Fitting and Activating removable appliances

Tavan edris
Shirin Safin
When the URA arrives from the laboratory

• Ensure a skilled orthodontic technician made it

• Fit the appliance within 2 weeks to prevent fitting
issues due to tooth movement.
• Check for accuracy, sharp edges, and proper wire
placement.
• Address any issues promptly, considering a
remake if necessary.
• Trim acrylic or wires for a comfortable fit.
• Ensure active components work smoothly like
screws and springs move freely
• Verify the expansion screw's functionality before
demonstrating it to the patient.
Advice to the patient prior to fitting

• Introduce the appliance on and off a model.

• Prepare the patient for initial discomfort: feeling strange,
lisping, and increased saliva.
• Explain that insertion and removal instructions will be given
by the dentist.
• Reassure them that they'll get used to the appliance within a
few days.
• Advise that their mouth will adapt to the appliance's feel in
about 10-14 days.
What to check prior to fitting the appliance

1- Place the patient in a supine position.

2- Ensure the appliance is seated firmly and elicits a click.
3- check retention by trying to remove it with firm
pressure on retentive components.
4- Position retentive components correctly to avoid
gingival impingement.
5- Check the palatal fit of the baseplate.
6- The baseplate should also be checked to ensure that no
acrylic will prevent the planned movement of teeth
7- Adequately heighten an anterior biteplane to prevent
overloading and ensure even contact.
8 For posterior capping, ensure even contact, prevent
differential eruption, and accommodate anterior crossbite
correction while avoiding interference from lower
incisors.
 There are occasions when the appliance is unable to be seated or, if
seated, is a poor fit. There are a number of reasons for this:

 Teeth have moved or erupted more since the impression was

taken. This is more likely if there is a significant delay in fitting
the appliance.
 The impression was distorted due to poor impression technique
or being left too long under inappropriate conditions before
being cast up
 The appliance has been poorly made.
There are a series of steps that should be followed in order
to determine the cause of the inadequate fit and how this
can be rectified:

 Don't touch active components until the fit is

verified by clinician
 Loosen retentive components to aid fitting.
 Check and adjust colleting and acrylic
baseplate.
 Acrylic that prevents the appliance from
seating because it extends too far along the
fly-overs on wire components should be
removed
Adjustment and/or activation of components
key to the success of a removable appliance The correct adjustment of the retentive components and
correct activation of the active components, in terms of both direction and force

Adjustment of retentive components

Adams’ claspst/ The universal clasp
Prior to any adjustment, the correct positioning on the tooth of each
part of the Adams’ clasp must be established

➢• The fly-overs should be as close to the contact points of the teeth

as possible as theycrossover from the palatal acrylic to the buccal
aspect of the tooth.

➢• The bridge should lie approximately two-thirds of the distance

from the gingival margin to the cusp tips, and there should be a gap of
no more than 1.5mm between the bridge and the buccal surface of
the tooth.
➢• The arrowheads should be positioned in the undercuts just above
the gingival margins on the mesio-buccal and disto-buccal aspects of
the crown.
Adjustment of Adam’s Clasp

1 bending the arrowhead

toward the undercut

Bending the occlusal 2

part toward the undercut
SouthendClasp Adjustment of Southend Clasp

1. The pliers grip the clasp just

1. Retentive components in where the wire exits the acrylic
the anterior part of the mouth. 2. Finger pressure is applied to the
2. They engage the undercuts on vertical arms of the clasp so that
the labial surface of the upper each side is pushed firmly toward
incisors, just incisal to the the baseplate
gingival margin.
3. Retention gained
from southend clasp is
much better on normally inclined
or proclined teeth and is minimal
on retroclined teeth
Adjustment /activation of Labial Bow

