Removable therapy
Plan :
Introduction
Advantages of removable therapy
Disadvantages of removable therapy
Principles and mechanisms of action
The components of a removable device
Indications for removable therapy
Contraindications and limits
Installation of the removable device
Wearing and maintaining the device
Introduction
It is the set of orthodontic mechanisms which consist of correcting dental malpositions and arch shapes as well as correcting the occlusion using removable devices.
Most often they are made of resin and metal, they can be removed, cleaned, dental hygiene is simpler with less risk of cavities.
These devices, when used judiciously, can correct a large number of anomalies that we encounter in daily practice. There are many removable devices in dentofacial orthopedics; they can be active working instruments or retention instruments; their actions are limited to version movements because the force exerted is applied at a distance from the center of resistance of the tooth.
Advantages of removable therapy
1- Allows us to correct a large number of anomalies that we encounter in daily practice.
2- Entirely achievable in the practitioner’s office with little means.
3- Relatively low cost price.
4- In orthodontic therapies, the devices can be made according to the shape and especially the color chosen by the patient.
Disadvantages of removable therapy
1- Indication limited to coronary versions.
2- The force exerted is poorly controlled (Point of application).
3- Risk of occurrence of parasitic movements and other complications.
Principles and mechanisms of action
Mechanical removable appliances generate simple, poorly controlled forces.
The applied force is exerted at a distance from the center of resistance of the tooth with a rather punctate point of application. Consequently, the movements caused will therefore be limited to vestibular or lingual versions, or mesial or distal or to unitary egressions.
So no translation is possible, the apices cannot be moved, nor ingressed, nor egressed on a sector.
Description and materials used
Materials used:
Stainless steel wire:
Must be worked and used in the condition it is in at the time of purchase.
When subjected to a sharp bend and unbent if this bend is not well placed; however, the wire cannot be bent again in the same place without risking fracture
Acrylic resins:
Acrylic resins are used for the production of plates, screens and functional devices:
Hot-cured acrylic resins.
Self-curing acrylic resins.
Removable appliances include:
A base plate.
Means of retention.
Means of action.
Upper base plate:
It covers the entire hard palate with a layer of resin approximately 2 mm thick and perfectly fits the palatal surfaces of the teeth at the necks. The thickness gradually decreases so that the posterior limit is not felt by the patient during phonation.
Lower base plate:
The plate fits like a horseshoe in the mandibular arch, the lower edge must be carefully rounded so as not to injure the floor of the mouth and to free the insertion of the lingual frenulum forward.
Variant:
Changes in the shape of the plaque can be noted, which will be carried out for therapeutic purposes:
1/ The addition of a raising plane in the retro-incisal zone
2/ Clearing the retro-incisal area
3/ The anti-tongue grid
4/ The addition of a raising plan in the rear sectors
Retention means: They are made of round stainless steel wire 0.7 mm in diameter.
The single crochet:
It contours the tooth along the marginal ridge and ends by extending beyond an angle of the tooth to provide light retention at the crown. It is used when the tooth does not have sufficient crown height.
The ADAMS hook: This is a molar or premolar retention hook made from 0.7mm diameter stainless steel.
Advantages of the ADAMS hook:
– Retention on an isolated tooth.
– Little contact with the enamel therefore reduces the risk of decalcification and caries.
The cavalier hook:
It comes from the same principle as the ADAMS hook, it is placed on the proximo-vestibular side.
The Schwartz ramp or arrow hook: The ramps have one, three or preferably two lanceoles.
Means of activation:
The plate causes movements through the effect of the springs and through active modifications of the resin base.
The jack: This is a prefabricated mechanical device that rests on the edges of a slotted plate. Depending on the direction of activation, it will either bring the edges of this plate closer together or spread apart. This device allows movements to be made in the transverse direction and, incidentally, in the anteroposterior direction.
Active hooks or springs:
They are made with a 0.6mm diameter wire with the exception of the vestibular arch and the canine retractor which can be made with 0.7mm.
Vestibular arch:
It is applied to the vestibular faces of the 4 incisors and has a U-shaped compensation loop at the level of each canine, this loop allows the element to be activated by its closure; behind the canine it bends in the buccal direction to end in the base where its ends are embedded.
It can have multiple roles:
Lingualization of the anterior block.
Prevent movement of teeth in the vestibular direction (retention of previously moved teeth) Provide additional retention due to the friction created on the teeth with which it comes into contact.
Removable therapy
Removable therapy
The canine and premolar retractor:
Made of 0.7mm stainless steel wire, it is formed of two vestibular arms, one is active and the other passive linked by a coil. The active arm is placed on the mesial face of the canine and the end of the passive arm is embedded in the base plate.
The mesialor and distalor:
It allows the mesialization or distalization of the incisors Simple straight cantilever: Allows the mesialization or distalization of the molars and premolars.
The vestibule or Schwartz spring:
It is a palatal or lingual hook with a slightly rounded anterior part in contact with the palatal or lingual surface of the incisors to be vestibulated.
Lingual unit spring = Serpentine
Made of 0.6mm stainless steel wire, it allows you to vestibulate an incisor.
Rigid spring for lingualizing canines and premolars:
Made of 0.7mm stainless steel wire, it allows the palato (lingo) version of canines and premolars. Similar to a canine retractor, except that here the active arm is pressed against the vestibular face instead of the mesial face.
Indications for removable therapy:
Removable therapy may be indicated in the following cases:
Orthopedic treatment
Alveolo-dental treatment
Functional treatment
Restraint device
Contraindications and limits:
Related to the practitioner:
This is the inability of the practitioner to know or be able to, on the one hand, properly carry out the equipment and, on the other hand, to make a good diagnosis. Indeed, like all other medical disciplines, no therapeutic method is effective if it does not result from a good diagnosis ;
Once the diagnosis has been made, we will then be able to compare it with the mastery of the technique.
Related to the device itself:
Removable appliances are so-called simple appliances because at the level of the teeth, they only allow version movements to be carried out compared to multi-bracket techniques which allow gression movements to be carried out.Also, it will be contraindicated to use the device every time it is necessary to perform dental gression movements.
Patient related:
A good motivation of the patient is necessary for him to wear the appliance constantly. This is one of the most important conditions for success in treatments with removable appliances. The inability to maintain good hygiene is a valid reason to stop treatment. The patient’s hygiene will deserve or not his plaque.
Installation of the removable device:
Removable plates must be worn day and night, outside of meals. This particular aspect of wearing these devices outside of meals is justified to promote dental contact and also for the comfort and convenience of the patient.
Wearing and maintaining the device:
The patient and his parent are instructed on how to put on and take off the appliance, and they are also given or reminded of the instructions on maintaining oral hygiene and maintaining the appliance. Due to its volume, the appliance causes discomfort during the first few days that the patient wears it. This discomfort will be better accepted if the patient is informed about it in advance and will disappear all the more quickly if the appliance is worn regularly.
Removable therapy
Wisdom teeth can be painful if they are misplaced.
Composite fillings are aesthetic and durable.
Bleeding gums can be a sign of gingivitis.
Orthodontic treatments correct misaligned teeth.
Dental implants provide a permanent solution for missing teeth.
Scaling removes tartar and prevents gum disease.
Good dental hygiene starts with brushing twice a day.