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 cuspid had to stay 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 had narrowed to great extent. But instead of
re-expanding this space 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 was hampered, because the visited orthodontist was
one of that kind who make all patients first wait until all milk
teeth are gone. This strategy aggravates all cases more or less,
which increases the profit of 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 painful fixed bracket braces.
rarer specialists of gentle treatment offered mainly Crozat
appliances (see below), which were however rarely covered by
health insurance here.
with additional clasps (Voss plate): expansion, distalization,
develop a narrow jaw or a crowding of side teeth into a healthy
situation by means of a plate, this appliance requires screws in
the right positions. Moreover, it needs sufficient anchorage for
efficient transmission of their forces. Additional clasps at both
sides of the screw prevent the plate from lifting off when it is
screwed further and further, that means that it loses its proper
fit and that part of its force falls flat.
In this sense, the
first photo shows a typical vampire canine teeth situation, where
the narrowed gaps have already been re-gained. It is presumably a
Y plate (see below) which bears additional clasps on the 2s and 4s
here, and also guide wires for the cuspids which now are free to
The next photo shows a used plate expander with
additional clasps on the 2s. It had expanded the upper jaw by
approximately 5 mm even in this stage with no more milk teeth
left. Also the green specimen
under Plates for single-sided expansion
against single-sided crossbite has additional clasps.
b/w photo shows a successful re-distalization of 3 teeth which had
shifted forward. This plate contains a further screw for
simultaneous expansion, which was not used here. Teeth often
migrate forward when milk teeth are destroyed before their
successors are ripe, and narrow their gaps as it is displayed in
the sequence below: the gap for the cuspid is narrowed to 1/3!
Only 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, which was
able to re-gain 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 technique. In contrast,
manufacturers of countless fixed distalizers and bone
piercing (micro-implantat anchorage) engage reputable
speakers for courses in which they promote these risky and forced
techniques, which endanger children as well as adults.
plates, Z plates, Bertoni plates
to their large
roots, cuspids (canine 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 gain space for the cuspids. Their gaps can nicely
be expanded by the plastic ends of the screwed segments. These
have to be shortened little by little when the cuspid grows in or
is being aligned.
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 cuspids above obviously also wears 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 can be used like a Y or Z plate to shape the
In addition, it is equipped to derotate the
canine teeth, which are rotated by lack of space, already
while the space for them is under way to be recovered. Such are
the details which make the difference between high-value
plates for removable treatment and plates which are only for
preparing fixed braces. 3- or 4-way screw elements in various
sizes exist also for lower jaw plates.
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
.. cuspid had to stay trapped: only treatment with
extractions or with a headgear is offered there, or sometimes with
more 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 the
Compare all these options to wearing a segmented
distalization by screwed segments: (pre-prosthetic)
adult treatment; impacted cuspids
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
inside the plastic behind the incisors.
the next, younger example, the canine teeth stayed impacted in the
jawbone (as do impacted wisdom teeth sometimes without harm).
first, sufficient space was created for them with the violet
distal plate shown here and a subsequent one, by pushing teeth
forward as well as 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). There, also 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
well, it is advisable to choose the frontal screw bigger.
the required space was provided, one cuspid 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 20ies
of the last century, before plastic era. Wire elements of
different thicknesses were soldered together to light 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.
Experts, which become nowadays rare,
perform full treatments not only of simple cases with these
appliances, 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 almost no discomfort.
of the plenty of orthodontic late cases (= teenagers
and adults) being, 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).
old and recent Crozat cases in my case examples
type and upgraded Crozats
between Crozat and plate appliances can be built economically out
of 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 more human.
In contrast to plate appliances, normal
Crozats have just 2 clasps, which are in the molar region. Because
Crozat appliances were originally intended to give teeth just
stimuli in the desired directions, and to leave them otherwise
free to find their anatomic positions. Of course, Crozats can be
built with more clasps, but that could hamper this original
intention. Moreover, in some cases it cannot be judged in advance
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 better.
