4. This term was coined by JC Brauer in 1941.
It is defined as the process of maintaining a space
in a given arch previously occupied by a tooth or a
group of teeth
Boucher: it is a fixed or removable appliance
designed to preserve the space created by the
premature loss of a primary tooth or a group of
teeth
5. If a child loses a primary tooth early
through decay or injury, the child's
other teeth could shift and begin to
fill the vacant space.
When the child's permanent teeth
emerge, there's not enough room
for them.
The result is crooked or crowded
teeth and difficulties with chewing
or speaking.
6. This is a ideal case where a space maintainer would
have helped
7. 1. If the space shows signs of closing.
2. If the use of space maintainer will make the
future orthodontics less complicated.
3. If the need for treatment of malocclusion at a
later date is not indicated.
8. 4. When the space should be maintained for
two year or more.
5. To avoid supra eruption of opposing tooth.
6. To improve the masticatory system and
restore dental health.
9. 1. If the radiograph shows that the succedant tooth
will erupt soon.
2. When the space left is greater than the needed for
the permanent as indicated from radiographically.
3. If the space shows no signs of closing.
4. When the succedenous tooth is congenitally absent.
10. • It should maintain the entire space
created by the tooth
• It must restore function
• Prevent supraeruption of opposing
tooth
• It should be simple in construction
11. • It should be strong enough to withstand occlusal
forces
• Should permit maintenance of oral hygiene
• Must not restrict the growth of jaws
• It should not exert undue forces of its own
13. BAND & LOOP
CROWN & LOOP
LINGUAL ARCH HOLDING DEVICE
NANCE’S PALATAL HOLDING DEVICE
TRANS PALTAL
DISTAL SHOE
REMOVABLE SPACE MAINTAINER
14. Missing Tooth Treatment Treatment
Unilateral loss of primary 1st
molar
Band / crown and loop Band/crown and loop
Unilateral loss of primary 2nd
molar
No treatment until eruption of
1st permanent molar, later
transpalatal arch
Distal shoe until eruption of 1st
permanent molars and
permanent incisors, then lower
lingual holding arch
Bilateral loss of primary 1st
molars
Bilateral bands/crowns and
loops.
Bilateral bands/crowns and
loop
Bilateral loss of primary 2nd
molars
No treatment until eruption of
1st permanent molars, later
Nance palatal arch.
Bilateral distal shoes until
eruption of 1st permanent
molars and incisors, then
lingual arch
Multiple bilateral primary
molars loss
Saddle appliance until 1st
permanent molars are erupted,
later Nance.
Saddle appliance until 1s
permanent molars and incisors
are erupted, later lingual arch.
15. Missing Tooth Treatment Treatment
Unilateral loss of primary 1st
molar
No treatment unless leeway
space is to be preserved
No treatment unless leeway
space is to be preserved
Unilateral loss of primary 2nd
molar
Transpalatal Band and loop until eruption
of permanent incisors, then
lower lingual holding arch
Bilateral loss of primary 1st
molars
No treatment unless leeway
space is to be preserved
No treatment unless leeway
space is to be preserved
Bilateral loss of primary 2nd
molars
Nance Bilateral bands and loops until
eruption of permanent
incisors, then lower lingual
arch
Multiple bilateral primary
molars loss
Nance Saddle appliance until
eruption of permanent
incisors, then lower lingual
holding arch
16. Missing Tooth Treatment Treatment
Unilateral loss of primary 1st
molar
No treatment unless leeway
space is to be preserved
No treatment unless leeway
space is to be preserved
Unilateral loss of primary 2nd
molar
Transpalatal Lower lingual holding arch
Bilateral loss of primary 1st
molars
No treatment unless leeway
space is to be preserved
No treatment unless leeway
space is to be preserved
Bilateral loss of primary 2nd
molars
Nance Lower lingual holding arch
Multiple bilateral primary
molars loss
Nance Lower lingual holding arch
17. They are unilateral, fixed, nonfunctional and passive
Used when single tooth is missing in the posterior
segment.
Can also be given in bilateral posterior tooth loss
18. Indication:
1. Premature loss of one tooth.
Contraindication:
1. Long span.
2. Space lost
3. Severe malocclusion.
4. Abutment tooth mobile
19. Advantages:
1. Simple and easy constructed.
2. Moderate chair time.
3. Give room for erupting permanent tooth.
4. Easy to clean.
5. Inexpensive.
Disadvantages:
1. Not restore the function.
2. Not prevent the extrusion of opposing tooth.
3. Has to be replaced if the tooth anterior to space
exfoliated.
