plate appliances (here for lower jaw)
two similar appliances exemplify the formerly widespread
active plate appliance. It was not just an expander
to gain space, but allowed for dental straightening almost at the
same time if constructed and handled properly! H =
anchoring clasps, D = expansion screws (which in fact
require growth to work properly), here even in 2 directions E =
spring for a tooth correction, shaped according to the desired
movement, S = labial arch (a common element).
of the following appliances are based on this, but developped
In the second specimen, the anchoring clasps at the
rear are slightly simpler, but the front is equipped more
generously with protrusion springs
for tidying up crowded teeth.
examples of full treatments with plates in the case
examples chapter. Hints
for distinctive applications of Crozat and plate appliances are
there in the sub-chapter about classical Crozat treatment.
appliance ® (no image here)
nighttime appliance: for
children, teenagers and adults, 12 - 16 /24h
to success. DNA as well alludes to the theory
behind it, the utilization of epigenetic jaw and
arch development, including the nasal pathways, so that it cures
also certain cases of snoring.
plate appliance is for
controlled expansion in all directions, to fulfil what is
genetically possible. It is made with patented,
pre-shaped parts that require no or little adjustment. First
publication was in 2009 as a lighter wireframe appliance,
suitable for appropriate
a list of certified providers in the U.S., Canada,
Japan, Poland, Asia-Pacific and a few in further
However, this appliance seems to have no class-III
type, that means, for patients with lower jaw before upper (what
is for the lower jaw, honestly spoken, not a problem of
To track down further removable
appliances and treatment by orthopedic exercises, search also for
Wrong: how a
blocked canine tooth was kept trapped
is a typical example of a poorly designed plate appliance.
Treatment started in late mixed dentition, where the gap for one
of the cuspids (canine or eye teeth) had much narrowed. But
instead of re-expanding it little by little, the positions of the
adjacent teeth were retained by this plate.
Since it has the
screw elements in wrong positions, it wasted 2 precious years of
growth and made the case severe. An attempt to obtain a second
opinion in time failed, because the visited orthodontist was one
of those who make all patients first wait until all milk teeth are
gone. This strategy aggravates all cases more or less, which
increases the profit for the orthodontist as well as the pain and
damage that the late treatment does to the patients. The patient
here was menaced by a common package of orthodontic extortion:
mutilating extractions, or headgear, or expensive, but hampering
large fixed installations (pendulum, distal jet) - and each of
these combined with fixed bracket braces.
The rarer specialists
of gentle treatment offered mainly Crozat appliances (see below),
which are however rarely covered by public health insurance.
utilities: crossed wire fingers to close frontal gap;
incisors are not crooked in a medical sense. Nevertheless, these
little gaps may waste space which will later lack for the larger
canine teeth (eye teeth, cuspids).
Plate appliances for
gappers can be equipped with adjustable wire fingers
to close up the teeth. If, moreover, an expansion screw is used,
this can close up wire fingers by the same distance, if they are
embedded crosswise in the halves of the plate, as shown
Screwed expansion also stretches and flattens a common
frontal arch wire spring, as shown below. This is helpful if
incisors stick out.
Against the opposite case, if incisors grow
inward (retruded) of the arch line, plate appliances can be
equipped with protrusion springs, either one by one (see above
under Common plate appliances), or in the shape of an
inner arch with loops.
In the specimen for interceptive
treatment shown here, this element should stretch back when the
plate is expanded. However, if it would also be embedded with
crossed ends, then expanding the plate should bend it in the
desired forward direction. Such a plate design, out of standard
materials, may replace a specialized component: the robust, but
sometimes bulky 3-way screw of Bertoni (see below, for T-segmented
with additional clasps (Voss plate): expansion, distalization,
vampire canine teeth
develop a narrow jaw or a crowding of side teeth into a healthy
situation by means of a plate, this appliance requires screwed
segments in the right positions. Moreover, it needs sufficient
anchorage for efficient force
transmission. Additional clasps at both sides
of the screw prevent the plate from lifting off when it is screwed
onward, to avoid that it loses its proper fit and that most of its
force falls flat.