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 covers 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 (if
machine available). For children whose side teeth may change, on
the other hand, ordinary clasps are preferable.
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, see Lightweight
Even more than 4 -5 mm width can be gained in children
by removable expanders, with no need of splitting the palatal
suture or other cruel treatment. Such widespread forced methods
are due to an inhuman hurry and to a neclect of loving care.
the 6s are too conical or not yet fully erupted, so that these
appliances fit too loosely, then tiny white attachments could be
glued to these teeth, 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 as firm as an aligner splint (see
below) on these attachments.
In contrast, the fixed quad helix,
which is marketed as intensively as the devices for to brutal
palatal splitting (Hyrax et similar), disturbs swallowing, speech
and chewing. Every bit gets stuck
in its coils, and the tongue becomes sore by always scratching
Find victims´ reports in the Less
for single-sided expansion (really!)
an approximate force distribution of 2/3 to 1/3, to correct a
single-sided crossbite that has already grown-in. For single-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, and the fixed,
pre-fabricated quad helix which is nowadays advertised disturbs
swallowing, speech and chewing (see examples in the less
disturbing kinds... chapter) and moreover, has more relapses
than expansion plates have.
Both specimens here are
The green belongs to a 8-yr girl who
was threatened by rapid palatal
expansion (RPE) elsewhere. To unlock the wrong occlusion,
this plate extends over the side teeth. Many 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 cuspid.
specimen, which could also be equipped with further elements or
coverage of side teeth, has a simple, big expansion screw and
another solution for more continuous force delivery: the contact
zone to the teeth which are in crossbite consists of silicone
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 front teeth profits from
skillful removable treatment. The screws act from one side and the
frontal wire from the other, to untwist these teeth. Note also
that the expansion screw is already expanded by about 5 mm!
the 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
Find more details in the expl. of cases
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), and silicone rubber is molded around them onto the
outer framework and the distant inner plate border.
Such plates are much smaller than the common elastic
positioners, which are used when fixed braces gave no
good result, but can also be applied independently.
such a plate would allow larger alignments / untwistings with
litte effort, just by 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 correction by
Thermoformed splint for fine correction
of lower incisors, manufacture: At
first, a soft spacer splint is molded over the teeth of the
original plaster model which are to correct (the one with the blue
stripes here). The larger the required corrections
are, the thicker this material should be.
This part is cut to size and remains adjusted to the model while
the final, hard splint is molded. Then, this is cut to shape, and
the spacer is taken out.
Next, a set-up of these teeth is made,
and silicone rubber is filled around them into the void of the
splint which was created by the spacer.
Plate with silicone rubber
for upper front correction to a greater extent, an
At first, the silicone presses the teeth only there where larger
movement is required. The other regions of these teeth on the
plaster model are filled with wax. This allows the silicone of the
first run of the final appliance to expand to the sides while
squeezing frontally as
Depending on whether the silicone has point
contact or full contact to these teeth, it will move them rather
tipping or rather bodily. The plate can moreover be equipped with
For the second run of the appliance, the same set-up
model can still be used. But now, all void is filled with
silicone, no more wax. Note well that it acts from both sides
here: instead of just a frontal wire, the plate has a plastic
shield before the incisors, which bears also silicone inside.
discomfortable additives for fixed braces
original add-on parts for US style multibracket
techniques pay hardly 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 spreads 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 as well as children. In contrast, they are
completely useless for removable techniques! But nevertheless,
removables are frequently abandonned.
with less discomfort or danger are obvious to
those who are familiar with removable techniques, in
particular with plate appliances, as single jaw treatment is
concerned. 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.
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 things.
screw, fan screw or spring expander (find more about this under
prototypes). Instead of quad helix or
splitting of the palatal suture (for these, see victims´
reports in the less
disturbing kinds of braces chapter).
of front teeth: plate with protrusion springs / screws instead
of disturbing lingual arches.
shift) of the last molars: segmented plate with distal screws,
instead of headgear, lip bumper, pendulum, distal-jet or other
such fixed instruments.
correction and vertical deviations (deep bite, open bite),
prefabricated trainers are available, also such which are
compatible with multibracket appliances (T4B = trainer for
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 parts.
