Professional Documents
Culture Documents
Orthodontic Appliances
Second edition
GORDON C. DICKSON
B Ch U (Leeds).F D S, D Orth, R C S (Eng)
Orthodontic Consultant to the
Portsmouth Hospital Group
ALBERT E. WHEATLY
F B I S T. M O T A
Chief Technician, Dental Wing, Royal
Portsmouth Hospital
Turkish Power
OrTHoTaMiNe Tarafından
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CONTENTS
THE M A T E R I A L S
Acrylic resin
C L E A R acrylic denture base is used for the construction
of all appliances, chiefly as it allows blanching of the tissues
over pressure areas to be detected visually, and also
because it shows more clearly when f o o d debris has
collected around the springs.
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THE TOOLS
1. Universal pliers
These are used for all wire bending w i t h the exception of
the f o r m a t i o n of loops or coils. The beaks are s t o u t ,
tapered and rectangular in section, and meet o n l y at the
tips. Beaks which are in contact throughout their length
tend to eject a large diameter wire (Inset A ) . The beaks
of Universal pliers are parallel when gripping the wire
(Inset B). When the pliers become worn they should be
resharpened, maintaining a beak size of 1 mm square at
each t i p and c u t t i n g back so that a 0 . 6 m m wire can be
passed between them at the base when the pliers are
closed.
2. Loop-forming pliers
These have r o u n d , tapered beaks around which loops or
coils of various sizes may be f o r m e d .
3. Wire cutters
The diagonal type of wire cutter is used and must have
hardened blades.
4. Hollow-chop pliers
Used for making bends in wires which are already
anchored at b o t h ends in an appliance, these pliers have
one beak round and the other h o l l o w e d so as to wrap
round its opponent. They therefore exert pressure
simultaneously at three points on the wire. They may
also be used for increasing the bend in the labial canine
retraction spring shown on page 82.
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WIRE BENDING, 1
Soft curves
For labial arches of all kinds, smooth curves are formed
by holding one end of the wire firmly on one hand and
forming a curve with the thumb of the other hand. The
thumb is then drawn firmly along the wire, creating a
smooth curve of large radius. Repeating the process will
increase the curve to any desired extent. Avoidance of
the use of pliers will ensure a bend without kinks.
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WIRE BENDING, 2
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WIRE BENDING, 3
Acute bends
These are formed by holding the wire along the beaks of
the pliers and bending firmly back with the forefinger.
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WIRE BENDING, 4
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CONSTRUCTION OF THE ADAMS CLASP, 3
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C O N S T R U C T I O N OF T H E A D A M S C L A S P , 7
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Materials
All clasps are made with 0.7mm wire.
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Construction
Adams clasps 0.7mm stainless steel wire
Extraoral arch: 1.25mm wire
Tubing. 1.25 internal diameter stain-
less steel
Attachment of tubing Strapping with 2.0 x 0.1 mm
stainless steel tape or binding
with soft wire and soldering
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A L T E R N A T I V E CLASPS
Materials
B o t h clasps are made f r o m 0 . 7 m m stainless steel wire.
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THE EFFECT OF A FINGERSPRING
A. On the tooth
Owing to the tact that the palatal surface of an upper
incisor tooth has a downward and forward slope, it acts
as an inclined plane and the horizontal forward thrust of
a fingerspring is convened into an upward and forward
thrust. In the case illustrated in diagram A the palatal
surface is at 60 c to the horizontal and the thrust may be
divided, as shown by the length of the lines, into an
upward component of two units and a forward com
ponent of three units
B. On the appliance
Reciprocally, in accordance with Newton's Third Law of
Motion, the tooth exerts a backward and downward
force on the spring, as represented in diagram B. It
follows that the clasps on such an appliance must be
placed, not only to resist the backward thrust of the
tooth, but also to resist a considerable downward dis-
placing force.
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R E S I S T A N C E TO D I S P L A C E M E N T , 1
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RESISTANCE TO DISPLACEMENT, 2
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Direction of pressure
B. As friction between the spring and the t o o t h can be
ignored, the direction of pressure will always be at right
angles to the a r m of the spring and, if the spring has to
work over a l o n g angular range, this will change con-
siderably during t o o t h movement. The path traced by
the t i p of the spring is k n o w n as the Path of A c t i o n .