In this sense, the first photo shows a
typical vampire canine teeth (eye
teeth, cuspids) situation. The narrowed gaps have already
been re-gained. This appears to be a Y plate (see below) with
clasps on the 2s and 4s here, and with guide wires for the cuspids
which are now
free to grow down.
The next photo shows a used plate expander
with additional clasps on the 2s. It had expanded the maxilla by
approximately 5 mm even in this stage with no more milk teeth
left. Also the green specimen
under Plates for one-sided expansion against
single-sided crossbite has additional clasps.
b/w photo shows a successful re-distalization of 3 teeth which had
This plate has a further screw for simultaneous expansion, which
was not used here. Teeth often move forward when milk teeth are
destroyed before their successors are ripe, and narrow the gap as
is exemplified in the sequence below: the gap for the canine tooth
is narrowed to 1/3! Just 1 milk molar is left, but when
it falls, it will provide another 2 mm of space.
wire elements support this plate in the incisor region. It
successfully regained the lacking space by its backward screwed
(distal) segment. It was provided with a lining of fresh plastic
material during this, to re-establish the neat fit which generally
degrades when screwed segments are used to greater extent. This
treatment was accomplished by an activator which had additional
guide elements for the growing cuspid as well as for the bicuspids
which appeared rotated due to excess of space.
lobby acts for this proven and economic techniques like this one.
In contrast, manufacturers of countless fixed distalizers and
bone piercing (micro-implantat anchorage) engage
reputable speakers for courses to promote these risky and forced
techniques, which endanger children as well as adults.
plates, Z plates, Bertoni plates
to their large
roots, cuspids (canine or eye teeth) are important teeth, but
often develop later than both their neighbors. Space can lack for
them in case of insufficient jaw growth or premature loss of milk
teeth. Then they often grow off-site, mostly before, rarer behind
the main row of teeth.
Treatment would be easier when
not waiting so long.
Y and Z plates use 2
common screws to regain this space. Narrowed gaps can nicely be
expanded by the plastic ends of the screwed segments. These have
to be shortened little by little when the tooth grows in or is
The Y-shaped segmentation
of the colourful upper specimen causes expansion as well as
stretching of the jaw. This is a light case, whereas the harder
case in the mouth photo in vampire canine
teeth above obviously also uses a Y or Z plate: screw
elements inside of the narrowed gaps had already re-gained them by
expansion and stretching.
following specimens (yellow and violet-from-b/w) have their screws
more distally placed. They finger into the cuspid position by a
Z-shaped 3-segmentation of the plate. By their rather sagittal
direction, the gap is opened mainly by stretching and
and Z plates differ less in the lower jaw (pink specimen). The
screws can be placed more or less frontally there.
The indication for the Y plate
overlaps with that of the more recent Bertoni screw (3-way-screw).
The green plate shown below contains it, and moreover 2 distal
screws, so that this plate has 5 segments! Nevertheless it
is not bulky, and is even more versatile than a Y or Z plate to
shape the dental arch.
In addition, it is equipped to derotate
the canine teeth, which are rotated by narrowing, already
while the space for them is under way to be recovered. Such
details make the difference between high-value plates for
removable treatment and plates which are just preparing for fixed
braces. 3- or 4-way screw elements also exist for lower jaw
Such plates as shown here were
proven for treatment of children and, by taking some more time,
also for teenagers. Nowadays, they fall into oblivion,
irrespective that they offer a way out of the frequent bad
business which is exemplified above under Wrong
.. canine tooth had to stay trapped: only treatment
with extractions or with a headgear was offered there, or
sometimes with expensive, hindering fixed appliances under the
palate (Pendulum, Distal jet), or even piercing mini implants
(micro screws, micro pins) through the flesh into the bone, which
imposes a considerable risk of persistent bone inflammations to
distalization by screwed segments: (pre-prosthetic)
adult treatment; impacted canine
symmetrical blue plate contains on both sides 2 double screws with
2 independent segments each.
