2. Hawley Appliance and Molar Uprighting

Question 1

Purposes of Hawley - in ortho = used for ____, ____
• also can add various axillaries or attachments to it that can move teeth
But the traditional Hawley for orthodontic retention is a Hawley retainer with labial bow (will see pictures of soon) and some form of retention

Answer 1

retention

disarticulation

Question 2

Why Orthodontic Retention Is Needed?
• Orthodontic treatment results may be unstable, so ____ is necessary.
• Gingival and periodontal tissues require ____ for reorganization after orthodontic treatment is done.
• Soft tissue pressure constantly produces a ____ tendency.
• Growth changes may alter orthodontic treatment results.

Answer 2

retention
time
relapse

Question 3

Why orthodontic retention is needed?

Now let’s look at the fiber network
• Old paper from 1959
Showed how the fiber orientation is around the teeth
• When there are rotations, you could see how the gingival fibers are oriented totally differently than
they would be when the tooth is lined up
• This can lead to orthodontic ____ right after the braces are removed, if it’s not kept in retention
◦ Now there are other gingival or periodontal procedures that also help - we won’t get into them today
But for purposes of today and for retention, if you look at this article it very well describes what happens from the day that the braces are removed, over a 2 week period, then over a month, etc
• See on right side - the more “+” there are, means there has been more rearrangement of the fibrous tissues
◦ In the beginning, if look at first 15 days after braces or orthodontic appliance taken off, (he moves on to next point w/o ever finishing this sentence, but if look at picture - there are no “+”, so no remodeling has occurred)
◦ Applies to all forms of movement - invisilign, standard brackets
• Trays and brackets are only a vehicle - put pressure on tooth, and as long as tooth isn’t ankylosed, it will move
• So need retention. No matter what vehicle you use - need retention afterwards.
◦ If look at it one month out and look at “marginal area,” “middle area,” and “apical area” - can still see that all this remodeling is occurring
◦ Then look all the way down at 232 days, and the apical area and middle region most of the remodeling has occurred, but there is still some in the ____ portion around the gingival margin
• And that is partly due to these ____ networks
• So even at 6 months out, retention ends up being important
▪ The more rotations you have, the more ____ position that’s out of alignment, the greater the chances are that it will partially relapse to that position.

Answer 3

relapse
coronal
gingival fiber
buccal-lingual

Question 4

Types of Orthodontic Retainers
• ____
• ____

Answer 4

removable

fixed

Question 5

Hawley Appliance (Retainer)
• \_\_\_\_, first designed in 1920
• The most commonly used \_\_\_\_ after orthodontic treatment
• Can be used as \_\_\_\_ appliance (space consolidation, retraction of anterior teeth and other minor tooth movements, tongue crib... etc.) Can be used to \_\_\_\_ spaces and retract \_\_\_\_ teeth

Answer 5

removable
after
active
consolidate
anterior

Question 6

Components-
– ____ (adams, C, ball)
– ____ with adjustment loops (with or without acrylic on bow)
– Palate coverage with ____

Typical components (but not limited, there are other variations):

1. Reads
2. Labial bow can be expanded, adjusted, tightened
   a. Can also put acrylic on labial bow - some people put small layers of acrylic on labial bow so that when retaining teeth it is on the ____ and lingual around each tooth so it really holds it in position
   b. Many variations
3. Most hawleys have palatal coverage and it’s in acrylic

Answer 6

clasps
labial bow
acrylic
buccal

Question 7

Hawley Appliance (Retainer)

Left picture
See ____ clasp on molar
See labial bow on Mx and Md from canine - anterior
◦ Mx also has a soldered extension around it (the canine)
◦ Md is a standard labial bow picture

Right picture
When on a model - usually acrylic in the lingual - 3-3 labial bow
◦ 3-3 means canine to canine
On lower many times will put ____ back on posteriors - reason is if don’t put a rest or groove where doesn’t interfere with the occlusion, then the acrylic in back tends to push down
◦ If pushes down apically then it depresses and irritates the tissues.
If look at it carefully will see that have acrylic on lingual and ____ - so anterior teeth are almost cradled within that retainer
◦ So really prevents ____ movement and rotations Sometimes have variation where try to move a tooth and can reset teeth on model, but that actually has active tooth movement (won’t get into that now)
◦ For tooth that is rotated - can make an appliance called a ____ - has activation and can move teeth with it (that’s not for retention purposes)

