In the case of children…when dental development occurs normally at every stage and these stages occur in the proper sequence, there is a good chance that a normal, healthy, permanent dentition and occlusion will be established. Unfortunately, many factors can adversely affect normal occlusal development. Some of the more common are:
- Early Extraction of the Second Primary Molar
- Early Loss of a Primary Cuspid
- Abnormal Eruption Sequence
When space from the premature loss of a primary tooth has not been maintained, an appliance is necessary to to regain lost space and thus prevent crowding and malocclusion. While it may not completely eliminate the need for comprehensive orthodontic treatment, space regaining done at an early stage of development can often prevent a serious orthodontic problem from occurring.
Once a patient has a full complement of adult teeth, regaining lost space becomes much more difficult. For example, a first molar that has drifted mesially due to a premature loss of a primary second molar is much harder to move distally once the adult second molar has erupted. To regain the space for the bicuspid, you will have to move both teeth. This is very difficult to do at one time and usually involves multiple steps to accomplish. In an adult, a basic treatment goal is to create enough space so that all the adult dentition can be aligned in the arch form. This is usually accomplished through a combination of techniques ranging from distalizing molars, to lateral arch development, to air-rotor slenderizing.
Featured Appliances
Elastic Halterman Appliance U/L
This design is indicated when the ectopically erupting molar is caught under the distal edge of a primary molar. A mushroom-shaped direct bond button is bonded to the occlusal surface of the erupting molar.
An orthodontic band with a hook that extends distal to the molar is cemented to the molar.
Chain elastic is used between the hook and the button to provide the distal force needed to distalize the molar. Note: Always send an opposing cast to evaluate if there is sufficient occlusal clearance for this appliance.
CD Distalizer U/L
This popular molar distalizer can be used on either arch and can also be used in a unilateral or bilateral configuration.
The anterior portion typically attaches to the first bicuspid bands with a Nance Button — and often with an additional lingual wire for anchorage. Vertical tubes on the buccal aspect of these bicuspid bands accept the .032 guide wires that run back through the horizontal tubes on the molar bands. Gurin Locks and open coil springs are placed to provide the necessary distalizing force to the molars. Adjustments are made approximately every 3-4 weeks. Vertical tubes allow it to be placed segmentally, by first cementing the anterior segment, and then placing the molar bands (with .032 guide wires inserted in the tubes) as individual units. The appliance shown here is a depiction of the force module needed to distalize #14 — and also of the use of the Gurin Lock to maintain the already distalized #3. Note: When selecting this appliance, please provide the lab with detailed instructions.
Removable Space Regainer U/L
Early loss of primary teeth can allow a first molar to drift mesially and block the eruption of the bicuspids.
The Removable Space Regainer uses an expansion screw to distal drive the molar, regaining the space needed for the eruption of the bicuspid. Adjustments are made 1/4 turn once each week (with wrench provided). There is no occlusal rest on the first permanent molar. This will allow the molar to upright as it moves distally. Note: When distalizing a first molar, it is important to take an x-ray of the second molar to make sure distalization will not cause its impaction. If retention is a concern…when using “C” Clasps (shown), consider the use of bonded composite ledges on the buccal of the clasped molars.
Moving Anteriors Labially U/L
In the case of a Pseudo Class III or end-to-end bite relationship caused by an underdeveloped pre-maxilla, this anterior sagittal is often used to move the maxillary anteriors labially.
By using an expansion screw in an anterior-posterior direction, the anterior acrylic section moves the pre-maxilla forward. The labial arch wire moves with this section and provides additional stability. Finger springs can be added for individual tooth movement and, when appropriate, T-springs can be used to provide lingual movement of the cuspids. Note: With this appliance, it is important to understand that cuspid movement cannot occur until space is available.
Removable Ectopic Distalizer U/L
The Removable Ectopic Distalizer is quite effective in distalizing an ectopically erupting molar when there is insufficient vertical clearance to use the Fixed Ectopic Spring Distalizer.
