When treating children, it is important to regularly monitor their growth and development. The clinician should constantly check to see if interceptive orthodontics will be necessary. Even in cases where the arches are nicely developed and the skeletal relationship is well balanced, there is often the need for some minor tooth movement — because the sequence of eruption seems to be slightly different for every patient.
For example, it is not uncommon for a primary central to exfoliate late and cause an adult central to erupt lingually. When this is the case, a simple appliance can be used to help guide this central back into its normal position. Another common situation where minor tooth movement is appropriate occurs when cuspids are forced to erupt into a mesial-buccal position because the first bicuspids erupted before them. When the arch length is sufficient, the cuspids can easily be brought back into the arch by first moving the bicuspids distally prior to retracting the cuspids.
When it comes to adults, now more than ever cosmetic dentistry is an integral part of an active practice. You shouldn’t call yourself a cosmetic dentist if you are unable recognize when orthodontic therapy would enhance your ability to create a superior esthetic result. Minor tooth movement, in conjunction with your restorative care, can be used in many ways to enhance a patient’s appearance.
Featured Appliances
Mini-Screw Appliance U
In cases where you need to move a tooth labially and you choose not to use a recurved finger spring or a micro-screw, the use of a mini-screw is an excellent alternative.
Because they are easy for the patient to adjust, some doctors use them in situations when the patient cannot readily return to their office on the recommended bi-weekly basis. These screws add a modest amount of bulk to the anterior portion of the appliance, creating an anterior bite plane. This usually supplies enough occlusal clearance to jump the cross-bite.
Once the crossbite is jumped, it is necessary to switch to a final retainer. This stabilizes the correction while the occlusion settles into place. Note: If the patient has a skeletal open-bite tendency, adding posterior coverage to this design is appropriate in the interest of preventing any unwanted vertical changes.
Recurved Finger Spring U/L
An alternative to a micro-screw for moving a tooth labially.
With proper positioning and adjustment, this spring can also be used to correct minor rotations. To activate springs, simply pull forward on the spring’s arm with 139 Bird-Beak Pliers. Typically, if the lingual surface of the tooth to be moved is quite vertical, the acrylic is left over the top of the finger spring. However, if the lingual incline is rather shallow, it is suggested that a composite ledge be placed on the tooth’s lingual.
A composite ledge will prevent the activated finger spring from riding up the lingual incline of the central — and greatly improve its effectiveness. SML recommends that the acrylic be cleared away from the top of the spring. This makes it easier for the dentist to adjust the spring and easier for the patient to properly insert the activated appliance. Upon insertion, the patient needs to be certain that the spring arm “snaps” gingival to the composite ledge. Note: If any of the teeth are locked in lingual cross bite, it may be necessary to open the bite with an anterior or posterior bite plane.
Multi-Spring Appliance U/L
A properly designed removable appliance can be used to accomplish multiple tooth movements.
In this example, our objective is to close the space between the centrals, create room in the arch form for the blocked out laterals, and guide the laterals into place. This design shows the use of two different mesial kicker springs to move the centrals, a re-curved spring to move one of the laterals labially, and a T-spring to move the other lateral lingually. To accomplish the numerous movements, they must be done sequentially. Do not attempt to activate all the springs at once.
Micro-Screw U/L
Individual teeth can easily be moved labially with a removable appliance.
In this instance, a micro-screw is being used. This special screw has a spring-loaded piston within its housing. By adjusting the screw one-half turn weekly, a constant pressure can be maintained on the tooth to be moved. A special screwdriver is available from SML. Micro-screws work well when direct labial or buccal movement is needed and if the tooth is sufficiently erupted (at least 4mm of the lingual surface needs to be well exposed). If a tooth needs to be rotated as it is moved labially, it would be best to use a recurved finger spring or bonded brackets. Caution: Do not over-adjust the micro-screw. This may damage the spring-loaded piston.
Recurved Extrusion Spring U/L
When a primary molar has been overly retained, it can inhibit the eruption of a succedaneous bicuspid in relation to the rest of the arch.
This unique appliance uses a recurved finger spring to aid in the eruption of a single bicuspid. A direct bond straight wire bracket is placed on the bicuspid to create an undercut for the helical recurved spring. The patient then simply inserts the activated appliance and “snaps” the activated spring under the gingival tie wings of the bracket. This not only expedites the eruption of the tooth, but also aids in appliance retention.
Fixed/Removable Buccal Sling-shot
Another method to move a bicuspid buccally, other than a finger spring, mini-screw, or micro-screw, is the use of a “sling-shot” elastic.
By bonding a button onto the lingual surface of the bicuspid, an elastic can be carried from hooks on the labial bow to this button to move the bicuspid buccally. This method is sometimes preferred to a finger spring or a micro-screw, especially when timely office visits are difficult for your patient.
Multi-spring Cuspid Retraction Appliance U/L
This is another design using finger springs to accomplish a variety of objectives.
