REMOVABLE APPLIANCES

Removable Appliances are devices can be inserted into and removed from

the oral cavity by the patient at will.

Although removable appliances can be used effectively used to treat a number

of minor malocclusions, they are often ignored and the more complex

fixed appliances used instead.

ADVANTAGES:

1.Maintainance of good oral hygiene during orthodontic therapy.

2. tipping type of tooth movement can be readily carried out.

3. Many tooth movements like tipping, overbite reduction can be undertaken.

4. less chair side time

5. lesser forces are used

6. Removable appliances can be fabricated by general dental practitioners

who have received adequate training.

8. They are less expensive than fixed appliances.

9. large number of patients can be treated.

10. Removable appliances are less conspicuous than multi banded fixed

appliances.

DISADVANTAGES:

1. Patient co – operation is vitally important for the success of the treatment.

2. Are capable of only tipping movements, this is a major limitations of

removable appliances.

3. Whenever multiple tooth movements are to be carried out, it should be

done one at a time. Thus the treatment duration is prolonged in case of

severe malocclusion.
4. Multiple rotations are difficult to treat using removable appliances.

5. In cases requiring extraction, it is very difficult to close residual space by

forward movement of posterior teeth.

6. As the appliances are removable, there is a greater chance of patient

misplacing or damaging them.

7. Patients should exhibit enough skill to remove and replace the appliance

without distorting them.

8. They can not be used to treat severe cases of class II and class III

malocclusions with unfavorable growth pattern.

ACTION OF REMOVABLE APPLAINCES:

Removable appliances work by applying a single force on to the crown

of the teeth.

Thus removable appliances act by tipping the tooth around its centre of

resistance.
Tipping can be brought about in the mesio distal or bucco – lingual direction.

The key point to be considered is the position of the root apex before the

beginning of the treatment.

Removable appliances are generally considered ineffective in bringing about

bodily translation, derotation, and up righting of teeth due to the single point

of contact of these appliances.

Extrusions and intrusions using removable appliances are often mediated

using the forces of eruption and occlusion.

In addition the acrylic base plate of the appliances also can be designed by

incorporating bite planes that can aid in selective extrusion or intrusion of

the tooth.

COMPONENTS OF REMOVABLE APPLIANCES:-

a. Retentive components.
b. Active components.

c. Base plate.

RETENTIVE COMPONENTS:

These are components that help in keeping the appliance in place and resist

displacement of the appliance. The success of a removable appliance is to a

large extent dependent upon good retention of the appliance.

Adequate retention of a removable appliance is achieved by incorporating

certain wire components that engage undercuts that aid in retention of a

removable appliance are called clasps.

MODE OF ACTION OF CLASPS:

Clasps act by engaging certain constricted areas of the teeth that are called

undercuts.

When clasps are fabricated, the wire is made to engage these undercuts so

that their displacement is prevented.

Undercuts that are found in natural dentition:

a. Buccal and lingual cervical undercuts.

b. Mesial and distal proximal undercuts.

BUCCAL/ CERVIACAL UNDERCUTS:

The buccal and lingual surfaces of molars have a distinct undercut at the

cervical margin. These can be seen from the mesial aspect of a molar.

These undercuts are available for clasp fabrication only in those teeth that

are fully erupted. C – clasp and full clasp engage these undercuts.

MESIAL AND DISTAL PROXIMAL UNDERCUTS:

The molars are widest mesio – distally at the contact point and gradually

taper towards the cervical margin. These surfaces slopping from the

mesial and the distal contact areas towards the neck of the teeth are called

the mesial and distal proximal undercuts.

They can be seen when molar is viewed from the buccal aspect. These

under-cuts are more pronounced than the cervical undercuts and therefore

offer more retention.

Adam’s clasp and Crozat clasps engage these undercuts.

Requirements of an Ideal clasp:

1. It should offer adequate retention.

2. It should permit usage in both fully erupted as well as partially erupted teeth.

3. It should offer adequate retention eve in the presence of shallow undercuts.

4. They should not themselves apply any active force that would bring about

undesirable tooth movements of the anchorage teeth.

5. It should be easy to fabricate.

6. It should not impinge on the soft tissues.

7. It should not interfere with normal occlusion.

CIRCUMFERENTIAL CLASP:

The circumferential clasp is also known by the terms three – quarter clasp or

‘C’ clasp. They are simple clasps that are designed to engage the bucco –

cervical undercut. Wire is engaged from one proximal undercut along the

cervical margin then carried over the occlusal margin then carried over the

occlusal embrasure to end as a single retentive arm on the lingual aspect

that gets embedded in the acrylic base plate.

