The International Journal of

Orthodontia and Oral Surgery

VOL. V ST. LOUIS, JUNE, 1919 No. 6

ORIGINAL ARTICLES

A REMOVABLE RETAINER*

By C. A. HAWLEY, D.D.S., WASHINGTON"D. C.

T the meeting of this society in Chicago, July, 1918, in the course of a dis-
A cussion of Dr. ]. V. Mershon's paper, I incidentally mentioned a removable
retaining device which I had been using with some success. My further ex-
perience with this retainer has been so gratifying that I now feel justified in
presenting the matter more in detail.
As I stated at the time, my first ideas of the retainer were gained from Dr.
R. D. McBride, of Dresden, Germany, while visiting his office in 1906. He'
had been using a form of retainer for several years which embodied certain
basic principles, the value of which impressed me very strongly.
This device consisted originally of a rubber roof plate with heavy flat bars
of metal passing between the first molars and second bicuspids to the buccal
surface. These bars on the buccal surface were fashioned into planes which
slid back of similiar planes on the lower apparatus for the purpose of holding
the proper mesio-distal relation of the two jaws. A piece of 17-gauge round
wire extended around the outside of the arch in contact with the labial and
buccal surfaces of the teeth and was fastened at either end to the bars which
passed between the teeth as previously mentioned (Figs. 1 and 2). He used
also in some cases, instead of a roof plate a very heavy wire bent to the lingual
surface of the teeth as shown in the illustrations.
The use of the retainer as made by Dr. McBride was never very successful
in my hands, yet I have considered the principles upon which it was based so
promising that I have persisted in its limited use and study since that time.
One after another the most objectionable features have been eliminated, until
I now have great confidence in its practicability and have used it almost to the
exclusion of everything else for a couple of years.
"Read before the Nineteenth Annual Meeting of the American Society of Orthodontists, St. Louis,
lila., March 10, 11, 12, 1919.
292 The International Journal of Orthodontia and Oral Surgery

It is hardly necessary to enumerate the obviously objectionable features of

this original appliance, yet it might not be out of place to mention some of them.
First, the wide spaces necessary between the first molars and second bi-
cuspids were often troublesome. Food often became packed in a pocket under
the bar and often the bar was pushed down further than intended through the

Fig. 1.

Fig. 2.

breaking or displacement of the stops. Then, if the appliance was left out a
few days the spaces would close. This possibility prevented a most important
final use of the retainer which will be described later.
Second, the side planes for holding the mesio-distal relation I found suc-
cessful in only a few cases. With our present understanding and practice, I
think they are wholly unnecessary.
 A R euuniable R etain er 293
Third, the labial wire was too hea vy and had too long an extension without
supports.

Fig. 3.

Fig. 4.

F ig. 5.

The retainer as I am now using it con sist s of a skeleton plate fitting ac-
curately the ling ual surfac es of the teeth. From the plate, back to the cuspid s,
wher e there are always spaces even in closely occluding dentures, pas ses a 19-
294 The Internat ional Journal of Orthodontia and Oral Surgery

ga uge gold wire, which is formed into loops, and bet ween them passing over the
labial surfaces of the incisor s is a flat wire .022x.03 6. Att ached to, and extend-
ing backward from the 19-9auge wire is a bicuspid clasp ( F igs. 3, 4 and 5).
On th e lower a wire hook is emb edded in the plate and pas ses between the lingual
cusps of the first molar over th e margin of tooth to keep the plate from being
pressed down at the heel s. ( F ig. 6.)
If it is desired to cor rect or hold th e overbite, a flat ledge is built on the
upper plate. This can be extended into a bite- plane to assist in correcting or
holding the mesio-distal relatio n where it is needed ( Fig. 7).
There are fou r important movements that mu st be provided again st 1D
retention:
First: The ex pan sion and form of the a rch.
Second: The rotated teeth mu st be prevented fr om returning to their for-
mer positions.

Fi g. 6. Fig. 7.

Third: The mesio-di stal relation must be maintained.