20. Design
It consists of a band fabricated from 0.005’’ steel band
and a loop that extends from the band to the distal
surface of the anterior abutment tooth.
Loop is placed 1mm from the gingival surface.
Construction
Band two types- Preformed, Custom made
21. Custom made bands are made by taking the required
amount of band material from the spool and pinching
them to form the band.
Fabricated using various pliers- Beak pliers, band
adaptor and how’s plier.
Band pinching
Festooning
Trimming
Folded flap method
22. Band is adapted on to the
tooth
Impression of the arch
Cast is obtained with the band
secure on the tooth
Loop is prepared with 0.9 mm
hard round stainless steel wire.
Loop soldered to the band
Cemented to the tooth
24. Controversy:
Recently a study has shown that space changes with regard to arch
width or arch perimeter 6 months following premature loss of a
primary maxillary first molar was minimal.
The early space changes in the maxillary dental arch consist mainly of
palatal migration of the maxillary incisors indicating that the mesial
movement of permanent molars might not occur as a consequence of
the tooth extraction.
There was statistically significant 1 mm of space loss detected; however,
it is not likely to be of enough clinical significance for the use of a space
maintainer. If palatal movement seems to be needed, a palatal arch was
suggested instead of band and loop space maintainer.
JADA 2007 vol 138:362-8
25. Lingual arch space maintainer
Bilateral, fixed or semifixed, nonfunctional
passive
Indications
1. Bilateral loss of primary first or second
molars after the eruption of permanent
mandibular incisors,
2. If there is multiple loss of primary teeth.
3. In late mixed dentition stage, may be used to
hold leeway space to allow sufficient space for
permanent canines & premolars to erupt or
to preserve space for later alignment of
crowded incisors.
26. Advantages:
Used with uncooperative patient.
Used in children with bad oral hygiene.
Can maintain the space through period of mixed dentition.
Preserve the integrity of the whole arch.
There is no breakage problem or retention problem.
It allows free individual movement of teeth while maintaining
space.
It is easily removed, adjusted and replaced.
Disadvantages:
Not restore masticatory function.
Not prevent over eruption of opposing teeth.
27. Construction
The wire should be made to contact the cingula of the
mandibular incisors
In the edentulous ridge region wire curved down to the
lingual 1 mm away from the soft tissue
Should maintain 3-4 mm contact with the lingual surface
of the band
Konstantinos et al (1998) have suggested that in the canine
region 2 omega bends need to be given ???
28. Bilateral, fixed, passive and
nonfunctional space maintainer
Indicated when there is bilateral missing
deciduous molars in the upper arch
The first permanent molars are banded
The arch wire extends from the palatal
surface of one molar band to the other,
anteriorly it extends upto the rugae area
and is embedded in an acrylic button.
29. Can be made active-
The acrylic button may irritate
30. Bilateral, fixed, passive and nonfunctional
Used when there is unilateral loss deciduous
molars
The first permanent molars are banded
The wire component extends from the
palatal aspects of the bands to cross..
It prevents the mesiolingual rotation of the
molars around..
It can be used in bilateral loss of posterior
teeth !!!
PEDIATRIC DENTISTRY V 29 / NO 3 MAY / JUNE 2007
31. Early version of distal shoe – Willet’s distal shoe
Present version – Roche’s modified distal shoe appliance
Unilateral, fixed, nonfunctional and passive
An intraalveolar appliance
INDICATION
The distal shoe appliance is used to maintain the space of a
primary second molar that has been lost before the
eruption of the permanent first molar.
The result of this mesial drift is loss of arch length and
possible impaction of the second premolar
32. Contraindication:
1. Medically compromised pt. (because no complete
epithelization around alveolare bone) lead to (subacute bact
endocarditis).
2. Poor oral hygiene.
3. Long span.
4. Damaged abutment.
33. Construction
• The crown/band is adapted on the first deciduous molar
and impression is taken…
• An IOPA is taken..
• On the cast position of the mesial surface of the first
permanent molar is marked, then V shaped notch is made
• Loop is fabricated
34. Loop is soldered to the crown, appliance is sterilized..
Extract the tooth just before cementation..