Advantage is its simplicity of design and fabrication.

Disadvantages is that it cannot be used in partially erupted teeth where in
the cervical undercut is not available for clasp fabrication.
JACKSON’S CLASP:

This clasp was introduced by Jackson in the year 1906. It is also called full

clasp ‘U’ clasp. This engages the bucco – cervical undercut and also the

mesial as well as distal proximal undercuts.

The advantage of this clasp is that it is simple to construct and offers

adequate retention.

Disadvantages is that it offers inadequate retention in partially erupted teeth.

ADAM’S CLASP:

The Adam’s clasp was 1st describes by professor Phillip Adams. It is also

known as liver pool clasp, universal clasp and modified arrow head clasp.

When properly constructed this clasp offers maximum retention. This clasp

is constructed using 0.7mm hard round stainless steel wire.

Parts:

a) Two arrow heads.

b) Bridge

c) Two retentive arms.

The two arrow heads engage the mesial and distal proximal undercuts.

The arrow heads are connected to each other by a bridge which is at 45*

to the long axis of the tooth.

Advantages:

1. It is rigid and offers excellent retention.

2. It can be fabricated on deciduous as well as permanent teeth.

3. They can be used on partially or fully erupted teeth.

4. It can be used on molars, premolars, and on incisors.

5. No specialized instrument is needed to fabricate the clasp. Young’s

Plies is used for fabrication.

6. It is small and occupies minimum space.

7. The clasp can be modified in a number of ways. These modifications

permit additional uses or enhanced retention.

MODIFICATIONS:

1. Adam’s with single Arrow Head: This type is indicated in partially erupted

tooth which usually is the last erupted molar. The single arrow head is made

to engage the mesio – proximal undercut of last erupted molar.

The bridge is modified to encircle the tooth distally and ends on the palatal

aspect as a retentive arm.

2. Adam’s with ‘J’ Hook:

A ‘J’ Hook can be soldered o to the bridge of the Adams clasp. These Hooks

are useful in engaging elastics.

3. Adam’s with incorporated helix:

A Helix can be incorporated into the bridge of the Adams clasp. This also

helps in engaging elastics.

4. Adam’s with soldered buccal tube:

A buccal tube can be soldered on to the bridge of the clasp. This permits

use of extra – oral anchorage using face – bow head gear assembly.

5. Adam’s with additional arrow head:

Clasp can be constructed with an additional arrowhead which engages the

proximal undercut of the adjacent tooth and is soldered o to the bridge of

the Adams. This type clasp offers additional retention.

6. Adam’s with distal extension:

Can be modified so that the distal arrowhead has a small extension

incorporated distally. This helps in engaging elastics.

7. Adam’s on incisors and premolars:

Can be fabricated on incisor and premolars when retention in those areas

are required. They can be constructed to span a single tooth or two teeth.
SOUTHEND CLASP:

Used when retention required in the anterior region. The wire is adapted

along the cervical margin of both the central incisors. The distal ends are

carried over the occlusal embrasures to end as retentive arms on the

palatal side.

TRIANUGLAR CLASP:

Small triangular shaped clasps that are used between two adjacent posterior

teeth. Thus they engage two proximal undercuts of two adjacent teeth.

These clasps are indicated when additional retention is needed.

BALL END CLASP:

This clasp is fabricated using stainless steel wires having a knob or ball like

structure on one end. The ball can be made at the end of the wire using

silver solder. Pre – formed wires having a ball at one end are also available.
The ball engages the proximal undercut between two adjacent posterior

teeth as in a triangular clasp. The distal end of the wire is carried over the

occlusal embrasure to end on the palatal aspect as a retentive arm. The

ball end clasp is indicated when additional retention is required.

SCHWARZ CLASP:

The Schwarz clasp or arrowhead clasp can be said to be the predecessor of

the Adam’s clasp. The clasp is designed in such a way that a number of

arrow heads engage the interproximal undercuts between the molars and

between premolars and molars.

Drawbacks:

1. Need special arrowhead forming pliers to fabricate.

2. Occupies a large amount of space in the buccal vestibule.

3. The arrow heads can injure the interdental soft tissues.

4. It is difficult and time consuming to fabricate.

CROZAT CLASP:

This clasp resembles a full clasp but has an additional piece of wire which

engages into the mesial and distal proximal undercuts. Thus if offers better

retention than the full clasp.