All 4 premolars lack in this adult
upper jaw: 2 had been sacrified for orthodontic treatment long
ago, and 2 were destroyed more recently. These latter should now
be replaced, but the molar teeth have already migrated forward and
narrowed the gaps too much. Therefore, the screwed segments should
recover sufficient gaps. The enlarged image with the red arrows
shows that the front segment is to shift towards the fixed
position of the screw heads, while the rear segment is to shift
away from it. A jagged anchor for this long element can be seen
embedded in the plastic behind the incisors.
the next, younger example, the canine teeth stayed impacted in the
Sufficient space was created for them with the violet
distal plate shown here and a subsequent one, by pushing teeth
forward and others backward. The big molar teeth had to be pushed
individually, each with its own screwed segment of the plate, 1 on
the right and 2 on the left hand side here (when the above double
screw was unavailable). Thus, the second-but-last molar can be
shifted individually, if the more frontal screw is opened and the
rear screw closed by the same distance. To prevent breakage, it is
advisable to choose the frontal screw bigger.
required space was provided, one canine tooth grew in by itself
(at an age of 25), whereas the other had to be cut free and pulled
out slowly, by glueing a hook to it and connecting it with a
rubber band to a corresponding hook at the appliance. Crozat
appliances (see below) would also be suitable for this.
are the oldest system of
removable braces, invented and developped to mastery in the
1920ies, before plastic era. Wire elements of different
thicknesses were soldered together to light, hygienic appliances
which are well-suited for full-time wear, in
particular for adult and pre-prosthetic treatment, and if teeth or
gums have already damages.
full treatments with these appliances, not restricted to simple
cases, since they can widen and lengthen the arches and
correct individual teeth. A limited expansion of the upper jaw
is still possible in adults slowly, but with these
appliances with little discomfort.
of all the orthodontic late cases (= teenagers and
adults), this gentle and proven method is hardly reported
anywhere in the mass media.
implants are systematically disseminated in
congress-filling manner as a high-profit invasive technique, but
endanger the patient with persistent
bone inflammations (see below under Less discomfortable
additives.. for more about it).
Crozat cases and details of this method in the case
type and upgraded Crozats
between Crozat and plate appliances can be built economically from
common materials without soldering or welding. E.g. the blue
lightweight spring expander in the upper photo. There, small
plastic wings bear common clasps (anchors) and are connected by a
thicker wire spring. Even prefabricated parts which are intended
for fixed use (lingual arch, palatal bar, quad helix ...) could be
adapted for this, to make their use friendlier.
Normal Crozats have just 2 clasps, which
are in the molar region. Because they were originally intended to
give teeth just stimuli in the desired directions, and to leave
them otherwise free to find their anatomically functional
positions. Of course, Crozats can be built with more clasps, but
that could hamper this original intention. In some cases, it
cannot be foreseen if 2 clasps would be enough. The lower photo
shows an upgraded Crozat. Before, its anchorage had turned out to
be insufficient. Occlusal extensions were also desired to treat a
crossbite. They were added out of plastic material, and additional
clasps embedded in them.
expanders with screw or spring instead of quadhelix
or other fixed expanders
expanders can be built such that they do not hinder speech,
because leaving the frontal palate free, and that they are little
visible when worn. In the upper specimen, plastic snaps over the
side teeth instead of clasps. This is also suited for slow
expansion in permanent dentition (upper jaw still expandable
up to 4-6 mm). It could also be made by thermoforming of plastic
sheet. For children whose side teeth are changing, on the other
hand, ordinary clasps are preferable.