Answer 7

adams
rests
facial
buccal-lingual
spring aligner

Question 8

Hawley Appliance (Retainer)

Top: typical Mx Hawley with acrylic
• See ____ clasp on upper right molar
• See labial bow and a thin acrylic overlay on anterior teeth
• On upper left molar have an ____ spring
◦ So after finish ortho, if have one tooth you want to tweak and move a little (push forward or de-rotate it) can do minor movement
◦ Or don’t after ortho is finished and patient comes back and says
tooth is slightly rotated (years later) - can correct it through attachments on your removable retainer
• Serves 2 purposes = ____ and ____

Bottom left - facial shot where can see little acrylic we discussed

Bottom right - here have a ____ clasp (not an Adams clasp)
• Sometimes put a clasp also here (first molar off the labial bow)
◦ In ____ cases it’s not unusual to solder a C clasp to the distal of the labial into an extraction space - space opens up, and this helps hold that space

Answer 8

adams
active
retention
active movement

C
extraction

Question 9

Hawley Appliance (Retainer)

This case you see a C clasp on both sides Still see the acrylic overlay
Standard canine-canine labial bow

When this person bites down- lower dentition may hit these clasps and won’t be able to bite all the way
• Often that patient wont be able to ____ completely
• When goal is retention though - not too big a deal b/c can take it out and
put it back in

Answer 9

occlude

Question 10

Hawley Retainer - Wrap Around

Another variation - called a Wrap Around
• Here there is no ____ coming up over the occlusal portion - no wire
extending interproximally over the occlusal portion

So if look at this: have a labial bow on outside that is not only canine-canine, but is extended further back and ____ all the way around
• Still a Hawley retainer but is called a Wrap Around Hawley
◦ Used for person who has really ____ occlusion
• patient bites down completely and everything comes into occlusion
and don’t want to ____ them all
• Or trying to get certain teeth to settle then this works very well
◦ ____ should be the same with Hawley in or out

Answer 10

clasp
wraps
tight
disarticulate
bite

Question 11

Hawley Appliance - With ____

Answer 11

tongue crib

Question 12

Fixed Orthodontic Retainer

Here is a case that see before and after
Post-Ortho retention is off of a fixed retainer where patient has bridges in the back
• Serves as a way to retain all the posterior teeth (lower posteriors usually aren’t a problem unless there are edentulous areas)
• (top right picture) - so if finished and didn’t put anything mesially to the back molars, then they will drift mesially - come forward and extrude
◦ So need to do something, can’t just do fixed for anteriors
◦ This case was planned to do molar uprighting and then put two posterior ____ and a fixed canine-canine retention

Answer 12

3-unit bridges

Question 13

Fixed Orthodontic Retainer - Pretreatment

Another case
• Severe crowding, constricted Mx, anterior open bite
• This case need to extract teeth, but even after extractions and aligning has
high frequency of ____ - b/c look at the rotations, have ectopically erupting teeth, severe crowding
◦ So have B-L issues as well as rotations - those teeth will relapse • So NEED to put in retention

Answer 13

relapse

Question 14

Fixed Orthodontic Retainer - Posttreatment

Top left picture - see some fixed retention on anterior - made out of rigid wire, wire with ____ (companies now make wires that are rectangular with a little give) ____ is a concern here when put Mx retainer in - cannot put it into occlusion
• So this person has an open bite - lower incisal edges aren’t touching the cingulum of the upper incisors.
• If had ____ occlusion of lower incisors against cingulum - this wouldn’t work (cant put it into occlusion (it can touch lightly, but can’t have it interfere with occlusion

Answer 14

flexibility
occlusion
strong

Question 15

Hawley Anterior Bite Plate

• To control ____ bite, occlusal trauma, bruxism - Musculature type
____ (strong)
____ (weak)
• To determine ____ (CR)
• To ____ spaces and retract anterior teeth

Answer 15

deep
brachyfacial
dolichofacial
centric relation
consolidate

Question 16

Hawley Anterior Bite Plate

Now let’s talk about another variation of it - The Bite Plate (it always sounds like he says “Plane” but since the slide says “Plate” I’m going to keep writing “Plate”)

