Orthodontic Retainers and Removable Appliances E-Book

Friedy Luther

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 352

Veröffentlichungsjahr: 2012

Beschreibung

This book is a practical guide for both dental students and practitioners to designing, fitting and adjusting removable orthodontic appliances and retainers. The book offers step by step instructions with clear illustrations on the key areas of clinical practice. In each case, information is provided on indications for use, principles of design, fitting, activation and trouble shooting. Further chapters coach students to deal effectively with their patients and to manage the treatment plan in question.

Leseprobe

Table of Contents

Cover

Title page

Copyright page

Preface

Why we need this book and who is it for?

Acknowledgements

Abbreviations

1 Assumptions: What You Should Know and Understand Before You Use this Book

2 Upper Removable Appliances: Indications and Principles of Design

Prerequisites for orthodontic treatment

Anchorage

Components of URAs

What are the indications for the use of URAs?

Advantages and disadvantages of removable appliances

Design

3 Cases Suitable for Treatment with Removable Appliances

Expansion

Moving teeth around the arch

Reduction of overbite

Reducing an overjet

Other individual tooth movements: Extrusion of incisors

Space maintainers

Basic errors

Summary

4 Fitting and Activating Removable Appliances

When the URA arrives from the laboratory

Advice to the patient prior to fitting

Fitting the appliance and what to check for

Adjustment and/or activation of components

Instructing the patient/parent/ guardian on insertion and removal of the appliance

5 Follow-up Appointments: What to Check and Why

Appointment frequency

What to monitor

Adjustments at follow-up appointments

Managing the end of treatment and retention

What not to treat with standard removable appliances

When to refer

6 Test Yourself

Questions

Answers

7 Retainers

What is relapse?

Cases that are particularly prone to relapse and why

Types of retainers

Removable versus fixed retainers

Retention regimes

Liaison with the specialist: why do we need to know what is being retained?

Contra-indications to retention

‘Natural’ retention

8 Fitting and Checking Retainers

First fitting of removable retainers

Follow-up visits: is the retention working?

Long-term follow-up

9 Problems with Retainers and Trouble-shooting

Problems with removable retainers and trouble-shooting

Problems with bonded retainers and trouble-shooting

Managing treatment termination and removal of retainers

10 Removable Appliances for the Postgraduate in Specialist Orthodontic Training

Removable appliances for correcting excessive positive overjet

Removable appliances and their role in correcting molar relationships

Other types of removable appliances for correcting reverse overjets

11 Vacuum-Formed Active Appliances

General considerations

Summary

Example cases

Index

This edition first published 2013

© 2013 by Friedy Luther and Zararna Nelson-Moon

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Library of Congress Cataloging-in-Publication Data

Luther, Friedy.

 Orthodontic retainers and removable appliances : principles of design and use / Friedy Luther, Zararna Nelson-Moon.

p. ; cm.

 Includes bibliographical references and index.

 ISBN 978-1-4443-3008-3 (pbk. : alk. paper)

 I. Nelson-Moon, Zararna. II. Title.

 [DNLM: 1. Orthodontic Appliances, Removable. 2. Orthodontic Appliance Design. 3. Orthodontic Retainers. WU 426]

 617.6'43–dc23

2012022787

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover images: left - courtesy of iStockphoto/© Dawn Poland; top right and bottom right - courtesy of the authors

Cover design by Meaden Creative

Preface

Why We Need This Book and Who Is It For?

This book aims to fill a gap in the literature that has existed for many years. Whilst it is a General Dental Council (GDC) requirement (quite rightly) to teach dental students orthodontic diagnosis and the principles of interceptive treatment (amongst other things), there seem to be no books that explain concisely, in practical terms (and in enough detail), what principles to apply when trying to design the appliances to enable this interceptive treatment to be undertaken. This book therefore sets out to address this.

Many books contain the principles but these are often obscured by excessive detail – or perhaps there is too much theory in the wrong place. Either way, things can get confusing. Alternatively, suggestions are made for ‘standard appliances’, but a one-size-fits-all approach is not always useful when it comes to work­ing out when the ‘standard appliance’ is not appropriate. To reinforce this point, we also include a “Test yourself” chapter. Here, the reader can assess some patients for themselves and see whether or not a URA (upper removable appliance) would be appropriate or not.

