ORTHODONTICS PRINCIPLES AND PRACTICE- GRABER TM

REMOVABLE ORTHODONTIC APPLIANCES- GRABER NEUMANN

TEXTBOOK OF PEDIATRIC DENTISTRY- DAMLE

DENTOFACIAL ORTHOPEDICS WITH FUNCTIONAL APPLIANCES- GRABER RAKOSI PETROVIC

REMOVABLE ORTHODONTIC APPLIANCES – M. S. RANI

ORTHODONTICS THE ART AND SCIENCE- SI BHALAJI

TEXT BOOK OF PEDODONTICS - SHOBHA TANDON

INTERNET

Download - Appliances in Pediatric Dentistry

Top Related