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Buccal inclined planes, in conjunction with the pin appliance, for stimulation of growth of the mandible (clinic)
BUCCAL
INCLINED
APPLIANC’E.
PLANES,
IS CONJUSCTION
FOR STIMULATIOS JIA~SDTRI,E
T
HIS clinic is intended to ation of inclined planes mandible in cases of Class distal in its relation to the terior region is not desired.
WITH
OF GROWTH
TIIE
PIS
OF THE
(c”rJrsrc~~”
tlrinoIistratt~ tile tletail of construction and operfor tlict stitrilllatioii of forward growth of the I1 (i~l~gslr) \rhc~rr the main body of the bonr is wasillac~. ant1 wlic~rr vri*tical growth iir th(> pos-
These planes have been called bnccal ])lanrs, bwanse of the fact that they are placed in the buccal region. ailtl to tlistingnish them from those used in the incisor region. ‘rlle~. a~‘(’ oi’ solllrwllat the sitllle forlu as those which in lC890. II I’IYDr. R. D. MclJride, of Dresden. C;et~l~~an~,says hc first, nsetl . vious to this time Dr. ICtlwwrd II. Angle iitl\-OCiltPd a sOnlc>n-hat similar rltt~tllOt1, known as a plane and spur, for the rrtrntioll OF casw \vllerc the bite llatl been jumped by the use of the Kingsley l,itcl I)latr. ‘I’llCSC~ \\‘(‘1’P attacllrtl to ]~al~tls 11p0n the first permanent molars. Dr. McIkide originally soltlrrccl the ]~laiirs to yoltl (‘1’O\\‘llS acljt~strtl u]mll Ill)011 l’Pl11OVR]~I1 ])liltC?S fO1 the first l)ermanent nlolaw, ijilt! IiltPV llSf?tl tllclll both maxilla and inalidihlc. A rery necessary factor in obtaining tlica greatest l)ossiblr efic*iciicy 1, the use of this method is tllc pwvcntiolt of til)pinp of ally of thr trlctll. In his endeavor to fulfill this req~~iwiiiwt. tllrl wi.itcar iiscs Ihe pifi il])pli;lllC4~~ in c’olljunction with the ])I~IIw. IIi111’-1~o1iutll)iil a~itl tlilws, iis atl\ocatctl for all teeth Iy Dr. Han-Icy: have l)tlibtl 11svtl :‘or ~~c~a~s.Olig~rlilll~~ tllWP l)iiis i+lld tubes were 11.08” lonm~. but i nn\r I)cb!icavthtliat tiilws 0.10” long, tlir length advocated by Dr. d. IJO\\-c l’on~!g. ilYe 11lllCll 11101’? liIiel>7 to ])reVPllt uutlesirable tipping of the teeth. Tile tlIl)PS ill‘? iilvlilierl t0 Stl’picll, illltl it is iltlViSable to Beep the pins, p~~~~ti~~~~l;~ri~~ for tile lll(~lill~s. fitting l)wtt\- s~ll~gly. In the construction of the bnccal [)laltes aiiy tl?tilil of twhuic which ilk)peals to the individual operator may be usetl, but, iI1 their use with the pill appliance, it is important tlial tlie half-ronntl trthcs he place~l as far mrsiall~ upon the buccal swface of’ the maxillary- molar ha11t1s as possible v.ithout get@ them on the curved portion of the bands it1 the illtersl)ace. (SW Fig. 1.) The reason for this will bc critlcnt \vlir~i~ l)lacirig the planes upon t,lif mandibular molar bands. For tire base of the l)lanes I \~se clasp mrtal about 0.15” wide and 0.015” tllick, ant1 I do the fitting in the mouth. Thr edge 01 the base for the maxillary l)lanr is so!dcred, FlY?Fll~lIlt1, at il right angle to the buccal surface of the ~EIII~. and far cnouph distal of thn tube to ljermit the mandibular plane, \I-hen the twth are in owlusiou. to l)ass up bcltween the tube and plane on the maxillary bantl-abont 0.08”. The steep portion
George IV. Grieve of the maxillary plane should lean distally at an angle of about 28 degrees, and extend nearly to the soft tissues overlying the mandibular teeth when the latter are in occlusion with the maxillary teeth. The plane at this point should now be bent distally at a lesser angle, as shown in illustration, just sufficient to clear the soft tissues and extend far enough back to prevent the patient placing the mandibular plane distal to it. The maxillary plane may be in one piece, or, after fitt.ing the steep portion with the mandibular plane, an extension may be added. The planes for the mandibular molars must extend far enough buceally to clear the buccal surface of the maxillary teeth and, if necessarily long, the overlying soft tissues and permit a little lateral swing of the mandible. In constructing the mandibular plane, solder a short, piece of the clasp metal at right angles to the plane proper, in the form of an IJ, lapping the material its’ full width; now trim and fit the horizontal portion to obtain the requisite buccal extension, and solder to the band at the desired angle. The mandibu-
Fig.
