Fixed appliances II.Dr. Káldy Adrienn , Semmeweis University

• Head gear/facebow• Delair mask/ face mask• Fixed Class II. correctors• Lip bumper• Eva plate• Nance appliance• Pearl appliance• Habbit crib

Applied forces in orthodontics

• Orthodontical forces• dentoalveolar part

• periodontium• (cementum, periodontal

ligament, alveolar bone, gum)

• intraoral forces

Orthopedical forces– dental jaws

– maxillary bone sutures, caput mandibulae and symphysis

– extraoral forces

Classification I.• Extra- and intraoral• Intraoral :• Lip Bumper , ClassII correctors , Eva plate, Nance appliance, Pearl appliance• Extraoral( connteced to an intraoral part):• -Headger, Delaire- mask

Classification II.• Dentition:

• -Mixed dentition (Headgear, Delair mask, Pearl, Herbst, Habbit crib, Lip Bumper, Nance appliance)• -Permanent dentition ( Headgear, Forsus appliance,Eva plate, Nance appliance )• Fixed

• -Nance, Class II correctors, Habbit cribs, • Removable

• - headgear, Delaire-mask, Lip bumper

Extraoral forces- Headgear, Delaire mask

Extraoral forces- Headgear

• Can decrease the sagittal growth of the maxilla• can rotate the maxilla forward and backward• can push(slide) the dental arch in the maxillary bone• can rotate the upper occlusal plane• can distalise, extrude, intrude, back and front tilt the 6th• reinforce the anchorage• can be attached to removable or fixed appliances too (Headgear tube)

Headgear • Effects:

• -dentoalveolar adaptation(periosteum, proc.alveolar )• -skeletal adaptation ( sutures)• Forces:

• -orthodontic ( tooth moving ) periosteal ligaments• -orthopaedic ( jaws )force is appled to the teeth for transmission to the sutures ( more teeth in one block)

Extraoral forces- Headgear

• Parts of the headgear:• facebow

• rubber stripes

• modules

Extraoral forces- diversity in the parts of the Headgear

Occipital pull Cervical pull

Selection of headgear1. Anchorage location-facial pattern -headcap—superipor and distal force(high-pull headgear) -neckstrap-inferior and distal force ( cervical pull)

Selection of headgear2. How to attache to the dentition? -Fixed applaince, tubes on the permanent first molars( to correct the classII malocclusion by restarining the growth of the maxilla) -Removable appliance, splint or functional appl(children with vertically excesive growth )

Selection of headger3. What kind of tooth movement is desired?

Line of force through the center of resistance bodily moovement Line of force above or below to this pont tipping

Extraoral forces- tooth moving with Headgear• Moving the 6ths

• Decrease the maxillary growth

Extraoral forces- tooth and bone moving with Headgear

• rotating the jaw and the teeth

Extraoral forces- tooth and bone moving with Headgear• Base of the succes - the direction of the pulling• High/low pulling• Can be combined

Extraoral forces- some useful notes about Headgear• Daily wearing time cca.14 hours• Very effective in Angle class II.• Not only sagittal but also vertical treatment• Have use it carefully - eye injuries during the night• If the indication is only anchorage reinforcement - we can use orthodontical implant

Extraoral forces- Delaire mask/Face mask/ Reverse headgear

• Can increase the growth of the maxilla• Can mesialise the maxilla• Lean against chin and forehead• Skeletal effect - young age• Very useful in Angle class III.• Can be effective in cleft palate treatment

-Maxillary deficiency and mandibular excess ( better with true maxillary problems, not combinated)-Move the maxilla into a more anterior position-Bone is added at the posterior and superior sutures-Usually after transverse expansion-Up to the age of 10-Force is applied to the teeth for transmisson to the sutures-Obtains anchorage from the forehead and chin-Elastics attach to a maxillary appliance,maxillary teeth should be splinted together

10-year-old girl with maxillary deficiency

Small, posteriorly positioned maxilla

Cephalometric analysis

Splint Hyrax with hooks After expansion Protraction with Face maskTooth movement and skeletal changes350-450 grams per side for 12-14 hours per day

After 8 weeks of Face mask treatment

Tágítócsavaros kivehető lemezek

Both anterioposterior and vertical maxillary deficiency To move the maxilla into a more anterior and inferior position wich also increases its size

Class II. correctors-to correct the distalbite by pulling the mandible into a protruded position-the jaw repositioning is passive-force transmitted to the temporomandibular joint-condyle translates forward away from the temporal bone-the temporomandibular joint remodels posteriorly(bone is added to its posterior area) and the mandible is growing longer-both skeletal and dental effects

About timing

Indication• Class II/1• Class II/2

Herbst appliance -fixed with bands -very effective in altering jaw growth and eliminate overjet-full-time action-no need of patient cooperation-8-12 months-after a positive response it is possible to reactivate by increasing the tube lenght

Sideeffects• Distalization and intrusion of the upper first molars Loss of anchorage • Proclination of the lower incisors

Forsus appliance-used with fix appliance-connected to the head gear tubes of the first upper molar’s band and to the lower arcwire between the brackets of the canine and first premolar-telescope part is active with closing

• Liberty Bielle appliance • Jusper Jumper applaince

Applied with braces

Skeletal and dental effects: -posture the mandible forward-increase SNB, decrease ANB-distalize the upper teeth-eliminate the overjet-changes in the profile

Lip Bumper appliance -a labial appliance fitted to the tubes of the bands of the lower molars -constructed of 0,045 sst wire bow fitting to the lower arch and acrylic pad in the vestibulum-space regainer, holds the lee-way space-reduce the pressure of the lips -changes the muscle balance-eliminates the anterior crowding

Lip Bumper appliance-the plastic shield positioned facial to the incisor crowns without touching them-also used for moderate transversal expansion-periodically it needs to be advanced

presses against the lipstransmits force to move the molars posteriorly

alters equilibrium of forces between lip and toungeforward movement of the incisors

Increase arc lenght

12.

Eva platte-used with fix appliance-in deep bite cases to correct the deep bite and avoid the loss of brackets-fitted to the palatinal tubes of the upper molars (0,045 sst wire bow)-acrylic pads in the front palatal area-intruding the lower incisors-extruding the premolars and molars

Nance appliance -the palatal vault provides increased anchorage

- maintane the molar position while alignement of anterior teeth is completed- Extraction cases- Soft tissue irritaion-Acrylic button in the palatal vaultWire bowMolar bands

Bad oral habits, disfunctionsFunctional Influences on Dentofacial Development

Respiratory pattern-Mouth breathingThumb, finger suckingTonge thrusting, abnormal swalloing

Ujjszopó gyermek

Effects of thumb sucking

Habit crib- habit breaking appliances-cemented to primary or permanent molars with bands-extended anteriorly-0,028-0,036 wire bow-remind to interrupt a finger sucking habbit-retrain thr toung-interfer with the finger position during sucking -good for toung thrusting -trains the tongue to rest in its normal superior position

Pearl applianceEffective in cases with functional insufficiency-spinning the pearl at least 20 times a day-retrain the toung, correct the speech