Miscellaneous Use of Separators

INTRODUCTION

Functional appliances are variety of removable appliances that will alter the arrangement of various muscle groups that influence the function and position of the mandible. But the main criterion prior to functional therapy is the presence of well aligned arches.

Patients are often presented with crowded or rotated dentition,which is a concern before commencing with functional therapy. So, we require prefunctional therapies, like various removable plates or 2x4 applianes or fixed mechanotherapy. Number of factors are involved in the rotation of teeth like space inadequacy, abnormal tooth eruption sequence, and undesirable forces exerted by the tongue and lips or any above combination. Biomechanical principles involve application of single or couple of force for correction of rotation. Rotated teeth can be corrected by removable, semifixed or fixed appliance depending upon the severity of rotation. Removable appliance containing z spring along with labial bow and semifixed (whip appliance) can treat mild rotations. Fixed appliance is a treatment of choice for severerotations of teeth .

So, as a part of an innovative idea,we have designed an appliance for correcting bilaterally rotated, in-standing lateral incisors without using fixed mechanotherapy. The present case report documents a case of young patient who required pre-functional therapy followed by functional therapy. As the upper lateral incisors were severely rotated , a removable plate with “z” spring did not show any significant changes in the position inspite of being using it for 3 months.

CASE REPORT

A 13-year-old girl with CVMI stage V , reported with the chief complaintof discontented facial esthetics due to irregularly placed upper front tooth.

On clinical examination patient had a convex profile, with lip trap and an in-standing and rotated upper right lateral incisor and rotated upper left lateral incisor with bilateral Angle’s Class II molar relation. On cephalometric examination, she had skeletal class II base with orthognathic maxilla and retrognathic mandible. ( Figure 1)

The objective of the treatment was to align the upper arch, so that the incisal lock of the mandible can be relieved.As a part of prefunctional therapy, z spring with posterior bite planes were given for 3 months. But appliance was not efficient enough to decrowd the arch. The appliance was modified.

Treatment Objective

To align upper arch for relieving incisal lock as soon as possible.

Treatment Plan

1. Upper arch alignment
2. Functional appliance ( twin block)

APPLIANCE CONSTRUCTION AND TREATMENT OUTCOME

An upper removable appliance (Hawley retainer type) was constructed with Adams clasps on both upper first molars and a labial bow of 19 gauge of wire and an extension between canine and lateral incisor was made bilaterally. Begg’s tube was placed on the lateral incisors in order to derotate both the tooth. The aim of the extension was engage to separators to the Begg’s tube. Initially separator was engaged in the left side upper lateral incisor (22) and the other was balanced by placing the gray elastics. The correction on the left side took place within 15 days and then the extension on the right side was made to bend more and then separator was engaged in the right side also. The correction was seen within 1and half months.

TREATMENT PLAN AND DURATION

The patient was instructed to replace the elastic band every day. The treatment time was 2 months with the removable appliance. The removable appliance was discontinued when the alignment was done. Patient is now undergoing removable twin block therapy for correction of retrognathic mandible.

DISCUSSION

There are bewildering array of different orthodontic appliances. The correct appliance choice is essential for optimum treatment outcome. Removable appliances have an important but limited role in contemporary orthodontics.The case exemplifies a cost effective prefunctional therapy for derotation using removable appliances. With the advent of this appliance, rotations were corrected without using fixed mechanotharapy. Although,fixed appliance is a treatment of choice for severe rotations of teeth but current strategy largely avoids the placement of full strap up for correction of rotations in young children. Furthermore, this can also drastically decrease the financial burden on the patient.

So, this appliance can be routinely used as a conservative and cost effective strategy as a part of prefunctional therapy.Derotations are challenges in orthodontics. There are various methods for derotations, but always look for appliances with which patient gains same amount of corrections with lesser cost.

REFERENCES