Dr. rer. nat. Larissa Dloczik, Sellostr.22, D -
14471 Potsdam, GERMANY
tel. +49 (0)331
9513440, fax +49 1803
551863913 e-mail: firstname.lastname@example.org
prototypes of removable braces
is not a commercial
brochure for removable braces, but a collection of ideas and
prototypes, which could be developped into budget jaw orthopedic
solutions with low risk and high patient comfort.
Emphasis is here
just on their principles. The prototypes are not professionally
machined, are mostly not made on plaster models of realistic
cases and may comprise some wrong details.
of these appliances have only small plastic parts. These are better
made by casting a viscous plastic mixture, than by mixing plastic
powder and liquid on the model. Wax
boundaries prevent this mixture from covering adjacent parts which
should stay plastic-free.
The appliances are labelled with
F für early treatment,
J for treatment
beginning in late mixed dentition and E
for later and adult treatment.
Removable flexible lip bumpers
stimulate frontal upper or lower jaw growth in children in case of
crowing, without any danger of over-expansion and subsequent
relapse. and can keep molars in place.
Carefully placed loops
and bends allow to adjust the position of the bumper shield at the
patient, and to re-adjust it later for further correction.
flexible suspension of the shield, and even more the use of soft
silicone rubber there, enhances the activity of the lip muscles.
By this, it accelerates the desired correction without applying
any external force.
top to bottom:
1. Conventionally made shield for
lower jaw, containing 4 pre-fabricated triangular clasps. Two of
these rest with their other end on the molars.
for lower jaw with plastic surrounding the molars (here both 6 and
7). Reinforced by a frame of thin wire, this acts as clasps, with
the advantage that the suspension of the shield can be anchored
outside the molars and therefore does not need to cross the teeth.
The shield itself is quickly made of plastic around the suspension
and silicone rubber towards the lip pocket, auch schnell
herzustellen. 2 additional interdental springs come from inside
3. similar, but the plastic clasps surround just
the first molars, the shield is entirely of silicone and suspended
deep in the lip pocket, to stimulate growth of the jawbone by the
4. Combined screw expander and lip
shield (material like in 2.) for upper jaw with
conventional triangular clasps.
All these appliances must leave
the back of the jaw front free, to allow the tongue to enhance jaw
growth, while screening the force of the lips which reduces jaw
growth. Therefore, combination with an expansion screw is not
possible for the lower jaw. Instead, the inner wire arch can be
shaped as an expansion spring, as in the blue specimen under
lightweight spring expanders. Shield 2. has
also an expandable inner support, of which the back loops are not
not hinder speech and are easy to adapt for patients of any age.
Whereas the effect on adults is limited, larger expansions are
possible in children with time. This removable appliance does it
painlessly and economically. Any kinds of common clasps can be
used. The strength of the spring can be made as required by
choosing the thickness and the length of the bendings. The top
right specimen is for the lower jaw.
bottom right specimen contains a memory-screw, which
has a spring included inside. Plastic which extends over the side
teeth serves as clasps here. This could also be made by
thermoforming of plastic sheet.
For derotating individual
teeth, setup technique can be used here. Combination with silicone
rubber (3.) is recommended when doing this in a greater
anchoring teeth are too conical or not yet fully erupted, so that
the appliance fits only loosely, then tiny white attachments can
be glued to these teeth, as are common in Invisalign® or
similar therapies for certain cases. In contrast to bands or
brackets, these neither hurt inside the cheeks, nor hamper to keep
these teeth clean. The appliance will snap in firmly on them.
rubber in removable orthodontics
rubber can be stuck to plate appliances by use of a primer. Such a
plate can deliver a surrounding force to teeth which have been
aligned on the plaster model before (setup / aligner technique). This
rational technique would allow to correct tilted or twisted
teeth already in mixed
dentition, and would not require the manufacture of wire spring
elements (but allow the use of screw elements, if advised).
Derotations are also possible. If teeth lack a grip in the desired
direction of force, white
attachments can be added as a grip, see 2.
orange specimen, silicone comprises 8 lower teeth, to re-align a
beginning adult´s crowding, after slight stripping of these
teeth. In the blue specimen, it comprises 6 upper teeth, also from
both sides. This patient had a holistic treatment with prefabricated
elastic trainers before, but a slight frontal crowding remained
(perhaps no size of the trainers fitted perfectly). Moreover, his
occlusion retained his left
bicuspids in their visibly rotated positions. The
silicone furnishing shown here is for the first of 2 or 3 derotation
further application of compounding silicone to plastic is to increase
the efficiency of functional jaw orthopedic appliances, e.g.
activators against deep bite.
keep the silicone clean, it is recommended to brush it daily with
Find detailed instructions with further examples (in
German) from Fachlabor W. Paulus, Burgbernheim:
> Arbeiten mit Silikon
Recovery of lateral gaps:
simply built distal plate appliances
teeth can migrate forward into gaps of milk
teeth which were pulled too early, especially the lastmost milk
molar 5 (usable in case of lacking
Sometimes they migrate also in adults after a tooth was lost. Even
if the dentition changes normally, side teeth may push so much
forward that they leave hardly any space for
the important cuspids and are in poor occlusion.