Appliance tried in patient’s mouth and IOPA taken to
confirm…
Final cementation.
36. It is like a removable partial denture, Not only Mesiodistal
space but also the vertical space is maintained.
Masticatory Function is restored in functional type
Esthetics & speech improvement
37. removable unilateral space maintainers
They are too small and present swallowing and
choking dangers for children.
38. The esthetic and hygienic EZretainer maintains the
mesiodistal dimension of an extraction space and can also
be used to regain slightly closed spaces, according to Dr.
Güray.
The appliances are color-coded for each quadrant and are
available in boxes of four.
39. Gajanan et al.concluded that ribbond space maintainer as well as repaired
ribbond space maintainer are comparable to the conventional band and
loop in terms of physical strength.
McDonald and Avery suggested that the band and loop space maintainer
should be removed once a year to inspect, clean and apply fluoride to the
tooth. FRC loop space maintainer seems to eliminate these annual
maintenance steps.
Contemporary Clinical Dentistry | April 2012 | Vol 3 | Supplement 1
40. These space maintainers are available with stainless steel
crowns or stainless steel bands with an assortment of
attachments. There is no welding or soldering required and
they are fully adjustable to different edentulous spans.
41.
42. Newell in 1912
Principle
Both on principle of force elimination and force application
Indications
Mostly to intercept mouth breathing; thumb sucking,
tongue thrusting , lip biting and cheek biting
Flaccid hypotonic upper lip
Correction of mild anterior proclination
43. Mechanism of action
When patient closes the lips or swallows
All muscle forces transmitted to anterior teeth
Retraction of the proclined teeth
48. Mode of action- Lip bumper will
prohibit lip from exerting
excessive force on the
mandibular incisors and
reposition the lip away from the
lingual aspect of the maxillary
incisors
Types
Removable
Fixed
Denholtz modification
49. The Palatal Crib is designed to reduce the comfort of thumb sucking by placing
a metal crib over the most anterior portion of the palate, preventing the thumb
from resting along or contacting the palate.
50. The Blue Grass appliance is designed to prevent the patient
from sucking their thumb or tongue thrusting. This fixed
appliance uses a spinning roller to help break the patient's habit
and allow the anterior teeth to return to their normal position
51. Modified blue grass appliance was used using 3 mm acrylic
beads as recommended by Baker.
It encourages neuromuscular stimulations by using
multiple beads.
Between 4–6-year-old children can be instructed to play
with the beads with the tongue immediately after
placement.
52. Since Teflon rollers are not in contact with palatal tissues,
children can roll them with their tongues. Within few days,
the tongue establishes new non-harmful habit of playing
with roller.
Hence, this appliance works through counter conditioning
response to the original conditioned stimulus for thumb
sucking.
Case Reports in Dentistry Volume 2013, Article ID 537120
53. The Quad Helix appliance is designed to achieve arch development by
providing a light, continuous force to both anterior and posterior
segments. Fabricated as either fixed or removable (MIA), this
appliance can also be used for molar rotation
55. PURPOSE
About one third of people brux (grind or clench) their teeth. Many of
these people do so subconsciously .
The purpose of a night guard is to reduce the negative effects of
bruxism. These negative effects can include:
Mobile teeth
Drifting teeth
Recession or clefting of the gum tissue
Wear of teeth
“v” shaped erosions in the root surfaces
Increased bone loss
Muscle soreness or stiffness
Joint clicking
Joint soreness or stiffness
56.
57. Called as three quarter clasp
Construction
This need 0.8 mm stainless steel wire, extends from the
interproximal embrassure either mesially or distally and
passes below the maximum bulge area and above the
gingival margin buccally.
Adjustment
The clasp is adjusted by holding it at the contact point and
bending it towards the tooth.
58. Drawbacks
It cannot be used on deciduous teeth as there is no infra-
bulge area.
Only on posterior..
Cannot be used in partially erupted teeth
Thick wire..
Create space..
59. Used on premolars and molars
Construction
0.8 mm wire is used
Take apiece of wire of 5 inches
Begin to form the clasp from the buccal aspect…….
Adjustment
Clasp is adjusted by bending the clasp towards the tooth by
holding it at the contact point.
60. Used for additional retention
About 3 inches of 0.7 mm, stainless steel wire is used for
forming the clasp.