1. The Hawley Anterior Bite Plate is used often in cases where need to do ____.
   a. So if need to separate the posterior teeth, if have case with trauma due to occlusion, for bruxers (adults but some kids), or patient with really deep bite that now can’t even put braces on their lower teeth.
   b. Disarticulate and sometimes done with Hawley
   c. Now anterior contact and posterior disarticulation also helps when have
   patient with all types of muscular problems - b/c if disarticulate the posterior teeth then the forces generated (due to mechanics, jaw, and muscle placement) can get a lot more force in back than can in front
   i. Studies show that if disarticulate and only have ____ contact - then when bite down they aren’t generating as much ____ as would if bite on back (but here back is completely separated)
   - So allows you to do molar uprighting in posterior section or allows for posterior extrusion (so there are many scenarios where can use them)

Two types of musculatures - One generates very weak forces, other very strong forces
◦ Brachyfacial - ____ angle with powerful muscles generate a lot of ____
• So sometimes will disarticulate them to help control some of the forces
• May even do it in retention afterwards
◦ Dolichofacial - ____ angle, flaccid musculature, much ____ - doesn’t generate the same amount of force

Answer 16

disarticulation
anterior
force
low
force
high
weaker

Question 17

Hawley Anterior Bite Plate

2. Next situation where use a bite plate = when have trouble establishing ____ position
   a. Patient who have tight ____ and can’t get them into CR
   b. So those patients will put them in a bite plate and will deprogram the muscles
   i. Muscles start to relax and now patient can much easier go into CR. Works very ____
   c. Some cases with CO vs CR discrepancy - becomes a big deal b/c if huge
   discrepancy and can’t get them back into CR
   i. Then when you do your ortho in CO and later in treatment put them
   into CR, then can’t bite the same
3. muscle memory starts to get confused - so jaw drops back and now have ____ that didn’t have before
   d. So if truly want to get a CR position and have muscles that are preventing
   it, then can disarticulate with Hawley bite plate then go into CR
4. Also can be used to ____ spaces - ways to take anterior teeth and bring them back using rubber bands on patient who has lost some posterior teeth and anteriors are flaring
   a. So reestablish ____ support and bring the ____ teeth back
   i. Done with Hawley appliance with rubber bands

Answer 17

CR
musculature
quick
overjet
consolidate
posterior
anterior

Question 18

Anterior deep bite

Case - can see anterior deep bite
• Difficult to put in orthodontic brackets on lower teeth
◦ Would need to open up the ____, ____, may have to do some ____ (depending on the case)
• Situations that will have to address before just start putting on
some braces and moving teeth

Answer 18

bite
disarticulate
intrusion

Question 19

Hawley Anterior Bite Plate

A flat bite plane that articulates evenly with ____ teeth

Case where go ahead and put in a Hawley bite plate
• Design: just like Hawley earlier with Adams clasp on back, ____
labial bow
• But now in front have an anterior platform
◦ Reads bottom line (adds ALL mandibular anterior teeth)
Bottom pictures: When appliance is in can see that bite is much more open than previous slide (he quickly turns back to previous slide).
• Also see disarticulation of ____ teeth

Answer 19

mandibular anterior
canine-canine
posterior

Question 20

Hawley Anterior Bite Plate - Bite Opening

When bite plate is in - go ahead and do movements
• Open up the bite, establish new ____ support, and can change the position of the anterior relationship completely

Left pre-treatment = deep bite
Right post-treatment = much shallower here - have significant amount of bite opening

Answer 20

posterior

Question 21

Anterior deep bite

Can see all the wear
• Case that is creating trauma that is damaging the
dentition
• Wear facets in upper anterior b/c lower teeth are hitting against it
◦ Normally will see chip and wear on lower teeth, and see wear facets on uppers
◦ When they are locked in like this, they don’t have normal freedom of ____
• So if they are clenchers or at nighttime are bruxers - they lock in and start jiggling or moving these teeth
• Cause all kinds of occlusal trauma and muscle discomfort Want to correct that - don’t want to leave them in ____ like this

