Beruflich Dokumente
Kultur Dokumente
0TU U0T
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Foreword
Ursula Wirtz:
The idea to compile an atlas of orthodontic and orthopedic technique emerged after hearing
the same questions over and over from students, dental technicians from private practices and
technician students.
This widely illustrated atlas with short explanations will provide a quick help to technicians
and students during their practice. It provides guidelines for the construction of orthodontic
and orthopedic appliances and explains the techniques for bending wire more easily with the
use of pliers. It illustrates orthodontists the use of alternative appliances and serves as
instruction for patients.
In this atlas, the construction of removable and fixed orthodontic and orthopedic appliances is
described. But as the single appliances vary considerably depending on the region or
practitioner, this atlas should mainly be a stimulus to make the construction of orthodontic
appliances using wire, screws and acrylic as simple as possible.
Whether the desired treatment goal is always achieved with the orthodontic appliance
depends mainly on the treatment method and the corresponding treatment appliance. The
effectiveness of the active and passive plates depends on their adequate retention and support.
The competence and teamwork of the practitioner, technician and patient are necessary for the
treatment result and the effectiveness of an appliance.
Because the technician is responsible for the perfect execution of the appliance, it must be
designed and constructed with the greatest care. This is the only way to guarantee that an
appliance is accepted by the patient and is worn with pleasure.
The therapeutic grinding and activating of the appliances is not dealt with in this atlas since it
is the task of the practitioner and not of the technician.
In past time, known and proven base appliances have undergone many modifications through
ideas and empirical understanding so that there are inexhaustible possibilities for the
individual appliance design.
Mrs. Ursula Wirtz, collaborator of many years´ standing in my clinic, has set herself the task
to show this variety of appliances in a color atlas.
This successful synoptic depiction starts with the detailed description of the passive and
active basic elements of removable appliances. Based on this, the construction of all common
plates, functional orthopedic appliances, and combined fixed / removable devices as well as
active and passive fixed special appliances is compared.
This atlas is outstanding for its competence, systematology, love for details and endeavors to
provide the reader with the actual available therapeutic range. The atlas is a treasure trove for
everyone, practitioner or specialist technician, who is connected to the discipline of
orthodontics and orofacial orthopedics.
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Author
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Acknowledgements
This atlas was created while working at the clinic of the University of Aachen.
Therefore, I want to express my special gratitude to Prof. Dr. med., Dr. med. dent. P.
Diedrich, chief of orthodontics of the clinic of the University of Aachen. He enabled
me to put my ideas into practice and supported me generously in all areas. Dr. W.
Bauer made the professional orthodontic corrections in many hours of her time.
Dr. T. Hetz translated this reference work into English and Spanish, so that it can be
understood "in the whole world".
Dr. G. Kinzinger collaborated mainly in the Pendulum appliances section.
The idea and title of this atlas resulted together with Prof. Dr. med., Dr. med. dent H.
Wehrbein.
Mrs. I. Sous worked tirelessly finding and correcting errors with a trained eye,
detailed the draft, supported me with ideas and valued advice and in this way
sacrificed many hours for me.
My husband Heinz supported me in every way, accepting restrictions of our free time
activities in common.
I owe them all a debt of gratitude.
I would like to thank the Dentaurum Company sincerely for our friendly and good
cooperation, as well as the extensive promotion which made possible the making of
this project.
Ursula Wirtz
2T
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Content
Chapter 1
Chapter 2
Spring elements
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Nance and pendulum appliance, space maintainer, cleft and stimulation plate
Chapter 8
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CHAPTRR 1
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• The dental models
U U
Function: Basis for treatment planning Description: Plaster models are the most
important records for diagnosis, treatment planning and the working basis for
removable and fixed appliances in the laboratory
After shaping the models, they are smoothed out with wet
sandpaper, all bubbles, positive or negative, have to be
removed and the surface is polished and sealed with talcum
powder, soap or shine liquid. This way models can be
stored dustfree for years.
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In order to scatter the acrylic better, it is useful to
frame the labial bow with wax. This wax frame should
be shaped in a dimension that later corresponds to the
thickness of the acrylic shield.
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On this occasion attention, should be paid on the
counter bite. In order to avoid occlusal interferences,
occasionally, the labial bow has to be adapted deeper
The tag, bent over from the labial to the lingual side
(transversal tag), should lie as close as possible to the
premolar if the gap distal of the canine is to be closed.
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• The labial bow with retractive canine loop
U U
If the loop is bent the other way around, the canine can
be moved mesially.
The labial bow is led to the end of the canine gap and
there it is bent back 180°. Then distal of the lateral
incisor it is bent into the transversal tag.
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If the four incisors have to be stabilized, the
transversal tag should contact the lateral incisor.
Because of the loop design, the canine can not migrate
labially during its eruption.
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The labial bow with Andresen loop plays a rather
subordinate role in orthodontics; it is often used in
technical school as a bending exercise.
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• The modified labial bow
U U
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A hook is soldered on the loop of the labial bow to
engage vertical elastics for the alignment of canines.
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• The intermaxillary bow
U U
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The horizontally lying triangle continues into a vertical
part, then into the transversal tag and finally ends in
the retention portion. In order to protect the cheek, the
open part of the triangle should face distally.
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The buccal component should not be over-
dimensioned in direction of the cheek. It is formed
directly into the transversal tag and then into the
retention.
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This variation of the triangular clasp allows a good
activation
Function: Retention for the first molar if the second molar is missing
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• The Adams clasp according to Adams
U U
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Now two marks are made on the vertical parts, each
0.3 mm from the buccal bridge portion including the
wire diameter. With the round tip of the pliers, the
wire is bent upward by 180° at the markings on both
sides.
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Function: Verbesserter Halt gegenüber der Adamsklammer nach C. P. Adams
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Adams clasp with horizontally proceeding U-loop.
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• The Adams clasp with anchorage for extraoral traction
U U
The bridge portion with the coil should not contact the
teeth and should match the height of the coil on the
opposite side. This way, the headgear can be inserted
without any problems into the Adams clasps.
Function: Good retention if the Adams clasp is the only retentive component (in an
incomplete tooth row)
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The Adams delta clasp is the combination of an
Adams clasp and a triangular clasp.
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The arrowhead is bent downward with the arrow-
bending pliers and laid horizontally into the interdental
area.
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Forming an additional loop on the distal tag, a
buccally positioned tooth can be aligned into the tooth
row.
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• The eyelet clasp according to Stahl
U U
For the eyelet clasp in the lower jaw, one has to pay
attention to avoid causing any interference with the
buccal cusps of the upper jaw. Therefore, a small bent
has to be made into the ascending part of the clasp.
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The eyelets are to be located in the undercut area.
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In order to avoid irritation the loop should not touch
the gingival tissue.
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• The Lorenz spring
U U
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One can bend the occlusal rest to an eyelet.
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The incisal rests fixed in this manner prevent tipping
of the incisors and tilting of the appliance.
CHAPTRR 2
Spring E lements
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• The active circumferential clasp
U U
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Equally, the final loop can be bent in a horizontal
direction. On this occasion the loop reaches deep into
the interdental area at the cervical margin.
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The loop has to be designed to neither contact the
gingival tissue nor disturb the labial bow which
afterwards is laid over it.
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Canine retracting spring with a long cantilever and
helix. The end of the loop is bent overlying the
cantilever into the transversal tag as a guide to hold the
spring in proper position.
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The helix is positioned directly under the tooth crown
and covered with wax together with the active portion.
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When the spring is covered properly with wax and the
appliance is finished there is enough free play to
activate the spring.
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• The free end protrusion spring with retaining
U
function U
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• The free end protrusion spring with mesial arm
U U
Function: Protrusion
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It is fixed in the lower third of the clinical crown and
is covered with wax.
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• The helical protrusion spring for the anterior
U
segment U
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It proceeds horizontally to the occlusal surface and is
covered with wax in the usual manner.
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The acrylic of the activator has to be removed in such
a way that the tooth is not hindered in its movement.
The buccal box spring is mainly used in activators.
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• The paddle spring over several teeth
U U
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The entire spring area has to be covered with wax and
the screw has to be fixed before finishing the
appliance.