Fourth: The overbite must be established.
As for the first , the holding of the expansion and form of the arch, th e
efficiency of a plate needs littl e comment. It is one of the oldest and most re-
liable means used for that purpose.
A s for the second, the re tention of rotated teeth, the possibility of this
method most aroused my interest in Dr. McBride's appliance and I might say
my skepticism as well. H owever, I may say that I am now succeeding better
in holding such teeth by th is method than I have by bands or spurs or an y other
meth od I ha ve ever employed. By glancing again at thi s device ( F ig. 3 ) ,
it will be seen that in orde r to rotate, a tooth mu st lift a way from the plate
whi ch closely fits the palat al surface. This the labi al wir e prevents it fr om
doing . If a tooth is seen to start in thi s movement the wire may be mad e to
press harder at thi s point, the tooth will return to place and the movement will
be stopped. The que stion might naturally arise, why th e device succeeds wh ile
lingual and labial wires combi ned, soldered to cemented cu spid bands are gen-
 A Removable Retainer 295

erally a failure in preventing incisor teeth hom rotating. The reason probably
is that no wire has been made to fit the lingual sur face as accurately as does the
plate and would not be sa fe fr om injury to the tooth, if it were not removable,
even though it were so fitted . Also the labial wire in such a cemented device ha s
110 t the same elasticity or adjustab ility,
Th ere are some exceptions to be made to the teeth that may be held fr om
rotation with thi s retainer. Round or commonly called peg-shaped lateral in-
cisors or lower bicu spids for obvious reason s can not be retained by thi s mean s.
F or the latter I use a cemented band with a flat vertical bar attached, which fits

Fig. 8.

Fig. 9.

into a slot in the plate (Fig. 8). To hold the second bicuspids when rotated, it
is neces sary to extend the bicuspid clasp over these teeth (Fig. 9).
As to the third, the mesio-distal relation, this ha s been one of the most
troublesome problems in the development of thi s retainer. The use of inter-
maxillary rubbers with a removable fixture is imp ossible unles s some bands are
used to make it semi fixed and the se bands seriously detract from the perfection
of the retainer. However, I have found that if the arches are so harmonized
that the forward and proper occlusion is the only comfortable one for the pa-
tient and all interfering cusp relations corrected, and with the help of mu scle
exercises developed by Dr. Rogers, we will have very little, if any , need of for-
mer method s of retaining thi s relation. In extreme cases as previou sly men-
296 The International ] ournal of Orthodontia and O ral Surgery

tioned the old form of bite plane can be constructed on thi s plate and gradually re-
moved as it is found th at it is no long er needed.
Fourth, the overbite is retained and can be cor rected by building on the
plate a flat or slightly inclin ed shelf back of the inci sor s.
The method of constructi on is very simple. The wire framework is mad e
on a model of pla ster or artificial stone ( F ig. 10). These I have bent by hand
with bending pliers. The wire, embedded in. the plate and up to the end of the
loops is 19-9auge cla sp gold or N ey's " E" wire. The portion from thi s point
pa ssing over th e labial surfaces of the inci sor teeth is flat or ribbon wire .022
x .036, th e size of A ngle's ribbon arch wir e. I prefer N ey's "E" wire for thi s

F ig. 10.

,
,
,
\. ,
Fig. 11.

also. The uni on is made with 18 karat solder. The flat WI re is slightly fes-
tooned to fit the labial surface of the se teeth . E xt ending backward from th e
loop is a bicuspid clasp, solde red to th e loop. Thi s is 19-9auge "E" wire. Th e
convex for m sho wn in the illus tra tion has been very successful. It is imp or-
tant that it should pa ss over th e bulge of th e bicuspid with some spring and lie
at r est, without tension, near th e gum line. A fter the fram ework is finished
th e plat e is waxed up and vulc anized.
It is essenti al th at the rubber plate should be as tou gh and spr ingy as pos-
sible. The waxing should be acc urately done without surplus and vulcanized
between tw o she ets of No . 60 tin foil. The plate, where it come s in contac t with
 A Remouable Retainer 297