C. The longer the arm of a spring the greater will be its
range of action. A short spring not o n l y has a short
range of action but, as it moves, its tip describes an arc
of a small circle. As its length increases so this arc
becomes straightened and its path of action is nearer to
a straight line. As length increases, so the spring must be
made of thicker wire to exert the same force,
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BOXING-IN
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P A I R E D C A N T I L E V E R SPRINGS
Construction
Springs: 0.5mm boxed-in
Clasps: 0.7mm
Retention: Adams clasps on 64/46
Baseplate: Continued over all check teeth as capping
Inset A
This lateral view shows boxed-in spring and just
sufficient clearance to allow the upper incisors to move
f o r w a r d w i t h o u t f o u l i n g the lowers.
Inset B
A double cantilever spring may be used as an alternative
for the same t o o t h movement ( 0 . 6 m m wire), b u t this
requires a greater degree of skill in adjusting.
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Construction
Springs; 0.5 mm boxed-in
Clasps: Adams clasps on 64/46
Baseplate. Full palate (capping on cheek teeth if
the lateral incisors must pass over the
bite)
Inset A
Lateral movement is produced by opening the right-hand
coil
Inset B
Forward movement is produced by opening the left hand
coil
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Construction
Spring: 0.6 or 0.7mm boxed-in
Clasps: A d a m s clasps on 6 4 / 6
Baseplate: Full palate (capping on cheek teeth if
the canine must pass over the bite)
Inset
The position of the spring at completion of tooth move-
ment
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Construction
Left side Right side
Springs: 0.6mm 0,6mm with guide wire
boxed in
Clasps: Adams clasps Adams clasps on 6/6
on 6/6
Baseplate Full palate Full palate, cut away
to expose spring
Inset
The spring must follow as closely as possible over the
contact point.
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P A L A T A L MOVEMENT OF PREMOLARS A N D
MOLARS
Materials
Clasp: 0.7mm
Spring: 0.6mm
Tape: 2 . 0 x 0 . 1 mm
Solder and flux
Construction
Springs: 0.6mm
Clasps: Adams clasps on any cheek teeth not
being moved
Baseplate: Full palate, cut away to allow palatal
movement of teeth
Inset
This shows the level of the a r m of the spring and the
large coil in an alternative design where the spring is
attached to the molar clasp.
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Construction
Springs: 0.6mm
Labial arch: 0.7mm
Guide wire: 0.6mm
Clasps: Adams clasps on 6 / 6
Baseplate: Full palate in A
Full palate cut away in B
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Construction
Springs: 0.6 or 0 . 7 m m
Guide wires: 0 . 7 m m
Clasps: Adams clasps on 6/6
Baseplate: Full palate, cut away to expose springs
and if necessary carrying bite platforms
on all the cheek teeth to allow the
canines to move over the b i t e
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Construction
Spring: 0 . 6 m m boxed-in
Clasps: Adams clasps on 6 / 4 6
Space-holding clasps on 4 2 / : 0 . 6 m m
Baseplate: Full palate, with cut-away in cover for
spring. Bile platforms where necessary
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D I S T A L M O V E M E N T OF CANINES
Inset
To avoid sliding d o w n the mesial slope of the canine the
spring is carefully bent so as to f i t between the lateral
incisor and canine and to take advantage of the flat
mesial surface of the t o o t h . Once movement has begun
it can be m o d i f i e d to fit r o u n d the neck of the t o o t h .
Construction
Springs: 0 . 7 m m boxed-in
Clasps: Adams clasps on 6 / 6
Baseplate: Full palate
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Points to note
1. The end of the spring should be bent at a r i g h t angle
before being shaped to the curve of the t o o t h , like a
golf-club.
2. The loop should lie as high as possible in the sulcus
w i t h o u t interfering with any f o l d of soft tissue
c o m m o n l y f o u n d in this area.
3. The tag should lie as close as possible to the second
premolar, and the posterior arm should not cut across
the first premolar position where it would interfere
w i t h retraction of the canine.