Answer 21

jaw movement

traumatic occlusion

Question 22

Hawley Anterior Bite Plate

This is what it looks like in the mouth Put bite plate in and have:
• Posterior ____
• Only have anterior contact
• Can put ____ for this - put a ramp to allow incisal guidance
◦ May not need to as much b/c already have posterior disarticulation, but when they go into protrusive and need to decrease opening, then can put in ramp so that when they go forward will keep posterior disarticulation

Goes to previous slide “fixed ortho retainer - posttreatment”
• disarticulate with Hawley bite plane
If want to extrude some posterior teeth and open up the bite - can
• Allow some ____ eruption if don’t have obstructions in the way

Answer 22

disarticulation
guide planes
posterior

Question 23

Hawley Anterior Bite Plate

Looks in the mouth
• Here have ____ clasp - another variation
◦ (seemingly when make C clasp and wire goes over mesial [instead of distal] of tooth)
◦ Can do many different variations

Answer 23

reverse C

Question 24

Hawley Anterior Deep Bite
- Loss of Vertical Dimension

Here is a case that mentioned earlier can have loss of vertical dimension and flaring of teeth - see that in adults when they lose posterior teeth
• b/c adjacent teeth mesially drift and get extrusion and have posterior bite collapse (termed here at Penn)
See loss of vertical dimension, ____ of anterior teeth, tipping of posterior teeth (2nd molars) when they lost their 1st molars
• Very hard to manage - orthodontically hard, difficult restorative, also difficult perio concern (and when teeth are in trauma can have endodontic issues too
◦ Case like this has to be ____ first
• Can use Hawley anterior bite plate
◦ Then do molar ____
◦ Establish posterior support,
◦ then start working on anteriors - ____ anterior, get rid of flaring/ spacing, bring them into proper alignment, and get adequate overbite and overjet

Answer 24

flaring

disarticulated
uprighting
retracting

Question 25

Hawley Anterior Bite Plate
- Anterior Bite Opening and Extrusion of Posterior Teeth

Here’s a bite plate already in the mouth with an Adams clasp on upper left (can also add springs if want to distalize and still disarticulate)
• This is a case of ____ bite opening and also extrusion of the ____ teeth

Answer 25

anterior

posterior

Question 26

Bite Opening and Retraction of Flared Incisors

See anterior flaring, want to consolidate these spaces bring these teeth back
• This patient does have ____ support, but have slightly deeper bite
◦ If get wear on posterior teeth and get more contact on anteriors -
then can start to ____ and space opens up (one of the many reasons why will get space)
• When get flaring then will see this space

Answer 26

posterior

flare

Question 27

Bite Opening and Retraction of Flared Incisors

Here it is closed
• Go ahead and open up the bite a little bit, retract ____ teeth, reestablish ____ support and this is how you can finish the case

Answer 27

anterior

posterior

Question 28

Hawley Anterior Bite Plate - Anterior Bite Opening

If you put this appliance in - can be used for retention, also used as an ____

Answer 28

occlusal appliance

Question 29

Adult Adjunctive Orthodontic Treatment
– Molar Uprighting
• \_\_\_\_ nature 
• \_\_\_\_ dentition
• \_\_\_\_ condition

Answer 29

interdisciplinary
mutilated
periodontal

Question 30

Adult Adjunctive Orthodontic Treatment

Adjunctive ortho treatment can be many different things: Can be molar uprighting, can be removal of ____, can be extrusion of teeth for restorative purposes
• Some of these you may choose to do in your own office and may not want to get into some more comprehensive treatment - depending on if specialize or not
• There are many general dentists who do minor tooth movement. This is within your scope of practice - something you can do, should know how to do
• Not unusual to have patient come in with 1st molar missing and 2nd molar tipped forward
• Once you know the mechanics and the biology of everything and understand the principles - then can easily do this in your practice.
◦ Done for implant purposes, crown and bridge purposes, etc.

