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Myofunctional Appliances Important Notes

• Definition of myofunctional applications
  • Myofunctional appliances are defined as loose fitting or passive appliances which harness natural forces of the oro-facial musculature that are transmitted to the teeth and alveolar bone through the medium of appliance
• Visual treatment objective [VTO]
  • Helps in realizing the therapeutic goals
  • Helps to motivate the patient to cooperate by making the patient realize the esthetic improvement
• Types of bionator
  • Standard appliance
  • Class 3 appliance
  • Open bite appliance
• Classification of myofunctional appliances
  • According to Tom Graber
    • Group A – Teeth supported Ex. Catlan’s appliance
    • Group B – Teeth/tissue supported
      Example. Activation
    • Group C – Vestibular positioned Ex. Lip bumper
  • Removable – Activator
    • Semifixed – Bass appliance
    • Fixed – Herbst
  • Classical – Activator
    • Hybrid – Bass
  • Teeth borne passive – Activator
    • Tooth borne active – Elastic open activator
    • Tissue-borne passive-oral screen
    • Tissue borne active – FR
    • Functional orthopaedic magnetic appliance
• Frankel regulator

Myofunctional Appliances Long Essays

Question 1. Classify myofunctional appliances. Name components of FR – 2 and describe its mode of action.
Answer.

Classification Of Myofunctional Appliances:

• According to Tom Graber
  • Group A – Teeth supported Ex. Catlan’s appliance
  • Group B – Teeth/tissue supported
    Example. Activation
  • Group C – Vestibular positioned Ex. Lip bumper
• Removable – Activator
  • Semifixed – Bass appliance
  • Fixed – Herbst
• Classical – Activator
  • Hybrid – Bass
• Teeth borne passive – Activator
  • Tooth borne active – Elastic open activator
  • Tissue-borne passive-oral screen
  • Tissue borne active – FR
  • Functional orthopaedic magnetic appliance

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

Frankel Appliance

• It is myofunctional appliance developed by Professor Rolf Frankel of Germany

Components Of Myofunctional Appliances:

Acrylic component:

• Buccal shields
  • Extends deep into the vestibule
  • Helps in unrestricted dentoalveolar development
  • Also causes periosteal bone deposition
• Lips pads
  • Helps in the elimination of abnormal perioral muscle activity
  • Eliminates lower lip trap
  • Causes periosteal pull resulting in bone growth
• Lower lingual pad
  • Stimulates protractor muscles of the mandible by activating proprioceptors

Wire component:

• Labial bow
  • Adapted on labial surfaces of the lower anteriors
• Canine extensions
  • Eliminates restrictive muscle function
  • Helps in transverse development in the canine region
• Palatal bow
  • Prevents supra eruption of first permanent molars

• Upper lingual wire
  • Runs between the upper canines and first deciduous molars
• Lower lingual springs
  • Prevents supra eruption of the lower incisors
  • Screens the tongue pressure from lower incisors
  • For proclaiming the lower incisors actively
  • Causes bite opening by the relative intrusion

Lingual Cross Over Wire:

• Runs between mandibular first and second premolar

Mode Of Action Of Frankel Appliance:

Increase in transverse and Sagittal intra-oral space:

• Buccal shields and lip pads:
  • Eliminates abnormal muscular forces
  • Favours forces from tongue
  • Exerts outward pull on connective tissue and muscles
  • This transmits force on the bone
  • Results in bone formation
  • Leads to lateral movement of dental alveolar region
• Increase in vertical space:
  • Frankel appliance does not contact posterior teeth
  • Thus, they are free to erupt
  • This leads to an increase in vertical intra-oral space
• Mandibular protraction:
  • By lingual pads
  • These apply pressure on the lingual alveolar process
  • Causes activation of protractor muscles
  • Position the mandible mesially
• Muscle function adaptation:
  • Overcomes abnormal muscular forces
  • Rehabilitates muscles
  • Causes muscle pull
  • This leads to bone formation
  • Massages soft tissues
  • Improves blood circulation
  • Improves muscle tone
  • Prevent hyperactivity of mentalis
  • Eliminates lip trap
  • Establishes lip seal

Question 2. Define and classify myofunctional appliances. Discuss indications and mode of action of the activator.
Answer.

Definition:

• Myofunctional appliances are defined as loose fitting or passive appliances which harness natural forces of the oro-facial musculature that are transmitted to the teeth and alveolar bone through the medium of appliance

Classification Of Myofunctional Appliances:

• According to Tom Graber
  • Group A – Teeth supported Ex. Catlan’s appliance
  • Group B – Teeth/tissue supported
    Example. Activation
  • Group C – Vestibular positioned Ex. Lip bumper
• Removable – Activator
  • Semifixed – Bass appliance
  • Fixed – Herbst
• Classical – Activator
  • Hybrid – Bass
• Teeth borne passive – Activator
  • Tooth borne active – Elastic open activator
  • Tissue-borne passive-oral screen
  • Tissue borne active – FR
  • Functional orthopaedic magnetic appliance

Activator Of Myofunctional Appliances:

• Activator is myofunctional appliance described by Andresen and Haupl

Indications Of Myofunctional Appliances:

• Class 1 open bite
• Class 1 deep bite
• Class 2 div. 1
• Class 2 DDiv 2
• Class 3
• Preliminary treatment
• Post-treatment retention
• Decreased facial height

Mode of Action Of Myofunctional Appliances:

• Prevents dentoalveolar growth of maxilla
• Moves it distally
• Move mandible forward
• Stretches elevator muscles
• Adaptation of condyle

Question 3. Classify myofunctional appliances. Describe indications, construction and trimming of the activator.
Answer.

Classification Of Myofunctional Appliances:

• According to Tom Graber
  • Group A – Teeth supported Ex. Catlan’s appliance
  • Group B – Teeth/tissue supported
    Example. Activation
  • Group C – Vestibular positioned Ex. Lip bumper
• Removable – Activator
  • Semifixed – Bass appliance
  • Fixed – Herbst
• Classical – Activator
  • Hybrid – Bass
• Teeth borne passive – Activator
  • Tooth borne active – Elastic open activator
  • Tissue-borne passive-oral screen
  • Tissue borne active – FR
  • Functional orthopaedic magnetic appliance

Activator Of Myofunctional Appliances:

• Activator is myofunctional appliance described by Andresen and Haupl

Indications Of Myofunctional Appliances:

• Class 1 open bite
• Class 1 deep bite
• Class 2 div. 1
• Class 2 Div 2
• Class 3
• Preliminary treatment
• Post-treatment retention
• Decreased facial height

Construction Of Myofunctional Appliances:

Trimming:

For Vertical control: 

• Intrusion:
  • Acrylic – Over incisal edge/cusp tips
  • Labial bow – Below the height of the contour initially
• Extrusion:
  • Acrylic – Lingual surface
  • Labial bow – Above the height of contour gingivally
    For Sagittal control:
  • Protrusion
  • Acrylic – lingual surface
  • Labial bow – Passive, away from teeth

Retrusion:

• Acrylic – Away from the lingual surface
• Labial bow – Active

Movement of posterior teeth in the sagittal plane:

• In class 2 – Acrylic over the mesial lingual surface of maxillary molars
• Distolingual surface of mandibular molars

Movement of teeth in the transverse plane:

Myofunctional Appliances Short Essays

Question 1. Jasper jumper.
Answer.

Jasper jumper is a flexible, fixed tooth-borne appliance introduced by Jasper in 1980

Jasper jumper Indications:

• Class 2 malocclusion with maxillary excess and mandibular deficiency

Effects Of Jasper jumper

• Skeletal effects:
  • Holds and displaces maxilla distally with a small shift of point A distally
  • Clockwise rotation of the mandible
  • Forwarded movement of condyles
• Dental changes:
  • Posterior tipping and intrusion of upper molars and palatal tipping of maxillary incisors
  • Anterior translation and tipping of mandibular teeth and intrusion of mandibular incisors

Jasper jumper Advantages:

• It produces continuous forces
• Allows a greater degree of mandibular freedom
• It is easier to maintain better oral hygiene

Question 2. Name components of FR2 and describe the uses of buccal shields.
Answer.

Components Of FR2:

Acrylic component:

• Buccal shields
• Lip pads
• Lower lingual pad

Wire component:

• Labial bow
• Canine extensions
• Palatal bow
• Upper lingual wire
• Lower lingual springs
• Lingual cross-over wire
• Support wire for lip pads

Use of Buccal Shields:

• Prevents abnormal muscular forces
• Creates forces on tissue
• This leads to bone formation
• Rehabilitates muscles
• As it stands away from posterior teeth, it allows their eruption

Question 3. Mode of action of functional appliance.
Answer.

Force Application:

Force Elimination by

• Bite planes – Effects:
  • Disocclude the posterior teeth
  • Differential eruption of posteriors
  • Intrusion of incisors
  • Downward and backward mandibular rotation
  • Reduces mandibular prognatism
• Shields/Screens – Effects:
  • Prevents muscular forces on dentoalveolar structures
  • Allows unrestricted growth of the jaw
• Construction bite – Effects:
  • Displaces mandible from its rest position
  • Stretches muscles
  • Displaces mandible in sagittal and transverse plane

Question 4. Case Selection for Functional Appliances.
Answer.

Factors Considered:

Age – Growing patient:

• Between 10 years of age and pubertal growth phase

Social considerations:

• Patients living far from the clinic
• Hostelites

Dental considerations:

• Uncrowded cases
• Local irregularities

Skeletal considerations:

• Moderate to severe skeletal class 2 malocclusions
• Low angle cases
• High-angle cases with deep bites
• Class 2 Division 2
• Mild class 3 malocclusions

Question 5. Oral Screen.
Answer.