Construction
Spring: 0 . 7 m m wire or 0 . 6 m m sleeved (see page 84)
Retention: Adams clasps on 6 / 6
Baseplate: Full palate, cut away to allow movement
of canines
Inset A
Shows (1) Posterior arm in contact w i t h second pre-
molar and passing over the contact point of
this t o o t h .
(2) Golf-club end of anterior a r m , sharpened at
tip.
Inset B
Shows (1) Path of action.
(2) Clear area behind the canine, unobstructed by
the spring.
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Materials
Spring: 0.6mm hard polished stainless steel
Sleeve: 0.6mm internal diameter soft (annealed}
stainless steel tube
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T H E C U T - A N D - B E N D SPRING
Construct ion
Spring: 0.6mm
Clasps: Adams on 6/6
Baseplate: Full palate
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Construction
Springs: 1.0mm wire thinned to 0.6mrn
anodically
Retention: Adams clasps on 6/6
Baseplate: Full plate, c u t a w a y b e h i n d 2/2
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T H E SVED B I T E P L A T E
Construction
Springs: 0.6mm sleeved
Retention: Adams clasps on 6 / 6
Baseplate: Pull palate and covering tips of upper
incisors, thickened to f o r m bite plane
Inset A
This shows relationship of lower incisors to bite plane
which must be extended sufficiently to make it
impossible for the lower incisors to bite behind it. It is
necessary to m o u n t the models on an articulator for this
purpose
Inset B
Should this open the bite on the check teeth by more
than 3 or 4 m m , the plane should be lowered, and later
in treatment it can be raised by adding c o l d c u r i n g
acrylic resin.
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THE L A B I A L ARCH
Construction
Labial arch: 0 . 7 m m wire
Retention: Adams clasps on 6/6
Baseplate: Full palate
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Construction
Labial a r c h : 0 . 7 m m wire
Retention: Adams clasps on 6 / 6
Baseplate: Full palate, thickened a n t e r i o r l y to
f o r m bite plane
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Construction
Retractor: 0.5mm wire sleeved in 0.5mm internal
diameter soft stainless steel tubing
Spurs: 0.6mm wire
Retention: Adams clasps on 6/6
Baseplate: Full palate
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Materials
0.5mm hard polished stainless steel wire
0.5mm internal diameter bright annealed
stainless steel tubing
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APRON SPRINGS
Construction
High labial arch: 1.0mm wire
A p r o n spring: 0.35mm
Retention: Adams clasps on 6/6 w i t h
ancillary arrowheads on 5/5
Baseplate: Full palate
Inset B
Shows an individual apron spring to retract a central
incisor. Here the spring is strapped on to the arch by
stainless steel tape which is welded tightly r o u n d both
wires. The spring is w o u n d r o u n d the high labial arch
on both sides of the strap and again, loosely, at the
opposite end of the apron spring.
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MORE V A R I A T I O N S O F THE L A B I A L A R C H
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Construction
Inverted labial arch: 1,25mm wire anodically
thinned to 0.8mm wire or
sleeved as shown in Inset C
Palatal springs: 0.5mm wire boxed-in
Retention: Adams clasps on 64/46
Baseplate: Full palate and covering all
cheek teeth sufficiently for
upper incisors to clear lowers
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SPACE-MAINTAINERS
Construction
Half-clasps: 0 . 6 m m stainless steel wire
Retention: Adams clasps on 6/6
Baseplate: Pull palate
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E X P A N S I O N SCREWS, 1
Rate of activation
Using a screw w i t h one end threaded, this is one
quarter-turn per d a y ; a screw w i t h both ends threaded,
one quarter-turn every other day.
Construction
Screw; A screw of hard metal such as stainless
steel, w i t h guide pins i n t a c t , should be
used and its length should be adequate
Retention: Adams clasps on 6 4 / 4 6
Baseplate: Full palate, divided d o w n the centre
after processing
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E X P A N S I O N SCREWS, 2
Radial expansion
Lateral movement of the premolars and canines is
achieved by uniting the t w o halves of the appliance
across the posterior border w i t h a tie-wire so that the
appliance hinges at the back and opens fanwise. It
follows that the screw must open on a curve. Special
screws have been manufactured to permit this to take
place, but it is q u i t e satisfactory to use a loose, soft-
metal screw such as the Badcock screw w i t h the guide
pin cut o f f (Inset B).