Continuous force can either be
provided by a screw with an included spring, which is a
specialized part, or by simple wire loops in spring expanders as
shown below with various clasps. The strength or thickness of
their spring can be varied, and also the position where it leaves
the plastic wings. For details on this, also for the lower jaw,
more than 4 -5 mm width can be gained in children by removable
expanders, with no need of splitting the palatal suture, fixed
quad helix or other cruel treatment. Such widespread
forced methods neclect loving care (find
victims´ reports in the Less disturbing
kinds-chapter), but are favoured by orthodontic
manufacturers of many profitable prefabricated parts. These force
the dentitions of individual humans into uniform shape.
molars are too conical or not yet fully erupted, so that these
appliances fit too loosely, then tiny white attachments could be
glued to them, which are now widespread in aligner orthodontics.
In contrast to bands or brackets, they neither hurt the flesh, nor
hamper cleaning these teeth far inside the mouth. The appliance
would snap in firmly on these attachments, like an aligner splint
for single-sided expansion (yeah!)
an approximate force distribution of 2/3 to 1/3, to correct a
one-sided crossbite that has already grown-in. For one-sided
crossbite in early state
(muscular crossbite), a simple expansion plate would
often be sufficient (force distribution of 1/2 to 1/2).
solution from old literature, the 1/4 3/4 divided activator
(double decker appliance), would be larger scale. The fixed,
pre-fabricated quad helix, in contrast, disturbs swallowing,
speech and chewing (see examples in the less disturbing
kinds... chapter). Moreover, it has more relapses than
expansion plates have.
Both specimens shown here
are asymmetrically divided.
The green belonged to a 8-yr girl
who was menaced with rapid palatal
expansion (RPE) elsewhere. To unlock the wrong occlusion,
this plate extends over the side teeth. Additional clasps
assure a good grip, and the large expansion screw bears an
included spring to deliver a continuous force. Simultaneously, 3
protrusion springs are to widen the frontal arch, and a finger
spring is to re-gain the narrowed space for a growing canine
The yellow specimen, which could also be equipped with
further elements, has a simple, big expansion screw and another
solution for a more continuous force delivery: the contact zone to
the teeth which are in crossbite consists of silicone rubber.
with spring bolt screws
use of a reamer, the tiny spring-bolt screws can be
inserted later into a plate appliance, e.g. if changing teeth
appear too much inward.
In the example here, a young
cleft-palate patient with 45° twisted incisors profits from
skillful removable treatment. The screws act from inside and the
frontal wire from outside to untwist these teeth. Note also that
the expansion screw is already expanded by about 5 mm!
following picture, the left one of the frontal screws has been
re-inserted, to re-adapt its direction to the proceeding
This example demonstrates that
even a cleft-palate child is not condemned
to palatal splitting and other painful fixed stuff,
if the treatment is continuous.
Find more details in the expl.
of cases chapter.
Plates equipped with
silicone rubber for complicated tooth corrections
sufficient space has been provided, this rational technique can
correct teeth which are in the row but nevertheless not straight,
that means tilted (around 3 axes possible).
This appliance is
mainly a plate, with a rigid body and clasps (and screws would
also be possible). It should provide a framework around those
(tilted) teeth which are to align. On the plaster model, these are
then cut out and re-fixed in aligned positions (setup / aligner
techniques). Silicone rubber is molded around them onto the outer
framework and the distant inner plate border.
Such plates are smaller than the common elastic positioners,
which are mainly used when fixed braces gave no good result, but
can also be applied independently.
Moreover, such a plate would
allow larger alignments / untwistings
by modification: stepwise alignment of the plaster model
and subsequent renewal of just the silicone rubber parts, which is
more examples for silicone rubber bearing plates and splints: 1
fine and 1 wide alignment by
Thermoformed splint for fine correction
of lower incisors, manufacture: First,
a soft spacer (with
the blue stripes here) is molded over the
teeth of the original plaster model which are to align. The larger
the required corrections
are, the thicker should be this.
It is cut to size and positioned
on the model before the final, hard splint is
molded. That is cut to shape, and the spacer discarded.
set-up of these teeth is done. Silicone rubber is filled around
them into the void of the splint which was created by the spacer.