Synonym – Vestibular Screen:

• Introduced by Newell in 1912

Principle Of Oral Screen:

• Application of muscular forces to teeth by applying forces of circumoral to teeth
• Elimination of forces to teeth and allow them to move due to forces exerted by the tongue

Oral Screen Indication:

• Interception of habits
• Treatment of mild malocclusions
• For muscular exercises
• Correction of mild anterior proclination

Management Of Oral Screen:

• Frequency of wear – During the night 2-3 hours during day time

Question 6. Frankel 2.
Answer.

Uses of Frankel 2 – For treatment of class 2 division 1 and division 2 malocclusion.

Components Of Frankel 2:

Acrylic:

• Buccal shields
• Lip pads
• Lower lingual pad

Wire:

• Palatal bow
• labial bow
• canine extension
• Upper lingual wire
• Lingual cross-over wire
• Support wire
• Lower lingual spring

Functions Of Frankel 2:

Acrylic components:

• Eliminate the muscle as well as lip function over the dentoalveolar segment

Wire component:

• Palatal bow – Prevent supra eruption of posteriors
• Canine loops – Help in transverse development in the canine region
• Labial bow – Passive
• Lingual stabilizing bow – Prevents lingual tipping of incisors
• Lower lingual springs – Screen tongue pressure
• Procline lower incisors
• Lingual cross-over wire
• Labial support wires – Support lip pads

Question 7. Explain the treatment procedure in a child of 8 years with a deficient maxilla, the appliance used and the mode of action.
Answer.

An 8 years old child is a growing child

• Thus my function appliance can be used to facilitate the change
• Among them, Frankel regulator 3 can be used

Mode of Action:

• In transverse and sagittal intraoral space
  • By acrylic component
• In vertical space
  • As the appliance is kept free from posterior teeth
• Muscle function adaptation
  • Overcomes abnormal perioral muscle activity

Question 8. Difference between Activator and Frankel Appliance.
Answer.

Question 9. Lip Bumper.
Answer.

Combined removable fixed appliance

Mode of Action:

• Force application/elimination

Uses Of Lip Bumper:

• Interception of lip biting habits
• Increases arch length
• Reduces crowding
• In the case of active mental activity
• For augmentation of anchorage
• For visualization of 1st molar
• Used as space regainer

Designs Of Lip Bumper:

• Stainless steel wire from one molar to the opposite molar passing away from the anterior
• Acrylic portion from canine to canine

Myofunctional Appliances Short Questions And Answers

Question 1. Herbst Appliance.
Answer.

By Emil Herbst in the early 1900’s.

Herbst Appliance Indications:

• Post-adolescent patient – treatment of Class 2
• TMJ disorders
• Interception of mouth breathing habit

Types Of Herbst Appliance:

• Banded Herbst
• Bonded Herbst

Effects Of Herbst Appliance:

• Class 1 molar correction
• Increase in mandibular growth
• Visualization of molar
• Reduction of over-jet
• Increase SNB and decrease SNA

Question 2. Twin Block.
Answer.

Design: Consist of inclined planes with intermaxillary and extraoral traction

Acrylic Components:

• Upper inclined plane – Covering lingual cusps of upper posterior till mesial ridge of upper 2nd PM [Premolar]
• Lower inclined plane – From lower anterior upto distal marginal ridge of 2nd premolar
  • The angle between them – 45

Wire components:

• Modified arrow head clasp – To retain the upper plate
• Molar tube – for attachment of face bow
• Jack screw – for maxillary expansion
• Interdental ball clasp – Retain lower plate

Myofuctional Appliances Viva Voce

• Reverse binator is used for Angle’s class 3 malocclusion
• Newell developed an oral screen
• Lip bumper should be worn for 24 hours a day
• Myofunctional appliances harness natural forces from perioral structures
• Oral screening works on both force application and force elimination principle
• Twin block is the most acceptable functional appliance

Cleft Lip And Palate Important Notes

Classification of cleft lip and palate:

• Davis & Ritchie Classification:
  Group 1 – Prealveolar clefts – Involves only lip
  Group 2 – Post alveolar clefts
  Involves palate and alveolar ridge
  Group 3 – Alveolar clefts
  Involves the palate alveolar ridge and lip
• Veau’s Classification [1931]:
  Group 1 – Involves only soft palate
  Group 2 – Involves palate up to incisive foramen
  Group 3 – Involves palate, lip, and alveolar ridge unilaterally
  Group 4 – Involves palate, lip, and alveolar ridge bilaterally
• Carnahan’s Stripped ‘Y’ Classification:

• • Block 1 and 6 – Lip
  • Block 2 and 5 – Alveolus
  • Block 3 and 4 – Hard palate anterior to incisive foramen
  • Block 7 and 8 – Hard palate posterior to the incisive foramen
• Lahshal Classification:
  • L – Lip
  • A – Alveolus
  • H – Hard palate
  • S – Soft palate
  • H – Hard palate
  • L – Lip

Treatment protocol:

• Immediately after birth
  • Pediatric consultation
• First few weeks
  • Hearing testing
• At 10 – 12 weeks
  • Surgical repair of lip
• 3 months after palate repair
  • Speech & language repair

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

• 3 – 6 years
  • Soft palate lengthening
• 5 – 6 years
  • Pharyngeal surgery
• At 7 years
  • Orthodontic treatment phase 1
• 9 – 11 years
  • Pre-alveolar bone grafting
• 12 years or later
  • Full orthodontic treatment phase 2
• 15 – 18 years
  • Placement of implant
• 18 – 21 years
  • Surgical advancement
• Final nose & lip revision
  • Rhinoplasty

Millard’s rule:

• Timing of cleft lip repair should be when hemoglobin is 10 gm%, age 10 weeks, weight 10 lbs, and total leukocyte count less than 10,000 per mm3

Cleft Lip And Palate Long Essays

Question 1. Write in detail about the development of the maxilla. Elaborate on etiology and treatment of cleft palate.
Answer.

Development Of Maxilla:

According to Moyers, development refers to all the naturally occurring unidirectional changes in the life of an individual from its existence as a single cell to its elaboration as a multi-function unit terminating in death.

Development Of Pre-Natal Maxilla:

• Around the 4th week of IU life, a prominent bulge appears on the ventral aspect of the embryo.
• Below it, there develops a depression called stomodeum, primitive mouth
• Downward projection developing from the mesoderm overlaps the stomodeum called the front-nasal process
• By around 4th week of IU life, the mandibular arch one of the 5 branchial arches develops
• The mandibular arch gives off a bud from its dorsal end called the maxillary process
• Thus, stomodeum is overlapped

Postnatal Growth Of Maxilla:

• Its growth occurs as

Displacement:

• Primary and secondary displacement leads to the growth of maxilla
• Primary displacement is seen in a forward direction due to the growth of its tuberosity in a posterior direction

Growth at sutures – Sutures involved are:

• Fronto – nasal
• Fronto – maxillary
• Zygomatic – temporal
• Zygomatico – maxillary
• Pterygo – palatine

Surface remodeling:

• Remodeling changes

Cleft Palate:

Etiology:

Predisposing Factors:

• Increased maternal age
  • Women who conceive later
• Racial
  • Mongolids are at greatest risk
• Blood supply
  • Reduces blood supply to the nasomaxillary arch

Treatment Of Maxilla:

The cleft palate is treated at different stages

• Birth-Initial assessment
  • Pre-surgical orthopedics
  • It is done by extra-oral strapping across the premaxilla

• 3 month – Primary lip repair
• 9 – 18 – Palate repair
• 2 years – Speech assessment
• 3 – 5 years – Lip revisional surgery
• 8 – 9 years – Initial interventional orthodontics
• 10 years – Alveolar bone grafts
• 12 – 14 years – Definitive orthodontics
• 16 years – Naal revisional surgery
• 17 – 20 years – Orthognathic surgery

Cleft Lip And Palate Short Essays

Question 1. Classify Cleft lip and Palate (1922).
Answer.

• Davis & Ritchie Classification:
  • Group 1 – Prealveolar clefts – Involves only lip
  • Group 2 – Post alveolar clefts
    • Involves palate and alveolar ridge
  • Group 3 – Alveolar clefts
    • Involves the palate alveolar ridge and lip
• Veau’s Classification [1931]:
  • Group 1 – Involves only soft palate
  • Group 2 – Involves palate up to incisive foramen
  • Group 3 – Involves palate, lip, and alveolar ridge unilaterally
  • Group 4 – Involves palate, lip, and alveolar ridge bilaterally
• Carnahan’s Stripped ‘Y’ Classification:

• • Block 1 and 6 – Lip
  • Block 2 and 5 – Alveolus
  • Block 3 and 4 – Hard palate anterior to incisive foramen
  • Block 7 and 8 – Hard palate posterior to the incisive foramen
• Lahshal Classification:
  • L – Lip
  • A – Alveolus
  • H – Hard palate
  • S – Soft palate
  • H – Hard palate
  • L – Lip

Question 2. Role of Dental Surgeon in treating Cleft lip and palate/Surgical closure of Cleft lip.
Answer.