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The sheet spring has to emerge sufficiently out of the
acrylic to allow enough free play for its activation.
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• The buccal spring
U U
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In order to make the oral movement of those teeth
possible, they are covered with wax on their lingual or
palatal surface, or the according acrylic on the base
plate is removed.
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The exposed loop makes activation easy.
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• The lingual or palatal spring
U U
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The active portion of the clasp is covered with wax on
the lingual side in order to avoid damaging the wire
while trimming the base plate.
With the oral spring, not only the tooth crown can be
tipped lingually, also alveolar remodeling takes place
in oral direction as a result of the bone remodeling
during tooth movement.
The endings of the clasps are bent into small loops; the
palatal portions of the clasp are bent parallel over each
other.
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• The closed intermediate spring with loop
U U
On the palatal side, the wire ends cross over so that the
centered lying screw which expands the upper jaw in a
transverse direction pulls together the springs
simultaneously and therefore moves both teeth
together. Both clasps have to be covered with wax as
far as their retention.
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CHAPTRR 3
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• The tongue guard
U U
Elements: The tongue guard runs inside along the tooth rows in the
area of the open bite.
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The spring, which also serves as a grip, is bent once
around the loop forming pliers. The following zigzag
bent is used for activation if the tension decreases. The
retention works simultaneously as reinforcement for
the acrylic shield.
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In order to have the lip pads in a certain distance from
the gingival tissue, the bent lip bumper wire is
underlaid with wax. The distance between the wire and
the wax layer is about 1 mm.
Elements: Modified wire of the lip pads, engaged labial bow 0.7 mm spring hard
Function: Protection from the upper lip (combination with the engaged labial bow)
Description: The lip pads wire contains a closed loop in order to be able to engage the
labial bow
The area in which the lip pads should keep away the
lip has to be underlaid with wax.
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Depending on the desired function, the labial bow can
be either engaged or not.
Elements: Simple retention elements and labial bow 0.7 mm spring hard
Function: Movement of single teeth or tooth groups
Description: Simple appliance for the correction of the position of single teeth
or tooth groups in anterior cross-bites and for the anterior
movement of the mandible
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The inclined plane in the anterior area of a maxillary
plate can be used to move the mandibular teeth
forward, or to advance the mandible from a distal bite
into a neutral occlusion.
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• The Cetlin appliance
U U
The labial bow is only laid over the four incisors and
an acrylic shield is adapted. Adams clasps are bent
over the first bicuspids. In order to adjust the distal
springs between the bicuspid and the molar, the plaster
model has to be slightly erased in this area.
The springs and the acrylic shield are blocked out with
wax and covered with acrylic.
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• Upper and lower plate with pressure-traction
U
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• Appliance with open screw
U U
n the area of the gap, the acrylic edges are grinded off
parallel so that the screw can be closed without any
obstacles.
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The elements are bent according to the planned design.
The diastema screw is centered with its plastic holder
in the middle of the arch. The activation extensions are
adapted on the distal surface of the tooth and are
eventually shortened.
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The whole length of the extensions and the slots of the
screw are covered with wax.
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The acrylic is scattered as usual. Before finishing the
appliance, the assembly screw is unscrewed. Possible
acrylic or polishing residues are removed and the
desired piston spring screw is screwed in. The resilient
pin of the screw should only emerge slightly out of the
nut.
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If the inclination of the tooth is severe, the point of
application of the pan plate does not have to lie under
the biggest circumference of the tooth in order to avoid
interferences when inserting the appliance. In
combination with a labial spring, the lever pan screw
can also be used to rotate a molar.
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The three dimensional screw allows a transversal
expansion of the arch with simultaneous protrusion of
the incisors. The screw has to be adapted in such a
way that it allows an independent activation of all
plate sections.
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After the polymerization of the acrylic, the mounting
of the screws is removed and the appliance is finished.
Afterwards, the sawing is performed.
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1. Anterior expansion
2T 2T
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The top view of an activated fan type split plate with
one piece screw.
2. Posterior expansion
Fan type plate with reverse built-in, divided screw The
screw can also be adapted in the opposite direction;
then its function is the posterior expansion of the
maxilla.
3. Eccentric expansion
2T 2T
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Because of the oblique position of the screw, the
activation results in an eccentric rotation of the arch.
This way, space can be gained in specific parts of the
arch, as in this example, in the area of the lip and
palatal cleft.
to Müller U
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• Labial spring bow plate according to Bandulet
U U
Elements: Adams clasp 0.7 mm hard, labial arch 0.7 mm spring hard
Function: Alignment of the incisors
Description: The incisors are aligned with a set-up which is transferred
with an acrylic covered labial arch
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• The Roberts retractor
U U
Elements: Labial arch 0.6 mm spring hard, Adams clasp 0.7 mm hard
Function: Retraction of the incisors
Description: Simple appliance for the retraction of incisors
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• The double bite jumping plate (VSD, VD-plate)
U U
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• Modifications of the bite jumping guards
U U
to Schaneng U
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The elements are bent according to the design. After fixing
the mandibular screw, the mounting pattern is held
parallel to the occlusal plane over the mandibular model.
Here, the holder lies between the guiding surfaces of the
pattern and these have to adapt closely to the body of the
screw. The plastic adapter is fixed over the guiding surface
onto the holder of the screw.
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When closing the fixator the screw should be close to the
palate without contacting it. After this, the acrylic can be
applied on the maxillary model.
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The thorns are fixed with wax as mentioned before onto the
lower plate. The finished mandibular plate is covered with
wax to avoid sticking on the maxillary plate. Now acrylic
can be applied on the upper plate and the fixator has to be
closed while the acrylic is not yet polymerized.
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CHAPTRR 4
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• The Roberts retractor as bite jumping appliance
U U
Elements: Labial bow 0.6 mm spring hard, Adams clasp 0.7 mm hard
Function: Mandibular advancement
Description: The addition of an inclined plane into the acrylic base results in a
mandibular advancement
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• The double plate according to Planas
U U
Elements: Labial bow 0.7 mm spring hard, circular clasp 0.7 mm spring
hard, thorns 0.7 mm spring hard
Function: Increase of the vertical dimension
Description: This double plate appliance serves to increase the vertical
dimension
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• The Berlin reactivator
U U
Elements: Connecting wire for the lingual shield 1.2 mm spring hard, labial bow 0.8
mm spring hard, ball clasp, headgear hook 0.8 mm hard
Function: Mandibular advancement
Description: Combined with a headgear the upper jaw is restricted in its growth
Ball clasps are used in the buccal area. The wire diameter
can vary according to the tooth dimension. The retentions
have to be designed according to the reduced base plate.
The hooks for the extraoral traction are located between the
upper lateral incisor and the canine.
according to Buño U
Elements: Anterior intermaxillary bow 0.8 mm spring hard, labial pads 0.8 mm spring
hard
Function: Treatment of mandibular prognathism in the mixed dentition
Description: Bimaxillar appliance with a strong lingual shield which can be used in the
mixed dentition
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The upper plate is anchored with simple retention thorns.
Loops are bent on both sides of the intermaxillary bow. The
part which lies on the lower incisors is covered with a
spring and a plastic tube. The labial pads are similar to
those of Fränkel’s function regulator although in the centre
they are not connected
Elements: Labial bow 0.7 mm spring hard, arrow clasps 0.7 mm spring
hard, lingual bow 0.7 mm spring hard
Function: Forward positioning of the lower jaw into a neutral position
Description: The mandible is positioned forward through the removable
lingual bow
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After the polymerization, the lingual bow is removed from
the tube to finish the plate. The opening of the tube should
be slightly inclined backwards on the surface of the upper
plate in order to allow a safe anchorage of the labial bow
and to prevent a sharp transition to the acrylic base.
After polishing the upper plate, the lingual bow is fit to the
lower jaw and its proper anchorage is assured. The lingual
bow should contact the cervical third (of the crowns) of the
lower incisors and premolars.