Plate with silicone rubber
for derotation of upper incisors at larger scale, an
First, the silicone presses the teeth only there where larger
movements are needed. The other regions of these teeth on the
corrected plaster model are waxed out. This allows the silicone of
the first run of this plate to expand sidewards, when squeezing
frontally as desired.
Depending if the silicone has
point contact or full contact to these teeth, it will move them
rather tipping or rather bodily. The plate can moreover use
For its second run, the same set-up
model can be re-used. But now, all void is stuffed with
silicone, no more wax. Note well that it acts from both sides
here: the frontal wire before
the incisors is modified with a plastic shield, which bears
also silicone inside.
discomfortable additives for fixed braces
add-on parts for US style multibracket techniques pay
little attention to patient comfort, because the patient,
especially if a child, has no other choice
anyway. In addition, they hamper oral hygiene.
profitable international orthodontic business began to spread
further orthodontic armament in form of little mini implants (mini
pin, micro screw, mini screw, ...), which are pierced through the
flesh into the bone, for all type of better fixation of fixed
braces. Since they create a highway for bacteria into the bone,
where inflammations are difficult to cure, their unneccessary use
endangers adults and children. In contrast, they are completely
useless for removable techniques! But nevertheless, removables
have largely been abandonned.
with less discomfort or danger are obvious to
those who are familiar with removable techniques. For
single jaw treatment, no functional, but just plate
technique can already help a lot. The
images show a speech-friendly, frontally open design of such an
add-on plate, and 2 solutions to snap it in: silicone
rubber to fixed buttons, or ball head clasps and outer grips for
removal. Common orthodontic
tasks to apply it:
-Maintain jaw width
or position of last molars: simple blank plate to wear at night or
part-time. Instead of head gear, lip bumper, nance appliance,
palatal arch or other disturbing stuff.
screw, fan screw or spring expander (find more about this under
prototypes). Instead of quad helix or
splitting the palatal suture (for these, see victims´
reports in the less
disturbing kinds of braces chapter).
of incisors: plate with
protrusion springs / screws instead of disturbing lingual
-Distalization (backward shift) of molars:
segmented plate with distal screws, instead of headgear, lip
bumper, pendulum, distal-jet or other fixed instruments.
correction and vertical deviations (deep bite, open bite),
prefabricated functional trainers are
available, also such which are compatible with multibracket
appliances (T4B = trainer for braces).
1) Class II overjet,
also with increased overbite (deep bite), can be corrected by
sustained use of such trainers for 1 3 years, instead of
hampering Herbst appliances or other bulky, unhygienic fixed
2) More rapidly, a covered or deep bite can be levelled
out painlessly. The required vertical forces are easily provided
by biting on the trainer, instead of fixed bite blocks which
extremely hamper any mastication (and subsequent digestion).
from the T4B, which resembles the Muscle force Jaw shaper in shape
(find instructions under Kaukraft
Kiefer-Former), but has grooves for fixed braces, a thicker
fixed-compatible trainer for covered bite is available. In
contrast, the covered-bite type of the Jaw shaper allows the
patient to keep an arch shape which is somewhat more tapering than
exterior plate (buccal plate), e.g. for gap closure of
a missing tooth
appliance wears comfortably because without plastic parts inside.
It is described in literature only for the lower jaw and has
advantage for straightening inward tilted teeth and for gap
closure with a traction screw. E.g. for those 5% of people whose
premolars in position 5-below are not formed, if
their respective milk molars could not be preserved. The
coloured specimen is for demonstration.
is told with commercial interest that this
task would require fixed braces to perform properly. But look in
reports for successful removable treatments of such gaps.