Surgical Goals:

• Symmetric, well-contoured lip
• Preservation of all functional landmarks
• Minimum scar tissue formation

Timing For Repair:

• Millard’s Rule – Child of 10 weeks old, 10 pounds weight and 10 gm Hb – For cleft lip
• Cleft palate – 12-24 months of age

Surgery:

• Cleft lip – by rotational advancement
• Cleft palate – Closure of soft palate followed by hard palate

Dental Care:

• Sound teeth are essential for the development of the alveolar process
• Malocclusion occurs due to the collapse of the maxilla
• Orthodontic treatment is essential
• Expansion of maxillary arch may be done

Orthognathic Surgery:

• For deficient maxilla – maxillary advancement done/Distraction osteogenesis
• The corresponding retrusion of the mandible is done
• The amount of advancement is largely dependent upon the amount of scarring of the lip and palate and on the elasticity of soft tissues.

Cleft Lip And Palate Short Questions And Answers

Question 1. Cleft lip.
Answer.

Cleft lip

A cleft lip involves a breach in the continuity of the lip formed during facial development

Incidence: 1 in 600 – 1000 births

Associated Problems:

• Dental problems
• Esthetic problems
• Psychological problems
• Speech and hearing problems

Question 2. Teratogens.
Answer.

Teratogens

These are certain drugs/agents transmitted from infected mothers to features causing a disturbance in the growth and development of fetus

Examples Of Teratogens:

Infections Of Terotogens:

• Rubella virus
  • Syphilis

Drugs Of Terotogens:

• Cortisone
• Methotrexate
• Dilantin
• Valium
• Mercepto purine

Question 3. Clinical features of cleft lip and palate
Answer.

Clinical features of cleft lip and palate

• Hypoplastic maxilla
• Shallow gingivo labial sulcus
• Nose deformity
• Hypoplastic teeth
• Supernumerary teeth
• Congenitally missing teeth
• Germinated, fused, conical teeth
• Feeding difficulties
• Posterior crossbite

Cleft Lip And Palate Viva Voce

• German measles during 1st trimester of pregnancy can cause cleft lip/palate
• Cleft lip occurs due to disturbances in 6-8 weeks of IU life
• A cleft palate occurs due to disturbances in 8-10 weeks of IU life
• Cleft palate repair should be attempted between 12-24 months of age
• Cleft lip repair is carried out at 3 months of age
• Bifid uvula is the mildest form of cleft palate
• The lower lip is least affected by cleft
• Increased maternal age increases the risk of clefting
• Cleft lip arises from the failure of fusion between the medial nasal process and maxillary process

Age Factor In Orthodontic Short Questions And Answers

Question 1. Age factor in Orthodontics.
Answer.

Age factor in Orthodontics

Important for diagnosis and treatment planning

• Diagnosis: The following are considered
  • Transient malocclusion

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

• • Chronological age, skeletal age, and Dental age
  • Growth spurts
• Treatment and age:
  • Early treatment
    • Choose of appliances/therapy
    • Growth modifications possible
  • Late treatment – limited due to
    • Cessation of growth
    • Limited choice of therapy
    • Bone density
    • Periodontal diseases.

Management Of Malocclusion Important Notes

• Overbite
  • It is a vertical overlapping of anterior teeth
  • Value – 2-3 mm
  • Normal over-bite percentage – 33.33%

Management Of Malocclusion Long Essays

Question 1. Discuss a treatment plan for Angle’s Class 2 malocclusion.
Answer.

Treatment Objectives:

Class 2 Div. 1:

• Reduction of overjet
• Reduction of over-bite
• Correction of crowding
• Correction of molar relationship
• Correction of posterior cross-bite
• Normalizes muscles

Class 2 Div. 2:

• Correction of incisor relation
• Relief of gingival trauma
• Correction of crowding
• Correction of molar relation

Treatment Plan:

Growing Patient:

• Skeletal Class 2
  • Maxillary Prognathism
    • Headgear
  • Maxillarly Prognathism and Mandibular Retrognathism
    • Headgear & Myofunctional Therapy
  • Mandibular Retrognathism
    • Myofunctional Therapy
• Dental Class 2
  • Orthodontic Treatment

Non-Growing Patient:

• Skeletal class 2
  • Mild to Moderate Class 2
    • Orthodontic Camouflage
  • Severe Class 2
    • Maxillarly Prognathism
      • Surgical Maxillary Setback
    • Mandibular Retrognathism
      • Surgical Mandibular Advancement
    • Dental Class 2
      • Orthodontic Treatment

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

Treatment Approaches:

Growth modification:

• Reduces the severity of skeletal relationship
• Carried out during mixed dentition period before cessation of growth
• Involves

Correction of mandibular deficiency

• Mixed dentition period – Activator, FR 2
• After growth cessation – Herbst appliance
• Jasper Jumper

Correction of maxillary prognathism

• Face bow with headgear

Camouflage:

• Done by extraction of teeth
• To reduce overjet, overbite, molar relation, crowding, deep bite
• In excellent inter occupation – Extraction of the upper first premolar
• In unstable molar relation – Extraction of all first premolars

Surgical Correction:

• After cessation of growth
• mandibular advancement and maxillary set back is done

Question 2. Define Preventive, Interceptive orthodontics. Enumerate various modes of bilateral posterior cross bite correction and discuss any one.
Answer.

Definitions: Refer to Interceptive Orthodontic topics

Treatment Of Bilateral Posterior Cross Bite:

Crossbite elastics:

• Stretched between palatal surfaces of maxillary molars and buccal surfaces of mandibular molars
• Worn day and night
• Not worn for more than six weeks as it extrudes teeth

Coffin Spring:

Parts:

• Omega-shaped wire – In mid mid-palatal region
• Free ends of wire – Over slopes of the palate

Quad helix:

• Consist of four helices
• 2 anterior helices
• 2 posterior helices
• Connected by anterior bridge and palatal bridge

Rapid maxillary expansion:

Incorporating screws by splitting of mid-palatal suture

Management Of Malocclusion Short Essays

Question 1. Rotations.
Answer.

• They are tooth movements occurring around the long axis

Types Of Rotations:

• Mesiolingual/Disto-buccal rotation
• Disto lingual/Mesio-buccal rotation
  • Rotated interiors occupy less space
  • Rotated posterior occupies more space

Treatment Of Rotations:

• Space Management – For rotated anterior
• Removable appliances – Z spring along with labial bow
• Fixed appliances
  • Rotation wedges
  • Elastic threads engaged in lingual attachments
  • Force couple
• Retention – By circumferential suprarenal fibrotomy/precision

Question 2. Features of openbite.
Answer.

• Skeletal features:
  • Increase in lower anterior facial height
  • Decrease in upper anterior facial height
  • Increase in anterior and decrease in posterior facial height
  • Vertical maxillary increase
  • Long and narrow face
  • Steep anterior cranial base
  • Downward and forward rotation of mandible
  • Steep mandibular angle
  • Upward tipping of maxillary skeletal base
  • Divergent cephalometric planes
• Dental features:
  • Proclination of upper anterior
  • Narrow maxillalry arch
  • Upper and lower anteriors fail to over lap each other resulting in space between incisal edges of maxillary and mandibular anteriors

Question 3. Midline Diastema.
Answer.

Refers to any spacing/gaps existing in the midline of the dental arch

Etiology:

• Abnormal frenal attachment
• Ugly duckling stage
• Mesiodents
• Congenital missing teeth
• Trauma
• Hereditary
• Pressure habits

Diagnosis:

• Blanch test

Management Of Midline Diastema:

Removable appliance:

• Hawley’s appliance along with finger springs
• Split labial bow along with Adam’s clasp

Fixed Appliances:

• M springs
• Elastic threads
• Elastic chains
• Closed coil spring

Question 4. Management of Class 2 Div. 1 Malocclusion.
Answer.

Interception of Habits associated with it:

• By habit breaking appliances

During Mixed Dentition period:

• In maxillary Prognathism – Headgear
• In mandibular deficiency – Activator

Management of Dento alveolar – Class 2:

• Maintenance of premolar – to prevent mesial drifting of molars
• In premature loss of premolars – Space regainers

Management in Adults

• Camouflage
• Orthoguathic surgery
  • Mandibular advancement in mandibular retrognathism
  • Maxillary setback in Maxillary prognathism

Question 5. Treatment of Class 3 malocclusion.
Answer.

In Pre – Adolescent Child:

• Frankel 3
• Chin cup
• Anterior Facemask
• RME with anterior facemask
• 3D – screws

In Adolescent Child:

• Camouflage

Treatment During Adulthood:

• Orthognathic surgery
• Maxillary advancement by Lhefort 1 osteotomy
• Mandibular setback

Question 6. Open Bite.
Answer.

Condition in which there is lack of vertical overlap between maxillary and mandibular teeth.

Classification of Open Bite:

Based on location:

• Anterior open bite
• Posterior open bite

Based on components:

• Skeletal open bite
• Dental open bite

Etiology:

• Habits
• Abnormal tongue size
• Inherited

Abnormal Growth Pattern:

Management of Open Bite:

• Anterior open bite
  • Interception of habits
  • Box elastics
  • Chin cup with vertical pull head cap
  • Skeletal Open bite
  • Lefort I osteotomy
  • Muscle retraining exercises
• Posterior open bite
  • Interception of habits
  • Vertical elastics

Question 7. Anterior Crossbite.
Answer.

Crossbite: Condition where one/more teeth may be malposed abnormally, buccally or lingually, or labially about the opposing tooth/teeth.

Classification:

• Single tooth crossbite
• Segmental crossbite

Treatment of Anterior Crossbite:

• Use of tongue blade
• Catlan’s appliance
• Z spring
• Screw appliances
• Face mask
• Frankel 3
• Chin cup appliances

Question 8. Deepbite.
Answer.