Elements: Labial bow 0.9 mm spring hard, Coffin spring 0.9 mm spring hard, labio-
lingual bow 0.9 mm spring hard, anterior spring 0.8 mm spring hard
Function: Treatment of protruded incisors
Description: The appliance is a delicate functional appliance with a low acrylic share
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While bending the lower labio-lingual bow the wire is
positioned in the centre of the incisors. From there, it is
bent towards occlusal and then in height of the first
premolar is guided back to the canine. After this, it is bent
by 180° back to the molar and from there arched into the
upper jaw for retention.
In the upper jaw the side wings, and in the lower jaw the
labial shield are limited with wax.
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• The Bimler appliance type B
U U
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The design of the upper base plate is delicate. In the lower
jaw the anterior spring and the labio-lingual bow are
anchored in the incisor shield.
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In the lower jaw, the lingual bows are led from the
mesial edge of the canine distally, then buccally
between the canine and the first premolar. On the
buccal side the wire is bent into a mesial loop and then
back distally. Now the wire is led between the first and
second premolar over to the oral side again. After a
loop formed indentation towards anterior, the lingual
bow moves over to the acrylic base plate of the upper
jaw.
Both lingual bows are joined through a connecting
wire with three zigzag bents into the lingual acrylic
pads.
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• The twin block appliance
U U
Elements: Labial bow 0.8 mm spring hard, Adams clasp with spring for extraoral
traction 0.8 mm spring hard, ball clasp 1.0 mm spring hard, Adams clasp
0.7 mm hard
Function: Correction of mandibular retrognathism
Description: The mandibular position is determined with a construction bite and is fixed
through inclined bite planes
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• The double plate with intermaxillary elastics
U
according to Neuner U
Elements: Arrow clasp 0.7 mm spring hard, thorns for elastics 1.0 mm
hard, labial bow 1.0 mm spring hard, occlusal rest 1.0 mm hard
Function: Retrusion of the mandible and anterior movement of the upper
jaw
Description: Elastics are engaged in soldered ball hooks in order to adjust the
occlusion
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• The bimaxillar appliance according to Sevinc
U U
Elements: Guiding bow 1.2 mm spring hard, labial bow 0.7 mm spring hard,
connecting wires 0.7 mm hard
Function: Alteration of the position of the upper jaw in relation to the cranial base
Description: By the application of force onto single teeth, tooth groups or the tooth rows,
alveolar tooth movements are induced and the position of the upper jaw in
relation to the cranial base is altered
First, the upper plate is finished with its buccal pads which
serve to control the buccinator muscle and if needed, keep
its effect from the alveolar bone. After its polishing, the
upper plate is grinded free for the retention tags of the
lower spring bows in order to connect the lower and the
upper plate.
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The lingual pad located in the anterior region allows a
reduction or increase of the vertical effects. Similarly,
a retrusion of the whole mandible can be achieved by
an activation of the spring bow.
Elements: Adams clasps 0.7 mm hard, helical protrusion spring for the
anterior segment 0.5 mm spring hard, canine retracting spring
0.8 mm spring hard, incisal spring 0.5 mm spring hard, guiding
thorns 1.2 mm spring hard
Function: Treatment of mandibular retrognathism using an upper
expansion plate and a lower buccal plate
Description: This combination of an upper and lower plate with guiding
thorns and notch in the bite blocks is very pleasant for the
tongue
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On each side the upper plate has posterior bite blocks. In
the area of the second premolars these smooth bite blocks
are grinded to form inclined planes of 45°. When closing,
the guiding thorn of the lower plate is driven into these
inclined planes and therefore guided into the desired
occlusion.
• The rilinator
U U
Elements: Adams clasps 0.7 mm hard, inner pressure bows 0.5 mm spring
hard, labial bows 0.8 mm spring hard
Function: Pressure is exerted on the jaws while opening and swallowing
Description: Smooth occlusal covers towards both teeth and the occlusal
plane are the distinct feature of this appliance
The wire elements are bent and fixed with wax onto the
model. When the treatment goal is bite closure, the acrylic
occlusal surfaces are replaced with occlusal springs. The
inner pressure bow and the labial bows are used to align the
incisors.
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The special features of the rilinator are the lateral occlusal
covers. The posterior teeth can be maintained in their
vertical position, they can erupt grinding the acrylic or
being intruded using occlusal springs. In this occlusal view,
one can confirm that the planes are grinded completely
smooth and that they fit perfectly onto one another. When
expanding, the occlusal planes have to glide over each
other.
Elements: Labial bow 0.7 mm spring hard, Adams clasps 0.7 mm hard,
protrusion springs 0.5 mm spring hard
Function: Fast conversion from an Angle class II-1 to class I
Description: Instead of the VSD-planes, in this case, the Jasper Jumper
produces the advance
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• The Bass appliance
U U
Elements: Adams clasps 0.7 mm hard, torque springs 0.6 mm spring hard,
lingual pads 1.2 mm spring hard, vestibular shields 1.0 mm
spring hard, labial pads 1.0 mm spring hard
Function: Mandibular advancement
Description: Growth stimulation due to the vestibular shields
First, the Adams clasps are bent over the molars and the
first or second premolars (or second deciduous molars).
Before bending the torque spring for the incisors, wax has
to be added on the palatal side of the incisors 2 mm from
the incisal edge up to covering 5 mm of the gingival
margin. This way, an acrylic step can be designed behind
the central incisors. The torque spring is bent carefully over
the round edge of the pliers in order to reduce the risk of
breakage and is then fixed onto the model.
The finished plate is set onto the model and then the wax
layer is added for the vestibular shields and labial pads. The
retention tags for the vestibular shields are bent
individually. An alternative is to use preformed vestibular
shields. In order to insert the labial pads into the vestibular
shields, a tube is soldered onto the individually bent
retention tags. This tube is inserted into the labial pad.
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The anterior tube on the palatal side of the plate is used as
opening for the labial pads. Both models are put together in
the fixator in order to centre the lingual pads 4 to 5 mm
underneath the gingival margin of the lower premolars; the
retention tags are bent according to the situation.
Elements: Closed torque spring 0.7 mm spring hard, upper connecting bow
1.0 mm hard, Adams clasp 0.6 and 0.7 mm spring hard
Function: Treatment of Angle class II-1 malocclusions
Description: In this functional orthopedic appliance special springs connect
the upper plate to the lower plate
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When all wire elements are bent, the wax layer for the
reduced lower plate is added. A slim wax stripe limits the
free part of the palate and simultaneously blocks out the
connecting bow.
The wax lining of the lower model covers the cuspids of the
posterior teeth in such a way that the compensation curve is
maintained. In the anterior region, the wax is added in the
same manner as in the posterior region so that there is no
transition between them. Now acrylic can be added
separately on the lower plate and it can be finished.
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The lower plate is also finished separately. The base plate
ends on the level of the 2nd. deciduous molar or distally of
the 2nd. premolar. In the incisal or lingual area the plate has
to be shortened in order avoid interfering with the height
determined by the construction bite. This way, the
separately finished appliances can be polished without
problems.
to Marillo U
Elements: Labial bow 0.7 mm spring hard, expansion spring 0.9 - 1.0 mm
spring hard, protrusion spring 0.5 mm spring hard, posterior
wire loops 1.0 - 1.2 mm spring hard, occlusal rests 0.8 mm
spring hard
Function: Three dimensional double plate being activated through wire
loops and springs
Description: The design of the double plate is more delicate with wire loops
and springs as with screws
The labial bow is laid between the 1st. and 2nd. premolar
into the acrylic base. Depending on the planned design,
protrusion springs and the occlusal rests can be included in
the lower plate. The expansion springs for the upper and
lower jaw are fixed onto the model in such a way that the
active parts are covered with wax and only the retentions lie
free.
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To increase the support, small acrylic pillars are added in
the canine region.
according to Schwarz U
Elements: Labial bow 0.7 mm spring hard, spring loops 1.2 mm spring
hard
Function: Treatment of anterior cross bites
Description: With the distal spring loops the double plate can be reactivated
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In order to be able to activate the springs better, they are
extended minimally over the base plate.
Elements: Labial bow 0.8 mm spring hard, labial bow with pads 0.8 mm
spring hard
Function: Treatment of Angle class III patients
Description: A bimaxillar appliance which can retrude the mandible by
activation of the screw
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After bending the labial bow in the lower jaw and the labial
bow with integrated pads in the upper jaw, the acrylic can
be added.