In addition, in some cases, it may be necessary to refer a patient for specialist advice. For example, a patient may require initial, interceptive treatment but, in addition, may require referral for definitive treatment thereafter. It should be said that this would hopefully not be as a result of the interceptive treatment! Again, it is a GDC requirement that the dental graduate be competent at making appropriate referrals based on assessment. This is another aspect that this book gives advice on – what makes a good referral letter.

This book also includes a basic section on orthodontic retainers: current trends increasingly mean that patients wish to maintain their teeth as straight as possible following frequently lengthy, usually fixed, appliance treatment. Specialists performing orthodontic treatment must necessarily focus on the active treatment of the patients referred to them. Ultimately, such patients, if they wish to continue wearing retainers long term, need to be referred back to their own general dental practitioner (GDP) so they take over the responsibility of looking after their own patients and their patients’ retainers. However, there is little, readily available information for the GDP to enable them to perform this duty. Therefore, this book aims to provide some basic guidance to address this.

In addition, there are a limited number of lower removable appliances (LRAs) which may have a use in certain, somewhat restricted, circumstances. These will be referred to at appro­priate points in relevant chapters. For reasons of completeness, the book also includes chapters, specifically for the specialist trainee, on some other uses of removable appliances. These cover basic aspects of functional appliance design and the use of vacuum-formed active appliances (VFAAs; also known as aligners).

This book is thus aimed at dental undergraduates who have received basic training in orthodontic diagnosis; have a reasonable level of understanding; and are familiar with the basic terminology. However, we also intend it to be useful to postgraduate students of orthodontics; orthodontic therapists; qualified GDPs; orthodontic technicians, and postgraduates in paediatric dentistry – all of whom require a knowledge of interceptive orthodontic treatment.

Friedy LutherZararna Nelson–Moon

Acknowledgements

We have written this book in the hope that it will be useful to future generations of students of orthodontics. We have tried to achieve this by illustrating it as well as we possibly could. To this end, we have been reliant on the goodwill of fellow colleagues, clinicians and postgraduate students to help us obtain photographs (often at short notice), when we have not been able to obtain them ourselves. Jay Kindelan, Consultant Orthodontist at York (York Teaching Hospital NHS Foundation Trust) also helped us greatly by writing Chapter 11 for this book. We hope everyone will forgive us for badgering them.

However, above all we have been reliant on patients who have so kindly agreed to let us use their clinical photographs. We could not have produced this book without their willingness to help others.

We must also thank all the following colleagues and departments for all their help in supplying photographs or materials to be photographed. In no particular order, they are as follows.

At The Charles Clifford Dental Hospital, Sheffield Teaching Hospitals NHS Foundation Trust /School of Clinical Dentistry, University of Sheffield:

Fiona Dyer, Consultant Orthodontist;

Joanne Birdsall, Post-CCST Specialist Registrar;

Say Mei Lim, Staff Grade Orthodontist;

Peter Germain, SpR;

Rachel Norman and Jane Kilvington, Orthodontic Therapists.

At the Leeds Dental Institute/Leeds Teaching Hospitals NHS Trust/University of Leeds:

David Morris, Consultant Orthodontist;

Angus Robertson and the Team of Medical & Dental Illustration;

Michael Flynn and the Orthodontic Technicians;

Jacki Keasberry, Postgraduate Paediatric Dentistry student.

At St Luke’s Hospital, Bradford/Bradford Teaching Hospitals NHS Foundation Trust:

Simon Littlewood, Consultant Orthodontist;

Carol Bentley, Orthodontic Therapist.

At York, York Teaching Hospital NHS Foundation Trust:

Sandra Hudson, Orthodontic Therapist;

Mike Pringle, Department of Medical Illustration.

Andrew DiBiase, Consultant Orthodontist, East Kent Hospitals University NHS Foundation Trust.

Thanks are also due to the following for their help:

Jancyn Gardiner for her timely legal advice;

Clearstep™ for permission to use some of the figures in Chapter 11 (as noted therein);

Oxford University Press (for permission to use Figure 2.1).

Finally, huge thanks must also go to our long-suffering partners and families who survived the ordeal as well as to our publishing team at Wiley-Blackwell who include: Sophia Joyce, Lucy Nash and Katrina Hulme-Cross.