ACTIVE COMPONENTS OF REMOVABLE APPLAINCE

They are components of the appliance which exert forces to bring about the necessary

tooth movement.

The active components include

1. Bows

2. Springs

3. Screws

4. Elastics
Bows:

Bows are active components that are mostly used for incisor retraction.

There are various types of bows routinely used by the orthodontist.

Some of the commonly used labial bows:-

1. Short labial bow.

2. Long labial bow.

3. Split labial bow

4. Reverse labial bow

5. Robert’s retractor

6. Mill’s retractor

7. High labial bow with apron spring

8. Fitted labial bow

Short labial bow:
This type of labial bow is constructed using 0.7mm hard round stainless steel
wire. The short labial bow consists of a bow that makes contact with the most
prominent labial teeth and two ‘U’ loops that end as retentive arms distal to
the canines. This type of labial bow is very stiff and exhibits low flexibility.
Indications:
minor overjet reduction and anterior space closure
Retention purpose after fixed orthodontic therapy
The short labial bow is activated by compressing the ‘U’ loops. The activation
should be such that the labial bow is displaced palatally by 1.mm.
Long labial bow:
This labial bow is similar to the short labial bow except that it except that
it extends from first premolar to the opposite first premolar the distal arms of
the ‘U’ loops are adapted over the occlusal embrasure between the two
premolars to get embedded in the acrylic plate.
The indications of long labial bow are:
a) Minor anterior space closure.
b) Minor overjet reduction.
c) Closure of space distal to canine.
d) Guidance of canine during canine retraction using palatal retractor.
e) As a retaining device at the end of fixed orthodontic treatment.
Split labial bow:
This is a labial bow that is split in the middle. This results in two separate
buccal arms having a ‘U’ loop each. This type of labial bow exhibits
increased flexibility as compared to the conventional short labial bows.

The split labial bow is used for anterior retraction. A modified form of split

labial bow can be used for closure of midline diastema. In this form, the free

end of the buccal arms are made to hook on to the distal surfaces of the

opposite central incisor. The split labial bow is activated by compressing the

‘U’ loop 1-2mm at a time.

Reverse labial bow:
Also called reverse loop labial bow.
Loops are placed distal canine.
Bow exhibits greater flexibility.
Activation:
Done by two steps
1. U-loop is opened  results in lowering of the labial bow.
2. Compensatory bend is given at the base of the loop. To maintain the
proper level of the bow.
Robert’s retractor:
This is a labial bow made of thin gauge stainless steel wire having a coil of
3mm internal diameter mesial to the canine. The use of thin 0.5mm
diameter wire along with increased wire length due to the incorporation of a
coil makes the labial bow highly flexible. As very thin wire is used for its
fabrication, the bow is highly flexible and lacks adequate stability in the
vertical plane, Thus the distal part of the retractor is supported in a stainless
steel tubing of 0.5mm internal diameter.
Mill’s retractor:
This is a labial having extensive looping of the wire so as to increase the
flexibility and range of action.
Indicated in patients with a large overjet.
Disadvantages:
- Difficulty in construction.
- Poor patient acceptance.

High labial bow:

Consists of a heavy wire bow of 0.9mm thickness that extends into the

buccal vestibule. Apron spring made of 0.4mm wire is attached to the high

labial bow. This spring can be designed for retraction of one or more teeth.

Indicated in cases of large overjet. The apron spring is activated by bending

it towards the teeth.

Disadvantages:

- Difficulty in construction.

- Risk of soft tissue injuries.

Fitted labial bow:

In this type of labial bow the wire is adapted to confirm to the contours of the labial

surface. The U–loop is usually small. The fitted labial bow cannot be used to bring

about active tooth movement.

They are used as retainers at the completion of fixed orthodontic therapy.

SPRINGS:

Springs are active component of removable orthodontic appliances that are used to

effect various tooth movements.

Classification of springs:

I. Based on the presence or absence of Helix.

a. Simple – without Helix.

b. Supported springs:

- Usually made of thinner gauge wire and thus lacks stability. Hence selection of the

spring is encased in a metallic tubing to give it adequate support.

Ideal requisites of a spring:

a. The spring should be simple to fabricate.

b. It should be easily adjustable.

c. It Should fit into available space without discomfort to the patient.

d. It should be easy to clean.

e. It should apply force of required magnitude and direction.

f. It should not slip or dislodge when placed over a sloping tooth surface.

g. It should remain active over a long period of time.