The screw must be positioned as f o l l o w s :
1. as far f o r w a r d as possible,
2. as high in the palate as possible (Inset A ) ,
3. at right angles to the median raphe,
4. w i t h its l o n g axis parallel to the occlusal plane.
Rate of activation
The screw is given one quarter-turn twice a week.
Construction
Screw: Soft metal w i t h guide pin removed
Tie; 0 . 9 m m stainless steel wire
Labial arch: 0.7mm stainless steel wire
Retention: Adams clasps on 6 / 6
Baseplate; Full palate, divided through the mid-
line after processing
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E X P A N S I O N SCREWS, 3
Asymmetrical expansion
Correction of unilateral lingual occlusion of the cheek
teeth (and sometimes a canine and a lateral incisor)
presents problems in anchorage due to the tendency of
the lingually occluding side to resist movement more
than the normal side. The appliance illustrated raises the
bite on the cheek teeth on b o t h sides and carries a lingual
flange on the normal side, to engage w i t h the lower
cheek teeth and so to add them to the anchorage. A
short stainless steel screw should be used, placed near to
the centre of the segment to be moved, w i t h its long
axis parallel to the occlusal plane and at right angles to
the line of the cheek teeth. Spurs or half-clasps engage
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Rate of activation
The screw is usually turned at the rate of t w o quarter-
turns per week.
Construction
Spurs: 0.6mm stainless steel wire
Screw: Short, stainless steel
Retention: Adams clasps on 6 4 / 4 6
Baseplate: Full palate, divided as shown and
carrying a smoolhed-off b i t i n g section
on the small segment and a b i t i n g section
indented by the lower teeth and w i t h a
lingual flange on the ' f i x e d ' side
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A S Y M M E T R I C A L R A D I A L EXPANSION
Rate of activation
The screw is turned at the rate of t w o quarter-turns per
week.
Construction
Screw: Soft metal (Badcock type)
Tie: 0.9mm stainless steel wire
Spurs: 0.6mm on 3 1 / .
Retention: Adams clasps on 6 4 / 4 6
Baseplate: Full palate, divided as shown
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Rate of activation
The screw is turned at the rate of one quarter-turn per
week.
Construction
Screw: Hard metal (stainless steel) with guide
pin
Spur: 0.6mm stainless steel wire
Retention: Adams clasps on 64/46
Baseplate: Full palate with anterior inclined plane,
divided by two cuts, one across the
screw and the other exactly parallel with
the buccal segment to be moved and
with the long axis of the screw
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Rule of activation
The screw is turned at a rate of one or two quarter-turns
per week, the slower rate being used if the appliance
tends to slip off the teeth.
Construction
Screw: Stainless steel, minimum bulk
Spurs: 0.6mm on 32/23
Retention: Adams clasps on 64/46
Baseplate: Full palate, with capping over molars and
premolars, divided transversely as shown
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R O T A T I O N OF A S I N G L E T O O T H , 1
R O T A T I O N OF A S I N G L E T O O T H , 2
Construction
Premolar band: 3.0 x 0 . 1 m m stainless steel tape OR
3.0 x 0 . 1 5 m m w h i t e gold tape
Channel: 2.0 x 0.1 mm stainless steel tape OR
2.0 x 0 . 1 5 m m while gold tape
Strap: 2.0 x 0.1 mm stainless steel tape
Spring: 0 . 3 5 m m extra hard stainless steel wire
Labial a r c h : 0 . 8 m m stainless steel wire
Retention: Adams clasps on 6/6
Baseplate: Full palate, cut away around
premolar t o o t h
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R O T A T I O N OF A S I N G L E T O O T H , 3
Over-rotation
To achieve good final alignment it is c o m m o n practice
to over-rotate and to retain in the over-rotated position
for six months. To avoid displacing the adjacent t o o t h
it is necessary to bend a dog-leg in the spring as in
diagrams 3 and 4.