Excessive vertical overlapping of mandibular anterior by maxillary anterior

Classification of Deepbite:

• Skeletal deep bite
• Dental deep bite

Etiology:

• Over eruption of anteriors
• Infra occlusion of molars

Treatment of Deepbite:

Removable appliances:

Anterior bite plane:

Parts: Adam’s clasps on molars

• Labial bow
• Acrylic behind maxillary anteriors

Mode of action:

As the posteriors erupts upto height of bite plane, its height is further increased.

Myofunctional appliances:

• Activator – Trimmed to allow extrusion of teeth
• Bionator.

Fixed Appliance Therapy:

Use of anchorage bends:

• Bends given in arch wire mesial to molar tubes
• Creates intrusive force on incisors

Reverse curve of spee:

• Resilient arch wires curved in a direction opposite to curve of spee

Utility arches:

• Arch wires are bent to by pass buccal teeth and engaging incisors

Question 9. Cross bite.
Answer.

Cross bite: Condition where one/more teeth may be malposed abnormally, buccally or lingually or labially with reference to the opposing tooth/teeth.

Classification of Cross bite

• Based on location
  • Anterior cross bite
    • Single tooth
    • Segmental
  • Posterior cross bite
    • Unilateral
    • Bilateral
• Based on the nature of crossbite
  • Skeletal crossbite
  • Dental crossbite
  • Functional crossbite

Etiology of Cross bite:

• Persistence of a deciduous teeth
• Arch length – tooth material discrepancy
• Presence of habits such as thumb sucking and mouth breathing
• Retarded development of maxillalry
• Narrow upper arch
• Collapse of maxillary arch
• Unilateral hypo or hyperplastic growth of any of the jaws
• Persistence of a deciduous teeth
• Arch length – tooth material discrepancy
• Presence of habits such as thumb sucking and mouth breathing
• Retarded development of maxilla
• Narrow upper arch
• Collapse of maxillary arch
• Unilateral hypo or hyperplastic growth of any of the jaws

Question 10. Anterior cross bite – etiology and management
Answer.

Definition of Anterior cross bite:

• It is defined as malocclusion resulting from lingual position of the maxillary anterior teeth in relationship with the mandibular anterior teeth.

Etiology of Cross bite:

• Persistence of a deciduous teeth
• Arch length – tooth material discrepancy
• Presence of habits such as thumb sucking and mouth breathing
• Retarded development of maxilla
• Narrow upper arch
• Collapse of maxillary arch
• Unilateral hypo or hyperplastic growth of any of the jaws

Management of Anterior Cross bite:

• Use of removable appliances
  • Use of tongue blade
    • It is used to treat single tooth anterior cross bite
    • It resembles ice cream stick
    • It is placed inside the mouth contacting th epalatal aspect of the tooth in crossbite
    • Rest the blade on the mandibular tooth
    • Patient is asked to rotate the oral part of blade upwards and forward
    • Repeat the exercise for 1-2 hours for about 2 weeks
  • Catlan’s appliance
    • It is lower inclinded plane constructed on maxillary arch
    • Have 45 angulation
    • Forces the maxillary teeth to a more labial position
  • Use of Z spring
    • Used to treat anterior cross bites involving one or two maxillary teeth
    • Used when there is adequate space for labialization
• Use of fixed appliances
  • Multilooped archwires or nickel titanium arch-wires are used for corrections
  • Indications
  • Dental anterior crossbites involving one or more teeth
  • Requirement of more tooth movement along with correction of crowding and rotations
  • Patients who exhibit minimal overbite

Management Of Malocclusion Short Questions And Answers

Question 1. Camouflage treatment.
Answer.

• Done by extraction of teeth
• To reduce overjet, overbite, molar relation, crowding, deep bite
• In excellent inter cuspation – Extraction of upper first premolars
• In unstable molar relation – Extraction of all first premolars

Question 2. Treatment of cross bite.
Answer.

Cross bite: Condition where one/more teeth may be malposed abnormally, bucally or lingually or labially with reference to the opposing tooth/teeth.

Classification Of Cross bite:

• Single tooth cross bite
• Segmental cross bite

Treatment Of Cross bite:

• Use of tongue blade
• Catlan’s appliance
• Z spring
• Screw appliances
• Face mask
• Frankel 3
• Chin cup appliances

Question 3. Imbrication.
Answer.

• Imbrication denotes especially lower incisors arranged in an irregular manner within the arch due to lack of space

Etiology of Imbrication:

• Tooth material-arch length deficiency
• Presence of supernumerary teeth
• Discrepancy in individual tooth size and shape
• Abnormal eruption path
• Rotation and transposition of tooth
• Premature loss of deciduous or prolonged retention of primary tooth

Question 4. Spacing.
Answer.

Etiology of Spacing:

• Disproportion between arch length and tooth material
• Alteration in tooth morphology
• Habits
• Macroglossia
• Premature loss of permanent

Treatment of Spacing:

• Interception of habits
• Removable appliances – labial bow
• Fixed appliance – Elastic chains/threads
• Use of crowns and prosthesis

Question 5. Causes of Crowding.
Answer.

• Arch length – tooth material discrepancy
• Supernumerary teeth
• Prolonged retentiono f deciduous
• Abnormal tooth size and shape
• Premature loss of deciduous causing drifting of adjacent
• Late mandibular growth
• Pressure from erupting third molars
• Reduction of inter-canine width

Question 6. Inclined Plane/Catlan’s Appliance.
Answer.

Uses Of Catlan’s Appliance:

• Treatment of anterior cross bite
• Palatally displaced maxillary incisor

Design Of Catlan’s Appliance:

• Acrylic/metal covering the maxillary incisor at 45 angulation

Disadvantages Of Catlan’s Appliance:

• Problem in speech
• Dietary restriction
• Supra eruption of posteriors

Question 7. Midline Diastema.
Answer.

Refers to any spacing/gaps existing in the midline of the dental arch.

Etiology Of Midline Diastema:

• Abnormal frenal attachment
• Ugly duckling stage
• Mesiodens
• Congenital missing teeth
• Trauma
• Hereditary
• Pressure habits

Management Of Malocclusion Viva Voce

• Rotated posterior teeth occupy more space than normal
• Rotated anterior teeth occupy less space than normal
• Brodie syndrome is scissor bite of first premolar of patient with class 2 division 1 malocclusion
• Narrow upper arch is feature of skeletal posterior cross bite
• Cross bite is abnormal occlusion occuring in transverse plane
• Cross elastic is stretched from palatal surface of maxillary posterior teeth to buccal surface of mandibular teeth
• Cross elastic is best to treat single posterior cross bite
• Coffin spring causes slow and bilateral symmetrical expansion
• Tongue blade therapy is used for anterior cross bite correction
• Flat anterior bite plane is used to correct deep bite in angle class 2 division 2 malocclusion
• Skeletal deep bite is seen in skeletal class 2 division 2
• Deep bite is increased overbite
• Skeletal open bite is treated in adults by surgical correction
• Anterior openbite can be treated in mixed dentition by vertical pull head gear with chin cup
• Closure of space in midline is done by composite build up it th espace is upto 0-2 mm
• Abnormal labial frenum is cause of midline diastema
• Class 3 bionator and Frankel appliance type 3 is used for class 3 malocclusion
• Sagittal split osteotomy is used for management of class 3
• Class 3 malocclusion management involves extraction of lower first premolars and second premolars
• Class 3 elastics are placed between upper molar to lower canine
• For management of class 2 requires correction of maxillary retrognathism
• Class 2 malocclusion is most difficult to treat
• Mild rotations can be treated by NiTi arch wires
• Face mask is used for treatment of class 3 malocclusion

Fixed Appliances Important Notes

• Components of fixed appliances

Fixed Appliances Long Essay

Question 1. Classify orthodontic appliances and discuss in detail the various components of fixed appliances. Add a note on its advantages and disadvantages.
Answer.

Classification Of Orthodontic Appliances:

• Mechanical appliances
  • Removable appliances
  • Fixed appliances
• Myofunctional appliances
  • Removable appliances
  • Fixed appliances

Components Of Fixed Appliances

Active components:

• Archwires
  • Bring about tooth movement
    Ideal requirement:
  • High spring back
  • Low stiffness
  • High formability
  • High resilience
  • Bio-compatible
  • Resist to tarnish and corrosion
  • Can be soldered/welded
  • Least friction creating
    Classification:
    • Based on material
      • Gold and Gold alloys
      • Stainless steel
      • Nickel titanium
    • Based on Cross section
      • Round
      • Rectangular
      • Square
      • Multistranded

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

Elastics:

• Simple elactic – Resemble rubber band
  • Made of latex rubber
  • Available – various diameters and colors
    Use:
    • Closure of space
    • Correcting of open bites
    • Correction of cross bites
    • Correction of inter arch relationship
• Elastic chain
  • Material – Polyurethane
  • Use – Closure of Space between teeth
• Elastic thread
  • Material – Core of latex rubber, surrounded by silk
  • Use – Closure of space, Derotation
• Elastic modules – Two rings separated by variable distance
  • Use – Closure of space and derotation
• Ligating rings
  • Use – To secure arch wires to brackets

Springs:

Use: To bring about tooth movement

Types Of Orthodontic Appliances:

• Uprighting – to move the root mesially
• Torquing – Move root labially/palatally
• Open coil springs – To open space between teeth
• Closed coil springs – To close space

Separators:

Uses Of Separators: To break tight contact

Types Of Separators:

• Brass wire
• Ring
• Dumbbell
• Kesling

Passive Component:

• Bands:
  Use – To fix various attachments to tooth
  Advantage:
  • Reduces chair time
  • Comfortable for patient

        Available:

• • In various sizes for different teeth
  • Of stainless steel
• Brackets:
  • Use – To transmit force to teeth
    Type:
    • Edge wise
    • Ribbon arch
    • Weladable and bondable
    • Metallic
    • ceramic
    • Plastic
• Available – In various sizes
• • Have one/more slots to accept arch wire

Buccal Tubes:

• Fixed on anteriors/premolar
• On molar called molar tube
• Can be welded/bonded/cemented
• Can be round/rectangular
• Additional tubes for extra-oral anchorage
• Lingual Attachments:
  • Attachments fixed on lingual aspect
    Example: Lingual buttons, lingual cleats, eye lets and ball end hook
• Ligature Wires:
  • Use – To secure arch wire
  • Size – 0.009 – 0.011 inched diameters
  • Available in various colors
  • Used in edge wise brackets
• Lockpins:
  • use – To secure ribbon arch brackets
  • Made of brass

Advantages Of Fixed Appliances.

