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An esthetic and effective retainer for lower anterior teeth
An esthetic and efective retainer for lower anterior teeth E. Gazit,
D.M.D.,*
Ranznt-Aviv,
and M. A. Lieberman,
D.D.S., KS.**
Israel
T
here are no hard and fast rules governing the need for posttreatment orthodontic retaining appliances. Clinical experience, applied biologic principles, and common sense tell us that certain orthodontic corrections are self-retentive. many possibly require retention, and some definitely require retention.l, 2 There is general agreement that some form of retention is required to maintain lower incisor realignment against the return of crowding, spacing, and flaring.2-4 Various types of lower retainers are currently available : The fixed active applia.nce itself. Unless direct bonded attacehments have been used, there are certain disadvantages to this approach : (1) In cases of spacing or flaring, maximum space closure and retraction arc Ilot possible because of the presence of interproximal hand material. (2) Esthetic requirements of the patient arc not satisfied. The removable Hawley applia?tce. This appliance has several disadvantages: (1) It is not especially effective in maintaining rotation corrections. (2) Complete cooperation of the patient is required. (3) Gingival tissue irritation is a usual untoward side effect. The rubber JirGshiing appliallce. While the gingival tissue reaction to this appliance is favorable, severe lower incisor rotation corrections usually require the concomitant use of a. fixed labial or lingual wire. Again, the patient’s complete cooperation is required. The standard canine-to-caGtle (or prerrlolax-to-prel,lola,~) lower lipgual retainer. While highly effective against the return of rotations, this method does not protect against the return of spacing or flaring. The presence of bands also fails to meet the esthetic requirements. The modified cani?le-to-ca’nine lotcer ling?ufT, retainer permits (A) tlw use of direct bonded wire mesh on the lingual aspect of the lower canine *Chairman, Section School of Continuing **Chairman, Medicine,
of Occlusion, Tel Medical Education,
Department of School of Continuing
Orthodontics, Medical
Aviv University, Dental Division. Tel Education,
Sackler
Aviv University, Dental Division.
School Sackler
of
Medicim-, School
of
91
92
Am.
Gazit and Lieberman
Fig.
1. Precontoured
Fig.
2. Appearance
after
wire
second
mesh
Fig.
3. Appearance
after
trimming
before application and
J. Orthod. July 1976
cementation. of direct
bonding
material.
polishing.
instead of bands5 and (B) the use of direct bond material.on the lingual aspect of the lower canines without wire mesh.” While both methods are effective against the return of crowding and rotations, neither one is effective against the return of spacing, flaring, or incisor torque changes. We propose the use of direct bonded wire mesh, applied to the lingual surfaces of the lower teeth (canine-to-canine or premolar-to-premolar) (Figs. 1 to 3). This modification has the following advantages: (1) It is an effective retainer for maintaining correction of crowding, spacing, flaring, and rotation. (2) The increased surface area covered by the direct bonded wire mesh affords greater control of posttreatment torque changes in the lower incisor area. (3) Esthetic requirements are satisfied, as there is no need for a labial wire or bands on the lower teeth. (4) The patient’s cooperation is not a requirement for use of this retainer. Material
and
method
The direct bonded wire mesh is applied in the following manner: 1. A lower plaster model of the finished case is constructed. 2. Wire mesh is form-fitted to the lingual surfaces of the lower anterior teeth, including canines or first premolars as may be required. 3. Teeth are prepared for direct bond cementation by cleaning with pumice
4. 5. 6. 7.
but without fluoride. Acid etch is applied to the dry surfaces of the teeth. The teeth are rinsed and dried again. Direct bond material is applied to precontoured wire mesh and to tooth surfaces simultaneously. Wire mesh is pressed to place and held until bonding material sets. IXrect bond material is applied a second time to provide a smooth surfac*c~ over the wire mesh and to increase retention. Excess material is trimmed away and the remainder is polished.
