Lecture 3 - Fixed and Removable Appliances

Fixed and removable
orthodontic appliances
Dr. Donald George, DMD,MS,MS
Orthodontics is the speciality of dentistry

designed to move teeth into
their
correct functional and esthetic positions.
There are several
ways to move teeth.
#1. Removable appliances which tip teeth.

#2. Fixed appliances whichcan
know
translate teeth.
Removable appliances have 2 advantages over

fixed: First they are made in a lab
so do not take time in the office to fabricate. Second
they can be taken out if the patient wants.
Removable appliances have some disadvantages:

1.The patient must wear the appliance
2.The appliance has 1 point contact with the tooth and
therefore tends to tip teeth.y
So,if you are going to recommend a removable

appliance for your patient, be sure that they will
wear it! Also, be sure that tipping of teeth is all
that you want!
Tipping of
teeth results from a 1
point contact likefrom a removable
appliance.
Translation of teeth
from a fixed appliance.
Tipping: no bodily movement

Translation: bodily movement
know
Removable appliances are often called

retainers.
Removable appliances are made of acrylic with

wire embedded into the acrylic.
The wire can be made to either hold teeth in
place, or move teeth as desired. (tip)
Maxillary Hawley Retainer

Wires embedded in
acrylic
acrylic
labial bow
Adams clasp to hold appliance to teeth.
acrylic
labial bow
Removable appliances
can be made in a
number of different
configurations.
Can add springs to

hawley retainer to
PalatalHawley
retainer
move teeth.
finger springs
facially
to move lateral incisors
lateral incisor could benefit from
facial movement
you could do this in your office!
another case a GP could use a removable

appliance with springs.
spring
screw to
procline lateral
incisor.
Most removable appliances should be used to

move teeth only a few millimeters. This is
because most movement is crown tipping. Too
much tipping can cause periodontal problems.
Know!
Periodontalstripping and
bone loss
periodontal problems
due to tipping incisors
labially
PalatalHawley retainer
Can add expansion screw to
widen upper arch.
Expanding the maxilla with a removable

appliance tips the teeth labially.
maxillary appliance
with expansion
screws
Each turn of the expansion screw

expands the appliance 0.25mm.
need to widen maxilla to increase

dental arch length.
expansion screw to widen maxillary

dental arch.
maxillary removableappliance with
springs
expansion screw to widen maxillary arch.
An upper or lower removable acrylic

appliance with expansion screws is
called a Schwartz appliance.
know
Expansion screw in lower.
Schwartz Appliance
You would use an upper or lower Schwartz

appliance to widen the arch and increase
the dental arch length to correct minor
crowding.
know
as well as to increase dental arch length.
Most acrylic appliances are held to the teeth with

clasps. There are several shapes of clasps:
ball clasps
C clasps
Adams clasps
labial bow
Adams clasps
Removable appliances can be used for

bone growth modification as well as
moving of the teeth.
These are called functional appliances
1. Bionator
2. Activator
3. Twin blockappliance
know!
Growth modification functional appliances can

only be used on growing children!
Why?
know!
Twin
block appliance
Twin Block appliance: used to

increase mandibular growth in growing
children. (class 2 malocclusion
patients)
Twin Block appliance: has

upper and
lower acrylic parts that force
the
mandible forward
on closing. Used 9 months to encourage
growth.
There are
many other
functional
appliances that can
be used on growing
children to influence growth.
All are
removableacrylic appliances.
bionator: for
mandibular
growth
activator for
mandibular
growth
Can also increase forward growth of the maxilla in a

growing child using a facemask attached to a
removable or fixed upper appliance.
8oz elastics
Clear Aligners: (Invisalign, Clear Correct, etc.)

Made of clear, thin acrylic. Patients use a
series of aligners to move teeth.
Models of the patients teeth are scanned into a

computer. The teeth are moved electronically by
1mm increments. Then a series of clear aligners
are made according to the increments.
Most patients receive between

10-40 sets of aligners.
attachments
computer models
To move teeth with aligners you often need to do

interproximal reduction to have space.
So,removable appliances can be used to tip teeth into a

more proper location and function. These appliances range
from retainers with springs, to elastics, to clear aligners.
Fixed orthodontic appliances
Fixed appliances are attached to the teeth and

translate teeth rather than tipping them into
place.
know
Rapid palatal expander: bands

cemented to molars with
Hyrax crank screw in mid-palate.
rapidpalatal
expander
A fixed palatal expander uses a screw which rotates .