• Cooperation of patient is achieved
• Various tooth movements are possible
• Tooth movement of multiple teeth is possible simultaneously
• Good occlusion is achieved
• More precise tooth movements possible
• Can be used in complicated malocclusions
• Better anchorage is obtained
• Management of appliance possible
• Convenient for the operator as no need of timely wear of appliance
• Less time of treatment required

Disadvantages Of Fixed Appliances.

• Difficult to maintain oral hygiene
• More time consuming
• More chair time required
• Technique sensitive
• May apply misdirected forces
• Frequent visits required
• Expensive

Fixed Appliances Short Essays

Question 1. Name 3 fixed appliace techniques. Differntiate begg and Edgewise appliances.
Answer.

Fixed Appliance Techniques:

• Edgewise technique
• Begg appliance
• Lingual technique

Question 2. Passive Components of Fixed Appliances.
Answer.

Bands Of Fixed Appliances:

Use – To fix various attachments to tooth

• Advantage:
• • Reduces chair time
  • Comfortable for patient
• Available:
  • In various sizes for different teeth
  • Of stainless steel

Brackets Of Fixed Appliances:

Use – To transmit force to teeth

Types Of Brackets:

• Edge wise
• Ribbon arch
• Weladable and bondable
• Metallic
• ceramic
• Plastic

Available – In various sizes

• Have one/more slots to accept arch wire

Buccal Tubes:

• Fixed on anteriors/premolar
• On molar called molar tube
• Can be welded/bonded/cemented
• Can be round/rectangular
• Additional tubes for extra-oral anchorage

Lingual Attachments:

• Attachments fixed on lingual aspect
  Example: Lingual buttons, lingual cleats, eye lets and ball end hook

Ligature Wires:

• Use – To secure arch wire
• Size – 0.009 – 0.011 inched diameters
• Available in various colors
• Used in edge wise brackets

Lockpins:

• use – To secure ribbon arch brackets
• Made of brass

Fixed Appliances Short Questions And Answers

Question 1. Fixed Appliances.
Answer.

Appliances that are fixed/fitted onto the teeth by the operator and cannot be removed by the patient at will are called “Fixed appliances”

Important Advantages Of Fixed Appliances:

• Patient cooperation
• Capable of all tooth movements
• Capable of even root movements

Disadvantages Of Fixed Appliances:

• Poor oral hygiene maintenance
• Time consuming
• Technique sensation

Question 2. Elgiloy Wires.
Answer.

Chemical Name: Cobalt Chromium Nickel

Properties Of Elgiloy Wires:

• Adequate spring back
• Formability
• Biocompatible
• Arch wires – Active component of fixed appliance

Question 3. Molar Tubes.
Answer.

• Fixed on anteriors/premolar
• On molar called molar tube
• Can be welded/bonded/cemented
• Can be round/rectangular
• Additional tubes for extra-oral anchorage

Question 4. Parts of Fixed Appliances.
Answer.

• Active components:
  • Archwires
  • Elastics
  • Springs
  • Separators
• Passive components:
  • Bands
  • Brackets
  • Buccal tubes
  • Lingual attachments
  • Ligature wires
  • Lockpins

Question 5. Stainless Steel.
Answer.

• Austenitic stainless steel
• Use – To make orthodontic archwires

Properties Of Stainless Steel:

• Adequate strength
• Adequate spring back
• Resilience
• Formability
• Biocompatible
• Economical

Fixed Appliances Viva Voce

• Brackets are fixed on anterior teeth and premolars
• Buccal tubes are used on molars
• Elastic chains are made of polyurethane
• Zinc phosphate can be used for cementatin of bands onto the teeth
• Oral hygiene maintenance is difficult in case of fixed appliances
• Plastic brackets are made up of poly carbonate
• Titanium arch wires exhibit superior elastic properties
• Lock pins are made of brass
• Buccal tube is passive component of fixed appliance

Removable Appliances Important Notes

Components of removable appliances

Methods of activation of different components

Types of labial bows

Types of springs

Removable Appliances Long Essays

Question 1. Classify orthodontic appliances and discuss in detail the various active components of removable appliances.
Answer.

Classification Of Orthodontic Appliances:

• Mechanical: Exerts mild pressure on the tooth
  • Removable appliances
  • Fixed appliances
    Myofunctional: Harness natural muscular forces

• • Removable appliance
  • Fixed appliance

Active Components Of Removable Appliances:

Bows

• Used for incisor retraction

Types Of Bows:

• Short labial bow: Parts
  • Bow
  • ‘U’ loop
  • Retentive arms distal to the canine
    Uses:
  • Minor overjet reduction
  • Anterior space closure
  • For retention after fixed mechanotherapy

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

Activation: Compressions of U loops

• Long labial bow: Extends from one 1st premolar to the opposite side
  Indications:
  • Minor anterior space closure
  • Overjet reduction
  • Retaining device
  • Closure of space distal to canine
• Split labial bow:
  • Labial bow split in the middle
  • Have separate buccal arms
    Indications:
  • Midline diastema
  • For anterior retraction

• Reverse labial bow: Free ends of U loops adapted occlusal
  Activation:
  • Opening of U loop
  • Compensatory bend at the base of U

• Others:
  • Robert’s retractor
  • Mills retractor
  • High labial bow with apron springs
  • Fitted labial bow

Springs

Classification:

• Based on the presence/absence of helix
  • Simple without helix
  • Compound with helix
• Based on the presence of loops/helix
  • Helical springs
  • Looped springs
• Based on the nature of the stability of spring
  • Self-supported
  • Supported

Screws:

• To bring about different tooth movement

Example:

• Arch expansion
• Buccal movement of teeth
• Mesial/distal movement of teeth

Elastics:

• For anterior retraction
• May cause gingival trauma

Removable Appliances Short Essays

Question 1. Adam’s clasp and its modifications.
Answer.

• By Professor Phillip Adams

Synonyms Of Adam’s Clasp:

• Liver pool clasp
• Universal clasp
• Modified arrow head clasp

Wire Used:

• 0.7 mm round stainless steel

Parts:

• Two arrowheads – Engaging proximal undercuts
• Bridge – Connects two arrowheads

Two Retentive Arms – Incorporated In Acrylic

Advantages Of Adam’s Clasp:

• Rigid retentive
• Simple to fabricate
• Occupies minimum space
• Can be used for
  • Deciduous and permanent teeth

• • Partially and fully erupted teeth
  • Incisors, premolars and molars
    • Modified in many ways

Modifications Of Adam’s Clasp:

• Adams with single arrowhead
• Adams with additional arrowhead
• Adams with J hook
• Adams with incorporated helix
• Adams with soldered buccal tube
• Adams with distal extraction
• Adams on incisors and premolars

Question 2. Canine retractors.
Answer.

U loop canine retractor:

• Wire used – 0.6/0.7 mm

Parts Of U loop canine retractor:

• U loop: Base is 2-3 mm below the cervical margin
• Active arm:
  • Bent at right angles
  • Passed below mesial contact point of canine
• Retentive arm: Incorporated in acrylic
  Uses: In 1-2 mm of retraction

Helical canine retractor:

• Wire – 0.6mm

Parts Of Helical canine retractor:

• Coil – 3mm diameter
• Active arm – towards tissue
• Retentive arm

Activation: Opening of helix

Use: In shallow sulcus

Palatal canine retractor:

• Wire – 0.6mm

Parts:

• Coil – 3mm diameter
• Active arm – mesial to canine
• Guide arm

Use: Retraction of palatally placed canine

Buccal canine retractor:

Uses Of Buccal Canine Retractor:

• Bucally placed canines
• Highly placed canines

Parts Of Buccal Canine Retractor:

• Coil – 3mm diameter
• Active arm – away from tissue
• Retentive arm

Types Of Buccal Canine Retractor:

• Supported – with 0.5mm wire
• Self-supported – with 0.7 mm wire

Question 3. Advantages and disadvantages of removable appliances.
Answer.

Advantages Of Removable Appliances:

• Oral hygiene maintenance
• Useful in tipping movement
• Less chair time
• Convenient for operators to handle more patient
• Fewer forces required
• Not technique sensitive
• Easy to fabricate
• Relatively cheaper
• Damaged appliances can be replaced

Disadvantages Of Removable Appliances:

• Poor patient cooperation
• Capable of only tipping movement
• Prolonged duration of treatment
• Difficult to treat multiple-movement
• Difficult to close residual space created due to extraction
• Risk of damaging and misplacing appliances by patient
• Cannot be used to treat severe cases of Class 2 and Class 3 malocclusions with the unfavorable growth pattern

Removable Appliances Short Questions And Answers

Question 1. Z spring/Double cantilever.
Answer.