A small triangle is made….
The triangle should be perpendicular to the tooth surface…
The free end of triangle should be placed distally to prevent
injury to the cheek.
Adjustment
The clasp is adjusted by bending it towards the tooth at the
contact point.
61. Introduced by C. P. Adams
Modified arrowhead clasp or Liverpool
Clasp or Universal Clasp
0.7 mm stainless steel wire is used
Arrowheads should be positioned at …
Arrowheads should have a point contact..
The bridge should be located at the middle
third of the tooth
The bridge should be 2 mm ..
When viewed from the side the bridge…
Advantages
62.
63. Uses
Used for retraction of anterior teeth
Used for retention of teeth
Used for reinforcement
Used for the attachment of auxiliary springs
Stainless steel wire 0.6 mm- Retraction
0.7 mm- Retention
0.8 to 1.0 mm- Reinforcement
Contra-Indication
Activation
64. Stainless steel wire of 0.6 mm- Retaction
0.7 mm- Retention
Activation
Advantage
• Can be used to close space between canine
and premolar.
• Can control canines
• Used for retention
65. Type a – the labial bow is split in the mid-line
and the two halves do not overlap each other
Activation – by closing the U loops
Advantage –
Uses- For minor correction of spaces, to flatten
arch
Type b – the two halves of the split labial bow
cross each other at the midline and engage the
distal aspect of the central incisor of the
opposite side.
Activation
Advantage
66. 0.5 mm stainless steel wire
Activation
By placing a bend on the vertical limb of wire….
Advantage
Can be used for correction of severe protrusion of teeth
Light force is applied
Range of action is longer
67.
68. Classification
Based on the direction of tooth movement brought
about by the springs
Based on the nature of the support required for the
action
1. Self-supporting spring
2. Guided spring
3. Auxiliary spring
69. Formula
F α Edr4 / l3
Factors to be considered
Wire dimension
Force applied
Deflection
Direction of the tooth movement
73. Activation
A key is provided by the manufacturer
In adults one-quarter turn is opened once in a week
In case of children, one-quarter turn is opened once in
three days as the periodontal ligament is wider
74. Advantages
• Can be used in many types of tooth movements…
Intermittent forces..
Controlled force..
Activation is simple, can be done by patient or parent
Useful in moving the teeth which are to be clasped
Disadvantages
Appliance is bulky
Sometimes the screw tends to turn back
Expensive
75. For clinical application, the expansion screw appliances are
grouped as
Group 1 – Expansion screw appliances used to widen the
arch
Group 2 – Expansion screw appliances used to move teeth
in labial direction
Group 3 – Expansion screw appliances used to move teeth
in mesio-distal direction
Group 4 – expansion screw appliances used to move
individual teeth in buccal or labial direction
Group 5 – Traction screws used for closure of extraction
spaces
76.
77.
78. 1. Tooth borne passive appliances
Tooth borne active appliances
Tissue borne passive appliances
2. Myotonic appliances
Myodynamic appliances
3. Removable functional appliances
Fixed functional appliances
4. Group I, II and III appliances
80. Indications
Maxillary anterior teeth in cross bite
Single tooth crossbite
Palatally displaced maxillary incisors
Segment of upper arch in cross bite
Contraindications
Cross bite due to true manibular prognathism
NOTE- Inclined plane is of value in patients whose
permanent molars have not erupted + loss of
primary molars
81. Mode of action
When appliance cemented contact established only at
anterior region
When patient swallows
No contact posteriorly
All forces transmitted to the region of contact
Teeth guided to erupt in normal position
82. Duration of treatment
2-3 weeks, maximum
Disadvantage
Speech
Dietary restriction
Worn more than 6 weeks– anterior open bite
Frequent re-cementation
85. Indications
Class II, Division 1 malocclusion
Class II, Division 2 malocclusion
Class III malocclusion
Class I open bite malocclusion
Class I deep bite malocclusion
As a preliminary treatment before major fixed appliance
therapy to improve skeletal jaw relations
Children with lack of vertical development in lower
facial height
Activators As Retainers [JCO 1980 Aug(529 - 545)]
86. Contraindications
Class I problems of crowded teeth caused by disharmony
between tooth size and jaw size.
In children
with excess lower facial height and extreme vertical
mandibular growth.
whose lower incisors are severely procumbent.
with nasal stenosis caused by structural problems within
the nose or chronic untreated allergy.
