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Uses of the wire crib appliance
USES OF THE WIRE CRIB APPLIANCE
W. B.
STEVENSON,
D.D.S.,
AMARILLO, TEXAS
H I S case was rather complex in nature, and to add to the perplexity it required a two-hundred-mile trip by auto for each visit to the office. The case has not been completed, but shows what has been accomplished in a little more than two years with the appliances used. The removable appliance has its advantages but should not be considered as a universal appliance by any means. The greatest advantages of the remov-
T
Fig. l.-Models showing case before treatment.
able appliance, as I see it, are the mild stimulation of growth and, at the same time, the freedom of tooth movement. This allows the cusps and incline planes to seek a physiologic cusp relation, and in addition to this there is the advantage of its simplicity, cleanliness, inconspicuousness, and ease of adjustment. The general principle of the wire crib appliance is little different from that of the lingual appliance j since it will carry fingersprings, the labial loop, or the bite plane. The object in selecting this particular case was to show the application of certain basic principles of expansion, opening of spaces, and rotation of teeth. Presented at the Thirty-Fourth Annual Meeting of the American Society of orthodonttsts, St. Louis, April 20-23. 1986.
164
Uses of the Wire Orib Appliance
165
Diagnosis.-The patient was fourteen years of age at the time she came in for treatment. It was found upon an examination of the study models and x-ray pictures that the maxillary second bicuspids and maxillary right cuspid were impacted, and all were found to be in the palatine portion of the maxilla. The
Fig. 2.-X-ray pictures showing Impactions.
Fig. 3.-Models with original appliances.
spaces for the bicuspids were entirely closed, and there was only 3 mm. of space for the maxillary right cuspid. The maxillary left first bicuspid had erupted buccally with only 3.5 mm. of space between the cuspid and the second bicuspid. The maxillary first molars were rotated.
166
lV. B . Stevenson
In the mandibul ar arch t he r ight mandibular first bicuspid was erupt ing buccally with only 2.5 mm, of space, and t he left mandibular second bicuspid was er upt ing lin guall y wit h 1.5 mm. of space for it. Proposed Tr eatment.-It was planned to r otat e t he maxillary molars, widen the arc h, and open spaces for the second bicuspi ds and cuspids, and to widen the mandibular arch and open spaces for t he bicuspids. Appliances.- Wire cr ib appliances were selected. Th e body wire of chrome alloy was 0.036 r ound wire, with clasps of the same mat eri al, but 0.025 in size.
Fig. 4.- Models show ing case after t wo years ' treat me nt .
Fingersprings for opening spaces and rotating were 0.020 as the spa ces wer e opened and as the impacted teeth mad e t heir appearance; then fingersprings wer e added to guide t hem into place. Occlusa l r ests wer e used on the molars t o pre vent the wires fro m impinging on t he gums. Adjustment s were mad e tw o to four weeks apart. It is advisable to use the millimeter gauge when makin g adjustments, especially when opening loops. The principle of adjustment f or the removable type is no different than that for ot her appliances. F orces mu st be known and ap pli ed only where their reactions are desired for development al changes as the r esult of pressure stimuli.
W. B.
STEVENSON,
D.D.S.,
AMARILLO, TEXAS
H I S case was rather complex in nature, and to add to the perplexity it required a two-hundred-mile trip by auto for each visit to the office. The case has not been completed, but shows what has been accomplished in a little more than two years with the appliances used. The removable appliance has its advantages but should not be considered as a universal appliance by any means. The greatest advantages of the remov-
T
Fig. l.-Models showing case before treatment.
able appliance, as I see it, are the mild stimulation of growth and, at the same time, the freedom of tooth movement. This allows the cusps and incline planes to seek a physiologic cusp relation, and in addition to this there is the advantage of its simplicity, cleanliness, inconspicuousness, and ease of adjustment. The general principle of the wire crib appliance is little different from that of the lingual appliance j since it will carry fingersprings, the labial loop, or the bite plane. The object in selecting this particular case was to show the application of certain basic principles of expansion, opening of spaces, and rotation of teeth. Presented at the Thirty-Fourth Annual Meeting of the American Society of orthodonttsts, St. Louis, April 20-23. 1986.
164
Uses of the Wire Orib Appliance
165
Diagnosis.-The patient was fourteen years of age at the time she came in for treatment. It was found upon an examination of the study models and x-ray pictures that the maxillary second bicuspids and maxillary right cuspid were impacted, and all were found to be in the palatine portion of the maxilla. The
Fig. 2.-X-ray pictures showing Impactions.
Fig. 3.-Models with original appliances.
spaces for the bicuspids were entirely closed, and there was only 3 mm. of space for the maxillary right cuspid. The maxillary left first bicuspid had erupted buccally with only 3.5 mm. of space between the cuspid and the second bicuspid. The maxillary first molars were rotated.
166
lV. B . Stevenson
In the mandibul ar arch t he r ight mandibular first bicuspid was erupt ing buccally with only 2.5 mm, of space, and t he left mandibular second bicuspid was er upt ing lin guall y wit h 1.5 mm. of space for it. Proposed Tr eatment.-It was planned to r otat e t he maxillary molars, widen the arc h, and open spaces for the second bicuspi ds and cuspids, and to widen the mandibular arch and open spaces for t he bicuspids. Appliances.- Wire cr ib appliances were selected. Th e body wire of chrome alloy was 0.036 r ound wire, with clasps of the same mat eri al, but 0.025 in size.
Fig. 4.- Models show ing case after t wo years ' treat me nt .
Fingersprings for opening spaces and rotating were 0.020 as the spa ces wer e opened and as the impacted teeth mad e t heir appearance; then fingersprings wer e added to guide t hem into place. Occlusa l r ests wer e used on the molars t o pre vent the wires fro m impinging on t he gums. Adjustment s were mad e tw o to four weeks apart. It is advisable to use the millimeter gauge when makin g adjustments, especially when opening loops. The principle of adjustment f or the removable type is no different than that for ot her appliances. F orces mu st be known and ap pli ed only where their reactions are desired for development al changes as the r esult of pressure stimuli.