1. Interdisciplinary - can have a restorative, ortho, perio, and even endo component to it
2. Usually utilized in mutilated dentition
   a. Saw a slide already with anterior flaring, loss of posterior teeth, loss of
   vertical dimension
   i. That is a more comprehensive ortho case
   b. But if had a case with just ____ molars, then can use adjunctive ortho to
   put them into their proper position
3. Also helpful in periodontal condition - when have teeth that are tipped, they are
   harder to ____
   a. Mesial aspect is very difficult to clean, the tissues rolls - can develop a
   pseudopocket
   i. Then if actually get attachment loss can get a true pocket
4. b/c hygiene becomes difficult with tipped tooth, hard to get underneath there to clean

Answer 30

rotations
tipped
clean

Question 31

Adult Adjunctive Orthodontic Treatment
• – Molar Uprighting
• To move teeth to facilitate restorative treatment by positioning the teeth so more ideal and conservative ____ (including implants) can be used.
• Takes ____ time, a few months to 1 year.
• Long term retention is supplied by ____.

1. Reads word for word
   a. If you have an edentulous area with a missing 1st molar and a tipped 2nd
   molar, but you feel like you have enough space for the implant
   i. Can’t just put the implant in and leave the 2nd molar tipped like that
2. 2nd molar will be difficult to maintain
3. Can affect new implant, b/c when have tooth that is tipped and the
   other is straight next to it - very hard to clean in between. So putting new implant at risk as well
   a. So important with implants to put teeth in proper position so
   that they have better contacts and patient can maintain them
   better.
4. Based on the case complexity, can take very little time or much longer
   a. Can take from few months to 1 year 3. Reads.
   a. Before were shown case with 3-unit bridges, that’s for retention as well as restorative (serves many purposes). Will hold it in position. (Fine to use implants too)
   i. Have to do something after the uprighting is done, otherwise it will collapse again

Answer 31

technique
shorter
restoration

Question 32

Mesially Inclined Molar

Here is a typical case where a 1st molar is missing and can see what’s happening with the 2nd molar
Very hard to clean - cannot maintain this very easily. Cleaning this area becomes a big problem
• Tissue begins to ____ and bunches on itself as tooth moves forward

Important to upright this tooth before put anything into the space - whether will put bridge or implant, doesn’t matter
• First have to create space here, but 2nd need to put it into better position

Occlusally why is this important?
• If a patient bites down and hit on this think about where the forces are most
favorable - are they more favorable straight down or along long axis of the tooth
◦ Obviously down the long axis of the tooth
• So putting this in its proper position will dissipate the forces in a
more favorable direction, which will allow the patient to maintain
this area better and won’t have a plaque trap here ◦ Think of this like an undercut that can’t get into
• This patient is lucky they haven’t had sever periodontal problems
◦ Over time this can develop a severe periodontal problem - huge infrabony pocket
• Then even more difficult to save the teeth

Answer 32

roll

Question 33

Mesially Inclined Molar

• Gingival tissue becomes ____
• Deep pocket formed on ____ – difficult to clean
• ____ pocket

Answer 33

folded
mesial
infrabony

Question 34

Mesially inclined molar

____ of mesial side and infrabony pocket

Tooth that’s tipped - it also then leans forward and also extrudes
• So when bring it back into its proper position - either have to ____ it down or ____ it
◦ That’s why we disarticulate it because as you upright it, it is going to go into occlusal trauma
• So by separating, you upright it w/o putting it into occlusal trauma
• Then do an occlusal adjustment to take it down
▪ Or find other mechanical ways to intrude it. Once that is upright can do what you want to do restoratively

Answer 34

intrusion
cut
intrude

Question 35

Mesially Inclined Molar

____ of opposing molar

Answer 35

supra-eruption

Question 36

Mesially Inclined Molar
• Could be second and third molars both mesially tipped
• Both can be ____. If third molar is uprighted to a place good ____ cannot be maintained, then ____ would be appropriate.

Answer 36

uprighted
hygiene
extraction

Question 37

Molar Uprighting
 Reduce the \_\_\_\_ 
Reduce the \_\_\_\_
Extrude the \_\_\_\_
Occlusal reduction needed to prevent \_\_\_\_ and improve crown/root ratio

Answer 37

pseudopocket
infrabony pocket
molar
occlusal trauma

Question 38

◦ So if you look to a case like this and you measure it out from the top of the cusp to the tip of the root - if you look at where the attachment level is it is pretty close to a ____ ratio of crown to root ratio
• Half of the tooth is supported by attachment and the other half is not.
(Pretty close to 50:50)
◦ When upright it - will need to cut the top of it off b/c it will be above the plane of
the occlusion and will be in occlusal trauma if you don’t. • So need to do an occlusal reduction