the lingual surfaces of the bicuspids and molars, should be thin so as to spring
over their convex lingual surfaces and thus assist as much as possible in hold-
in the plate in position (Fig. 11). The use of a rug-a-pack to reproduce the
natural rugce of the mouth adds materially to the comfort of the plate.
After making ten gold plates, both cast and swaged, I have abandoned
them altogether and replaced everyone with rubher plates. They were pre-
ferred by the patients on account of the lightness, and by myself on account of the
greater simplicity of construction and ease of changing the part in contact with
the tooth. One idea that I had was that the wires could be mended easier when
broken with the gold plate, but I find that by using a strip of wet cotton in con-
tact with the rubber held with a 'pair of pliers, the wires can usually be mended
successfully on the rubber plate.
My scheme for the use of the retainers is as follows: They are only used
when the denture is complete, that is when there are no deciduous teeth remain-

Fig. 12.

ing in the mouth. When the case is ready for retention, I take the impression,
make the plate and fit it carefully in the mouth, adjusting the labial wire so
that it is in contact with each tooth. A piece of floss silk passed between the
wire and the teeth will help to determine this fact. The patient is instructed to
wear them constantly, removing them only for cleaning, and if necessary while
eating. They should be examined in a few days or a week, and any small ad-
justments made that are necessary. They are worn constantly for two to six
months, during which time they should be occasionally examined. If, during this
time the patient wishes to remove them for a few hours for some special engage-
ment, it can be done without harm. After this period, I have found that wearing
them at night only, is sufficient. Prophylactic treatment or filling operations can,
of course be done without interference at any period of the retention. It will be
understood that if there is a bite plane, its work must be finished and the molars
and bicuspids must be in close occlusion before the constant wearing is aban-
doned.
After they have been worn at night for about a year, they can be left out
298 The International Journal of Orthodontia and Oral Surgery

for several days or a week and then tried in. If they bind or go in hard, it is
evident that the teeth are changing and the nightly use mu st be re sumed. The
patient can thus keep the plates for years as a check against retrograde move-
ment and we have a provision for the different lengths of time that different
cases need retention. Thi s important feature could not be utilized in Dr. Me-
Bride's retainer on account of the closing of the spaces between the first molar
and second bicu spid s. In some cases of patients going to foreign countries I
have two sets made to be used in case of loss or break age.
The appearance in the mouth is not displeasing (Fig. 12), in fact, much
less so than most fixed retention. Where teeth are missing from any cau se,
they can be satisfactorily supplied during retention by attaching to the plates.
A considerable amount o f movement can .be accompli shed with this retainer.
Either arch can be expanded a small amount by heating in the center, stretching
and then cooling in that position. The position of a tooth that is labial to the
proper line can be corrected 'by cutting back the plate with a small stone, being
ca reful, however, to preserve the form of the lingual surface, then adjusting
the labial wire to press upon the tooth. Teeth that are slightly lingual can be
moved out by cutting a rece ss in the plate and building on cement, amalgam or
fu sible metal. Thus, if in an emergency, it is neces sary to retain before the
teeth are qu ite in a satisfa ctory position, it can be done and the final movement
accomplished later.
If the teeth are in place at the time the imp ression is taken, no fear need
be exp erienced for th e slight movement that wiIl ·take place during the few days
that will elap se while the retainer is being made. Wearing the retainer a day or
two will bring them back to the positions they occupied when the impression
wa s tak en.
In conclusion, I wish to say that no claim whatever is made in thi s re-
tainer for originality or invention. It is a new adaptation of some of the olde st
things in orthodontia. It s development has consumed considerable time and
thought, but the relief fr om th e uncertainties of fixed retention in my. own prac-
tice has been ample comp ensation. I have no idea that it is perfect or can not
be improved, but am offering it to the society with th e hop e that many helpful
suggest ions will be mad e.