Spontaneous gap narrowing by forward migration of the molars
should be allowed before fitting an appliance. Moderate speed when
screwing or light force when using springs (also Crozat appliances
would work here) are crucial for a tilt-free gap closure.
monochrome views show a specimen with an additional space creating
screw between the crowded tooth 5 and 6 here on the right, and a
traction screw to close a little gap on the opposite site.
further application would be the contraction of the lower front
e.g. if it had been expanded by tongue habits. With a frontal
traction screw, and with elastic silicone joints in the canine
region, such an appliance would contract the front, but not the
(elongation) of teeth / use of shelves (tiny
close an open bite after
growth has finished, and
if it has
just developped by muscular imbalance,
the respective teeth need grips
to apply a force in extruding direction (the
image shows a dummy). But no need to make the grips
broader than required to pose a spring wire on them. Such tiny,
do not irritate, nor hamper cleaning. They are common in active
splint treatment (see below), for teeth which
can otherwise not be grabbed sufficiently to direct the desired
force to them.
the attachments give a
grip to the surrounding spring of a speech-friendly
constructed open plate, so that its extrusion force can be
transmitted. This principle can be transferred to extrude side
teeth if required, and the plate can bear further elements e.g. an
expansion screw. Compare with the discomfort of a common
extrusion method: rubber bands stretched between brackets or
buttons in upper and lower jaw.
can also be used to improve anchoring clasps in difficult cases
e.g. when teeth are not fully erupted.
(= pressing too long teeth more into
specimen shown here is intended for rather cosmetic
intrusion of the incisors. More often, re-intrusion of single side
teeth which have grown too long is required medically in
Here, removable appliances are hygienic, especially
for patients who have gum disease.
plates need good anchorage at all other teeth, or extensions which
allow to transmit the force of biting down just to the teeth which
should be intruded. When anchoring teeth lack, also in children
who lost many milk teeth at once, one-piece appliances could
be a better choice, e.g. prefabricated trainers like
the Muscle force Jaw shaper (see Kaukraft
Active orthodontic splints,
e.g. Invisalign or hand-crafted aligners
rather for permanent dentition
and are continuously developped further. They are no budget
method, but comparison of their price between several
systems often pays, or
even between doctors offering the same system.
set of many thin transparent aligner
splints is generated, each of which is some 0.2 mm
correcter than the previous. Adults
should wear each aligner full-time for 2 weeks. Part-time wear
will prolong the treatment, but may be straightforward for
Some gain of space
for crowded teeth is possible by narrowing
(stripping, slicing) the teeth, as has been done in this example.
In cases of open bite, little
tooth-coloured attachments can be included, similar as in
Extrusion (elongation) of teeth.
combination of hard and softer
splint materials can be helpful, because under continuous force,
orthodontic movements proceed rapidly in the first
14 days and then slow down because the surrounding tissue
exhausts. Certain dental
laboratories provide hard-and-soft
either as compound
aligners, or as hard and soft aligners to wear in turns. Both
would improve the recovery of the surrounding
tissue from orthodontic strain, and thus make the
treatment more comfortable and nevertheless fast.
list (in German) under
(Korrekturschienen) for recommendable
Plate with tongue attracting
malfunctions can cause teeth / jaw disorders.
Speech training can help more or less. The most violent method of
tongue correction are fixed spikes!
In sharp contrast, this
comfortable-feeling appliance mimicks
the morphology of the frontal palate by thin
silicone rubber, to give the tongue an almost natural surrounding
around a little hole, which is placed to attract the tip of
the tongue to its correct position.
Such a plate could perform
and alignment at the same time, e.g. with screws. If
the incisors were tilted forward (protruded) by tongue
thrusting, they can be pushed back by
tightening the frontal arch wire. For this, the rim of the plate
has to be shortened there, of course.
old text Headgear Plate: attaching a headgear to a
removable plate spreads its heavy force much wider than the
usual fixation to the first molars, which are menaced with root
(pain is always a warning!). Besides, some kinds of
coupled plates or function regulators have similar effect
as the headgear, but offer additional features for further tasks.
Be aware that the headgear is historically old and primitive.