1.
lar plane, when the teeth are in occlusion, may, or may not, extend above the gingival border of the maxillary molar, depending upon the distance which the patient can separate the jaws. Care must be taken to have the planes at right angles to the buccal surface of the teeth, and so placed as to establish the normal mesiodistal relations of the molars upon which they are placed, each side independent of the other. The planes should lzot lean out toward the cheek, but be parallel with the latter. The maxillary planes are now invested and reinforced with solder. When this has been accomplished they are fitted again and any necessary adjustment made of the mandibular planes, when these also are ready for reinforcement. The finished planes need not be wider than O.lO”, their buccal edges smooth and in line when the teeth are in occlusion, provided that the maxillary and mandibular molars occupy relatively normal buccolingual relations. If rotation is required of any molars upon which planes are to be placed, this rotation should be obtained before placing the planes, unless such rotation would be facilitated by the action of the planes, in which latter case the planes must be so located that when the rotation has been accomplished the molars
Clinics
885
will occupy their normal mesiodistal relations and the planes be in proper relation when the teeth are in occlusion. As the mandible grows, the planes may be shortened. A paper by the writer upon the use of incisor, as well as buccal, planes was published in the Dental Cos~aos of April, 1926, and also in the INTERNATIONAL JOURNAL OF ORTHODONTIS, ORAL S~RGEKY AND RADIOGRAPHY of the same month. This paper, as well as another which will be found in the Proceedings of the Seventh International Dental Congress, will show illustrations of cases treated by this method.
BUCCAL
AND
LABIAL
EXTENSIONS (CLINIC)
BY DR. G. C. BROWN,
FROM
TEE
LINGUAL
BRCH
* WORCESTER,
Rlass.
C
ASE A.-Age of patient, eight years, six months. Class I, maxillary incisors protruding. Appliance, maxillary lingua.1 arch with extensions as shown in Fig. 1. The heavy pieces (a) soldered to the main arch wire are of 0.035 material and the pieces (b) 0.022. An appliance of this type is neat, clean, and constantly gentle in its application. Adjustments are required infrequently and occupy a minimum of time.
Fig.
CASE B.-Age
Class I. rotated.
1.
of patient,, eleven years, two months.
The maxillary
second premolars
were crowded
buccally
and
Appliance. Maxillary lingual arch with extensions as in Fig. 2. These were of 0.022 diameter and soldered directly to the main arch wire. Room was made for the second prekolars and they were then moved lingually with no irritation, by means of the buccal extensions. The variations of these extensions are innumerable and with a little ingenuity they can be so adapted that they will cause no irritation, be easy to beep olean, and will require adjusting very infrequently.
16-20.
*Given 1926.
before
the
First
International
Orthodontic
Congress.
New
York
City,
August
INCLINED
APPLIANC’E.
PLANES,
IS CONJUSCTION
FOR STIMULATIOS JIA~SDTRI,E
T
HIS clinic is intended to ation of inclined planes mandible in cases of Class distal in its relation to the terior region is not desired.
WITH
OF GROWTH
TIIE
PIS
OF THE
(c”rJrsrc~~”
tlrinoIistratt~ tile tletail of construction and operfor tlict stitrilllatioii of forward growth of the I1 (i~l~gslr) \rhc~rr the main body of the bonr is wasillac~. ant1 wlic~rr vri*tical growth iir th(> pos-
These planes have been called bnccal ])lanrs, bwanse of the fact that they are placed in the buccal region. ailtl to tlistingnish them from those used in the incisor region. ‘rlle~. a~‘(’ oi’ solllrwllat the sitllle forlu as those which in lC890. II I’IYDr. R. D. MclJride, of Dresden. C;et~l~~an~,says hc first, nsetl . vious to this time Dr. ICtlwwrd II. Angle iitl\-OCiltPd a sOnlc>n-hat similar rltt~tllOt1, known as a plane and spur, for the rrtrntioll OF casw \vllerc the bite llatl been jumped by the use of the Kingsley l,itcl I)latr. ‘I’llCSC~ \\‘(‘1’P attacllrtl to ]~al~tls 11p0n the first permanent molars. Dr. McIkide originally soltlrrccl the ]~laiirs to yoltl (‘1’O\\‘llS acljt~strtl u]mll Ill)011 l’Pl11OVR]~I1 ])liltC?S fO1 the first l)ermanent nlolaw, ijilt! IiltPV llSf?tl tllclll both maxilla and inalidihlc. A rery necessary factor in obtaining tlica greatest l)ossiblr efic*iciicy 1, the use of this method is tllc pwvcntiolt of til)pinp of ally of thr trlctll. In his endeavor to fulfill this req~~iwiiiwt. tllrl wi.itcar iiscs Ihe pifi il])pli;lllC4~~ in c’olljunction with the ])I~IIw. IIi111’-1~o1iutll)iil a~itl tlilws, iis atl\ocatctl for all teeth Iy Dr. Han-Icy: have l)tlibtl 11svtl :‘or ~~c~a~s.Olig~rlilll~~ tllWP l)iiis i+lld tubes were 11.08” lonm~. but i nn\r I)cb!icavthtliat tiilws 0.10” long, tlir length advocated by Dr. d. IJO\\-c l’on~!g. ilYe 11lllCll 11101’? liIiel>7 to ])reVPllt uutlesirable tipping of the teeth. Tile tlIl)PS ill‘? iilvlilierl t0 Stl’picll, illltl it is iltlViSable to Beep the pins, p~~~~ti~~~~l;~ri~~ for tile lll(~lill~s. fitting l)wtt\- s~ll~gly. In