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• The application field of the LS-Duobloc screw
U U
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CHAPTRR 5
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• The activator
U U
Labial bows and retention thorns are fixed with wax onto
the model. For the acrylic base, the model can be blocked
out additionally in order to accelerate the grinding and
finishing. After the models are prepared this way and
hydrated, acrylic can be added on each one individually and
before its polymerization, they are set together in the
fixator. The transitions are smoothed with additional
acrylic.
Elements: Labial bow 0.8 mm spring hard, retention thorns 0.8 mm spring
hardLabialbogen 0,8 mm fh,Haltedorne 0,8 mm fh
Function: Modification of the muscular effect through an over dimensional opening
of the occlusion
Description: The over dimensional vertical opening of the occlusion, which is intended
to alter the muscular activity, is characteristic for this appliance
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The Herren activator differs from the classic activator only
in the high vertical opening. The elements are bent as in the
traditional activator and a wax collar is fixed for the
limitation of the acrylic.
Elements: None
Function: Treatment of maxillary dentoalveolar protrusions in the mixed
dentition
Description: Bimaxillar appliance without wire elements
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When the retentive parts are blocked out, the models are
covered with wax for the acrylic base. In the upper jaw the
complete labial surface is covered with acrylic, in the lower
jaw the lingual surface. The connection of the upper buccal
shield to the lower lingual shield serves also as occlusal
support and stabilizer for the appliance. The lower incisal
edges are also mounted into acrylic in order to prevent the
lower incisors from tipping.
In the posterior area the interocclusal acrylic is removed in
order to allow the premolars to erupt.
The upper base plate is kept small. The palatal area of the
upper anterior teeth is blocked out with wax in order to
allow a retrusion. The lateral bite plane reaches to the
centre of the occlusal surfaces. In the premolar region, the
lower base is extended as far as possible downwards.
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• The activator according to Pfeiffer and Grobety
U U
Elements: Modified labial bow with soldered triangular clasp 0.8 mm spring hard
Function: Retraction of the upper jaw with simultaneous distal movement of the
upper teeth
Description: Retraction of the upper jaw, and under influence of the masticatory
muscles, mesial movement of the lower teeth with simultaneous distal
movement of the upper teeth; the headgear is only used combined with the
fixator
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The lower wings of the activator should be very
pronounced on the lingual side favoring the activity of the
masticatory muscles.
Elements: Labial wire 0.8 mm spring hard, triangular clasp 0.7 mm spring hard,
Adams clasp 0.7 mm hard
Function: Treatment of class II-1 or class III
Description: Depending on the position of the labial wire, the upper front can be
retruded (class II treatment) or the lower front can be moved lingually
(class III treatment)
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A screw can be added to the appliance. For a desired
anterior-posterior correction an inclined anterior plane can
be integrated in addition to the bite block.
Schwarz U
Elements: Labial bow 0.8 mm spring hard, spring bow 1.2 mm spring hard
Function: Activation through muscle function
Description: Through the spring bows, which can be activated horizontally or
vertically, the muscle activity is stimulated
The polished and finished plates are set onto the models
which were articulated according to the construction bite.
Now the unifying spring bows can be bent and be added
into the acrylic of the single plates of the activator. These
spring bows are supposed to enhance muscle activity.
The spring bows reach distally over the base plate for a
proper activation. Different directions for their activation
are possible (horizontal, vertical).
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• The open bite activator with tongue crib
U U
Elements: Labial bow 0.8 mm spring hard, Coffin spring 1.2 mm spring
hard, tongue crib 1.0 mm spring hard, mandibular connection
bow 1.0 mm spring hard
Function: Intrusion of the posterior teeth, extrusion of the incisors and
simultaneous protection of the tongue
Description: The tongue is kept from the teeth because of the tongue loop
which follows the curve of the dental arch
The models are set into the fixator with the construction
bite and the vertical opening is determined. The labial bows
are bent as usual. The connecting bow in the lower jaw and
the Coffin spring in the upper jaw are fixed each 1 mm
from the gingival tissue. The divided tongue crib is fixed
parallel to the lingual or palatal area of the incisors.
The tongue crib consists of two divided loops. For the first
half, the wire is bent back 180° in the middle. The
separation of the parallel wires corresponds to half of the
area to be closed off. The loop is bent according to the
curvature of the anterior segment. Both wire ends are bent
over for retention and are anchored in the lateral part of the
activator. The second half is bent like a mirror image and is
set on the other side.
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• The SKEL activator according to Ruhland type II-1
U U
Elements: For class II-1 – II-2: Labial arch 0.9 mm spring hard, Coffin spring 0.9
mm spring hard, occlusal molar rests 0.8 mm spring hard, occlusal rests
canine 0.7 mm spring hard, protrusion spring 0.7 mm spring hard For
class III: Labial arch 0.9 mm spring hard, Coffin spring 1.1 mm spring
hard, lingual bow 0.9 mm spring hard, connection spring 0.9 mm spring
hard
Function: A reduced elastic activator with different tasks for class II-1, II-2 and III
Description: A reduced elastic activator
Type II-1
2T 2T
In the upper as well as in the lower jaw, the labial bows are
set into the acrylic between the 1st and 2nd premolar. The
distally closed Coffin spring is located in the molar region.
The lower incisors area is shaped with protrusion springs.
The canines in the upper jaw are held with C-clasps.
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• The SKEL activator according to Ruhland type II-2
U U
Elements: For class II-1 – II-2: Labial arch 0.9 mm spring hard, Coffin
spring 0.9 mm spring hard, occlusal molar rests 0.8 mm spring
hard, occlusal rests canine 0.7 mm spring hard, protrusion
spring 0.7 mm spring hard For class III: Labial arch 0.9 mm
spring hard, Coffin spring 1.1 mm spring hard, lingual bow 0.9
mm spring hard, connection spring 0.9 mm spring hard
Function: A reduced elastic activator with different tasks for class II-1, II-2
and III
Description: A reduced elastic activator
Type II-2
2T 2T
The acrylic base is the same as in type II-1. From the mesial
part of the canines to the distal end of the molars both
acrylic parts of the upper and lower jaw are connected
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• The SKEL activator according to Ruhland type III-a
U U
Elements: For class II-1 – II-2: Labial arch 0.9 mm spring hard, Coffin spring 0.9
mm spring hard, occlusal molar rests 0.8 mm spring hard, occlusal rests
canine 0.7 mm spring hard, protrusion spring 0.7 mm spring hard For
class III: Labial arch 0.9 mm spring hard, Coffin spring 1.1 mm spring
hard, lingual bow 0.9 mm spring hard, connection spring 0.9 mm spring
hard
Function: A reduced elastic activator with different tasks for class II-1, II-2 and III
Description: A reduced elastic activator
Type III-a
2T 2T
The elements in the lower jaw are two holding thorns and a
connecting bow. The upper jaw consists of protrusion
springs, an intermaxillary bow and a Coffin spring. First,
both parts, upper and lower, are finished separately.
Interocclusal acrylic is not necessary. With a construction
bite, the upper and lower parts are connected in the
articulator through spring bows in the distal part of the
plates.
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• The SKEL activator according to Ruhland type III-b
U U
Elements: For class II-1 – II-2: Labial arch 0.9 mm spring hard, Coffin spring 0.9
mm spring hard, occlusal molar rests 0.8 mm spring hard, occlusal rests
canine 0.7 mm spring hard, protrusion spring 0.7 mm spring hard For
class III: Labial arch 0.9 mm spring hard, Coffin spring 1.1 mm spring
hard, lingual bow 0.9 mm spring hard, connection spring 0.9 mm spring
hard
Function: A reduced elastic activator with different tasks for class II-1, II-2 and III
Description: A reduced elastic activator
Type III-b
2T 2T
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• The SKEL activator according to Ruhland type III-c
U U
Elements: For class II-1 – II-2: Labial arch 0.9 mm spring hard, Coffin
spring 0.9 mm spring hard, occlusal molar rests 0.8 mm spring
hard, occlusal rests canine 0.7 mm spring hard, protrusion
spring 0.7 mm spring hard For class III: Labial arch 0.9 mm
spring hard, Coffin spring 1.1 mm spring hard, lingual bow 0.9
mm spring hard, connection spring 0.9 mm spring hard
Function: A reduced elastic activator with different tasks for class II-1, II-2
and III
Description: A reduced elastic activator
Type III-c
2T 2T
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• The elastic open activator according to Klammt
U
(EOA) U
Elements: Palatal bow 1.2 mm spring hard, labial bow 0.9 mm hard
Function: Alignment of the anterior teeth
Description: Open activator with wide space for the tongue
The labial bows lie parallel to each other and are bent
buccally of the first molars into a loop. From there, they are
guided back mesially of the canines from where they are
bent palatal or lingual into the retention. The palatal bow is
bent similar to a Coffin spring and connects the acrylic
parts.