DISCUSSION

Dr. Ralph Waldr on, N eicark , N. f.-Mr. President, M emb er s a nd Guests of the Am eri-
ca n Society of Orthodonti sts : There is but very little I can say in opening the di scu ssion
on Dr. Hawley's pap er ex cept to end orse it, and this I most heartily ca n, for it ha s been a
grea t aid to me, not only a s a r etainer , but as a working a pplianc e. in certain cas es wh ich
I will ex pla in later.
About three years ago while visiting Dr. Hawley in W ash ington our conv er sati on
dri ft ed to th e pr oblem o f retention , and in his remarks Dr. Hawley sai d, " I ha ve a copy
of a paper written by Dr. R. D . M c'Br'idc o f Dresden, Germany, on a removable r etainer ,
whi ch possesses some ad mirable featu r es, al so some di sa dvantag es, I will let you take it.
On one of my sub sequent vi sits to Dr. Hawley, I f ou nd he ha d ove rcome som e o f th e
objectio nable featu res, such a s m or e secure attachment. closer a daptability, simplicity o f
adj ustm en t, etc .
I wen t home most fav ora bly im pr essed with the r emovable retain er , and began using
. it alm ost exclusivel y with its va rious modifications to suit th e case at hand.
 A R emovable Retainer 299
I do not wish to discuss th e con struction o f thi s app liance, for Dr. Ha wley has
alrea dy done so, but will tr y to ex plain th e dynamics o f it.
F ig. A shows the retainer with a loop in th e labial alignment wi re for th e adju st-
m ent of th e same, and a wire clas p wh ich fits accuratel y on th e first bicuspid tooth, mak-
ing a ver y secure attachment.
If we clo se up the loop whi ch is located in th e can ine re gion a millimeter or so, the
labial a lign ment wire is sho r tened jus t that much, bringing th e six anterior t eeth into a

more normal approx imal contact, a nd al so into a mor e lin gu al pos ition than th ey pr e-
viou sly occupied.
T his is well show n in Fi g. A".
F ig. B shows a sec tional view of an inci sor tooth an d a removabl e retain er. The
sha de d portion in a cr oss section o f th e vu lcanite por tion of the retainer , and the dark
circle shows a cro ss section o f th e labi al al ig nm ent wire.
If th e forc e is ap plied in the direc tion of th e a r row by clos ing th e adjusting loop
300 The International] ournal of Orthodontia and Oral Surgery

of the labial alignment wire, then the fulcrum will be at the apex of the tooth J, and the
tooth will be moved until it comes in contact with the vulcanite portion of the retainer
at the point X as shown in Fig. II corrected. Then if more force is applied at 2,. the point
X becomes the fulcrum and we now change from a lever of the second kind to a lever of
the first class, which would result in moving the apex forward.
Fig. C shows the alignment arch close to the gingiva. If force is applied in the di-
rection of the arrow, the tooth will be moved toward the lingual more bodily than in' the
previous Fig. B.
In the treatment of distoclusion cases, particularly when accompanied by labiover-
sion 'of the upper incisors which are often considerably elongated (Class II, Division 1
Angle), this IS an admirable posttreatment appliance.

Reproduction of Fig. 403 from Jackson's hook on Orthodontia.

We can not expect to equalize the arches with this appliance, but we can change the
angle of inclination of the incisor teeth, and keep the mandible forward without inter-
maxillary elastics by means of a bite plane attached to the appliance as shown in Fig. D"
thus depressing the incisors both upper and lower. and opening the bite in the posterior
region, which will permit of the elongation of the bicuspids and molar teeth if the case so
requires it.
Fig. E shows an occlusal view of this retainer in position. You will observe the
right upper lateral in torsoversion. I f the labial alignment arch is bent so as to bear with
slight- pressure on the mesial approximal angle, the tooth will be moved as indicated by
the arrow until it occupies its correct position as indicated in Fig. F.
While this appliance is new to us as a retainer and a great deal of credit is due to
 A Remouable Retainer 301