It is important to provide extra retention (in the form of “C” clasps soldered to the labial wire) when moving anterior teeth. To increase retention, a small composite button can be placed on the buccal — just occlusal to the “C” clasp — to create a retentive undercut. In situations where the mesial of the cuspid is not well exposed, the use of a bonded button or bracket will provide a positive contact point for the spring. Maximum stability is necessary to keep the appliance fully seated when activating the finger springs. Remember, it is recommended to activate no more than two springs at any one time. Activating more than two tends to compromise overall appliance retention, slowing down treatment time.
Multi-spring Posterior Space Regainer U/L
Abnormal exfoliation and eruption patterns can cause erupting teeth to be blocked out of the arch form.
When the overall arch length is sufficient, an appliance like the one shown here is ideal to move the bicuspids, allowing the submerged teeth to erupt. This example also illustrates the proper use and placement of the retention components needed for this active appliance. Note that the labial arch wire used here is of the “Reverse Hawley” design. This affords cuspid support without having cross-over wires distal to the cuspids. As a result, the right bicuspid can be moved into complete contact with the cuspid. Likewise, a “C” clasp (possibly used in conjunction with a composite ledge) is used on the left first molar to permit complete distalization of the left second bicuspid. These are all critical design considerations in this particularly treatment scenario.
Multi-Spring Molar Uprighter U/L
The Multi-Spring Molar Uprighter demonstrates the use of two very useful uprighting springs: the mushroom and the distal recurve.
Easy to adjust, they can effectively upright tipped molars, usually with only two or three adjustments. The rest, placed on the molar with the distal recurved spring, aids in prohibiting super-eruption when an opposing tooth is missing. Note: When using “C” clasps, consider the use of a composite ledge for superior retention.
Bloore Aligner U/L
Patients who have a small amount of crowding in their upper or lower incisors often prefer to try to correct this problem without having to wear braces.
The Bloore Aligner was designed specifically for such a purpose. Springs — “eyelet arms” — are placed lingual to each incisor and individually activated to move the teeth into alignment. As needed, interproximal reductions and incisal re-contouring are utilized to gain room and provide an esthetic result. Note: When used on the lower arch, it is important to make sure that the incisors are not coupling with the lingual of the uppers prior to initiating treatmen. Vertical and AP clearance are required to successfully correct the lower anteriors.
Direct Bond Cuspid Retraction U/L
Combining the versatility of a removable appliance with the positive control of a fixed attachment, the dentist can effectively retract a cuspid.
With the Direct Bond Retraction Appliance, attachments (buccal and lingual hooks and the bracket) can be strategically placed to move the cuspid distally (shown) or lingually – or even to help the cuspid erupt. Comes complete with the direct bond brackets — ready for cementation — and a supply of the appropriate size elastics. Note: Little adjustment is required, other than to change the elastics daily and keep the retentive clasps tight so the removable section remains stable.
Combination Fixed/ Removable Appliance U/L
It was once very difficult to effect rotation of a molar or bicuspid using a removable device.
The Combination Fixed-Removable Appliance has solved the problem. Direct bond buttons can be placed on just those teeth needing rotation, with hooks for elastics placed wherever they are needed on the removable appliance. Using a mirror, the patient can easily learn to hook up the elastics. Note: Well-designed finger springs can also be added to afford other needed corrections. In this case, a combination finger spring/direct bond button is used on the right cuspid to aid in its eruption and distal positioning as the first bicuspid is rotated.
Labial-Lingual Appliance U/L
Almost anything achievable with a removable appliance can be done with a fixed appliance.
This is very important when treating younger, less cooperative patients. The fixed Labial-Lingual Appliance includes two finger springs — one to rotate the central and the other to move the lateral labially into position. The labial arch has direct pressure arms in contact with the mesial edge of the centrals and adjustment loops opposite the cuspids. To retain the results, these loops may be closed as movement is accomplished. The lingual arch is easily removed so that adjustments can be made outside the patient’s mouth. Replacing it is just as easy.
Inman Aligner™
Ideal for mild-to-moderate anterior crowding (upper and lower arch) and orthodontic relapse, The Inman Aligner™ embraces the concept of proximal recontouring, but also brings to the mix a new overall design and new Niti coil-spring technology.
Nickel Titanium coil springs power two aligner bows that gently oppose each other, guiding the teeth into their new position. These gentle forces are active over a very large range of movement, which is why the Inman Aligner works so quickly.
The inner bow pushes forwards, while the outer bow pulls back on the front teeth. These forces allow for predictable rotation, protrusion and retroclination movements. Most cases are completed within 6 – 18 weeks (depending on the complexity of the case).
Direct Bond/Spring Cuspid Retraction U/L
Occasionally an erupting cuspid may need to be tipped distally and lingually while the remainder of the arch needs little (if any) additional treatment.
In this situation, you may consider use of a combination removable appliance with a cuspid retraction spring and a direct bond straight wire bracket. The bracket not only provides a positive contact point for the activated spring, it also allows for the use of an elastic (if desired) to enhance the movement.