The acrylic shares lay orally from the canines to the last
molars forming a small band contacting teeth and gingiva.
The occlusal surfaces are not covered with acrylic and a
vertical support by the acrylic is left only in the canine area.
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• The rigid open activator (SOA)
U U
For the SOA the elements are bent according to the planned
design and are fixed with wax. The rigid connecting bow is
underlaid with tin foil before its fixation in the area of the
first molars of the upper jaw to guarantee an even distance
from the palatal gingival tissue.
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• Modifications of the EOA and the SOA
U U
Elements: Labial bow 0.8 mm spring hard, protrusion loop 0.8 mm spring hard,
triangular clasps 0.7 mm spring hard, Adams clasps 0.7 mm hard, palatal
bow 3.0 x 1.5 mm half round steel wire, a special spring system according
to Sander: 1.0-1.1 mm spring hard wire with simple or triple loop
Function: Treatment of skeletal open bites and rehabilitation after TMJ injuries
Description: Special springs of 1.0-1.1 mm spring hard wire are located lateral in this
appliance and therefore do not hinder the tongue
For the making of the spring activator the models are set in
the fixator. As the acrylic base of the upper jaw is reduced,
the retentions have to be bent according to this situation
being anchored into this acrylic segment. The highest part
of the palate is covered with a tin foil which is 1 - 1.5 mm
thick to guarantee an even distance of the palatal bow and
to avoid pressure areas. The finished elements are fixed
onto the model, acrylic is added and the plate is finished.
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The base of the upper plate should extend palatally as much
as to guarantee sufficient retention and stability for the
special spring. The upper plate is finished and polished
completely in order to allow an even adjustment of the
upper and lower bite blocks. Isolated with a thick wax
layer, the upper bite block can be set onto the polymerizing
lower plate. Another option is to separate both plates with a
metal plate
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• The divided activator with screw for the upper jaw
U U
In the upper jaw, the screw is centered and fixed with wax
so that the retentions of the screw stick out into the lower
jaw. Therefore, in the anterior region, two notches have to
be grinded into the lower base plate. The fixator should be
able to open and close without interference. The area of
retention in the lower jaw is blocked out with wax.
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After this, both separately produced plates are unified to
one appliance. For this purpose, the division and the
interocclusal area close to the screw are covered with wax.
Now the retentions of the screw are polymerized into the
lower plate and therefore both plates are unified to one
bimaxillar appliance.
Elements: Labial bow 0.8 mm spring hard, retention thorns 0.8 mm spring hard
Function: Continuous retropositioning of the mandible with simultaneous
advancement of the upper jaw
Description: In this horizontally divided activator, through the effect of the screw
according to Weise a continuous retropositioning of the mandible and a
simultaneous advancement of the upper jaw are strived for
The body of the Weise screw unifies the upper plate with
the lower plate through a strong U-shaped bow. Only the
retention part of the screw is grasped in the acrylic. The
bow extends orally over the acrylic base. The sagittal
divided screw lets the upper plate glide over the lower plate
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The labial bow for the upper jaw normally does not contact
the incisors while in the lower jaw it contacts the incisors
passively. The retention thorns are bent as usual. The parts
of the upper and lower jaw are finished and polished
separately. It is important that the occlusal and interdental
tooth surfaces are grasped with acrylic.
The connecting bow from the upper to the lower part and
the part of the body of the screw that extends orally are not
covered with acrylic, only the retentions of the screw
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• The U-bow activator according to Karwetzky
U U
Elements: U-bow 1.2 mm spring hard, labial bow 0.8 mm spring hard
Function: Movement of the mandible in different directions, according to the specific
type (type I-III)
Description: Through the addition of different U-bows into the elastic activator, different
directions of mandibular movement are possibl
Type III-a
Pan activator In this type III-a two different bows are built
in. On the right side, the upper short arm shows distally, on
the left side, the short upper arm shows mesially. When
activating the U-loops a panning movement to the right is
produced.
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Type III-b Pan activator
In the type III-b the U-bows are incorporated opposite as in
type III-a. On the right side, the short upper arm shows
mesially, on the left side the short upper arm shows distally.
This way, when activating, a panning movement to the left
is the result.
Elements: Headgear tubes, torque springs 0.5 mm spring hard, Coffin spring 1.2 mm
spring hard
Function: Inhibition of the development of the upper jaw with simultaneous
mandibular advancement
Description: This headgear activator hinders the development of the upper jaw with
simultaneous advancement of the mandible
The headgear tubes lie between both tooth rows in the area
of the deciduous molars. The interocclusal area should be
high enough to allow a good anchorage of the retentions of
the headgear tubes in the acrylic. It should also be checked
from the occlusal point of view if they lie parallel to be able
to insert the inner bow without any problems.
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The acrylic base has to cover one third of the lower
incisors, and the upper incisors should be covered on the
palatal side up to one half and on the labial side, only to the
incisal edge.
c) Labial pads
2T 2T
d) Lip bumper
2T 2T
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e) Expansion screw
2T 2T
Elements: Labial bow 0.9 mm spring hard, distalizing springs 0.9 mm spring hard
Function: Functional change of the occlusal plane in a malocclusion class II-1
Description: A vertical opening of up to 20 mm is necessary for this activator; the
smooth lateral bite plane maintains the upper incisors and the lower are
grinded
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The coverage with wax should be done carefully. The
characterizing feature of this appliance is the large vertical
opening in the buccal sections which is determined by a
construction bite. In order to guide the anterior movement
in the posterior region, a thin wax plane is added in the
upper jaw and a high wax plane, higher than half of the
vertical opening, is added in the lower jaw; the main
purpose is to create plane surfaces for the acrylic platforms.
The labial shield covers the incisors over one third of their
clinical crown. The lateral bite planes have no contact at all
with the posterior teeth in order to achieve the desired
vertical eruption.
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• The Harvold-Woodside activator for class III
U U
Elements: Labial bow 0.9 mm spring hard, distalizing spring 0.9 mm spring hard
Function: Therapy of a class III malocclusion
Description: The class III activator should not hinder the buccal segments in their
vertical eruption
In this class III activator, the labial bow in the lower jaw is
bent as an intermaxillary bow; its task in the upper jaw is to
shield off the lips through loops bent as labial pads. The
retention lies as in the class II appliance, in the anterior area
of the vertical opening. Also, the distalizing spring is bent
with a big loop in the molar region. Although in this
appliance the distal cantilevers are located behind the first
molars, the retention ends in the anterior palatal area.
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In this class III appliance, the distal limitation is also
marked by the A-line. Once again, only the retention of the
distalizing springs is grasped in acrylic. In the upper jaw,
the labial bow does not contact but shields off the lip
The upper teeth only contact the acrylic shield. The acrylic
can be trimmed and shaped individually by the orthodontist.
The lateral bite plane allows more vertical eruption for the
upper posterior teeth.
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The Coffin spring is bent distally closed. The appliance can
be designed with an acrylic overhang for the lower incisors.
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In the anterior region the acrylic base of the reverse
appliance is vertically elongated in order to influence the
upper incisors labially, as with an inclined plane. This bite
plane serves as protrusion element for the maxillary
anterior teeth.
a) Headgear tubes:
The appliance can be used with extraoral traction for the
upper jaw including HG-tubes in height of the second
deciduous molars or the second premolars. A precondition
is a sufficient vertical opening which should be considered
during the realization of the construction bite. The HGtubes
can be integrated into the interocclusal acrylic during its
polymerization or they can be incorporated afterwards.
c) Lateral shields:
If the vertical opening is wide, the buccinator loops can
present a longer distance than 1 cm. In order to avoid the
interposition of the cheek, the loops are covered with
acrylic. Before this, it is important to underlay this area
with wax to guarantee a sufficient distance from the lateral
shields to the teeth in order to allow a transversal
expansion.