REFERENCES
1. Gianelly, A. A., and Goldman, H. M.: Biologic basis of orthodontics, Philadelphia, 1971, Lea 6- Febiger, pp. 347-366. 2. Reidel, R. A.: A review of the retention problem, Angle Orthod. 30: 179-199, 1960. 3. King, E. TV.: Relapse of orthodontic treatment, Angle Orthod. 44: 300-315, 1974. 4. Rosenstein, S. IV., and Jacobson, B. N.: Retention: An equal partner, AM. J. ORTHOD. 59: 323-332, 1971. 5. Wolfson, J., and Servoss, J. M.: Bandless but fixed retention, AM. J. ORTHOD. 66: 431-43-t. 19i4. lower cuspid to cuspid retainer, Angle Orthod. 43: 218-219, 197s. 6. Knierim, R. TV.: Invisible
D.M.D.,*
Ranznt-Aviv,
and M. A. Lieberman,
D.D.S., KS.**
Israel
T
here are no hard and fast rules governing the need for posttreatment orthodontic retaining appliances. Clinical experience, applied biologic principles, and common sense tell us that certain orthodontic corrections are self-retentive. many possibly require retention, and some definitely require retention.l, 2 There is general agreement that some form of retention is required to maintain lower incisor realignment against the return of crowding, spacing, and flaring.2-4 Various types of lower retainers are currently available : The fixed active applia.nce itself. Unless direct bonded attacehments have been used, there are certain disadvantages to this approach : (1) In cases of spacing or flaring, maximum space closure and retraction arc Ilot possible because of the presence of interproximal hand material. (2) Esthetic requirements of the patient arc not satisfied. The removable Hawley applia?tce. This appliance has several disadvantages: (1) It is not especially effective in maintaining rotation corrections. (2) Complete cooperation of the patient is required. (3) Gingival tissue irritation is a usual untoward side effect. The rubber JirGshiing appliallce. While the gingival tissue reaction to this appliance is favorable, severe lower incisor rotation corrections usually require the concomitant use of a. fixed labial or lingual wire. Again, the patient’s complete cooperation is required. The standard canine-to-caGtle (or prerrlolax-to-prel,lola,~) lower lipgual retainer. While highly effective against the return of rotations, this method does not protect against the return of spacing or flaring. The presence of bands also fails to meet the esthetic requirements. The modified cani?le-to-ca’nine lotcer ling?ufT, retainer permits (A) tlw use of direct bonded wire mesh on the lingual aspect of the lower canine *Chairman, Section School of Continuing **Chairman, Medicine,
of Occlusion, Tel Medical Education,
Department of School of Continuing
Orthodontics, Medical
Aviv University, Dental Division. Tel Education,
Sackler
Aviv University, Dental Division.
School Sackler
of
Medicim-, School
of
91
92
Am.
Gazit and Lieberman
Fig.
1. Precontoured
Fig.
2. Appearance
after
wire
second
mesh
Fig.
3. Appearance
after
trimming
before application and
J. Orthod. July 1976
cementation. of direct
bonding
material.
polishing.
instead of bands5 and (B) the use of direct bond material.on the lingual aspect of the lower canines without wire mesh.” While both methods are effective against the return of crowding and rotations, neither one is effective against the return of spacing, flaring, or incisor torque changes. We propose the use of direct bonded wire mesh, applied to the lingual surfaces of the lower teeth (canine-to-canine or premolar-to-premolar) (Figs. 1 to 3). This modification has the following advantages: (1) It is an effective retainer for maintaining correction of crowding, spacing, flaring, and rotation. (2) The increased surface area covered by the direct bonded wire mesh affords greater control of posttreatment torque changes in the lower incisor area. (3) Esthetic requirements are satisfied, as there is no need for a labial wire or bands on the lower teeth. (4) The patient’s cooperation is not a requirement for use of this retainer. Material
and
method
The direct bonded wire mesh is applied in the following manner: 1. A lower plaster model of the finished case is constructed. 2. Wire mesh is form-fitted to the lingual surfaces of the lower anterior teeth, including canines or first premolars as may be required. 3. Teeth are prepared for direct bond cementation by cleaning with pumice
4. 5. 6. 7.
but without fluoride. Acid etch is applied to the dry surfaces of the teeth. The teeth are rinsed and dried again. Direct bond material is applied to precontoured wire mesh and to tooth surfaces simultaneously. Wire mesh is pressed to place and held until bonding material sets. IXrect bond material is applied a second time to provide a smooth surfac*c~ over the wire mesh and to increase retention. Excess material is trimmed away and the remainder is polished.
REFERENCES
1. Gianelly, A. A., and Goldman, H. M.: Biologic basis of orthodontics, Philadelphia, 1971, Lea 6- Febiger, pp. 347-366. 2. Reidel, R. A.: A review of the retention problem, Angle Orthod. 30: 179-199, 1960. 3. King, E. TV.: Relapse of orthodontic treatment, Angle Orthod. 44: 300-315, 1974. 4. Rosenstein, S. IV., and Jacobson, B. N.: Retention: An equal partner, AM. J. ORTHOD. 59: 323-332, 1971. 5. Wolfson, J., and Servoss, J. M.: Bandless but fixed retention, AM. J. ORTHOD. 66: 431-43-t. 19i4. lower cuspid to cuspid retainer, Angle Orthod. 43: 218-219, 197s. 6. Knierim, R. TV.: Invisible