Construction
Spring: 0 . 3 5 m m extra hard stainless steel wire
Composite: A n y composite filling material
suitable for acid-etch retention
Baseplate, etc: As on page 129.
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R O T A T I O N B Y C O N T R A - A C T I N G SPRINGS
Construction
Springs: 0 , 5 m m stainless steel wire (boxed-in)
Labial arch: 0.7mm stainless steel wire
Retention: Adams clasps on 6/6
Baseplate: F u l l palate, relieved around 2/2
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E X T R A O R A L FRACTION, 1
Construction
Extraoral arch: 1.25mm stainless steel wire
Labial arch: 0.9mm stainless steel wire
Retention: Adams clasps on 6 4 / 4 6
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EXTRAORAL TRACTION, 2
Construction
C o f f i n spring: 1.25mm stainless steel wire
Extraoral wires: 1.25mm stainless steel wire
Labial arch: 0.9mm stainless steel wire
Retention: Adams clasps on 6 4 / 4 6
Baseplate: Two sections extending f r o m mesial
of 3/3 to distal of 6/6
Attachment of Strapping w i t h 2.0 x 0.1 mm
extraoral arms: stainless steel wire OR binding w i t h
soft wire and soldering
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EXTRAORAL ANCHORAGE, 1
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EXTRAORAL ANCHORAGE, 2
Construction
Retention: Adams clasps on 6 5 / 5 6
Springs: Canine retractor 0 . 6 m m sleeved;
Roberts retractor 0 . 5 m m
sleeved
Labial arch: 1.25mm stainless steel wire
Molar tubes: 1.25mm internal diameter
Extraoral whisker: 1.5mm stainless steel wire
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EXTRAORAL ANCHORAGE, 3
Construction
Retention: Double Adams clasps on 6 5 / 5 6
Retractor: 0.5mm stainless steel wire
Sleeve: 0.5mm internal diameter soft
tubing
Molar tubes: 1.25mm internal diameter
stainless steel
Extraoral a r c h : 1.25mm stainless steel wire
Extraoral whisker: 1.5mm stainless steel wire
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Construction
T-spring: 0.5mm stainless steel Wire
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INCISOR E L O N G A T I O N , 1
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INCISOR ELONGATION. 2
Construction
Clasps: Adams on 6/6
Spring 0.5mm stainless steel
Sleeve: 0.5mm internal diameter soft stainless steel
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T H E ANDRESEN APPLIANCE. 1
Diagram A
The C o f f i n spring.
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Diagram B
The appliance is shown here in plan view with a C o f f i n
spring in position. The appliance overlies the palatal half
of the occlusal surfaces of the cheek teeth.
Diagram C
The points of insertion of the labial arch and extraoral
wires.
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Diagram D
The baseplate is cut away behind the upper incisors but
should not be removed from the tips of the lower
incisors.
Diagram E
Removal of the acrylic material f r o m the occlusal
surfaces will allow adjustment of the occlusal level of
the cheek teeth.
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Diagram F
Full extension of the acrylic resin between the teeth
should be allowed, when cutting away from the occlusal
surfaces. In the mouth these extensions will bear on the
upper teeth as shown, causing them to move dislally.
Diagram G
When the acrylic is cut away from the occlusal surfaces
of the lower teeth the interdental extensions act as
shown, causing them to move mesially.
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Construct'on
A b i t e is taken in the protrusive position, w i t h o u t
straining and open 2 - 4 m m . This is m o u n t e d on an
articulator a n d the appliance waxed as s h o w n in
diagrams B and C. After t r i m m i n g the models very
closely they are flasked together as shown in diagram H.
The reverse half forms a plug in the palate and a raised
bite is impossible. The appliance is completed in the
usual way.
Materials
Baseplate: Deeply extended and thickened in
lower molar region, rising to clear
the gingiva and contact o n l y the
teeth in the lower incisor region.
Upper as shown in diagram A
C o f f i n spring: 1.25mm
Labial a r c h : 0 . 8 m m sleeved or 1.0mm anodically
t h i n n e d to 0 . 8 m m
Extraoral wires: 1.25mm
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