FACTORS TO BE CONSIDERED IN DESIGNING A SPRING:

1. Diameter of wire: The flexibility of the spring to a large extent depends upon the

diameter of wire used.

F= D4/L3

F -> Force

D -> Diameter

L -> Length of wire.

Thicker wires when used, decrease in flexibility occurs, it applies a greater force one the

tooth.

By doubling the diameter, the force increase by almost 16 times.

By decreasing the diameter, the force applied is less and therefore the spring remains

more flexible and active over a longer period of time.

2. Length of wire: Force can be decreased by increasing the length of the wire. Thus

springs that are longer are more flexible and remain active for a longer duration of time.
3. Force to be applied: The force that should be generated by the spring is calculated

based on the number of teeth to be moved, root surface area and patient comfort on

an average, forces of about 20gm/cm2 root area is recommended for most tooth

movement.

4. Patient comfort: Should not offer any patient discomfort by way of its design, size or

the force it generates.

5. Direction of tooth movement: The direction of tooth movement is determined by the

point of contact between the spring and the tooth.

Palatelly placed springs are used for labial and mesio – distal tooth movement.

FINGER SPRING:

-Also called as single cantilever spring as one end is fixed in acrylic and the other is free.

- It is constructed using 0.5mmor 0.6mm hard round stainless steel wire.

- Used for mesio – distal movement of teeth.

- Used only on those teeth that are located correctly in the bucco – lingual direction.
- Consists of

1) An active arm – 12-15mm length which is towards the tissue.

2) Helix – 3mm internal diameter.

3) Retentive arm – of 4-5mm length which is kept away from the tissue.

- Constructed in such a way that the coil should lie along the long axis of the tooth

to be moved.

- Activated by moving the active arm towards the teeth intended to be moved.

- Activated upto 3mm is considered ideal when 0.5mm wire is used.

CRANKED SINGLE CANTILEVER SPRING:

-> Constructed with 0.5mm hard stainless steel wire.

-> Used to move teeth lebially.

-> Spring consists of a coil, close to its emergence from the base plate.

-> The spring cranked to keep it clear of the other teeth.

-> Activated by unwinding the coil.

Z - SPRING:
- Also called double cantilever spring.
- Used for labial movement of incisors.
- Also used for bringing about minor rotation of incisors.
- Made of 0.5mm wire.
- Consists of 2 coils of very small diameter.
- Spring should be perpendicular to the palatal surface of the teeth.
- Activated by opening both the Helices by about 2-3mm at a time.
T – SPRING:
- It is made of 0.5mm hard round stainless steel wire.
- Consists of a ‘T’ shaped arm whose ends are embedded in acrylic.
- Loops can incorporated in both the arms of the ‘T’ so that as the tooth moves
buccaly the head of the ‘T’ can be made to remain in contact with the crown by
slightly opening the loops.
- Activated by pulling the free end of the ‘T’ towards the intended direction of tooth
movement.
COFFIN SPRING:
- Is a removable type of arch expansion spring.
- Was introduced by Walter coffin.
- Used to bring about slow dento – alveolar or there is a unilateral crossbite.
- Made of 1.2mm round stainless steel wire.
- Consists of ‘U’ or omega shaped wire placed in the mid-palatal region with
retentive arms incorporated in base plates.
- Activated by holding both ends at the regions of the clasps and pulling the sides
gently apart.
- Activation of 1-2mm at a time is considered ideal.
CANINE RETRACTORS: Are springs that are used to move canines in distal direction.
Classification:
I. Based on their location:
a. Buccal – Buccaly placed
b. Palatal – Palatally placed
II. Based on the presence of Helix or loop.
a. Canine retractor with helix.
b. Canine retractor with loop.
III. Based on their mode of action
a. Push type.
b. Pull type.
U – LOOP CANINE RETRACTOR:
- Made of 0.6mm or 0.7mm wire.
- Consists of a U – loop, an active arm and a retentive arm which is distal.
- Base of the U- loop should be 2-3mm below the cervical margin.
- Mesial arm of the U – loop is bent at right angles and adapted around the canine
below its mesial contact point.
- Used when minimal retraction of 1-2mm is required.
- Activated by closing the loops by 1-2mm.
- Advantages are easy in fabrication and less bulk.
HELICAL CANINE RETRACTOR:

- Also called reverse loop canine retractor.

- Made of 0.6mm wire.

It consists of a coil of 3mm diameter, an active arm (towards the tissue) and a retentive

arm.

- The mesial arm (retentive arm) is adapted between the premolars.

