Removable Appliances

Question 1

What tooth movement can be achieved with a removable appliance?

Answer 1

Tipping

Question 2

Clinical examples of tooth movement achieved by removable appliances

Answer 2

Retroclination of upper labial segment to reduce an overjet

Distal movement of buccal segments with “en masse” appliance headgear

Distal movement of upper buccal segment/ mesial movement of lower buccal segments with functional appliance.

Question 3

List and describe the function of the components (including wire sizes as
appropriate) that may be prescribed in the design of an upper removable
appliance (that could be used to correct an anterior crossbite of the upper
left central incisor in a 12-year-old patient in the permanent dentition

Answer 3

1.Z Spring (0.5mm SS) / anterior screw UL1 - active component
2.Adams Cribs 6 4 | 4 6 (0.7mm SS) - retention
3.Acrylic Baseplate – anchorage and hold components together
4.Posterior Bite Plane – to open the bite and permit forward movement of the UL1

Question 4

Your orthodontist has decided to use the appliance you have described
above. Describe the clinical and laboratory stages of fabrication

Answer 4

•Take an intra oral scan or alginate (upper & lower with bite)
• Disinfect alginate impressions.
•Take to Laboratory with prescription.
•Laboratory would either cast the impressions or digitally trim the intra
oral scan and print in resin.
•When constructing the appliance, they would create the components
then create the baseplate and posterior capping with acrylic.
•Then they would trim and polish the acrylic.
•Disinfect the appliance.
•Deliver to the department with a statement of manufacturer

Question 5

Describe how you would fit an Upper Removable Appliance.

Answer 5

•Cheek the Paperwork and ensure it is the correct appliance & matches
the prescription.
•Check the surfaces of the acrylic and ensure it is not sharp.
•Try in the appliance.
•Adjust the retentive components.
•Show the patient how to remove and place the appliance.
•Get them to try in and remove themselves.
•Ask specialist to activate any active components, (springs).
•Give patient verbal and written URA instructions.
•Give the patient an appliance box.
•Book a follow up appointment

Question 6

Describe how you would fit an Upper Removable Appliance.

Answer 6

•Cheek the Paperwork and ensure it is the correct appliance & matches
the prescription.
•Check the surfaces of the acrylic and ensure it is not sharp.
•Try in the appliance.
•Adjust the retentive components.
•Show the patient how to remove and place the appliance.
•Get them to try in and remove themselves.
•Ask specialist to activate any active components, (springs).
•Give patient verbal and written URA instructions.
•Give the patient an appliance box.
•Book a follow up appointment.

Question 7

What instructions are given to the patient at the first fit appointment of a
removable appliance?

Answer 7

•Initial discomfort will ease in a few days, but you can take pain relief.
•Speech may be tricky to start with, but this will improve with time, try
reading out loud.
•Wear the appliance as directed, (FT/PT)
•Clean the appliance with toothbrush and liquid soap at least once a
day.
•Remove appliance after eating and clean both the mouth and
appliance, ensuring clear of any food debris.
•Remove for contact sports and wear a mouthguard.
•If the appliance is not in the mouth, it should be kept in the box, so it
doesn’t become lost. Charges may be incurred if it is lost or damaged.
•Come back for extra appointments if it is uncomfortable.