25mm with each turn by the patient or parent.
Typically a fixed expander is used to widen the palate
about 6-7mm which can gain approx. 5mm in total
arch length.
A fixed rapid palatal expander actually

separates the mid-palatal suture to widen the
maxilla and correct posterior crossbites.
Do not get as much dental tipping with a fixed
expander as with a Schwartz appliance.
know!
Fixed rapid palatal expander can only be used on

patients whose mid-palatal suture has not fused:
Girls about 19 years old
Boys about 21 years old
know
hyrax screw
.25mm each
crank
orthodontic
bands
Crozat expansion
appliance
Crozat expansion
appliance
bands and wires
to expand
upper/lower
Herbst appliance for encouraging

mandibular growth only in
young growing children.
Growth
appliances in adults will
only tip
the lower incisors forward
creating a periodontal problem!
know!
Herbst plungers advance

mandible to encourage
growth.
(fixed appliance)
Removable
elastics
can
also be
connected to fixed appliances.
elastics
with
expansion appliance for crossbite correction
Next: Fixed appliances which translate

both the crowns and roots of teeth into a
more correct position.
know!
A twin bracket has 2 sets of wings, giving the

bracket a 2 point attachment to the tooth,
resulting in translation rather then tipping.
Know!
Orthodontic bracket
ball
hook
wire slot
tie wing
bracket base
bracket base pads for

retention to etched enamel
With fixed braces, both the crowns

and roots are aligned.
a force between the teeth initially tips

and bends wire. then translation
begins if constant, light force is used


bonding orthodontic brackets
Need dry
field!!
37% phosphoric acid etch
know
When applying 37% phosphoric acid etch, do

not rub the enamel surface!!
Rubbing smooths the enamel rods out that you
have just etched, and reduces bond strength!
Only dab the etchant onto enamel.
know
Bonding primer: flows into

rods
know
enamel
Light cure bonding paste
light cure paste goes on back of bracket base

and holds bracket to etched enamel rods
and primer.
bracket base pads for

retention to etched enamel
paste goes here
etched
enamel
paste
Be careful to clean away excess paste

around bracket pad. It will trap plaque and
can cause white spot lesions.
lever arms move force towards the

center of resistance
twin brackets with 2 point contact
clear ceramic
brackets and
stainless steel
brackets.
fixed bands and brackets. orthodontic wire held onto

brackets with power Os.
Before bands can be placed on the molars,

interproximal space is needed. Separators are
used for this gaining of space.
know
Molar band with

inside
cement
Bands are attached to the molars

using band cement. Are many
different kinds. Most are light-cure.
know
archwires are shaped

to move the teeth
into the correct arch.
know!
The fixed brackets and bands along with the

arch wires position both the crowns and
roots of the teeth.
(translation)
bends in the wires wil cause teeth to move.
malocclusioncorrected with
braces.
fixed
edgewise appliancefor root
positioning
self ligating
brackets
custom
milled edgewise brackets
lingual braces custom
milled
lingualfixed appliance
with custom wire
archwires made
to fit dental arch
shape
Temporary Anchorage Devices

TADS
Screw into bone. Orthodontic mechanics can
use tads to help move teeth.
know
Using TADs: A screw into the alveolar bone or

palatal bone will not move when force is
applied to it. A tooth tied to a TAD will move, but the
anchorage point (TAD) will not move in the opposite
direction as another tooth would.
TADS
Temporary Anchorage Device


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Fixed and removable

Orthodontics is the speciality of dentistry

ways to move teeth.

#1. Removable appliances which tip teeth.

Removable appliances have 2 advantages over

Removable appliances have some disadvantages:

So,if you are going to recommend a removable

Tipping: no bodily movement

Removable appliances are often called

Removable appliances are made of acrylic with

Maxillary Hawley Retainer

Adams clasp to hold appliance to teeth.

Can add springs to

to move lateral incisors

lateral incisor could benefit from

you could do this in your office!

another case a GP could use a removable

Most removable appliances should be used to

Expanding the maxilla with a removable

Each turn of the expansion screw

need to widen maxilla to increase

expansion screw to widen maxillary

maxillary removableappliance with

expansion screw to widen maxillary arch.

An upper or lower removable acrylic

Expansion screw in lower.

You would use an upper or lower Schwartz

as well as to increase dental arch length.

Most acrylic appliances are held to the teeth with

Removable appliances can be used for

Growth modification functional appliances can

Twin Block appliance: used to

Twin Block appliance: has

Can also increase forward growth of the maxilla in a

Clear Aligners: (Invisalign, Clear Correct, etc.)

Models of the patients teeth are scanned into a

Most patients receive between

To move teeth with aligners you often need to do

So,removable appliances can be used to tip teeth into a

Fixed orthodontic appliances

Fixed appliances are attached to the teeth and

Rapid palatal expander: bands

A fixed palatal expander uses a screw which rotates .

A fixed rapid palatal expander actually

Fixed rapid palatal expander can only be used on

Herbst appliance for encouraging

Herbst plungers advance

expansion appliance for crossbite correction

Next: Fixed appliances which translate

A twin bracket has 2 sets of wings, giving the

bracket base pads for

With fixed braces, both the crowns

a force between the teeth initially tips

a force between the teeth initially tips

a force between the teeth initially tips

bonding orthodontic brackets

37% phosphoric acid etch

When applying 37% phosphoric acid etch, do

Bonding primer: flows into