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e) Labial pads in the lower jaw:
To achieve an anterior-posterior development, the labial
pads can also be incorporated in the mandible.
• The kybernator
U U
Elements: Coffin spring 1.2 mm spring hard, labial bow and retention thorns 0.8 mm
spring hard
Function: Setting of a neutral occlusion
Description: Setting of a neutral occlusion with simultaneous elimination of an
increased overjet and overbite
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• The bite restrainer according to van Thiel
U U
Elements: Arrow clasps 0.7 mm spring hard, labial bow 0.8 mm spring hard
Function: Retrusion of the front
Description: The special construction of the labial bow retrudes extremely protruded
incisors
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General prerequisites for the FR I - IV
The buccal vestibule has to be measured intraorally in order
to be able to carve the upper model for the labial pads and
vestibular shields. Normally the orthodontist should carve
the model himself during the appointment. If not, he has to
give the technician exact measurements which have to be
transported onto the model.
Function: FR I
The function regulator type I is planed for the transversal
and sagittal compression of an Angle class I and II and for a
slight developmental inhibition of the apical base. It is also
used in the class II-1 without an increased overbite and
without a notorious mesial migration of the lateral
segments. Components: 2 vestibular shields, 2 lower labial
pads, 1 lingual shield with lingual bow, 1 palatal wire with
occlusal rests, 2 canine loops in the upper jaw and the
support or connecting wires of the pads and shields.
In the FR I the wire diameter for the labial bow in the upper
jaw is 0.9 mm. The canine loop (wire diameter 0.9 mm)
starts in the distobuccal aspect of the canine, it is bent
completely around the canine and ends buccally in the
lateral shield between the canine and the first premolar. The
palatal wire with rest is bent out of 1.0 mm wire
In the lower jaw, the support wires between the labial pads
and the vestibular shields as well as the connecting wire for
the pads are 0.9 mm strong.
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The connecting wire between the vestibular shield and the
lingual shield is bent out of 1.0 mm wire. The lingual bows
and the stiffening wire are bent out of 0.8 mm wire in this
example.
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Only the canine extension is bent in a different way as in
the FR I. It runs along with a parallel bent wire over the
labial surface of the canine and then is bent upwards to
finish with its retention in the vestibular shields.
The lingual shield and the protrusion bow should not hinder
each other.
Function: FR III
The function regulator type III is designed for malocclusion
class III, especially for patients with a notorious mandibular
prognathism in combination with a midfacial insufficiency.
Components:
2 vestibular shields, 2 upper labial pads, 1 protrusion bow,
1 lower labial bow and occlusal rests.
For the FR III the wax relief on the model has a different
shape. The model has to be carved more than usual in the
area of the upper lip pads. The wax relief is only added onto
the upper model as in the area of the upper lip pads.
Additionally, with a thin drill, a groove is grinded into the
lower front in height of the gingival papilla in order to
guarantee a tight fit of the lower labial bow onto the teeth.
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The wire elements for the FR III: lower labial bow, 2
occlusal rests on the last lower molars, 1 protrusion bow or
upper lingual wire in the upper jaw as well as the support
wires for the lip pads and vestibular shields. If necessary,
occlusal rests can also be added in the upper jaw.
Function: FR IV
The function regulator type IV is used in class I patients
with skeletal open bite, especially as early treatment in the
first mixed dentition. Another application area is the
bialveolar protrusion in the mixed dentition. In these
patients a labial bow is added in the mandible.
Components:
2 lower labial pads, 2 vestibular shields, protrusion bow,
occlusal rests and palatal wire.
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In the FR IV the occlusal rests and the labial pads contact
the model in contrast to both lateral shields.
When the pads shall shield the lip further off, both screws
are activated parallel.
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CHAPTRR 6
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• The Crozat appliance
0TU U0T
Elements: Crib (Jackson clasp) 0.7 mm, crescent (retention thorn) 0.8 mm, occlusal
rest 1.0 mm, lingual arm 1.0 mm, body wire 1.2 mm, buccal extension 1.3
mm, elastic hooks 1.0 mm, cuspid hooks 0.8 mm, distal extensions 0.8 mm,
precurved auxiliaries 0.8 mm, basic high labial arches 1.3 mm, pins, putters
0.7-0.8 mm, elastic hooks 0.8 mm
Function: The Crozat appliance can perform all functions of an active plate
Description: In this appliance, the wire elements are not anchored in an acrylic base,
but lasered or soldered together
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The preparation of the cast
First, the buccal equator of the teeth is determined with
a parallelometer in order to indicate the position of the
horizontal buccal part of the clasp. The gingival
triangles, mesially and distally of the molar, are
removed from the plaster cast. The erasing has to be
done parallel to the occlusal plane. It is important not to
erase too deep, so that once inserted, the crescent does
not crush the papilla. A careful erasement guarantees a
good support even when a stronger strain is applied. If
necessary, the cast is now duplicated to make a
soldering cast.
The crib
The crib is the most important clasp of the entire
appliance, and therefore, has to be adapted very
precisely to the shape of the tooth. It fits tightly on the
first molar and has to grasp the tooth interproximally in
such a way that even its rotation is possible. The
horizontal buccal part of the clasp lies over the equator,
underneath has to be enough distance to the gingival
margin in the buccal area for the crescent.
The crescent
In the interdental space on the buccal side of the first molar,
small holes are made with a 0.8 mm drill into the mesial and
distal area of the cast. These holes allow a better fitting of the
crescents onto the soldering cast. The curve of the crescent
has to lie mesio-distally, exactly onto the buccal contour of
the molar and the extremes have to lie in the holes. For the
later soldering the crescent on the buccal side has to lie
exactly along the crib. After the laser or conventional
soldering, the crescent has to be shortened according to the
holes drilled.
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The occlusal rest
The occlusal rest adapts onto the palatal groove
and the occlusal surface of the same molar (with
the clasp). To avoid occlusal interferences, the rest
has to end shortly before the central fossa. After
the soldering, a corresponding shortening is
possible.
The lingualarm
Continuing exactly with the occlusal rest, the
lingualarm is bent adapting up to the first
premolar. The bent between the first molar and the
second premolar has to be located in the interdental
space, the rest of the entire arm can either contact
in one point or can be curved and also reach into
the interproximal area.
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In the lower jaw
The body wire
When the crib and crescent for the lower jaw are
finished, the lingual arch can first be adapted
manually into U-shape in the approximate size of
the sublingual space. In the centre of both molars a
right angle is bent towards occlusal and in height
of the crescent, another bend is made mesially. The
wire has to have an even distance to the cast and
assure symmetry in the horizontal plane.
Precurved auxiliaries
In the upper as well as in the lower jaw, for the
protrusion of the incisors auxiliaries are soldered
or lasered onto the lingual or palatal arms. A U-
loop is incorporated in the area of the premolars
which extends over the gingival tissue. The active
part of the spring arm should contact the incisors.
The Pin
The single springs can be bent in different shapes
and serve different purposes. In this case, a simple
pin is soldered or lasered onto the labial arch for
moving the canine.
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The basic high labial
The basic high labial is located, as its name
suggests, in the vestibule and then soldered or
lasered buccally onto the crib. One has to pay
attention to avoid the labial and lateral frenum.
The putters
For the mesial movement of teeth, the point of
force application should come from a distal wire
ending. A distal movement takes place through
springs adapted mesially.
Elastic hooks
The elastic hooks for the intermaxillary elastics are
soldered in the area of the canine onto the labial
arch.
Buccal hooks
In the lower jaw, the buccal hooks are soldered or
lasered onto the crib. These hooks serve for
engaging class II elastics.
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For the soldering or lasering, all elements have to be
fixed with thermal wax onto the cast in order to check
the exact fitting of the single components once again.
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A finished third phase lower Crozat appliance.