Dr. Hawley for its development, I find Dr. V. H. Jackson used a similar appliance as
shown in Fig. 403, Jackson's Orthodontia, 1904 edition, for jumping the'bite forward, a
term used in those days for bringing the mandible forward.
Dr. Jackson makes no mention of using this appliance as a retainer as will be seen
from the following description of Jackson's appliance found on page 340 of his book, and
you will note froni the illustration and description that the clasps for attachment are dis-
similar from those advocated by Dr. Hawley.
"Jumping the Bite Forward.e-Wheu the jaws are inharmonious in their mesio-distal
relations, and jumping the bite forward is indicated, any spaces that exist between the
teeth of the upper arch should first be closed by moving them inward, and an apparatus
anchored in each arch for the attachment of, small rubber bands for causing the required
anterior and posterior traction as described; or a semicircular spring can be shaped to
pass in front of the incisors with the ends anchored in a palatine vulcanite plate used to
support an inclined plane, as seen in Fig. 403. The plate is made with suitable means of
anchorage, as with spring or wire clasps, with a projection of rubber extended from the
anterior part sloping sharply downward and hackward for forming the inclined plane; it
should be shaped so that during occlusion it will pass back of the lower incisors and cus-
pids, causing the lower jaw to be moved forward for a distance usually equal to the
width of one of the bicuspid teeth. The closing of the lower incisors against the inclined
plane in the manner described has the effect of stretching the lower jaw, encouraging its
anterior development."
Dr. Hawley recommends that you wax up these retainers and send them to the labora-
tory to be vulcanized and finished.
This procedure I would condemn for they are very likely to file and polish away the.
very parts you need and thereby ruin the retainer, particularly if you have a bite plane
which is to perform other functions than keeping the mandible forward, which I have
previously mentioned.
Dr. Alfred Paul Rogers. Boston, Mass.--A few weeks ago it was my privilege to
spend several hours with Dr. Hawley in his office, during which time I examined five or
six patients who had reached that stage of treatment where the application of the remov-
able 'retainer, which Dr. Hawley has been telling us about, seemed to be beneficial. One
of its features that impressed me particularly was its value from a prophylactic stand-
point. In many cases it would seem that the patient might be rid of bands and wires of
various sorts at least a year in advance of the other modes of retention. The teeth, being
free from unnecessary restraint, are enabled more readily to settle into final adjustment.
I believe it is going to be particularly valuable in undertaking muscular work in an en-
deavor to establish functional activity which is so essential to the permanence of occlu-
SIOn.
Of course, I imagine there are some types of irresponsible patients where it might
prove disadvantageous to make use of this kind of appliance, but the failures on this
account would be few. The appliance is used mostly on patients who have had consider-
able experience, being applied when the case is nearing completion.
Dr. Burt Abell, Toledo. Ohio.-I am anxious that this appliance and Dr. Hawley
should have all the credit that is due it and him, but there is one thing to its advantage,
it seems to me, that has not been mentioned either by Dr. Hawley or Dr. Waldron.
In a fixed retention attached to any tooth, cemented, of course, with both upper and
lower fixed, it takes a very successful man to so adjust tube that there will not be a
spring of one jaw or the other in the teeth where the bands are cemented. The posterior
teeth, the bicuspids and molars, with this appliance, are perfectly free to move in any
direction that the occlusion seems to force them. They can settle together without any
interference with the appliance. They can settle into normal occlusion so far as the
adjustment of the appliance is concerned. That is one disadvantage I find in using the
Lourie retention. Unless I am careful to use a horizontal tube between the jaws, either
upper or lower, there is a spring of one set of molars or bicuspids. That is one disadvan-
tage it seems to me, because we all admit that every tooth should have all the freedom
possible to move in a normal arch or circuit, or whatever you may call it, retained only
302 The International Journal of Orthodontia and Oral Surgery
so that it does not get out of position. The disadvantage to my mind occurs in the an-
terior teeth. There is not sufficient mobility, in my judgement, with the bar across the
front, and what amounts to a bar, the vulcanite rubber at the back.
Dr. Ralph S. Baldwin, Washington, D. C.-I would like to add a few words to what
has already been said with regard to this retainer. I have worn these retainers for some-
thing over a year, and I have put them to every kind of use and abuse for experimental
purposes, and personally I cannot say too much in favor of them. As the doctor said, 1
used the appliance for my case of protrusion, and my upper teeth shut inside of the lower.
After two years or more of treatment I established very fair occlusion and have main-
tained it with these retainers.
There is another added feature. I lost recently a right lateral, and I immediately
took an impression and attached to the appliance another tooth and it worked nicely indeed.
There are some cases in practice where the teeth are congenitally missing or fail to come in,
or there may be reason for maintaining spaces, and instead of the wire clasp and leaving
a space, this plate can be utilized to supply the missing tooth.
I have had the opportunity along with Dr. Hawley of applying two hundred of these
retainers, and we can show you how simple this retaining appliance is.
Dr. Frank M. Casto, Cleveland, Ohio.-I would like to ask Dr. Hawley whether or
not the patient wears this retainer continuously.
Dr. Hawley.-I answered that question I think in the paper. These retainers can be
removed at any time, for two or three or six or seven months I have them worn day and
night, according to the character of the case. After about six months, which is not a
definite time, or after a certain time they only need to be worn at night.
Dr. F. M. Casto.-The point I want to bring out is this: Whether or not the con-
tinuous wearing of the plate will interfere with the function of the soft tissues about the
teeth, and whether or not this interference with the soft tissues may not change the secre-
tions of the glands and make the teeth more liable to decay because of that fact. I wonder
whether Dr. Hawley has noticed that particular thing.
Dr. H awley.-You must remember that this plate is not worn continuously, and the
effect of vulcanite on the mouth is nothing so far as I have observed. So far as the con-
dition of the teeth and health of the patient are concerned, there is no one closely connected
with me, who has been so delighted with this retention as Dr. Gearhart of Washington.
He is a periodontist, and a great many of my patients go to him for treatment. During
retention these plates can be slipped off and the teeth can be properly cleansed. They have
noticed absolutely no effect upon the soft tissues from wearing the plate. As I have said,
they are not wearing these plates continually. The night wearing of the plate does not
affect the mouth.
Dr. George B. Winter, St. Louis.-If a child had the lateral incisors missing, I would
like to ask Dr. Hawley how long the child could wear a plate of this nature?
Dr. Hawley.-I do not know. We supply these teeth during the retention period, and
there comes a time when the missing teeth must be replaced. You can stop this retention
when you please. If you reach the stage that you should want to supply a missing tooth
permanently, a new plate must be made or the entire retention abandoned. That can be
decided by conditions.
Dr. Ralph S. Baldwin.,.-- In cases where the teeth are slightly rotated, with a ten-
dency to be lingual to their normal occlusion, before the plate is waxed up, the lingual
surfaces of the teeth on the model can be slightly cut away, and there will be an excess
of rubber that will contract with the rotated tooth. After wearing the plate for a day or
so, the tooth will be forced into the desired position. If you recognize that when you
wax the plate up it will be more satisfactory than adding cement or other filler because
naturally these wear away.
I have had several cases in which, when I took the apparatus off, the perspective
looked almost perfect, but when it came to a more careful and minute examination I
could determine to a fraction here and there that corrections should be made. In bend-
ing the wire on the labial surfaces of the teeth, if a tooth is rotated, it naturally causes an
irregularity in the outside contour line, and this irregularity is sometimes shaved down
 A Removable Retainer 303

