Adjustment/Review of a Removable Appliance
- Mouth mirror
- Stainless steel ruler (mm)
- Adams Universal Pliers
- Flat/Round Pliers
- Double action (Mauns) wire cutters
- Straight handpiece
- Acrylic bur
"How are you getting on?"
If there is problems a gentle reminder is needed to the effect that if they are having problems they should come in rather than wait for their next routine appointment. If the appliance has been left out there is likely to have been a serious loss of movement achieved to date. At first visit after fitting check specifically that they are wearing the appliance to eat with.
- Check oral hygiene.
- Check that the springs are in the correct places.
- Ask the patient to remove the appliance.
- Check for signs of wear
- the outline of appliance on hard palate
- indentations from crib arrowheads
- signs of redness around palatal attached gingivae
- tooth marks on the bite plane
If these are missing the patient is not wearing the appliance full time.
- The overjet with the teeth in occlusion (and appliance out) using the SS rule. RECORD THIS IN THE NOTES AT EACH VISIT.
- Tooth movement achieved - there ought to be 1mm + of canine retraction per month and 1mm+ of overjet reduction during incisor retraction.
If measuring arch expansion - use dividers and 'stab' the points into the page, drawing samll circles around them and noting what points (eg MesioBuccal cusp tip of first molars) that you used for measurement points.
At the first visit after fitting an appliance with a bite plane you may get a slight increase in overjet of 1mm due to eruption of the posterior teeth and backward rotation of the mandible. Otherwise the overjet should not increase. If it is, then you are losing anchorage (During incisor retraction you need to note the buccal occlusion as the means of checking that the anchorage is secure)
For example if retracting the canines measure the canine tip to molar groove on each side. Record this in the notes by stabbing the ends of the dividers into the page and draw small circles around them.
- Palatal springs are adjusted using pliers by bending at the point where the cantilever arm leaves the coil. Do not alter the coil itself. The adjustment should be such that when the appliance is inserted the free end of the spring slides up the mesial slope of the canine.
- Buccal canine springs are adjusted similar to palatal finger springs, using spring forming pliers with the round beak placed in the coil. The adjustment of these must be no more than 1mm if the spring is made of 0.7mm wire but can be 2mm if the spring is of the sleeved design (0.5mm in tubing).
- Z springs are adjusted by carefully expaning the sping forward. Note that the spring design tends to displace the appliance and so over activation may result in the appliance not being well retained.
- U Loop labial bow is adjusted by closing the U loop on both sides. It is important to ensure that the labial bow rests approx 13 up the labial face of the incisors.
- Reverse loop labial bow is adjusted by opening the closed loop on both sides. It is important to ensure that the labial bow rests approx 13 up the labial face of the incisors.
- Adams clasps are adjusted by turning in the arrow heads so they grip the undercut on the buccal surface of the tooth.
- Make sure that there is no acrylic impeding the retraction of any tooth
- Unless full overbite reduction have been achieved, check that the biteplane is still effective. That is the posterior teeth are separated by 2-3mm when the appliance is in place. If not add cold curing acrylic resin.
DISCHARGE THE PATIENT
- Check that the patient is happy with the adjusted appliance.
- See the accompanying parent or guardian to inform them of progress.
- Arrange another appointment of 4-6 weeks time