• After doing the occlusal reduction to get it into the proper centric stops w/o it being in trauma - now will have ____ ratio of crown to root
◦ 30% coronal to the attachment and 70% apically
• Pretty good ratio, when consider from crown to root ratio perspective or
what’s supported by bone vs what’s not.
• Periodontally can be very stable with this type of a ratio
▪ Now can go ahead and do something restoratively or can upright it further
• (if leave this case like this, still wont have room for implant (just looking at the picture))

Answer 38

50: 50
30: 70

Question 39

Appliances for Molar Uprighting
• \_\_\_\_ preparation
• \_\_\_\_ first molar, \_\_\_\_ canine and premolars of the quadrant
• Sectional wire and \_\_\_\_ spring
• \_\_\_\_ appliance

Answer 39

anchorage
banding
bonding
upright
removable

Question 40

Molar Uprighting Mechanics
• On molar, a band of ____ should be used.
• On premolars and canine, ____ can be placed to engage a passive steel wire.
• A ____ SS (or .017 x .025 SS) wire can be placed immediately.
• A ____ may be needed to control the trauma.
• An uprighting spring (____) is placed.

Answer 40

double tube
brackets
0.018
bite turbo (occlusal stop)
0.018 x 0.025SS

Question 41

Molar Uprighting Mechanics
• Bracket/band placement

• Here’s a case on a model.
◦ This is a bondable tube with an auxiliary slot at the boBom.
◦ This is a T loop- allows you to have more wire, gives you more ____.
◦ As you engage, the idea is to upright the tooth- it’ll kick it back, and extrude it a liHle bit more. When
uprighted, it’ll be above the plane of occlusion so you’ll need to reduce the occlusion.
◦ You use the 3 passive brackets on the premolar as ____. You can’t see the lingual por)on in this
view, but we need a ____ retainer from canine-to-canine. The wire will go up and engage the wire on the premolar, which will “kick back” the molar.

Answer 41

flexibility
anchorage
lingual

Question 42

Molar Uprighting Mechanics

A sectional ____ or ____ SS with T-loop - Without engagement

Answer 42

0. 016

0. 018

Question 43

Molar Uprighting Mechanics

____ SS Uprighting Spring

Answer 43

0.018 x 0.025

Question 44

◦ When they’re not ac)vated, they lean in the ves)bule.
◦ When it’s made in the lab, you have the uprigh)ng spring ready-made, there’s a helix right here that
goes ____ against the tube.
◦ You have to leave the wire a liBle bit long, but not too long that it’s gonna poke the pa)ent.
◦ As that tooth uprights, the wire has to be a liBle bit ____ in the back, to prevent it from coming out
of the tube over )me. You want the wire to remain engaged.
◦ You take an instrument (he uses the Weingart), and very carefully posi)on it over the wire to engage,
and then ____ the hook shut! If you don’t pinch it shut, it can pop off during func)on.

Answer 44

flush
longer
pinch

Question 45

Molar Uprighting - Anchorage
To prevent side effects from uprighting mechanics
• \_\_\_\_ retainer or holding arch
• \_\_\_\_ molar
• Bone screw- \_\_\_\_

Answer 45

bonded lower 3-3
ankylosed primary
temporary anchorage device

Question 46

Molar Uprighting - Anchorage

____ SS bonded 3-3

Answer 46

0.028

Question 47

Molar Uprighting Mechanics

• Here is what the wire from the TAD case (previous slide) looks like. You have ____ on both sides posteriorly, with ____-back bends. Bracket everything else to serve as anchorage and you can upright both molars.

Answer 47

helices

tipped

Question 48

• Here, you can see what both sides of the pa)ents look like (ankylosed teeth bilaterally).
◦ Side note: NOT ALL ____ TEETH CAN BE USED AS ANCHORAGE. Issues: ____ present, can’t find a place for aBachment, etc. Might not be able to use it, may have to resort to other means and
EXT.

Answer 48

ankylosed

caries

Question 49

• Here’s an occlusal view of the same pa)ent. Both primary teeth are completely buried, so you end up with a huge ____ discrepancy at the osseous level, the posterior teeth ____ forward, and the upper teeth ____.