Elements: Basic bow 1.0 mm, transpalatal arch with molar rests 1.0 mm,
lingual basic bow 1.0 mm, anterior vertical support 0.8 mm
(remaloy® wire)
Function: Functional orthopedic appliance for anterior-posterior
problems, preferentially applied in Angle class II-1 patients
Description: Delicate functional appliance which imposes slight restriction on
the tongue space and therefore promotes patients compliance
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The doubled casts are set into the fixator according
to the construction bite. Anterior vertical supports
are soldered in the height of the first premolars
between the upper and lower jaw for stabilization.
For the soldering process, the wires can be fixed
with either sticky wax or soldering plaster, or can
be pointed by a Spot Welding Unit. The wires
should all lie side by side and should be soldered
without tension in the assembled fixator. It is
favorable to use a Laser soldering unit because a
higher deformation and corrosion resistance can be
achieved.
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The braces appliance (MB) is used parallel to fixed
appliances, for example, in later dentitions,
angulation or rotation. The labial arch is bent
without U-loops and is placed incisally of the
brackets. In anterior open bites the labial arch is
located with its U-loops gingivally of the brackets
in order to use vertical elastics. The addition of a
moving pearl onto the transpalatal arch can also be
realized to achieve stimulation according to
Castillo Morales.
The lingual arms and the lingual bow are bent from
one piece of wire. The lingual arms are extended
over the center up to the distal part of the lateral
incisor of the counter lateral half of the arch and lie
therefore double on the incisors.
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Once the appliance, bent out of one piece of wire,
lies fitting passively with the anterior springs on
the incisors and the lingual bow has the necessary
distance, it is point welded with the Spot Welding
Unit and then soldered. With the corresponding
activation the incisors can be protruded, the molars
can be uprighted and a transversal expansion or
compression can be achieved.
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The precisely adapted Frozat appliance is fixed
onto the bands with a Spot Welding Unit.
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• The Lizat appliance (Lip bumper and Frozat)
0TU
Elements: Lingual arch and anterior spring 1.0 mm remaloy®, lip bumper
1.0 mm
Function: Molar distalisation with simultaneous anchorage through the
lower lip
Description: The lip bumper is mainly used to enhance anchorage, but can
also support the distalisation of the molars
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• The lingual arch according to Mershon
0TU U0T
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• The Herbst® appliance
0TU U0T
Elements: Occlusal rests, TPA and lingual bow 1 mm hard or one piece
casting method
Function: Achievement of a neutral occlusion after tooth eruption is
finished
Description: In order to avoid a transversal movement of the anchorage teeth,
the rigid construction of the Herbst® appliance is chosen
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• The Herbst® appliance with soldered bands
0TU U0T
Elements: Bands for soldering, upper connecting bow and connecting bow
in the lower jaw, lingual and buccal 0.9 mm hard
Function: Achievement of a neutral occlusion after tooth eruption is
finished
Description: This delicate version of the Herbst® appliance has no coverage
of the occlusal surfaces of the molars
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The casts are mounted on the articulator with a
construction bite. For this purpose, a simple “open-
close” articulator (articulator according to Körner)
can be used.
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After fixing all elements, the thermal wax is
covered with solder plaster or the wires are pointed
with a Spot Welding Unit. Now the appliance can
be soldered, finished and polished.
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The length of the guiding hinges has to be checked
and if necessary, modified.
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The spikes are fixed horizontal to the occlusal
surface in order to hinder the tongue from pressing
against the incisors.
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The extended arm of the tongue crib is guided
straight to the molars which are to be moved
mesially. There, it is fixed with the Spot Welding
Unit to the bands and then soldered.
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The screw should lie as deep as possible in the
centre of the palate. The connecting wires are led
towards the bands, then bent, and afterwards,
united between the first premolars and the first
molars in order to achieve a maximum stability of
the appliance. The adapted Hyrax® appliance is
soldered with laser or fixed with a Spot Welding
Unit to the bands and then ideally soldered on the
cast.
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Once the appliance is polished, acrylic is added on
the occlusal surfaces up to slightly under the
circulating clasp. The bite block should not be too
voluminous, the vertical opening should
correspond to the height of the construction bite.
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The rectangular wire should be adapted on both
sides from the first premolar to the first molar into
these brackets. Special attention should be paid
that this rectangular wire is ligated passively into
these brackets.
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After this, a direct replacement can take place in
the patient’s mouth. While inserting the appliance,
the screw is unscrewed to get past the brackets and
then is opened up again immediately. If the
dimension of the planned expansion makes it
necessary, a third appliance can be inserted.
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After the provisional fixing, the wires are
definitely lasered or soldered. The screw contains
two threads, one anterior and one posterior which
can be activated symmetric or asymmetrically.
Elements: Hyrax® screw, hooks 1.2 mm spring hard (occlusal rests 0.8 mm
hard)
Function: Anterior traction of the maxilla or movement of the upper
dentition when lower forces are applied
Description: The elastics of the Delaire mask are engaged into the hooks
which lie in the canine area
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To ensure a good oral hygiene, the hooks are
attached in a distance of 2 mm from the tooth row.
If vertical opening is desired, the premolar bands
are not needed. Instead, occlusal rests are adapted
onto the first premolars which are intraorally
bonded to simultaneously open the bite.
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In order to simultaneously open the bite vertically
with this appliance, acrylic bite blocks are
attached. In the area of the bite blocks a wax stripe
can be attached to limit the acrylic to achieve a
faster finishing. The casts should be set into the
fixator to guarantee a better adaptation.
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The RPE appliance can also include a buccally
lasered or soldered reinforcement wire. For this
purpose 4 bands are recommended.
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The occlusal surfaces of the posterior teeth are
grasped up to the buccal surfaces. The vertical bite
opening is determined by a construction bite in a
fixator.
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The retentive spots of the cleft are blocked out and
the extension of the acrylic base is limited with
wax.
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When the lower arch is to be expanded, the screw
body is located directly behind the incisors, the
extensions are soldered on the bands of the first
premolars and to increase the stability, brackets are
fixed in the molar area. The bracket bases are
bonded intraorally simultaneously with the bands.
Elements: Rotation bow with occlusal rest 0.7 mm spring hard, expansion
screw
Function: Rapid palatal expansion with simultaneous rotation of the
molars
Description: A delicate appliance which resembles the pendulum appliance
The occlusal rest and the rotation loop are bent out
of one piece of wire. The connecting part of the
wire serves as retention. The loop is placed distally
of the tooth to be rotated and should, in no case,
contact the gingival tissue. To position the
elements, the wire is pointed on and lasered or
soldered either before or after the polymerization.
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The expansion screw is fixed with wax in height of
the second premolars on the mid palatal suture and
the acrylic base is limited with wax stripes.
• Modified HPE
0TU U0T
Elements: Rotation bow with occlusal rest 0.7 mm spring hard, expansion
screw
Function: Rapid palatal expansion with simultaneous rotation of the
molars
Description: A delicate appliance which resembles the pendulum appliance
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With a Nardella screw, the anterior and posterior
area can be expanded in a different way.
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The helix has to be bent opposite in the same way
and should not contact the palate. The distance
between the appliance and the gingival tissue
should be approximately 1 mm.
appliance U0T
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The Bi-Helix appliance also exists preformed for the MIA or Wilson System.
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CHAPTRR 7
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• The soldered Nance appliance (Nance holding
0TU
arch) U0T
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• Modified Nance appliances
0TU U0T
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• Removable modified Nance appliance
0TU U0T
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• The manufacture of the pendulum spring
0TU U0T
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Afterwards, the wire is bent 90° twice in a distance
of 5 mm.
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The end of the wire lies in the centre of the palate,
points anteriorly and is bent into the retention.
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For the spray-on technique of acrylic application,
the springs are fixed with wax distal to the molars
and the closed loop is blocked out with wax. The
extension of the palatal plate, which resembles the
one in a Nance appliance, can be limited with wax
stripes.
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The expansion screw should be laid near the mid
palatal suture to be able to design the whole
appliance delicately. The pendulum springs are
fixed under the body of the screw and are located
mainly distally of the molars to be moved.
Snodgrass U0T
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The soldering of the connecting wires can be done
before the scattering of the plate (or afterwards,
cautiously with a small soldering flame). The
transversal screw is fixed in the centre of the
acrylic plate.