and the wire is passed squarely over it. When the plate goes into the mouth the labial
wire will come in contact more strongly at that point where the plaster was cut down.
By thus cutting and fitting and adjusting the plate accurately and forcibly with the bi-
cuspid clamp, a great deal of the final and accurate finish of the work can be accom-
plished.
Dr. V. E. Barnes, Cleveland, Ohio.-Dr. Hawley made the statement that this ap-
pliance was not original with him; that it was Dr. McBride's idea. I used this appliance
or a similar one for six or seven years, but have not employed it for the last four or five
years because I found too much decay occurring under the plates. The temptation is too
great to let the patient go for too long intervals between visits.
Dr. Casto raised the point as to whether the continuous wearing of rubber over gum
tissue did not in some way deteriorate the tooth structure. I am inclined to think it does,
but whether it is from irritation or change of function, or overheating or something of
that sort, I do not know; but I do know that a tremendous amount of decay has occurred
in some cases and the observation was not post hoc.
I have given up the use of the plate until I could get enough help to make a metal
plate.
Before I leave the subject, I want to ask Dr. Waldron about one point. He stated
that in putting pressure on the central incisor to the plate somewhere after this fashion
(indicating), he put it far enough so that the pressure did not hurt and the tooth would
be shortened.
Dr. W aldron.-If you have rounded central incisors and get above the portion with
the plate up high on the lingual surface, there is pressure in that direction (indicating on
blackboard), while resistance is exerted in the other direction. That is not any particular
gain.
Dr. Barnes.-That can not happen in any case. The plate will drop by the force of
gravity because there is nothing to hold it unless the plate is held around the tooth. If
you want to put that amount of pressure on, you should have small attachments, metal
pieces. such as we put in between plates like these and drill a hole in the plaster cast and
put in a pin and force this down the proper distance. If you put this on both sides we
get a locking device by the constriction of the tooth below the crown. If you have enough
of these you may get slight pressure at this point (indicating). If you put that kind of
.rnovernent on this device, that tooth would lift the plate, and something is wrong with
your technic.
D1'. Waldron.-No, not necessarily. You have a clasp go around the cuspid and bi-
cuspid which will go into the model with a postitive snap. The proof of the pudding is
in the eating. I have had these things happen, and Dr. Hawley has had them happen.
It is due to that particular shape. I have never had it happen where the labial third of the
tooth was in normal shape.
Dr. Barnes.-·It is more important that the bicuspids should elongate than that the
incisors shall go up.
Dr. W aldron.-The occlusion will not allow it.
Dr. Bames.-The use of a biting plate progresses most satisfactorily wherever we
obtain a bite. This (indicating) represents the planes of the upper and lower teeth. This
method opens the bite and it later closes in the back. We do not get the result we think
we get, and later if we take the plate out we have the overbite reestablished again. We
corrected that in this way: We built into the plate a section of metal or rubber which
reproduced the occlusal surfaces of the first molar in relation to the bite plane so that the
amount of range at this point (indicating) was equalized by the rest here. The tooth
here and there and the second molar are elongated. After that is .cstablished for a long
time, your occlusion might become established. Later on, you can cut off the surface of
this tooth and this lower tooth will elongate and you establish occlusion as it was. We
have had considerable success in doing that.
We have later used that principle in another type of retention, and it is essential in
opening the bite because you depend upon this part of the bite opening to sustain it by
another area, so that instead of shortening the tooth you elongate this tooth. Your
304 The International Journal of Orthodontia and Oral Surgery