➢Retentive or active components on anterior teeth

➢The retention gained from a labial bow is much better on normally inclined
or proclined teeth and is minimal on retroclined teeth.
➢Labial bow should lie in the middle third of the crowns of the incisor teeth with the
U-loops adjacent to the canine teeth.
 The beaks of the Adams’pliers should be placed on either side of the vertical aspects of
the U-loop
 and gentle pressure applied to bring the sides of the U-loop closer together
Activation of active components
Z-springs
• Avoid over-activation it can make seating the
appliance difficult.
• position of the free arm by using Adams' 65 pliers
and gentle finger pressure can be adjusted before
seating.
• Ensure free arm is parallel to tooth's palatal
surface.
• Point contact on the palatal surface may be
necessary for rotated teeth
• Once activated, Compression occurs when seating,
pushing the tooth labially.
• Good anterior retention is important to prevent
dislodgment.
It is activated by opening both coils by about
2-3mm at time
(incase of labial movement of incisors).
It is activated by opening one coil by about 2-
3 mm at time
(in case of correcting rotations)
 T-springs
 T-springs are used to move premolar and molar
teeth buccally. To use them effectively:
 Ensure good appliance retention before activation.
 Position T-springs with the terminal loop in
contact with the tooth's crown.
 Activate by gently raising the T-spring away from
the baseplate, positioning it more occlusal than the
crown's maximum bulbosity.
 When seated, the T-spring pushes the tooth
buccally.
 Adjust the T-spring's length as needed by releasing
wire from loop.
 Palatal finger springs
Palatal finger springs move teeth mesially and distally.
To use them effectively:

 Ensure proper appliance seating and retention.

 Position the spring just above the gingival margin
with a loop around the tooth.
 Activate by marking one-third of the tooth width
on the baseplate and adjust the spring to that point.
 Before full seating, position the spring below the
incisal edge/occlusal surface.
 Check for any discomfort or incorrect positioning
after activation, and make adjustments as needed
Buccal canine retractors
Buccal canine retractors reposition buccally displaced and
mesially angulated canines. Key points:

 Proper positioning is important to prevent pain or trauma.

 Check positioning during relaxed muscles, as well as during
oral functions like talking
 The appliance has strong retention provided by Adams'
clasps, ensuring it won't be dislodged by muscle activity.
 Activation involves marking one-third of the tooth's width on
the baseplate.
 Ensure the free end curves around the mesial aspect of the
canine.
 Check positions after activation to prevent issues.
 Retractor stretches and pushes the tooth back to its original
position.
Labial bows
Labial bows retract incisors. Key points:

 Create space by trimming the baseplate, but don't overdo it

to control lower incisor position.
 Chamfer the baseplate to accommodate palatal mucosa
changes as teeth move.
 Activate by squeezing U-loops, positioning it just incisal to
the incisal edges of the teeth before full seating.
 When fully seated, the bow should be in the middle third of
the crown, moving teeth palatally during its return to the
passive position.
Expansion screws
Expansion screws need regular activation by turning
a key:
 An arrow on the baseplate shows the turning
direction.
 The key is inserted into the hole closer to the
arrow's back and turned in the arrow's direction.
 A one-quarter turn (0.25mm) is sufficient per
activation.
 Ensure patient and parent know how to activate it
and emphasize its importance.
 Patients often like being actively involved.
 Store the key in the appliance container.
Elastics

Elastics in orthodontic treatment demand

good patient cooperation
They are rarely used with Upper
Removable Appliances (URAs) except for
1) extruding upper incisors during the
mixed dentition stage
2) for cosmetic improvements.
When should the appliance be worn?

Orthodontic appliances, except for retainers, should

ideally be worn full-time, 24 hours a day, including
during sleep, meals, and school. However, they must be
removed for specific reasons:

 For oral hygiene maintenance.

 After each meal to rinse off food debris.
 During contact sports.
 While swimming.
Instructing the patient/parent on insertion
and removal of the appliance
1. Confirm patient comfort and ability to insert and remove the appliance.
2. Demonstrate removal and insertion.
3. firm finger pressure is required on clasps around the back teeth for removal
4. Show appliance components.
5. Be prepared for saliva during removal and offer encouragement and tissues
6. Check spring placement after insertion.
7. Ensure the patient and their parent are confident in managing insertion and
removal at home.
Thank You