Methods of Gaining Space 1. / Orthodontic Courses by Indian Dental Academy

www.indiandentalacademy.
com 1
METHODS OF GAINING
SPACE.

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com

2
Key-stoning procedure-
Harry G.Barrer JCO Aug 1975
A. Malposed incisors B. interproximal relationship after key stoning
Rounded surfaces slip and
rotate.
3
Key-stoning procedure:
4
Nonsurgical rapid maxillary alveolar
expansion in adults:a clinical evaluation.
Chester S. Handelman, Angle Orthodontist, 1997 vol 67
Late teens and early 20s questionable.
Sutures: rigid and fuse.
SA-RME.
Non Surgical Maxillary expansion:
Pain, swelling, ulceration, flared posterior teeth, bite opening,
gingival recession, and perforation of the buccal alveolus.
Vanarsdall: in children, gingival recession and dehiscence of bone

5

Haas appliance

5 adults with transverse deficiency- treated
nonsurgically using Haas appliance.
RMAE- expansion centered in the alveolar process of
maxilla rather than the body.(lateral walls of the
palate)
Bilateral/unilateral crossbites, arch constriction.
2 quarter turns/day
Later 1 quarter turn/day
U 1 no separation.
12 weeks retention.
6
Displaces the alveolus with the teeth rather than
expanding the teeth through the alveolus.
7
bilateral
8
Unilateral
crossbite
left

9 www.indiandentalacademy.com
10 www.indiandentalacademy.com
11
RMAE acceptable alternative to SA-RME in adults for maxi deficiency.
12

Nickel-Titanium Palatal expander.

2 properties: Shape memory & superelasticity.
Exists in more than 1 crystal structure.
Lower temp-martensite. Transition temp:94degree
Higher temp-austenite {phase transition}
13
MOLAR DISTALIZATION
14
Indications for Molar distalization
1. In a growing child
- to relieve mild crowding
- causes permanent increase in arch
length of about 2mm on each side.

2. Late mixed dentition
- When lower E space utilized for relief of
anterior crowding,
- Upper molars distalized to get a class I
relation
15
3. Non-growing patient
- To regain lost arch length
- Blocking out of canines
4. Upper second molar extraction
- Lower arch normal
16

Class I malocclusion- with highly placed canine/impacted
canine
Lack of space for eruption of premolars due to mesial
migration of permanent first molars
17

Good soft tissue profile
Borderline cases
Mild to moderate space discrepancy with missing
3
rd
molars/2
nd
molars not yet erupted
End on molar relation with mild to moderate
space requirement.
Cases with less than full cusp class II molar relation.
18
Case selection
1. Normal or near normal mandibular arch
2. Late mixed dentition-ideal
- Early permanent dentition-growth still left in maxillary
tuberosity area.- 16-17 yrs-males
14-15 yrs-females
3. Molars placed normally- buccopalatally.
4. 3
rd
molars-absent stacking of upper molars unsuitable
5. Profile considerations- well developed nose & chin
6. High MPA- contraindicated-wedging effect
19
Classification
1. Location of appliance
Extra-oral
Intra-oral
2. Position of appliance in mouth
Buccal
Palatal
3. Type of tooth movement
Bodily movement
Tipping movement
20
Classification
4. Compliance needed from patient
Maximum compliance
Minimum or No compliance
5. Type of appliance
Removable
Fixed
6. Arches involved
Intra-arch
Inter-arch

21
Various appliances used for Molar
Distalization :
Head gears
Pendulum appliance.
Coil springs Niti and S.Steel
Distal jet
K loop
Jones Jig
Magnet
Wilsons Bimetric loop
Use of super elastic NiTi
Franzulum appliance.
22
Various appliances used for Molar
Distalization
ACCO
Crozat appliance
Crickett appliance
Modified Nance lingual appliance
Schmuth and Muller double plates
Claspring
Removable molar distalization splint
Fixed piston appliance
Using implants
Fixed functional appliance

23
Distalization using Headgears
Very efficient
Reciprocal forces are not transmitted to other teeth
Molar movements depends on direction of force in relation to
the C Res of the molar & magnitude of force
24
Biomechanics of Headgears:

C Res
Moments
25
Cervical Headgear
Short face Class II
maxillary protrusive
cases with low MPA
& Deepbites
Extrusive & distalizing
effect
Lower anterior facial
height is less.
26
High pull Headgear
Produces intrusive &
Posterior direction of pull
Long face class II
patients with high MPA
Force through C Res
Intrusion & distal
movement of molar
6-8 months class II-
class I
27
Straight pull headgear
Class II Malocclusion with
no vertical problems
Prevent anterior
migration of maxillary
teeth, translate them
posteriorly
Adv-effective, no reciprocal forces
Disadv- Patient compliance
28
Modification of the Bimetric arch
Class II correction- Distalization + expands canine-
premolar area- unlocks the occlusion
A mild-moderate class II div 2 with normal mandibular
arch-easily corrected
29
Modification of the Bimetric arch
Archwire design:
.016premium wire
Premolars bonded if
expansion is required
Teardrop shaped
loop
Bite opening bend
Mild toe-in
2mm activation
30
Elastic load reduction principle:
Class II elastics used sequentially
T.P Green 1
st
week
Pink - 2
nd
week
Yellow next 2-3 weeks
Initial heavy force- to resist forward
pushing force of new wire- force
transferred distally
Later Molar uprights-mesially directed
archwire force decreases- support with
light forces.
Extrusive component of class II- kept
to a minimum
1mm/month.wire
activated for 3
visits.
Borderline
cases Non Ext
31
K-Loop molar distalizing
appliance Valrun Kalra JCO 1995
K-loop forces - .017 x .025 TMA
Nance button anchorage
8mm long , 1.5 mm wide
Legs- 20 degree bend
Inserted into molar and first
premolar tube, marked
Stops bent 1mm distal , 1mm
mesial
Stops- 1.5mm long
32
Reactivated by 2mm 6-8 weeks later.
molars move by 4mm, premolars by 1mm
Anchorage can be reinforced by headgear
33
K- loop Appliance
34
Distalization of Molars with
Repelling Magnets Gianelley etal JCO 1988
Anchorage Modified Nance
appliance
Wire extending from 1
st

premolars
Acrylic button anteriorly
contacting the incisors
Auxiliary wire with a loop at its
end soldered - premolars bands
35
Distalization of Molars with
Repelling Magnets
Incisor brackets passive
sectional wire- maintain incisor
alignment
Repelling surfaces of magnets
brought into contact by passing
an .014 ligature through the loop,
then tying back a washer anterior
to the magnets
Force- 200-225 gms , dropped as
space opened
3mm in 7 weeks
Anchor loss 1mm

36
Molar distalization with Superelastic
NiTi wire Gianelly JCO 1992
100gm Neosentalloy upper
archwire
3 markings
Stops crimped, hook added
Insert wire such that posterior
stop abuts mesial end of molar
tube, anterior stop abuts distal of
premolar.Xs wire deflected gi
Anchorage reinforced by class II,
or Nance appliance
100g
37
Molar distalization with
Superelastic NiTi wire
Case report :
12 yr / F
Unilateral class II
Class II elastic against
upper 1
st
premolar
Overcorrected- 4 months
38
NiTi Double Loop system for simultaneous
distalization of first and second molars
Giancotti J CO 1998

Mandibular molars and 2
nd
premolars
banded, other teeth bonded
Lip bumper- prevent extrusion
Maxillary molars and bicuspids
banded, aligned
80 gm Neosentalloy maxillary
archwire placed marked
1. Distal to 1st premolar
2. 5mm distal to 1
st
molar tube
Stops crimped on markings

39
NiTi Double Loop system for
simultaneous distalization of first and
second molars
2 Sectional NiTi archwires
crimp stops
1. Mesial and distal to 2
nd

premolar
2. 5mm distal to 2
nd
molar
tube
Uprighting springs on 1
st

bicuspids
Class II elastics
Simultaneous, bodily
movement
40
24yr/f, class II div I
5months- overcorrected
41
NiTi Double Loop system for simultaneous
distalization of first and second molars
Useful technique Class II div I
Minimal patient co-operation
Ideal for simultaneous distalization U7 easier . anatomy.
Due to stretching of transeptal fibers, 1
st
molars can be distalized using
lighter 80 gm force
Anchorage easily controlled , without need for TPA/Nance.light forces
42
NiTi Open Coil Springs
Dia 0.012
Lumen 0.030
43
Pendulum Appliance for class II non-
compliance therapy