Uses Of Z spring:

• Labial movement of incisors
• Minor rotation of incisors

Wire used: 0.5 mm

Parts Of Z spring:

• Two coils
• Retentive arm – 10-12 mm length

Activation Of Z spring:

• Opening of helix
• One helix for rotation
• Both helices for labial movement

Question 2. Finger Springs/Single Cantilever.
Answer.

• One end is fixed and the other end is free

Wire used: 0.5/0.6mm

• Use
• Mesio distal movement of teeth

Parts Of Finger Springs:

• Active arm – 12-15mm length
• Helix – 3mm diameter
• Activation – Moving active arm towards teeth

Question 3. Cantilever Springs.
Answer.

Double cantilever:

Uses Of Double Cantilever:

• Labial movement of incisors
• Minor rotation of incisors

Wire used: 0.5mm

Parts Of Double Cantilever:

• Two coils
• Retentive arm – 10-12mm length

Finger Springs/Single Cantilever:

• One end is fixed and the other end is free

Wire Used: 0.5/0.6mm

Uses Of Finger Springs:

• Mesio distal movement of teeth

Parts Of Finger Springs:

• Active arm – 12-15mm length
• Helix – 3mm diameter
• Activation – Moving active arm towards teeth

Question 4. Canine Retractor.
Answer.

• Used for distalization of canines

Types Of Canine Retractors

U loop canine retractor:

• Wire used – 0.6/0.7mm
• Uses: In 1-2mm of retraction

Helical canine retractor:

• Wire – 0.6mm
• Use: In shallow sulcus

Palatal canine retractor:

• Wire – 0.6 mm
• Use: Retraction of palatally placed canine

Buccal canine retractor:

Uses Of Buccal Canine Retractor:

• Bucally placed canines
• Highly placed canines

Types Of Buccal Canine Retractor:

• Supported – with 0.5mm wire
• Self-supported – with 0.7 mm wire

Question 5. Adam’s clasp and its advantages
Answer.

• By Professor Phillip Adams

Synonyms Of Adam’s Clasp:

• Liver pool clasp
• Universal clasp
• Modified arrow head clasp

Wire Used:

• 0.7 mm round stainless steel

Parts Of Adam’s Clasp:

• Two arrowheads – Engaging proximal undercuts
• Bridge – Connects two arrowheads

Two Retentive Arms – Incorporated In Acrylic:

Advantages Of Adam’s Clasp:

• Rigid retentive
• Simple to fabricate
• Occupies minimum space
• Can be used for
  • Deciduous and permanent teeth
  • Partially and fully erupted teeth
  • Incisors, premolars and molars

Removable Appliances Viva Voce

• T spring is activated by pulling the free end of the T
• Labial movement of incisors is achieved by Z spring
• Buccal movement of premolars and canines is achieved by T spring
• U loop canine retractor is activated by compressing the loop
• Finger spring is a single cantilever
• Z spring is also called a double cantilever
• A modified split labial bow is used for the closure of midline diastema
• The palatal canine retractor is activated by opening the helix by 2mm
• Adam’s clasp is most commonly used
• The reverse labial bow is activated by opening the U-loop
• The finger spring is activated by opening the helix
• Z spring is activated by opening both helices simultaneously

Extractions Important Notes

Wilkinson’s extraction

• It involves the extraction of all the four permanent molars between the age of 8 1/2 to 9 years
• It is done to
  • Minimize arch crowding
  • Provide addition space for eruption of third molars
• Basic is that the first permanent molars are highly susceptible to caries

Extractions Short Essays

Question 1. Second Premolar extraction for treatment purposes.
Answer:

Indications Of Second Premolar Extraction:

• To strengthened anchorage of anterior segment
• For mesial movement of posterior teeth
• Treat mild anterior crowding
• When 4-5mm of anchorage loss is desired
• Impacted 2nd premolars
• In open bite – as it results in deepening of bite
• In case of grossly carious/extensive restored teeth
• Early loss of deciduous molars which leads to inadequate space for 2nd premolar to erupt
• When arch length-tooth material discrepancy is 2.5-5 mm

Question 2. First premolar extractions.
Answer:

Reasons Of First Premolar Extractions

• To gain space to utilized for correction
• Satisfactory contact between canine and 2nd premolar
• Teeth posterior to it offers adequate anchorage

Indications Of First Premolar Extractions:

• To relieve moderate – severe anterior crowding
• For correction of class 2, division 1 and Class 1 bimaxillary protrusion
• In case of > 5 mm arch length tooth material discrepancy

Question 3. Therapeutic Extractions.
Answer:

Extractions carried out as a treatment procedure for gaining space are called therapeutic extractions

Need for Extraction:

• Arch length – tooth material discrepancy
• Correction of saggital interarch relationship
• Abnormal tooth size and form
• Skeletal jaw malrelation

Choice Of Teeth – Common Premolars:

Factors Of Therapeutic Extractions:

• Arch length tooth material discrepancy
• Direction and amount of jaw growth
• Facial profile
• Tooth position
• Age of patient

Disadvantages Of Therapeutic Extractions:

• Mesial migration of posterior teeth
• De-crowding of lower anteriors – following extraction of lower 1st premolar

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

• Buccal non-occlusion
• Non coincidence of mid lines

Prevented By:

• Balaced extraction

Question 4. Wilkinson’s Extraction.
Answer.

• Advocated by Wilkinson
• Teeth extracted – All permanent 1st molars
• Age – 8 1/2-9 1/2 years

Benefits – Minimizes Crowding:

• Provides space for the third molar eruption
• Decreases risk of caries

Draw Backs:

• Limited space to relieve crowding
• Tipping of second premolar and 2nd molar
• First molar unable for anchorage

Extractions Viva Voce

• Maxillary first molar is the most commonly extracted teeth
• Maxillary anterior are least extracted

Methods Of Gaining Space Important Notes

• Proximal stripping
  • Contraindications
    • Young patients
    • Patient with high caries index
• Methods of Gaining Space
  • Proximal stripping
  • Expansion
  • Extraction
  • Distalization
  • Uprighting of molars
  • Derotation of posteriors
  • Proclination of interiors

Methods Of Gaining Space Long Essays

Question 1. What are therapeutic methods of gaining space? Explain in detail first premolar extraction.
Answer.

Methods Of Gaining Space:

• Proximal stripping
• Expansion
• Extraction
• Distalization
• Uprighting of molars
• Derotation of posteriors
• Proclination of interiors

First Premolar Extraction:

• Extraction forms a main part of all space-gaining procedures
• Extraction is indicated for the correction of
  • Crowding
  • Anteroposterior dental arch relations
  • Vertical problems
  • Skeletal jaw deformities
  • Presence of supernumerary teeth
• Factors affecting the choice of teeth
  • Condition of teeth
  • Position of teeth
  • Position of crowding
• Premolars are frequently extracted for this purpose

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

First Premolar Extractions:

Reasons:

• To gain space to utilize for correction
• Satisfactory contact between canine and 2nd premolar
• The teeth posterior to it offer adequate anchorage

Indications Of First Premolar Extractions:

• To relieve moderate-severe anterior crowding
• For correction of class 2, division 1, and class 1 bimaxillary protrusion
• In case of > 5mm arch length tooth material discrepancy

Question 2. Explain various methods of gaining space.
Answer.

Proximal stripping:

Synonyms Of Methods Of Gaining Space:

• Approximation
• Slenderization
• Disking and Proximal slicing

Procedure Of Methods Of Gaining Space:

• Proximal surfaces are sliced to reduce the mesiodistal dimensions of teeth

Means:

• Metallic abrasive strips
• Carborundum discs
• Long thin tapered fissure burs
  • Followed by fluoride application

Indications Of Methods Of Gaining Space:

• 0-2.5mm – Discrepancy
• Mild to moderate excess tooth material according to Bolton’s analysis

Contraindications Of Methods Of Gaining Space:

• Young patients
• High caries index
  • Amount of reduction – less than 50% of enamel

Expansion:

Indications Of Expansion:

• Constricted maxillary arch
• Unilateral/Bilateral crossbite

Types Of Expansion:

• Skeletal
  • By splitting mid palatal suture
• Dental
  • By jackscrew/springs like coffin spring

Extraction:

• Commonly extracted are premolars
• Provides sufficient space for correction
• Preserves functions and esthetics

Visualization of molars:

• Advantage – Avoids the need for extraction
• Indication – Mild to moderate class 2
• Time – Before the eruption of 2n permanent molar

Uprighting of molars:

• Indication: Mesially tipped molar
• Causes: Premature loss of 2nd deciduous molar
• Extraction of 2nd premolar

Appliances used:

• Molar uprighting springs
• Space regainers

Derotation of Posteriors:

• Rotated posteriors occupy more space
• Derotation of them helps to gain space
• Appliances used:

Incorporating springs/elastics using a force couple

Proclination of interiors:

• Indication: Retroclined interiors
• Precaution: Prevent damage to the soft tissue profile

Methods Of Gaining Space Short Essays

Question 1. Slenderization/Proximal Stripping.
Answer.