Limited application in non-growing individuals.
87. Two principles
Force application —the source is usually
muscular.
Force elimination —the dentition is
shielded from normal & abnormal
functional and tissue pressures by pads,
shields, and wire configurations
Mode of action
Myotactic reflex
88.
89. Herren modified the activator in two ways :
By over-compensating the ventral position of the mandible
in the construction wax bite.
By seating the appliance firmly against the maxillary dental
arch by means of clasps (arrowhead, triangular or Jackson's).
90. Horizontally split activator
maxillary portion and a mandibular portion connected
together by an elastic bow.
allows step wise sagittal advancement of the mandible by
adjustment of the bow.
91. This is an activator modification that is mostly used in
treatment of Class III malocclusion.
Opening --Anterior screw
92. Professor G.P.F. Schmuth.
Resembles a bionator with the acrylic portion of the
activator reduced from the maxillary anterior area
leaving a small flange of acrylic on the palatal slopes.
The two halves may be connected by an omega shaped
palatal wire similar to bionator.
93. • Developed - monobloc of Robin
Consists of a bimaxillary block of acrylic made with the bite
open and the mandible in a forward position.
Extra oral force used
Appliance worn only during nights
94. Mandibular portion resembles an activator
Maxillary portion has acrylic covering only the palatal
aspect of the buccal teeth
Palate remains free of acrylic -- more convenient to wear
the appliance for longer hours.
TMJ dysfunction cases – best in mandibular positioning
95. A modification of the activator by H.P. Bimler. There are
three main kinds of Bimler appliance:
Type A for patients with Class II Division 1 malocclusions,
Type B for those with Class II Division 2 and
Type C for patients with a Class III malocclusion.
96. Developed by Balter
Termed by Kantorowicz
Advantages over activator
Considerably less bulky than the activator.
It lacks the part covering the anterior section of the palate,
which is contiguous to the tongue.
Children able to speak normally, though the appliance fits
loosely in the mouth.
The bionator can be worn day and night except at meals.
An important feature -- its freedom of movement in the
oral cavity.
97. Indications
1. In a class II, div. 1 malocclusion having
- The dental arches are well aligned originally.
- The skeletal discrepancy is not too severe.
- A labial tipping of the upper incisors is evident.
2. Class III malocclusion
3. Open bite cases
98. Contraindications
1. The Class II relationship is caused by maxillary
prognathism.
2. A vertical growth pattern is present.
3. Labial tipping of the lower incisors is evident.
100. William Clark – 1977
Goal –maximize the growth response to
functional mandibular protrusion
Principle
Occlusal inclined plane
Use of masticatory forces
101. Indication
Class II Div 1 with a good arch form
Lower arch uncrowded
Upper arch aligned
Overjet 10-12 mm and a deep bite
VTO positive
Patient actively growing– pubertal growth spurt
102. Standard appliance design
Midline screw
Occlusal bite blocks
Clasps
Maxilla – molars and premolars
Mandible – premolars and incisors
Labial bows
111. FR – Ia
Class I malocclusion with mild to moderate crowding
Class I deep bite cases
FR – Ib
Class II, division 1 malocclusion
Overjet does not exceed 5mm
FR – Ic
Class II division 1
Overjet more than 7 mm
112. FR 2
Class II div 1 and 2
FR 3
Class III
FR 4
Open bite and bimaxillary protrusion
FR 5
• Incorporate headger
114. 2. Enhanced & supplementary widening of upper jaw
Shields – depth of vestibule ---- create tension ----
periosteal pull ---- apposition of bone
Stimulate midpalatal suture growth (Stutzman – 1983)
115. 3. Mandibular protrusion:
Normalizing musculature
Not by construction bite
Lip pads - proprioceptive signal for
maintenance of mandibular protrusion
116. 4. Dental effects:
• Anchored to maxilla positively --- Prevents downward &
forward movement of maxillary molars
• Lingual shields ---- decrease outward thrust of tongue ----
allows eruption in more vertical manner
• Buccal shields --- bodily eruption
119. Diagnostic criteria for selection –
Patients with convex profile ,class II skeletal & class II
dental.
Mainly with retrognathic mandible & orthognathic maxilla
( ANB – 50 )
Positive V.T.O
All first molars & permanent lateral incisors should be fully
erupted.
