Removable therapy

Removable therapy

Introduction

Is it still necessary to use removable appliances when multi-attachment fixed appliances are remarkably precise and effective ?

The answer is yes, because removable devices are irreplaceable in early or orthopedic treatment.

They present fewer iatrogenic risks than fixed devices.

Allows you to perform simple movements.

Also used as restraint.

Given the removable nature of these devices, patient motivation will be a critical element in the success of treatment.

1. Removable orthodontic appliances:

Resin plate which secures retention means and active means , the resin can also form molar or incisor elevations.

The most easily achieved tooth movement is coronal version.

Rotation, intrusion and root version (torque) movements are more difficult to perform.

1. Mechanical principles:

Any force applied to a tooth (without fixed appliances) will cause a version of this tooth around a point located approximately at the apical third of the root called the hypomochlion.

The point of application of the force is virtually punctate, unlike brackets for which it is a support surface . The force is therefore poorly controlled.

Force type: Light forces gradually decreasing.

2. Indication:

These devices will be used especially in young children with primary or mixed teeth and sometimes in young adults (simple cases).

They allow:

• Correction of a coronary version 
• Correction of rotation: on flat teeth (incisors).
• Egression movement: using a spring on a removable appliance, supported by a glued attachment (component of linguo-version or associated vestibulo-version): placement of a tooth in vestibular ectopia.
• Space maintenance: premature loss of the 2nd temporary molar.

3. Description: 

a) The base plate:

material: the plate is made of self-polymerizing resin; contours of the plate: it follows the contour of the necks and covers them by 1 or 2 mm; average thickness of the plate: 2 mm.

 It will be necessary to particularly check the anterior thickness, at the level of the lingual supports, during phonation.

The posterior area is largely clear.

(b) Anchoring and stabilization means:

Anchoring methods

The anchor hooks of a removable plate are made of 7/10 mm hard steel wire. Their end is rounded.

Single hooks: fitted under the largest contour of the tooth.

Saddle hooks: prefabricated or shaped (addition of a solder ball).

Removable therapy

Means of stabilization:

Main hooks on first permanent molars (ADAMS hooks).

• Crushing spurs: prevent the lower plate from sinking.
• Vestibular bands: 7/10ths hard (or 8/10ths ^soft ).

The resin, in addition to its role of maintaining hooks and devices, can also be used to distribute reaction forces, guide movements, block a movement that has been made and raise the occlusion.

c) Active means:

The springs:

— anterior palatal springs (Schwartz spring type).

— lingual unit springs 

— vestibular springs: canine and incisor egression springs;

— active vestibular arch.

• The cylinders : median, asymmetrical, lateral.

Included in a two-part split plate, moving away from each other when the v-cylinder is activated.

2.  Orthopedic action devices  :

Improve bone base ratios.

During the growth period. The ideal age is between 7-9 years and 12-13 years. Beyond that, the orthopedic action is more random and concerns the alveolo-dental structures.

Require greater patient cooperation. (bulky).

1. Activators

An activator is a device that induces a position of the mandible, different from that of maximum intercuspation occlusion or mandibular rest.

1.  Rigid activators:

a) Rigid monobloc activators :

These devices, rigid and non-deformable, have a resin interposition which dictates an advanced biting position to the mandible.

• They are distinguished by their framework which fixes the bite position thanks to the interposition of resin and which transmits to the facial mass the functional response to the therapeutic mandibular position.
•  This is the “activator effect”

2. Composite elastic activators:

• These activators solicit the musculature to reflexively propel the mandible; thus the propulsion is created by a physiological mucosal reflex. Ex: Bimler activator, Frankel function regulator

3. Thrust activators with stop:

These devices propel the mandible by mechanical guidance of elements attached to the maxilla and the mandible and force it to move forward during the closing movement. Ex: Herbst rods on gutters.

4. Soft activators:

It was thanks to these advances in the field of plastics that Gugino and Yoshii thought of using the elastic properties of a material to construct flexible devices from injected elastomer: polyvinyl silicone.

The device consists of a bimaxillary splint, the construction of which is carried out from a therapeutic model which integrates the orthopedic and/or orthodontic treatment objectives, considered and defined by the practitioner for the patient concerned.

3. Removable rehabilitation devices:
4. Nighttime lingual envelope:

It will act as a functional lingual re-educator and therefore as a dento-alveolo-skeletal corrector.

1. Language guide” or “pearl” of Tucat:
2. Removable retention devices:
3. Limitations of removable therapy:

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 stem from a good diagnosis;

Once the diagnosis has been made, we will then be able to compare it with the mastery of the technique.

• 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.

Removable therapy

6. Removable device port:

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 of the patient.

Due to its volume, the device 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 device is worn regularly.  

 The patient must follow the instructions for maintaining oral hygiene and maintaining the device.

Removable therapy

Untreated cavities can damage the pulp.
Orthodontics aligns teeth and jaws.
Implants replace missing teeth permanently.
Dental floss removes debris between teeth.
A visit to the dentist every 6 months is recommended.
Fixed bridges replace one or more missing teeth.
 

Removable therapy