Abbreviations

Throughout this text, the following abbreviations have been used:

EOT: extra-oral traction

FABP: flat anterior biteplane

FMPA: Frankfort–mandibular planes angle

GDC: General Dental Council

GDP: General Dental Practitioner

ICP: inter-cuspal position

IOTN: Index of Orthodontic Treatment Need

IPR: interproximal reduction

LLS: lower labial segment (usually taken to mean the lower incisors although some clinicians include the lower canines)

LRA: lower removable appliance

MOA: medium opening activator

PIL: patient information leaflet

RCP: retruded contact position

ss: stainless steel

ULS: upper labial segment (usually taken to mean the upper incisors although some clinicians include the upper canines)

URA: upper removable appliance (not to be confused with upper right deciduous central incisor, see below!)

VFAA: vacuum-formed active appliance

VFR: vacuum-formed retainer

In addition, readers should note that the commonly used abbreviation for a supernumerary tooth, $, is used.

Tooth notation: the alpha numeric tooth notation system will be used, e.g. upper right lateral incisor would be UR2. An upper right deciduous central incisor is noted as UR A.

1

Assumptions: What You Should Know and Understand Before You Use this Book

As a reader of this book, it is only fair that you know what you are getting as the remit is certainly not to teach orthodontics! It concentrates on discussing the practical aspects of only two, relatively discreet, but important aspects of orthodontics:

Interceptive treatment

deals with the developing, childhood dentition at a time when decisions can strongly influence long-term outcomes. Identifying and explaining the principles of interception are among the learning outcomes identified by the General Dental Council.

Retention

is an increasingly important part of orthodontic treatment for many patients. More and more, patients may wish to maintain (for as long as feasible) their treatment result following what may often have been lengthy and complex treatment. It is thus likely that general dental practitioners will need to take over the care and responsi­bility for their patients’ retainer requirements. Incidentally, however, it should be noted that whilst upper removable appliances (URAs) are appropriate for childhood interceptive treatment, they are not often useful for adults. In contrast, retainers may be worn by children or adults.

This book will also give pertinent advice on:

What makes a good referral letter

(again in line with the General Dental Council outcomes), e.g. when a patient requires referral to a specialist for definitive orthodontic treatment.

What is required when and the reasons for taking over the care and responsibility of a patient’s retainer requirements

.

In addition, discussion of lower removable appliances (LRAs) is included where appropriate, as well as specific chapters for the specialist trainee.

The authors acknowledge that the practical advice given in this book will sometimes not exactly match that given by every clinician, but subtle differences in approach are evident between clinicians in all specialties. The approach adopted here is one that we have found works for us. Furthermore, as this is essentially a practical guide based on clinical experience, it is not written nor intended as a fully-referenced academic text.

So, this book assumes a basic level of orthodontic knowledge of the sort you would hopefully receive from an undergraduate dental training. This means that it does not explain terms such as overjet, overbite, the different skeletal, incisor or molar classifications, etc. – it will assume you know these already. It will also not explain how to undertake an orthodontic diagnosis, only pointing out aspects of diagnosis that are relevant to the particular problem under discussion.

Also this book will not explain how to undertake all orthodontic treatment. That is a specialist area. However, what this book will do is give guidance on situations where interceptive treatment could potentially be considered and how. Yet, this can never be comprehensive since no two patients are ever entirely identical. Many aspects of diagnosis can influence a decision as to whether a treatment is reasonable, possible or even feasible.

In addition, this book does not discuss issues of consent, risks of orthodontic treatment and balancing the risk/benefit ratio. These are all vital issues, but again we assume a level of knowledge that basic undergraduate dental training should cover.

Lastly and obviously, this book provides no direct practical experience whatsoever!

2

Upper Removable Appliances: Indications and Principles of Design

Upper removable appliances (URAs) are ‘removable braces’ that fit on the upper arch only. In the past, URAs were used for many malocclusions, including severe Class II division 1 cases. However, this is no longer seen as appropriate because removable appliances can only achieve very simple movements, i.e. simple tipping of teeth, and the vast majority of malocclusions that warrant treatment require far more complex movements (using fixed appliances) to achieve an adequate outcome. Fixed appliances can also tip teeth, but in complete contrast to removable appliances, they can also achieve bodily movement (including rotations, intrusion and extrusion) as well as torque. Therefore, regarding active treatment, this book will mostly confine itself to interceptive treatment where the types of malocclusion to be intercepted are very limited; if tooth movement is required, it is confined to tipping movements. The exceptions are covered in Chapters 10 and 11.

Learning Outcomes

After reading this chapter you should know:

The indications for the use of URAsThe importance of anchorageThe advantages and disadvantages of removable appliancesWhat the components of URAs areWhat the components of URAs look likeThe design principles and steps to consider when designing URAs