the construction of the bnccal [)laltes aiiy tl?tilil of twhuic which ilk)peals to the individual operator may be usetl, but, iI1 their use with the pill appliance, it is important tlial tlie half-ronntl trthcs he place~l as far mrsiall~ upon the buccal swface of’ the maxillary- molar ha11t1s as possible v.ithout get@ them on the curved portion of the bands it1 the illtersl)ace. (SW Fig. 1.) The reason for this will bc critlcnt \vlir~i~ l)lacirig the planes upon t,lif mandibular molar bands. For tire base of the l)lanes I \~se clasp mrtal about 0.15” wide and 0.015” tllick, ant1 I do the fitting in the mouth. Thr edge 01 the base for the maxillary l)lanr is so!dcred, FlY?Fll~lIlt1, at il right angle to the buccal surface of the ~EIII~. and far cnouph distal of thn tube to ljermit the mandibular plane, \I-hen the twth are in owlusiou. to l)ass up bcltween the tube and plane on the maxillary bantl-abont 0.08”. The steep portion
George IV. Grieve of the maxillary plane should lean distally at an angle of about 28 degrees, and extend nearly to the soft tissues overlying the mandibular teeth when the latter are in occlusion with the maxillary teeth. The plane at this point should now be bent distally at a lesser angle, as shown in illustration, just sufficient to clear the soft tissues and extend far enough back to prevent the patient placing the mandibular plane distal to it. The maxillary plane may be in one piece, or, after fitt.ing the steep portion with the mandibular plane, an extension may be added. The planes for the mandibular molars must extend far enough buceally to clear the buccal surface of the maxillary teeth and, if necessarily long, the overlying soft tissues and permit a little lateral swing of the mandible. In constructing the mandibular plane, solder a short, piece of the clasp metal at right angles to the plane proper, in the form of an IJ, lapping the material its’ full width; now trim and fit the horizontal portion to obtain the requisite buccal extension, and solder to the band at the desired angle. The mandibu-
Fig.
1.
lar plane, when the teeth are in occlusion, may, or may not, extend above the gingival border of the maxillary molar, depending upon the distance which the patient can separate the jaws. Care must be taken to have the planes at right angles to the buccal surface of the teeth, and so placed as to establish the normal mesiodistal relations of the molars upon which they are placed, each side independent of the other. The planes should lzot lean out toward the cheek, but be parallel with the latter. The maxillary planes are now invested and reinforced with solder. When this has been accomplished they are fitted again and any necessary adjustment made of the mandibular planes, when these also are ready for reinforcement. The finished planes need not be wider than O.lO”, their buccal edges smooth and in line when the teeth are in occlusion, provided that the maxillary and mandibular molars occupy relatively normal buccolingual relations. If rotation is required of any molars upon which planes are to be placed, this rotation should be obtained before placing the planes, unless such rotation would be facilitated by the action of the planes, in which latter case the planes must be so located that when the rotation has been accomplished the molars
Clinics
885
will occupy their normal mesiodistal relations and the planes be in proper relation when the teeth are in occlusion. As the mandible grows, the planes may be shortened. A paper by the writer upon the use of incisor, as well as buccal, planes was published in the Dental Cos~aos of April, 1926, and also in the INTERNATIONAL JOURNAL OF ORTHODONTIS, ORAL S~RGEKY AND RADIOGRAPHY of the same month. This paper, as well as another which will be found in the Proceedings of the Seventh International Dental Congress, will show illustrations of cases treated by this method.
BUCCAL
AND
LABIAL
EXTENSIONS (CLINIC)
BY DR. G. C. BROWN,
FROM
TEE
LINGUAL
BRCH
* WORCESTER,
Rlass.
C
ASE A.-Age of patient, eight years, six months. Class I, maxillary incisors protruding. Appliance, maxillary lingua.1 arch with extensions as shown in Fig. 1. The heavy pieces (a) soldered to the main arch wire are of 0.035 material and the pieces (b) 0.022. An appliance of this type is neat, clean, and constantly gentle in its application. Adjustments are required infrequently and occupy a minimum of time.
Fig.
CASE B.-Age
Class I. rotated.
1.
of patient,, eleven years, two months.
The maxillary
second premolars
were crowded
buccally
and
Appliance. Maxillary lingual arch with extensions as in Fig. 2. These were of 0.022 diameter and soldered directly to the main arch wire. Room was made for the second prekolars and they were then moved lingually with no irritation, by means of the buccal extensions. The variations of these extensions are innumerable and with a little ingenuity they can be so adapted that they will cause no irritation, be easy to beep olean, and will require adjusting very infrequently.
16-20.
*Given 1926.
before
the
First
International
Orthodontic
Congress.
New
York
City,
August