Orthodontic Retainers and Removable Appliances: Principles of Design and Use

200 Pages·2012·7.47 MB·English

by  Friedy Luther

Orthodontic Retainers and
Removable Appliances
Principles of Design and Use

Orthodontic Retainers and
Removable Appliances
Principles of Design and Use
Friedy Luther
BDS (Hons), FDS RCS Eng, D Orth RCS Eng, M Orth RCS Eng, MSc, PhD, F HEA
Consultant Orthodontist and Honorary Senior Clinical Lecturer
The Charles Clifford Dental Hospital
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield
UK
Zararna Nelson-Moon
MSc, PhD, BDS (Hons), MOrth RCS Eng, FDS Orth RCS Eng
Consultant Orthodontist
York Teaching Hospital NHS Foundation Trust
York
UK
A John Wiley & Sons, Ltd., Publication
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
Set in 9.5/12 pt Palatino by Toppan Best-set Premedia Limited, Hong Kong
1 2013
Contents
Preface vii
Acknowledgements ix
Abbreviations xi
1 Assumptions: What You Should Know and Understand Before You Use this Book 1
2 Upper Removable Appliances: Indications and Principles of Design 3
3 Cases Suitable for Treatment with Removable Appliances 20
4 Fitting and Activating Removable Appliances 40
5 Follow-up Appointments: What to Check and Why 60
6 Test Yourself 84
7 Retainers 118
8 Fitting and Checking Retainers 132
9 Problems with Retainers and Trouble-shooting 142
10 Removable Appliances for the Postgraduate in Specialist Orthodontic Training 154
11 Vacuum-Formed Active Appliances 172
Jay Kindelan
Index 181
v

Preface
Why we need this book and In addition, in some cases, it may be necessary
to refer a patient for specialist advice. For example,
who is it for?
a patient may require initial, interceptive treat-
This book aims to fill a gap in the literature that ment but, in addition, may require referral for
has existed for many years. Whilst it is a definitive treatment thereafter. It should be said
General Dental Council (GDC) requirement that this would hopefully not be as a result of the
(quite rightly) to teach dental students ortho- interceptive treatment! Again, it is a GDC require-
dontic diagnosis and the principles of intercep- ment that the dental graduate be competent at
tive treatment (amongst other things), there making appropriate referrals based on assess-
seem to be no books that explain concisely, in ment. This is another aspect that this book gives
practical terms (and in enough detail), what advice on – what makes a good referral letter.
principles to apply when trying to design the This book also includes a basic section on
appliances to enable this interceptive treatment orthodontic retainers: current trends increas-
to be undertaken. This book therefore sets out ingly mean that patients wish to maintain their
to address this. teeth as straight as possible following frequently
Many books contain the principles but these lengthy, usually fixed, appliance treatment. Spe-
are often obscured by excessive detail – or cialists performing orthodontic treatment must
perhaps there is too much theory in the wrong necessarily focus on the active treatment of
place. Either way, things can get confusing. the patients referred to them. Ultimately, such
Alternatively, suggestions are made for ‘stand- patients, if they wish to continue wearing retain-
ard appliances’, but a one-size-fits-all approach ers long term, need to be referred back to their
is not always useful when it comes to work- own general dental practitioner (GDP) so they
ing out when the ‘standard appliance’ is not take over the responsibility of looking after
appropriate. To reinforce this point, we also their own patients and their patients’ retainers.
include a “Test yourself” chapter. Here, the However, there is little, readily available infor-
reader can assess some patients for themselves mation for the GDP to enable them to perform
and see whether or not a URA (upper remov- this duty. Therefore, this book aims to provide
able appliance) would be appropriate or not. some basic guidance to address this.
vii
viii    Preface
In addition, there are a limited number of orthodontic diagnosis; have a reasonable level
lower removable appliances (LRAs) which of understanding; and are familiar with the basic
may have a use in certain, somewhat restricted, terminology. However, we also intend it to be
circumstances. These will be referred to at appro- useful to postgraduate students of orthodontics;
priate points in relevant chapters. For reasons orthodontic therapists; qualified GDPs; ortho-
of completeness, the book also includes chap- dontic technicians, and postgraduates in paediat-
ters, specifically for the specialist trainee, on ric dentistry – all of whom require a knowledge
some other uses of removable appliances. These of interceptive orthodontic treatment.
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 under- Friedy Luther
graduates who have received basic training in Zararna Nelson–Moon