Proximal stripping:

• Synonyms:
  • Approximation
  • Slenderization
  • Disking and Proximal slicing
• Procedure:
  • Proximal surfaces are sliced to reduce the mesiodistal dimensions of teeth
• Means:
  • Metallic abrasive strips
  • Carborundum discs
  • Long thin tapered fissure burs
    • Followed by fluoride application
• Indications:
  • 0-2.5mm – Discrepancy
  • Mild to moderate excess tooth material according to Bolton’s analysis
• Contradictions:
  • Young patients
  • High caries index
  • Amount of reduction: less than 50% of enamel

Expansion:

• Indications Of Expansion:
  • Constricted maxillary arch
  • Unilateral/Bilateral crossbite
• Types Of Expansion:
  • Skeletal
    • By splitting mid palatal suture
  • Dental
    • By jackscrew/springs like coffin spring

Extraction:

• Commonly extracted are premolars
• Provides sufficient space for correction
• Preserves functions and esthetics

Visualization of molars:

• Advantage – Avoids the need for extraction
• Indication – Mild to moderate class 2
• Time – Before the eruption of 2nd permanent molar

Uprighting of molars:

• Indication: Mesially tipped molar
• Causes: Premature loss of 2nd deciduous molar
• Extraction of 2nd premolar

Appliances used:

• Molar uprighting springs
• Space regainers

Derotation of posteriors:

• Rotated posteriors occupy more space
• Derotation of them helps to gain space
• Appliances used:
• Incorporating springs/elastics using a force couple

Proclination of interiors:

• Indication: Retroclined interiors
• Precaution: Prevent damage to the soft tissue profile

Question 2. Slenderization/Proximal Stripping.
Answer.

Synonyms Of Proximal Stripping:

• Approximation
• Slenderization
• Disking and Proximal slicing

Procedure Of Proximal Stripping:

• Proximal surfaces are sliced to reduce the mesiodistal dimensions of teeth

Means:

• Metallic abrasive strips
• Carborundum discs
• Long thin tapered fissure burs
  • Followed by fluoride application

Indications Of Proximal Stripping:

• 0-2.5mm – Discrepancy
• Mild to moderate excess tooth material according to Bolton’s analysis

Contraindications Of Proximal Stripping:

• Young patients
• High caries index
• Amount of reduction: Less than 50% of enamel

Question 3. Molar distalization
Answer.

Aim: To move molars in a distal direction to gain space

Methods Of Molar distalization:

• Extraoral headgear
• Intra oral Sagittal appliance
  • Intraoral magnets
  • Open coil spring
  • Pendulum appliance
• Headgear
  • Consists of a face bow with an inner and outer bow
  • Head cap/neck strap

Disadvantage Of Molar distalization:

• Needs patient cooperation
• Has intermittent in their action

Sagittal Appliance:

• Consist of jackscrew positioned parallel to the occlusal plane
• Use only one tooth at a time

Intra-oral magnets

• Consists of repelling magnets

Open coil spring:

• Compressed spring placed between molar and anterior segment

Pendulum appliance:

• Consist of modified Nance button and helix
• Activated by opening the helix

Methods Of Gaining Space Short Questions And Answers

Question 1. Derotations.
Answer.

• Rotated posteriors occupy more space
• Derotation of them helps to gain space
• Appliances used
• Incorporating springs/elastics using a force couple

Question 2. Enumerate methods of Gaining Space.
Answer.

• Methods of Gaining Space
  • Proximal stripping
  • Expansion
  • Extraction
  • Distalization
  • Uprighting of molars
  • Derotations of posterior teeth
  • Proclination of anterior

Methods Of Gaining Space Viva Voce

• Visualization is an advanced method of gaining space in recent times
• A mixed dentition period before the eruption of the second permanent molar is the ideal time for distalization
• Proximal stripping requires space of 0-2.5mm
• Bolton’s analysis is done for proximal stripping
• Proclination of interiors creates space
• Slenderization is also called approximation, disking, and proximal slicing

Interceptive Orthodontics Definitions

• Interceptive orthodontics:
  • It is defined as that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions of the developing dentofacial complex.
• Preventive orthodontics:
  • According to Graber, it is defined as the action taken to preserve the integrity of what appears to be a normal occlusion at a specific time.
• Serial extraction:
  • It is a procedure that includes the planned extraction of certain deciduous teeth and later specific permanent teeth in an orderly sequence and pre-determined pattern to guide the erupting permanent teeth into a more favorable position.
• Space regainer:
  • Appliances used to regain the space lost by the mesial movement of the molar due to premature loss of deciduous, by distal movement of the first molar are called “Space Regainers”.

Interceptive Orthodontics Important Notes

• Serial extraction
  • Indications:
    • Skeletal class 1
    • Flaring of teeth
    • Localized gingival recession in lower anterior
    • Ectopic eruption of teeth
    • Unilateral/bilateral premature loss of deciduous canines
    • Discrepancy should be at least 5 mm
  • Contra-Indications:
    • Class 2 and 3 malocclusions
    • Open bite and deep bite
    • Midline diastema
    • Class 1 with minimum space deficiency
  • Types:
    • Dewey’s method
      • The most commonly used method
      • Extraction of deciduous canine is done at the age of 8-9 years
      • Followed by extraction of the erupting first premolar
    • Tweed’s method – D4C
• Exercises for different muscles:

Interceptive Orthodontics Long Essays

Question 1. Define Serial Extraction, and explain its indications, contraindications, and methods.
Answer.

Interceptive Orthodontics:

It is defined as that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions of the developing dentofacial complex.

Serial Extraction:

Definition: It is a procedure that includes the planned extraction of certain deciduous teeth and later specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.

Indications Of Serial Extraction:

• Class 1 malocclusion with normal muscle activity
• Deficient arch length
• Absence of primate spacing
• Premature loss of deciduous canines
• Impacted lateral incisors
• Crowded interiors
• Localized gingival recession
• Ectopic eruption of teeth
• Mesial migration of posteriors
• Abnormal sequence of eruption
• Lower anterior flaring
• Ankylosed teeth
• Deficient growth
• Straight profile persons

Contraindications Of Serial Extractions:

• Skeletal Class 2 and 3
• Spacing
• Anodontia
• Open bite/Deep bite
• Midline spacing

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

• Dilacerated tooth
• Extensive carious/restored tooth
• Mild discrepancy

Methods

Dewel’s Method:

Tweed’s method:

Nance method:

• Similar to Tweed

Question 2. Define Preventive and Interceptive Orthodontics. Explain various methods of interceptive orthodontics.
Answer.

Definition:

Preventive Orthodontics: According to Graber it is defined as the action taken to preserve the integrity of what appears to be a normal occlusion at a specific time.

Interceptive Orthodontics: It is that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and mal-positions of the developing dento facial complex.

Procedures Of Interceptive Orthodontics:

Serial extraction:

• It is planned extraction of certain deciduous teeth and later specific permanent teeth in orderly sequence and predetermined pattern
  • Rationale:
    • Arch lenght tooth material discrepancy
    • Physiologic tooth movement
  • Advantage:
    • Physiologic
    • More stable
    • Less retention required
    • Less psychological trauma
    • Healthy gingival tissue
  • Disadvantage:

Lengthy Procedure:

• Need of fixed mechano therapy
• Patient’s cooperation

Procedure:

Dewel’s method [CD4]:

• Step 1 – Extraction of deciduous canine [C]
  • For alignment of incisor
• Step 2 – Extraction of deciduous first [D]
  • To accelerate eruption of 1st PM
• Step 3 – Extraction of 1st PM [U]
  • To permit eruption of permanent canine

Tweed’s method [DC4]:

Nance’s method: Similar to Tweeds

Developing Anterior cross bite:

Significance: Treated to prevent minor orthodontic problem

Reason to treat:

• May manifest in permanent dentition
• May lead to skeletal malocclusion

Types Treatment/Appliances:

• Functional Eliminating occlusal prematurities
• Dento-alveolar Tongue blade, Catlan’s appliance
• Skeletal Myofunctional appliances

Interception of habits:

• Habit effecting dento-alveolar segment
  • Thumb sucking
  • Tongue thrusting
  • Mouth breathing
• Habit breaking appliances are used

Space Regaining:

• Space lost by mesial movement of molar can be regained by distal mivement of 1st molar.

Age: At early age

Appliance used:

• Gerber space regainer
• Jackscrew
• Cantilever spring

Muscular Exercises:

• Normal occlusal depends on the surrounding perioral musculature

Use:

• Muscle exercise help to improve aberrant muscle function

Interception of skeletal malrelations:

Importance: Reduces severity of disease

For class 2: Head gear is used

For class 3: FR 3/face mask therapy

Removal or soft tissues and bony barriers:

Question 3. Serial Extraction.
Answer.

Serial Extraction:

It includes the planned extraction of certain deciduous teeth and later specific permanent teeth in an orderly sequence and pre-determined pattern to guide the erupting permanent teeth into a more favorable position.

Basic Principles:

• Arch length tooth discrepancy
• Physiologic tooth movement

Serial Extraction Indications:

• Class 1 malocclusion
• Arch length deficiency
• Absence of primate spaces
• Mal-positioned/Impacted lateral incisors
• Markedly irregular/crowded anteriors
• Localized gingival recession
• Ectopic eruption
• Mesial migration
• Lower anterior flaring

Serial Extraction Contra-Indications:

• Class 2 and 3 malocclusion
• Spaced dentition
• Open bite and deep bite
• Mid line diastema
• Anodontia/Oligodontia
• Un-erupted teeth
• Extensive caries

Serial Extractions Advantages:

• More physiologic
• Less Psychological trauma
• Less duration
• Better oral hygiene
• Preserve gingival health
• Less retention required
• More stable

Serial Extractions Disadvantages:

• Prolonged treatment
• Patient co-operation
• Development of habits
• Deepening of bite
• Require fixed appliance therapy

Procedure:

Dewel’s:

• Step 1 – Extraction of deciduous canine [C]
  • For alignment of incisor
• Step 2 – Extraction of deciduous first [D]
  • To accelerate eruption of 1st PM
• Step 3 – Extraction of 1st PM [U]
  • To permit eruption of permanent canine

Tweed’s method [DC4]:

Interceptive Orthodontics Short Essays

Question 1. Serial extraction and write about its indications.
Answer.