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The double ending bent retentions are wrapped
around with ligature wire, and then with a small
flame, silver solder is melted in between. This way
a stop is created. Afterwards, they are covered with
a very thin layer of wax in order to create a
corresponding reception space to anchor the
retentions.
according to Kinzinger U 0T 0T
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To avoid the contact of the acrylic with the curve
of the palate, this part is previously underlaid with
wax.
Elements: Occlusal rests 0.7 mm spring hard, pendulum spring out of 0.8 mm
rematitan® SPECIAL
Function: First and second molars are moved distally one at a time
Description: The removable pendulum springs can be activated or deactivated
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To prepare the acrylic application, the retentions of
the pendulum springs are engaged into the
Goshgarian locks. The small hooks (cleats) on the
locks are bent over and serve as retention in the
acrylic. The engaged retentions of the springs and
the locks are covered with wax on their surface.
Elements: Occlusal rests 0.7 mm spring hard, segmented arch wire for
lingual technique out of 0.8 mm rematitan® SPECIAL, single
ended pendulum spring with mesially open U-loop, lingual
brackets
Function: Leveling of the incisors through the segmented arch wire with
simultaneous anchorage of the appliance
Description: The placement of the segmented wire in the anterior region
makes the extension of the acrylic base wider
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The segmented wire for the lingual technique is
fixed passively into the bracket slots. These can be
either already bonded directly in the patient's
mouth and be represented well on the working
cast, or fixed onto the cast for indirect bonding.
Elements: Occlusal rests 0.7 mm spring hard, pendulum spring out of 0.8
mm rematitan® SPECIAL
Function: The loops of the rematitan® SPECIAL springs are moved from
the horizontal to the sagital plane to move the molars distally
without transversal side effects
Description: Big designed pendulum loops without U-loops, removable
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The relatively big palatal plate is extended in a
mushroom shape behind the loops of the pendulum
spring. To be able to activate the springs
extraorally, they are slightly blocked out in the
retention area. This wax coverage is minimal so
that the retention does not sit too loose in the
acrylic but is still removable.
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The pendulum spring is first underlaid with wax,
then fixed in its preactivated position onto the cast.
The Bertoni screw is placed with the anterior part
of the screw over the retentions of the spring.
Afterwards, a wax stripe can be added to limit the
acrylic base.
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• The Aachener Implant Pendulum (AIP) according
0TU
to Kinzinger U0T
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spring out of 0.8 mm rematitan® SPECIAL
Function: Distal molar movement with anchorage of the pendulum through a palatal
implant
Description: When in the posterior region the anchorage situation is not sufficient, for
example because of periodontal damage, the pendulum can be fixed onto an
implant placed into the palate
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• Pendulum GNE Distalizer (PhD) according to
0TU
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• Labial bow pendulum according to Kinzinger, K
0TU
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• The space mantainer with teeth
0TU U0T
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On the anterior and posterior teeth a small bit of
gingival tissue is modeled. This enhances the
support and optimizes the esthetics as the upper lip
does not seem so retruded.
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• The gap or space mantainer
0TU U0T
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• The cleft plate
0TU U0T
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The palatal plate has to have in its whole extension
the same height as a complete palate. For the curve
of the descending cone, one can use the own thumb
as measure. But anyway, the cone has still to be
individually adapted to the curve of the palate.
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• The stimulation plate according to Castillo
0TU
Morales U 0T 0T
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CHAPTRR 8
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he retention plate
0TU U0T
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The splint type retainer
0TU U0T
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The Essix retainer
0TU U0T
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The Osamu retainer
0TU U0T
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The van der Linden retainer
0TU U0T
Elements: Labial bow with canine loop 0.8 mm spring hard, C-clasps 0.8
mm spring hard
Function: Retention
Description: Retention appliance without interfering occlusal contacts
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The Hawley retainer
0TU U0T
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The Hawley retainer can be replenished with
Adams clasps. For this purpose, both Adams clasps
and the labial bow have to be bent out of soldable
wire. In this case, the labial bow includes small U-
loops in the premolar/canine area.
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The labial bow is bent individually with a slight
distance from the teeth and covered with acrylic.
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The retention plate with interdental spurs
0TU U0T
Elements: Simple labial bow and interdental spurs 0.7 mm spring hard,
occlusal rests 0.7 mm hard
Function: Retention
Description: Retention plate without real retention elements
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The spring retainer
0TU U0T
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The incisors are limited with a wax box and the
labial and oral acrylic shield is made using the
spray-on technique.
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The positioner
0TU U0T
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On the basis of the new wax bite, the duplicated
casts are set into the fixator. The fixator should
allow a simple removal and insertion of the casts.
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After the cooling of the material, the positioner can
be cut neatly with scissors. The edges are
smoothed out with the “blue Jota”. As a
conclusion, the positioner is set onto the casts; it is
shortly passed through the flame of the Bunsen
burner and is again adapted with damp fingers.
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Afterwards, the tooth surfaces which are to be
bonded are isolated (isolation agent/Dentaurum or
Aislar/ Kulzer) and a drop of a fluid light-curing
bonding (e.g. Con Tec LCR/Dentaurum, Flowline/
Kulzer or Tetric-flow) is placed on each of the oral
surfaces from canine to canine or first premolar to
first premolar.
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Afterwards, the polimerized fluid silicone material
is covered with kneadable silicone (Lutesil/ Bisico)
and formed into shape using the fingers.
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The occlusal splint
0TU U0T
Elements: None
Function: Treatment of cranio-mandibular disorders
Description: Completely polymerized occlusal splint in therapeutic position
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The Gelb splint
0TU U0T
Elements: Ball retainer clasps 0.8 mm hard, lower jaw bow 2.5 mm oval
hard
Function: Treatment of patients with joint clicking sounds
Description: Reduced occlusal splint with extreme occlusal guidance which
avoids shifting from the therapeutic position
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The reduced splint
0TU U0T
Elements: Ball retainer claps 0.8 mm hard, bow 3.0 mm x 1.5 mm hard
Function: Treatment of cranio-mandibular disorders or for vertical
opening
Description: Delicate but stable splint which can also be used in patients with
fixed appliances
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Bite blocks
0TU U0T
Elements: None
Function: Treatment of cranio-mandibular disorders
Description: Intraorally bonded bite blocks
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The IST appliance according to Hinz
0TU U0T
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The surgical splint
0TU U0T
Centric-splint:
The casts are trimmed in all three dimensions after
their pouring. First, the upper cast is mounted on a
semiadjustable articulator using a transfer fork
(bite fork) in the correct relation to the cranium.
Afterwards, the lower cast is mounted using a
centric relation record. The incisal pin has to be
always in “0” position. The base of the articulator
is trimmed together with the cast base. The casts
and the base have a smooth surface to be able to
draw the orientation scale for the model surgery.
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Positioning splint:
The casts should be dry for the drawing of the
orientation scale being able to use a water resistant
pen. The vertical reference lines in the upper jaw
are drawn between the cast and the base in the area
of the lateral incisors between the canine and the
premolar and over the first molars. In the lower
jaw, the drawing is realized in the area of the
central incisors between the canine and the
premolar and underneath the first molars. The
reference lines should correspond to the vertical
axis of the teeth.
Definitive splint:
Immediately afterwards, the third (transparent)
splint can be made. The articulator pin is set again
into “0” position and the model surgery of the
lower jaw can be started. Therefore the lower cast
is cut away from the articulator base repositioned
according to the planning in all three dimensions
and the interfering plaster surface of the base is
trimmed if necessary. The cast is firmly fixed with
sticky wax.
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Once again, the wax limitation is set around the
teeth and the articulator pin is raised 2 mm exactly
as with the other two splints. After hydrating and
isolating, the acrylic is added and the splint is
finished. The acrylic should extend minimally over
the dental arch. Between the single teeth in the
upper jaw small holes are drilled into the splint to
allow the intermaxillary wiring. Small grooves are
grinded into the outer surface to receive the wire.
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After bending both splints, the model surgery is
realized as usual in the articulator. With the wire
splints in place, the transparent or definite splint is
made with the spray-on technique and then
finished.
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