Page 95 - REMOVABLE ORTHODONTIC APPLIANCES

Chairside management 87
built up with wax to ensure that the full depth skull radiographs are not essential. Where
of the buccal sulcus is reproduced. This enables limited tooth movement is being carried out
the form of the alveolar process to be assessed. and all successional teeth have erupted, it may
The models should be cast with adequate bases, be possible, in some circumstances, to carry out
the upper being trimmed symmetrically about treatment without radiographs.
the medial palatal raphe and the lower corre-
spondingly. This ensures that any asymmetry of
the arches will be recognized. The posterior Photographs
surfaces of the models are trimmed flush so that
the models can be related in occlusion by laying Photographs form an important record of the
them backs-down on a flat surface. At the visit patient's occlusion and appearance. Intraoral
following the taking of the impressions, the photographs should include an anterior view
models should be checked to ensure that the and right and left buccal views with the teeth in
occlusion is correctly recorded with the occlusion. Extraoral views should show full face
mandible in centric relation. If there is any and profile.
doubt about the articulation of the models the One advantage of intraoral photographs is
correct position should be registered by draw- that they will demonstrate any possible decalci-
ing a vertical pencil line through the occlusion fication or hypoplastic marks which are present
of the molars on both sides and the models at the start of treatment which may be a useful
returned to the laboratory for re-trimming. record in case of any questions arising at the
end of treatment.

Radiographs
Equipment
Good radiographic records are necessary to
confirm the position of any unerupted teeth The following equipment is required for adjust-
and the condition of the alveolar bones. This is ment of a removable appliance.
obviously important before deciding upon the
choice of teeth for extraction, but it may also be
useful in the event of untoward damage to the Wire bending pliers
teeth during treatment. The normal radiograph
would be a dental pantomogram (DPT). Adams' universal pliers (with tips impregnated
Should there be any doubt about the condition with tungsten carbide) are the most useful in
of the incisors or any possibility of supernu- the adjustment of appliances (Figure 10.2).
merary teeth being present, the DPT is supple- Spring forming pliers are also useful (Figure
mented with an intraoral occlusal view of the 10.3).
upper incisor region. An alternative method is Different manufacturers produce pliers with
to use rotated lateral oblique radiographs varying handle shapes and sizes. Find a pair
(bimolars) and a standard occlusal of the upper that feels comfortable before you buy them.
anterior region. Reserve the plier tips for adjusting the lighter
For the majority of cases that are suitable for wires and springs. Where heavy gauge wires
treatment with removable appliances lateral (for example extraoral facebows) require

Figure 10.2 Adams' universal pliers.