- The distal arm is active and is bent at right angles to engage the canine below the

height of contour.

- The coil is placed 3-4mm below the gingival margin. The height of the coil can be

adjusted based on the vestibular height.

- It is activated by opening the helix 1mm or by cutting 1mm of the free end

and readapting it around the canine.

- Indicated in patients with shallow sulcus and especially in the mandibular arch.
PALATAL CANINE RETRACTOR:

- It is made of 0.6mm stainless steel wire.

- It consists of a coil of 3mm diameter, an active arm, and a guide arm.

- The active arm place mesial to canine.

- The helix is placed along the long axis of the canine.

- Indicated in retraction of canines that are palatally placed.

- Activation is done by opening the helix 2mm at a time.

BUCCAL CANINE RETRACTOR:

- Indicated usually in case of buccaly placed canines and canines placed high in the
vestibule.

- They are used to move canine in distal as well as palatal direction.

- It consists of a coil of 3mm diameter an active arm [away from the tissue] and a
retentive arm.

- The coil is placed distal to canine.

Types:

a) Supported

b) Self supported

Supported buccal canine retractor:

- Made of thinner gauge wire (0.5mm).

- More flexible, therefore mechanically efficient.

- Lack of the stability and are therefore enclosed in a stainless steel tubing.

- Can be activated upto 2mm at a time.

Self supported buccal canine retractor:

- Made of thicker gauge wire (0.7mm) so that the spring can support itself.

- Activated by closing the helix 1mm at a time.

SCREWS:
- Active components of a removable appliance.
- Activated by the patient at regular intervals using the key that is supplied for this
purpose.
- Consists of split acrylic plate, and Adam's clasps on the posterior teeth.
- The screw is placed connecting the split acrylic plate.
Screws can bring about three types of tooth movements:
a. Expansion of arch.
b. Movement of one or a group of teeth in buccal or labial direction.
c. Movement of one or a group of teeth in a distal or mesial direction.
ELASTICS:
- Are active components seldom used along with removable appliances.
- Mostly used in conjunction with fixed appliance.
- Used for anterior retraction generally make use of a labial bow with hooks placed
distal to canines.
- Latex elastics are stretched between them and lie over the incisors.
Disadvantages:

- Risk of the elastic slipping gingivally causing gingival trauma.

- Risk of the arch form getting flattened.

BASE PLATE:

- The bulk of the removable appliance is made of the acrylic base plate.

- The prime function is to incorporate all the components together into a single
functional unit.

- Also helps in retention of appliances and for anchorage.

- Provides support for the wire components.

- Helps in distributing the forces over a larger area.

- Bite planes can be incorporated into the plate to treat specific orthodontic problems.

- Base plates of 1.5mm – 2mm thickness offers adequate strength and are tolerated
well by patients.

- Maxillary plate covers the entire palate till the distal of the 1st molar.
- The mandibular plate is shallow to avoid irritation to lingual sulcus.

- Should fit snugly around the necks of teeth that are not being moved. This helps in

avoiding food accumulating under the base plate.

- Made of – cold cure acrylic.

- Heat cure acrylic.

Bite planes: Helps in disengaging the occlusion.

Anterior bite planes:

Are fabricated by thickening the base plate behind the maxillary

anteriors.

Useful in treatment of deep over bites.

Posterior bite planes:

Formed by extending the base plate to cover the occlusal surface

of the teeth.

Used in treatment of cross bites.

CLINICAL MANAGEMENT OF REMOVABEL APPLAINCES:

DELIVERY OF THE APPLIANCE:

- The tissue surface should not have any sharp areas or nodules.

- Should be easy in insertion and removal of the appliance.

- Clasps should be examined for adequate retention.

- They should not impinge on the gingiva, sulcus or the frenum.

- The patient should be educated on how to insert and remove the appliance.

- Can be activated after a few days once the patient gets used to the appliance.

INSTRUCTIONS TO THE PATIENT:

1. Patient should be instructed on the number of hours of wear.

2. The appliance and the teeth should be cleaned after every meal.

3. Care should be taken not to bend or dislodge any of the components of the
appliance.
4. In case of screws, the patient should be given clear instructions on how to activate

the appliance.

5. The patient should be instructed not to leave the appliance out of the mouth for a

long period of time as it increases the risk of loss and damage.

PROBLEMS ENCOUNTERED IN REMOVABLE APPLIANCE.

1. Oral hygiene maintenance.

2. Soft tissue irritation.

3. Caries.

4. Pain.

5. Tooth mobility.

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