Answer 49

vertical
tip
extrude

Question 50

• Radiograph of same pa)ent.
• There are a few problems: we can see resorp)on or caries in the right primary molar, which can cause
some issues for us in terms of anchorage.
◦ We could s)ll use it as anchorage, but we may end up with a fracture, difficulty bonding.
◦ He’s not sure whether it’s caries or resorp)on, but he wouldn’t be surprised if it was resorp)on.
Primary teeth as you get older do tend to start to ____ (roots get replaced by bone).
◦ Our op)ons: keep those teeth as anchorage, or extract, place miniscrews, and use that as anchorage
to upright the posterior molars bilaterally and then do restora)ve.

Answer 50

resorb

Question 51

Miniscrew as anchorage

• This is what a miniscrew looks like radiographically.
◦ It’s v simple. Residents use it all the )me, he uses it rou)nely in prac)ce. Once you become
comfortable with it, understand the mechanics of it, they are really easy to place.
• They do NOT ____ to the surrounding bone, but they do serve ____ purposes. When
you’re done, you can easily back them out.
◦ You can aBach ____ to it, or screws with slots so you can place a wire through it.

Answer 51

osseointegrate
anchorage
attachmentd

Question 52

Molar Uprighting Mechanics

• This is what they look like clinically.
◦ You put it into posi)on, bind resin on top to lock it in, then place rigid wire, and bond resin to the
1st premolar to hold it in place.
◦ Note- the ankylosed primary molar IS the anchorage, however. So you can do whatever you want
posteriorly to that, and as long as the primary molar is serving as the anchorage & holds, it will
NOT affect the ____r that is bonded with the wire.
◦ Once in a while, they can become ____. You can’t put a tremendous force on it and overac$vate
them, so be careful and watch them closely.
‣ If it becomes loose, you will lose anchorage. So you find another place and reposi)on it.
◦ In terms of anesthesia: v ____ anesthesia required, usually just soj )ssue anesthesia. You don’t
need a full mandibular block. Just a small infiltra)on.

Answer 52

1st premolar
loose
little

Question 53

Molar uprighting mechanics

• This is what the anchorage looks like radiographically once placed.
• In this case, we kept one ankylosed tooth as anchorage, but we extracted the other ankylosed tooth with
ques)onable resorp)on/caries.
◦ In place of that, they aBached a rigid wire from ____ up to the premolar to serve as
anchorage.

Answer 53

TAD/miniscrew

Question 54

Molar uprighting mechanics

• Bracketed the two premolars, and used a rigid wire. The uprigh)ng spring has been taken off. You’re using the rigid wire now to hold it in posi)on, because now you want to do restora)ve to keep the space.
◦ If you’re choosing to do a bridge, you can remove the brackets/wire the same day you ____. Take it all off, prep, temp, and place 3 unit provisional for reten)on of space.
◦ If you’re doing an implant, you want to keep the brackets/wire in posi)on. Place an implant within a few months right before you’re ready to take brackets off. You want to place the implant, let it osseointegrate, THEN take impression, send it to the lab, once they make the crown, then they take brackets off same day.
‣ He likes to leave brackets on un)l right before he’s ready to put the restora)on in. If he has to take the brackets off ahead of )me, like if pa)ent’s not geqng implant for a year+, he puts some form of ____ in to keep the space (Essex, Hawley temp retainer with tooth on it).

Answer 54

provisionalize

retention

Question 55

Molar Uprighting mechanics
• \_\_\_\_ adjustment is important.
• Clinical evaluation of musculature type
- Brachyfacial `
 - Dolichofacial

◦ If it goes into trauma, you’re at high risk for aHachment loss.
‣ Risks of ____ & periodontal issues. If teeth are in trauma while moving them, they will become very mobile, hard to clean for pa)ents (sensi)ve, painful) –> ____ issues, gingival inflamma$on.
‣ Now you’re trying to move a tooth that’s in trauma AND undergoing inflamma)on –> v v bad scenario, and v hazardous.
◦ It’s VERY important to monitor occlusion closely.
• Depending on musculature type, the ____ will generate a lot of force!I It’s even more important
for them.
◦ ____ are STILL a concern, but less so. (s)ll need to check occlusion, and adjust it).

Answer 55

occlusal
endodontic
hygiene
brachyfacial
dolichofacial