Vertical clearance is achieved by adding occlusal coverage to the removable appliance. Activating the finger spring soldered to the molar clasp places a positive distal driving force against the button that is bonded to the occlusal of the second molar. Typically, this appliance needs to be worn for a relatively short period of time.
Sliding Loop Space Regainer U/L
Regaining space may be accomplished by using a Band and Loop Unilateral Space Maintainer with sliding molar tubes and coil springs.
This setup applies constant tension and may be used to move a premolar mesially with some reciprocal distal movement of the permanent molar. To adjust the appliance, simply stretch the coil springs prior to the initial seating of the appliance. No further adjustment is usually necessary. Note: To aid in easy insertion of this appliance, it is recommended to first pre-assemble the activated appliance on the working model. Then use dental floss to hold the activated loop passive during cementation.
Ectopic Spring Distalizer U/L
Designed (in principle) to function as does the Elastic Halterman, this appliance features a recurved wire spring to achieve the distal movement of the six-year molar caught under the primary second molar.
Placement of the occlusal button is usually on the distal aspect of the erupting molar. Note: Always send an opposing cast to evaluate if there is sufficient occlusal clearance for this appliance.
Unilateral Gurin Lock U/L
This appliance uses a nickel titanium coil spring — activated by an adjustable Gurin Lock — to regain space without tipping or rotating the teeth.
The amount of reciprocal movement of the molar distally and the bicuspid mesially will be effected by the proximity of the adjacent teeth. In order to restrict the movement of one of the abutment teeth, it is necessary to add additional anchorage. Using a jackscrew with labial/lingual arch wires, will accomplish this. A small dab of premixed cold-cure acrylic may also be applied to the threads behind the second nut to further ensure that the screw maintains its force and does not back up. Activating the Gurin Lock is easily accomplished with a special box wrench (available from SML).
Gurin Lock Regainer U/L
The typical anchorage system used when you wish to unilaterally move a bicuspid mesially, while preventing reciprocal movement of the other teeth.
This appliance uses nickel titanium coil spring and an adjustable Gurin Lock. Note: Activating the Gurin lock is easily accomplished with a special box wrench (available from SML).
Modified CD Distalizer U/L
This appliance works in much the same way as the CD Distalizer.
However, the design has been modified with the guide wires soldered to the first bicuspids (rather than using the vertical tube assembly to attach them to the bicuspids). Advantages: superior strength and added patient comfort — attachments to the bicuspids are smooth and reduced in overall bulk. Although this design requires all four bands to be seated at once, this is typically not a problem. Appliance shown depicts the force module necessary to distalize #14 — and use of the Gurin lock to maintain the already distalized #3. Note: Gurin Locks and open coil spring provide the necessary distalizing force to the molars.
Adjustable Lingual U/L
This lingual arch features lingual lap springs to align the incisors and adjustment loops to move them labially to regain lost cuspid space.
The lingual arch wire is attached to the bands with Wilson Vertical Attachments. This allows you to remove the arch wire, as well as easily adjust the lap springs and adjustment loops out of the patient’s mouth. Regular adjustments of the loops will continue to move the anteriors labially. Note : Make sure to protect the attachments from cement by placing wax in them prior to cementation.
Adjustable Loop Lingual U/L
The Adjustable Loop Lingual Appliance is a fixed anterior sagittal that allows you to regain lost anterior space and align lower anterior crowding.
Using a standard lingual arch wire as a base, this appliance features a second, lighter gauge wire with adjustable loops to apply pressure against the anterior teeth. As the loops are flattened, the wire is free to slide along the fixed lingual wire in a labial direction.
Muscle Anchorage Appliance L
This mandibular space regainer utilizes a labial lip bumper that inserts through buccal tubes on the molar bands.
Lip pressure creates a distal force that moves the molars posteriorly. To adjust the position of the lip bumper, simply open or close the loops that are soldered to the labial wire. The appliance also alters the equilibrium of forces acting upon the incisors. Removing the resistance of the lip against these teeth allows the tongue to move the incisors forward.