J AMES J .HI LGERS,J CO 1992
Nance button for anchorage
.032 sTMA springs-light
continuous forces
Broad swinging arc
(Pendulum) of force from
midline of palate to upper
molars
44
Pendulum Appliance
Fabrication :
Pendulum springs
consist
Recurved molar insertion
wire
1. Horizontal adjustment
loop
2. Closed helix
3. Loop for retention in
acrylic button
Springs- close to center
of Nance button
45
Springs close to center of
palatal button:to maxi range
of action, easy insertion.
Retaining wire is soldered to
the U4 and extended into
acrylic.
46
Pendulum Appliance
Nance button- extend to about 5mm
from teeth
Anterior retention loops fixed on
model, later soldered to bicuspid
bands
Acrylic pressed against the palatal
vault
Pendulum springs inserted
47
Pendulum Appliance
Pend-X
Expansion needed:
Jack-screw-One-quarter turn
every 3 days
48
Pre activation and placement
After cementation,before
activation:
Springs prefabricated to lie
parallel to midsagittal plane,
Which produces 60* of
activation after insertion.
As the molar distalizes it
moves on an arc towards
midline-counteracted by
opening horizontal loop
49
Intra oral reactivation:
Center of helix held with bird
beak plier while, spring is
pushed distally & reinsert.
Stabilization:
Nance button
Upper utility arch- anterior segment- anchorage.
Full arch bonding:continuous wire with omega loop.
Head gears ?
50
Pendulum Appliance
Unilateral correction
51
Pendulum Appliance
Conclusion :
Excellent patient tolerance
Upto 5mm distalization in 4 months
Distalization + Expansion
Patient compliance not needed
52
Franzulum appliance
Friedrich Byloff et al JCO2000 sep
Anterior anchorage : acrylic
button-5mm wide
Rests on canine and
premolars - .032S.Steel
wire
Tube from acrylic button to
receive active component
NiTi coil springs-100-
200g/side
J-shaped wire inserted into
tube

53
Franzulum appliance:
Niti spring over J shaped
wire
Inserted into tube of anterior
anchorage unit
Tied into lingual sheath
Anchor unit bonded
with composite.
Close to CR of molar-
pure bodily movement.
compressed
54
Case report
11yrs 10mts / M

end on molar relationship
Space deficiency in both the
arches
Premolars blocked out
Fixed appliance with cervical
headgear and Cl II elastics
End of treatment; Class I molar
relation, no significant change in
facial profile
U6:3mm,L6:6mm Lower incisors
proclined. Extrusion of U&L 6
Long term stability????

55
Distal jet Appliance
Aldo Carano, Mauro Testa JCO 1996
Lingual molar distalizing
appliance
Appliance design :
Wire extending from acrylic
through tube ends in a bayonet
bend-inserted into lingual sheath
Coil spring clamped on tube
Clamp
Anchor wire to 2
nd
premolar

.036 int dia
56

Reactivation- sliding clamp
closer to first molar,once a
month.
After distalization
- clamp-spring assembly-
acrylic,
- premolar arms cut off.
57
Case report
18/F, Class II div I
No skeletal abnormalities
Non-extraction therapy (3rd molars
removed)
Distal jet
4 months- Class I ,2mm-L, 3mm-R

58
Advantages :
Bodily movement
Easy insertion
Well tolerated
Esthetic
Unilateral, Bilateral
Permits simultaneous use of full bonded appliances.

59
Open Coil Jig
Jones, White JCO 1992 Oct
NiTi springs 70-75g
Nance button attached to
U5

Assembly tied in place
60
1. Heavy round wire
2. Light wire
3. Fixed Sheath
4. Hook
5. Sliding Sheath
6. Open coil spring
4-5mm of distal
movement.

3
1
2
5
6
4
Open Coil Jig
61
Conclusion
Borderline cases
Space gaining procedures
Simplicity
Clinical effectiveness
Patient compliance factor
62
Distraction Osteogenesis:
New bone formation b/w the surfaces of bone
segments gradually separated by incremental traction.
Tension-stimulates new bone parallel to vector of
distraction.
tension in surrounding soft tissues, initiating a
sequence of adaptive changes termed as distraction
histogenesis.
Skin, fascia, bl vessels, nerves, muscles, cartilage,
periosteum.
Illizarov.
63
Mandibular Sympyseal distraction.
Mandibular symphyseal distraction- space gaining.
Intra oral mandibular distraction device.
More stable results.
Corticotomy.
Latent period.5-7days.(fibro vascular bridge)
Activation.optimum rate: 1mm/day(0.5mm-premature
ossification,2mm-fibrous CT , ischemia)
Consolidation (remodeling) concomitant soft tissue
expansion.
Retention.

Thank you

For more details please visit

Methods of Gaining Space 1. / Orthodontic Courses by Indian Dental Academy

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Methods of Gaining Space 1. / Orthodontic Courses by Indian Dental Academy

Загружено:

Авторское право:

Доступные форматы

www.indiandentalacademy.

Вам также может понравиться