metal opening must sustain the stress of mastication until the other teeth elongate, or
your bite opening process it not a success.
The great difficulty with all these appliances depends upon whether you can trust
your patients to wear them. After you have worked on a case for two or five years you
want to be pretty sure you can trust a patient with a removable apparatus of this kind.
You are putting your experience and your work into that patient's hands. If he can be
trusted, all right. If he can not, don't use that kind of appliance. We find very often
we can get adjustment in a local area which we could not get by these little labial wires,
so that by cementing or soldering on little pins and little cross pins, you can put tension on
a tooth which will check rotation or rotate it if you want that done. These little pins
need not be made of heavy metal. They must not be very long, not over one-eighth of an
inch. Even that is too long for certain cases. There must be some slight range of ad-
justment which must have slight tension, but they give you 'an adaptability greater than
horizontal wire.
Dr. Wafdro/l.- The great problem with all these appliances is whether you can trust
your patients to wear them. After you have worked on a case for two or five years, you
want to be pretty sure you can trust a patient with a removable apparatus of this kind.
You are putting your experience and your work into that patient's hands. If he can be
trusted, all right. If he cannot, do not use that kind of appliance. We find very often that
we can get adjustment in a local area which we could not get by these little labial wires.
By cementing or soldering on little pins and little cross pins. you can put tension on a
tooth which will check rotation or rotate it if you want that done. These little pins need
not be made of heavy metal. They must not be very long, not over one-eighth of an inch.
Even that is too long for certain cases. There must be some slight range of adjustment
which must have slight tension, but they give you an adaptability greater than horizontal
wire.
Dr. C. A. Htnolcv (closillg).-Dr. Waldron spoke of using these devices on deciduous
teeth. ] have not tried it because my whole energy has been fixed on the question of re-
taining a complete denture.
Dr. Abell asked about the mobility of the anterior teeth. My impression is that the
anterior teeth are less restricted and more mobile. At any period practically all stress is
removed from the anterior teeth.
So far as the correction of the overbite is concerned, ] have found in my own ex-
perience no such difficulty as Dr. Barnes has described. I do not know that I could de-
scribe just exactly what takes place in such cases. My idea is that the bicuspids and molars
move down bodily to complete occlusion and the alveolus and soft tissues of the mouth
with them, but later there is reciprocal adjustment of both the anterior and posterior
teeth.
The small pins Dr. Barnes spoke of, soldered to the bar. in my experience are un-
necessary. I am giving you my experience; I am not at all arbitrary about it, but I have
not found these pins necessary.
Dr. Barnes says he has had troubled with rubber plates irritating the soft tissues.
You may have that trouble with a rough porous plate. I emphasized in the paper the de-
sirability of vulcanizing the plates on a heavy tinfoil which produces a hard smooth sur-
fice which is not irritating.
The most important objection to a removable retainer is the question of the patient's
losing it. I have put in something over two hundred. I have had three patients who lost
their plates. In one case a girl called me up saying that she was going away to a board-
ing school. Slie called me an hour before her train was to start, stating that she lost her
plate. She went off and came back four months later, saying she had found it about three
weeks afterward. and the teeth were all right. Another patient. a young man in the army,
lost his plate last] une, and I have not seen him since. Another boy going to school sixty
miles from Washington lost his plate, came into the office the next Saturday. I took an
impression, and the following Saturday put in the plate, and all went well.
I would rather make each patient five of these plates to guard against loss than
to leave them with fixed retention.
 A Removable Retainer 305