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.
from the (orange-coloured) T4B, which resembles the Muscle force
Jaw shaper in shape (find instructions under Kaukraft
Kiefer-Former), but has a groove 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 have an arch shape which is somewhat more tapering than
exterior plate (buccal plate), e.g. for gap closure if teeth are
This wears comfortably
because without plastic parts inside. It is described in
literature only for the lower jaw and has advantage for
straightening of 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.
if it is nowadays told with commercial interest that this task
would require fixed braces to be solved properly, look in the case
reports for successful removable treatments of such gaps.
Spontaneous gap narrowing by forward migration of the molars
should be allowed for before fitting an appliance. Moderate speed
when screwing or light force when using springs (also with Crozat
appliances which would be suitable here) are crucial for tilt-free
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 bad tongue habits. With a frontal
traction screw, and with elastic silicone joints in the cuspid
region, such an appliance would contract just the front and not
the whole arch.
(elongation) of teeth / use of shelves (tiny
close an open bite after
growth has finished, grips are
required at the respective teeth to apply a force in extruding
direction (the image shows a dummy). But no need to make them
broader than required to pose a spring wire on them. Such tiny,
do not cause irritations, nor hamper cleaning. They have become
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 how comfortable a common extrusion
method is: 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 side teeth
which have grown too long is required medically in pre-prosthetic
treatment. Here, removable
appliances are of hygienic advantage
especially for patients who have already reduced,
Intrusion plates require 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 an alternative, e.g. prefabricated trainers like
the Muscle force Jaw shaper (see Kaukraft
orthodontic splints (aligners): Orthocaps, Invisalign or
hand-crafted contact lenses for the teeth
rather for adults and older teenagers and not a budget
solution, but continuously developped further. A set of dozens of
thin colourless splints is generated, each of which is some 0.2 mm
more correct than the previous. Each is to wear in
full-time wear for 2 weeks. Part-time wear will prolong the
A moderate space
gain for crowded teeth is possible by
narrowing (stripping, slicing) the teeth, as has been done in the
example here. In
cases of open bite, little tooth-coloured attachments can be
included, similar as in Extrusion
(elongation) of teeth.
Other systems use a
combination of hard and softer splint materials, and are
continuous force, orthodontic movements
proceed rapidly during the first 14 days and then slow down
because the surrounding tissue exhausts. The system Orthocaps
prevents this exhaustion by using hard and soft splints
in turns. Here, the whole treatment consists of up to 8
possibility to profit from this orthodontic chewing
gum effect is offered by certain dental laboratories which
manufacture orthodontic hard-and-soft
turns or in one, the combination of hard and
soft material improves the recovery of the surrounding
tissue from orthodontic stress. This makes
the treatment more comfortable and nevertheless rapid.
Plate with tongue attracting
malfunctions are a major cause of teeth / jaw disorders.
Speech training can help more or less, but the most violent method
of tongue guidance are fixed spikes!
In sharp contrast, for
this comfortable-feeling appliance the morphology of
the frontal palate has been replicated in thin silicone rubber, to
give the tongue an almost natural surrounding around this
little hole, which attracts the tip of the tongue to its
Such a plate could perform further
corrections at the same time, e.g. with screws. If the incisors
were tilted forward (protruded) by wrong tongue
activity, they can be pushed back by
tightening the frontal arch wire. For this, the border of the
plate has to be shortened there, of course.
old text Headgear Plate: using a headgear with a
removable plate spreads its force much wider than the usual
fixation to the first molars, which are then menaced with root
damage (pain is always a warning!). Besides, some kinds of coupled
plates or function correctors have similar effect to the headgear.
They are more difficult to construct, but offer features for
further corrections. Note well that the headgear is