Serial Extraction:

It includes the planned extraction of certain deciduous teeth and later specific permanent teeth in an orderly sequence and pre-determined pattern to guide the erupting permanent teeth into a more favourable position.

Basic Principles:

• Arch length tooth material discrepancy
• Physiologic tooth movement

Serial Extraction Indications:

• Class 1 malocclusion
• Arch length deficiency
• Absence of primate spaces
• Mal-positioned/Impacted lateral incisors
• Markedly irregular/crowded anteriors
• Localized gingival recession
• Ectopic eruption
• Mesial migration
• Lower anterior flaring

Question 2. Interceptive Orthodontic Management of Maxillary Retrusion.
Answer.

Myofunctional appliance/face mask therapy is used to promote maxillary growth

Anchorage Site:

• Chin
• Skull
• Chin and Forehead together

Principle Of Maxillary Retrusion:

• Creates pulling force on maxillary structure
• Reciprocal pushing force on mandible/forehead

Parts Of Maxillary Retrusion:

• Chin cup: Takes anchorage from chin area – connected to face mask assembly by metal rods
• Forehead cap: Derive anchorage from forehead
• Elastics: Applies forward traction on upper arch
• Intraoral appliance: Consists of traction hooks on molars
• Metal Frame: Connects various components
• Receives elastic from intraoral appliance

Interceptive Orthodontics Short Questions And Answers

Question 1. Space Regainers.
Answer.

Appliances used to regain the space lost by mesial movement of molar due to premature loss of deciduous, by distal movement of the first molar are called “Space Regainers”.

Time: At early age

• Prior to eruption of second molar

Examples:

• Gerber Space Regainer
• Jack Screws
• Cantilever Springs

Question 2. Advantages of Serial Extraction.
Answer.

Physiological Procedure:

• Less psychological trauma
• Reduce treatment duration
• Maintenance of oral hygiene
• Preservation investing tissues
• Less retention required
• More stable

Question 3. Disadvantages of Serial Extraction.
Answer.

• Not universally applicable
• Prolonged treatment time
• Frequent visit required
• Development of habit
• Risk of reduction in arch length
• Creation of space between canine and 2nd premolar
• Requires short term fixed mechano therapy

Question 4. Interceptive orthodontic procedures.
Answer.

• Interceptive orthodontic procedures are
  • Serial extraction
  • Developing anterior crossbite
  • Interception of habits
  • Space regainer
  • Muscular exercise
  • Interception of skeletal malrelation

Interceptive Orthodontics Viva Voce

• Button pull exercise is done for lips
• Stretching of upper lip to maintain lip seal is therapeutic measure for short hypotonic lips
• Tug of war exercise is good exercise for lips
• One elastic swallow and two elastic swallow is for tongue
• Hold pull exercise is helpful in stretching the lingual frenum
• Serial extraction is crried out when space needed is 5-7mm
• First tooth to be extracted in Dewel’s method is deciduous canine
• First tooth to be extracted in tweed’s method is deciduous first molar
• Midline diastema is contraindication of serial extraction

Preventive Orthodontics Important Notes

Classification of space maintainers:

• According to Hitchcock:
  • Removable/Fixed/Semi-fixed
  • With bands/without bands/
  • Functional/non-functional
  • Active/Passive
  • Combinations
• According to Raymond:
  • Removable
  • Complete arch
  • Individual tooth
• According to Hinrechsen:
  • Fixed
    • Class 1 – Non-functional
    • Functional:
    • Class 2 – Cantilever type
  • Removable – Acrylic partial dentures
• Distal shoe space maintainer
  • Indications:
    • Loss of primary 2nd molar before eruption of permanent first molar
  • Contra-indications:
    • Patient with heart disease
    • Patient with poor oral hygiene
    • Haemophilic patients
• Indications of various space maintainers

• Factors considered for space maintainers
  • Time elapsed since loss of teeth
  • Dental age of patients
  • Thickness of be one covering the unerupted teeth
  • Sequence of eruption of teeth
  • Congenital absence of permanent teeth
• Disadvantages of fixed space maintainers
  • Nonfunctional maintainers can cause supra eruption of opposing teeth
  • Functional space maintainer can interfere with vertical eruption of abutment teeth
  • Expert skill and elaborate instrumentation are needed
  • Decalcification of tooth under bands

Preventive Orthodontics Long Essays

Question 1. Define preventive orthodontics. Discuss various preventive orthodontic procedures
Answer.

Definition: According to Graber it is defined as the action taken to preserve the integrity of what appears to be a normal occlusion at a specific time.

Procedures Of Preventive Orthodontics:

• Parent Education: To expected/lactating mothers
• Caries Control: Especially proximal caries – leads to loss of arch
• Care of Deciduous Dentition:
  • Restoring the carious teeth at the proper time
  • To prevent early loss of deciduous
  • Includes – application of topical fluorides
  • Pit and fissure sealants
• Extraction of Supernumerary teeth:
  • As it interferes with the eruption of adjacent teeth
  • Deflects its eruptive path
• Eliminate occlusal interference:
  • As occlusal prematurities deviate path of closure
• Maintenance of tooth shedding timetable:
  • More than 3 months difference should not be present between the shedding of deciduous and eruption of permanent
• Management of Ankylosed teeth:
  • Ankylosed tooth prevents eruption of permanent and deflects their eruption path
  • Thus, they should be removed
• Management of Abnormal Frenal Attachment:
  • Abnormal frenum – leads to mid-line diastema
• Management of Habits:
  • Habits lead to malocclusion
• Management of deeply locked permanent first molars:
  • Prominent distal bulge of deciduous second molars prevents eruption of first permanent molar
• Preventing Milwaukee Brace damage:
  • Milwaukee Brace used for correction of scoliosis
  • But this leads to retardation of the mandible
• Space maintainers:
  • Definition: It is a device used to maintain the space created by the loss of a deciduous tooth.

Read And Learn More: Orthodontics Short And Long Essay Question And Answers 

Classifications Of Preventive Orthodontics:

• According to Hitchcock:
  • Removable/Fixed/Semi-fixed
  • With bands/without bands
  • Functional/non-functional
  • Active/Passive
  • Combinations
• According to Raymond:
  • Removable
  • Complete arch
  • Individual tooth
• According to Hinrechsen:
  • Fixed
    • Class 1 – Non-functional
    • Functional:
    • Class 2 – Cantilever type
• Removable – Acrylic partial dentures

Preventive Orthodontics Short Essays

Question 1. Space Maintainers.
Answer.

Definition: It is a device used to maintain the space created by the loss of a deciduous tooth.

Space Maintainers Requirements:

• Maintain the space created
• Restores function
• Prevent supra eruption of opposing teeth
• Simple to construct
• Withstand functional forces
• Do not exert excessive stress
• Maintain oral hygiene
• Allow growth of permanent
• Not interfere during oral functions

Classifications Of Space Maintainers:

• According to Hitchcock:
  • Removable/Fixed/Semi-fixed
  • With bands/without bands
  • Functional/non-functional
  • Active/Passive

• • Combinations
• According to Raymond:
  • Removable
  • Complete arch
  • Individual tooth
• According to Hinrechsen:
  • Fixed:
    • Class 1 – Non-functional
    • Functional
    • Class 2 – Cantilever type
  • Removable – Acrylic partial dentures

Planning:

Depends on:

• Time elapsed
• Dental age enters Sequence of eruption
• Thickness of bone
• Sequence of eruption

Preventive Orthodontics Short Questions And Answers

Question 1. Define Preventive and Interceptive Orthodontics.
Answer.

Preventive Orthodontics:

According to Graber, it is defined as the action taken to preserve the integrity of what appears to be a normal occlusion at a specific time.

Interceptive Orthodontics:

It is defined as that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions of the developing dentofacial complex.

Question 2. Space maintainers.
Answer.

Definition: It is a device used to maintain the space created by the loss of a deciduous tooth.

Space Maintainers Requirements:

• Maintain the space created
• Restores function
• Prevent supra eruption of opposing teeth
• Simple to construct
• Withstand functional forces
• Do not exert excessive stress
• Maintain oral hygiene
• Allow growth of permanent
• Not interfere during oral functions

Question 3. Distal Shoe Space Maintainers.
Answer.

Synonym: Intra-alveolar appliance

Uses:

• Guides the unerupted first permanent molar
• Used in case of premature loss of second primary molar
• Controls path of eruption
• Prevents mesial migration

Preventive Orthodontics Viva Voce

• The crib appliance is placed palatal to the maxillary incisor
• Distal shoe space maintainer is a cantilever type of space maintainer
• Band and loop are the most effective space maintainers in the lower arch
• Preventive orthodontics is undertaken before the development of malocclusion
• Deciduous dentition is a classical example of a natural space maintainer
• Nance holding arch derives its support from the anterior plate
• Crown and loop are preferred when there is a carious tooth adjacent to the space