simple transversal expansion would not solve these problems and
would be wrong here. Instead, the migrated teeth should be shifted
back against the tide (distalized) to the places where they
belong. At removable appliances, this requires good grips. Arrow
clasps in series (see inset in pink) are well-proven, but
difficult to make unless with special tools. Due to their
deep-grip, they are recommended if the grasped teeth should still
grow higher. But if not, then a good grip is easier to make by a
simple wire frame with surrounding polymer around those teeth
which are to be screwed back. This is shown here for a
half-closed milk-5 gap (transparent-blue plate) and against
crowding of the cuspids (red-yellow plate, should be modified when
permanent 5s grow). The polymer tenon in the residual gap was
simply cut through. It needs to be carved out gradually when the
permanent tooth appears. Additional claspy elements in the frontal
region are recommended, rather than a frontal bow. If both sides
require distalization, a lip bumper (see 1. above) can be
attached to the lower or also upper plate to relieve the frontal
teeth from counter-force.
The all-blue plate (Thanks to
) served for pre-prosthetic treatment by means of
purchasable 2-segmented sagittal screws on both sides. These avoid
opening gaps which are unnecessary but sensitive. In both jaws,
space could be shifted painlessly and rapidly from the end to the
cuspid region, where it often lacks.
to create space for crowded teeth, distalizing all side teeth
should be second choice, since it just shifts the lack to the
region of the wisdom teeth. Stimulating jaw growth during growth
phase would be healthier. A little additional space can be created
rather harmlessly by narrowing (stripping, slicing) the teeth, to
an extent which depends on their shape.
4-element progenic plate appliance
but straightforward treatment of progenic children has become
rare, negating our tradition of removable appliances and
functional jaw orthopedics (see in the case examples chapter for
more about it).
Early treatment is essential in progenic cases,
and a common (?) upper plate appliance can be equipped such that
it would help, as in the 3 proven samples shown below. All 3 of
them contain an expansion screw, 2 have two different types of
a downward bow to hold the lower jaw back, and 2 have different
protrusion springs or wires, which even allow to leave the
frontal palate uncovered in the blue specimen, for higher comfort
and for a healthy posture of the tongue. The
pink-transparent sample, which seems to have been used in late
mixed dentition, has little upper lip shields in addition, whereas
large upper lip shields are recommended for Fränkel´s
function regulator 3 (measure the depth of the patient´s
lip pockets, replicate it on the plaster model and use a
2 mm thick wax spacer thereon, to leave 2 mm of free path
for jaw development in forward direction).
The prototype of a
frontally open bite back-shift plate which is shown here on the
right combines all 4 of these active elements, to give a higher
performance. For light / early cases, elements can be omitted
according to the situation.
bears a re-adjustable downward
bow (taken from Tränkmann´s sample on the right
below), large shields and a couple of single-ended protrusion
arms, which should therefore have a diameter of at least 1,0 mm.
The sturdy expansion screw was imitated
from the blue specimen,
where it was intended to be unscrewed for up to 3 mm per month in
cases of severely narrow jaw, up to a maximum of 10 12 mm,
including overcorrection. For this purpose, the plate should be
well equipped with strong clasps, worn 20/24
h and be screwed 1/8 turning per day. Up to 3-fold
faster expansion was also observed with special expansion
screws which contain a spring inside. To profit from these here,
all frontal double-ended elements (downward bow, shields) should
be transformed into single-ended, to uncouple both halves of the
plate for unhampered expansion.
regard to their purpose, these retainers are durable and easy to
clean. They are also hygienic in the mouth, because they leave
most of the palatal surface free, so that its self-cleaning is
only little hampered. The plastic extends there just 3 mm over the
gums for the lower retainer and 5 mm for the upper retainer.
remaining refinements can be done by included springs (here for
the lower front) or silicone rubber (see above). The shown
specimens are just
first examples for a possible variety.
The lower retainer has a
backbone of 1.1 1.2 mm wire, which touches the
molars from both sides. The plastic comprises only the 5s to 3s in
this specimen. To ensure a firm snap-in, it therefore bears
additional ball clasps between the 5s and 6s. For the front,
plastic can also be used
from one or both sides, as
for the upper retainer here. The pair of connecting bars of this
preliminary specimen is
too thick, 0.9 mm wire instead of 1.1 mm would be sufficient, and
the frontal bar should cross the palate 1 toothwidth more
backward, for not interfering with the tongue.
construction assures a tight fit by surrounding all teeth. A wire
along the inside of the front could be added if needed. But mind
the narrow vertical clearance behind the backmost teeth when
letting a frame wire cross there. The more commonly built pair of
light retainer plates shown on the left avoids this. It was
provided after a treatment with aligner splints.