My experience has been that there is less irritation of the soft tissues and less injury
to the teeth with these removable retainers, than there is with fixed retention. The patients
will occasionally lose a plate; there is no question about that, and there will be some cases
in which the soft tissues are injured by any retainer, and all retention has objections. If
we could make our corrections and take off our appliances and dismiss the patient, and
the teeth stay exactly where we place them, that would be ideal, but we know they will not
and there is no retention that does not have certain objections.
There is one feature of this retention that I do not know whether you fully grasp
or not, and I bring that out by asking you this question. Is there a man here who can
tell me how long any case needs retention? Can any of you with the longest experience
tell within three months of the time a case will need retention? I do not believe there is
one of you who can do it. What do we do? We put in a retainer and guess at it. We
get the patient to wear-it as long as we can and in two or three years we take it off. Do
these teeth stay? They do not in most cases. It may not be serious enough to take up
the case again and re-treat it. But suppose you do take it, as I have done, and treat it
again. Do you know any more the second time than you did the first?
The most important question is: Can you retain a tooth from rotation with a re-
movable retainer? I know you can, and you have something· there that relieves the
patient also from the appearance of a fixed retainer. They can keep them for years. You
can abandon it whenever you please. You can take off the retainer for a certain time, but
you have a check against adverse movement for many years.
Here is another advantage. Some patients, many of them, want to appear, at least
for a few hours, without anything on their teeth, and the removable retainer is a source of
great relief to them. I have had a number of patients say to me: "If you can regulate my
teeth and can retain them so that I can once in a while appear without any bands on the
teeth, I am willing to have it done.
Dr. F. M. Casto.-I was a little suspicious that these plates might have a deleterious
effect on the soft tissues, and those suspicions have been confirmed, because I have noticed
in the examination of this model that there has been a great change in the tissue. I do
not know how long this appliance has been worn. I would like to have Dr. Hawley explain
the changes that have taken place.
Dr. Hawley.-It is one of Dr. Waldron's models, not mine, so I will pass it around.
(Laughter.)