Lower incisors should be upright or even slightly lingually
positioned.
120. The appliance can be compared to an artificial joint
working between the maxilla and the mandible.
A bilateral telescope mechanism attached to orthodontic
bands keeps the mandible mechanically in a continuous
anterior jumped position
121. Each telescopic device consists of
1. A tube ( upper)
2. A plunger ( lower)
3. Two pivots
4. Two screws.
Plunger
Tube
Pivots
Screws
122. Bonded Herbst appliance.
Banded Herbst appliance.
Drawback
Banded Herbst appliance- Breakage & loose bands
Bonded Herbst appliance
difficult to maintain hygiene,
decalcification & decay are commonly seen .
can create posterior openbite which needs correction later.
123.
124. Jasper jumper -
developed & patented by James.J Jasper in 1987
The term jasper jumper --- combining the surname of its
inventor with the functional concept expounded by Kingsley
in late 19th century (jumping the bite).
125. The Jasper Jumper has 3 particular features –
It leaves standard oral functions such as mastication &
phonetics unimpaired by virtue of its slenderness &
flexibility.
It maintains the sense of touch of opposing tooth.
It cannot be removed readily from the mouth.
126. Indications for Jasper Jumper
They are basically indicated in skeletal Class II maloccusion
with maxillary excess and mandibular deficiency.
Dental class II malocclusion.
Deep bite with retroclined mandibular incisors.
127. Contraindications –
Cases predisposed to root resorption.
Dental & skeletal open bites.
Vertical growth pattern.
High mandibular plane angle & increased lower anterior
face height.
128. The system is composed of two parts
The Force Module and
The Anchor Units.
129. It is an open coil,
embedded in soft
synthetic & is attached
through special
connecting pieces.
130. Other accessories supplied
are –
A ball stop – placed on a
continuous or segmented
orthodontic archwire,
forming a ventral stop for
the appliance.
131. A ball pin – with which the
appliance is attached to the
upper head gear tube.
132.
133.
134. Basis for orthopaedic appliances
Forces applied to the teeth have the potential to radiate
outwards and affect the nearby skeletal structures. For such
skeletal changes to occur, the forces employed should be
over 400 grams.
Thus the orthopaedic appliances utilize the teeth as
handles to transmit the forces to the adjacent structures.
139. Indications
It can be used in a growing patient having a prognathic mandible
and retrusive maxilla.
It can be used for bending the condylar neck for stimulating Tmj.
Selective rearrangement of the of the palatal shelves in cleft
patients.
Correction of postsurgical relapse after osteotomies.
140.
141.
142. A modified RPE appliance in conjunction with a facemask
can be used in growing Class III patients to correct
transverse and sagittal discrepancies.
IJO VOL. 21 NO. 3 FALL 2010
143. Cephalometric analysis showed a forward and downward movement of the
maxilla, backward and downward rotation of the mandible, proclination of the
maxillary incisors, and slight retroclination of the madibular incisors. The
mandibular plane angle remained stable
The patient’s facial profile improved. The nasolabial angle became more acute
and the upper lip and nose came forward in relation to the chin
IJO VOL. 21 NO. 3 FALL 2010
144. In many studies, it was shown that cervical headgear significantly
restrained maxillary forward growth. However, with cervical headgear,
many experienced the undesirable backward rotation of the palatal
plane, the opening of the mandibular plane and maxillary molar
extrusion
A maxillary splint design that provided a much larger base area than
merely maxillary first molars for the high-pull headgear force
application
145. Due to application of extra oral force to the maxilla with
maxillary traction splint appliance there was restriction of
downward and forward growth of the maxilla and maxillary
dentition
Retraction and intrusion of the maxillary incisors and
retraction and inhibition of vertical development of the
maxillary molars were significant.
The mandibular plane angle showed a significant reduction
in the treated group as compared to control group.
Orthodontic Waves, March 2010
146. The Tandem Appliance comprises three separate components,
one fixed and two removable.
The upper section is a fixed Hyrax appliance with buccal arms
soldered for attachment of protraction elastics.
The lower section is similar to a removable retainer, with
posterior occlusal coverage and buccal headgear tubes
embedded in the lower first-molar regions
147. The Tandem Appliance provides a toothborne anchorage system that
combines skeletal and dentoalveolar movement.
The increased level of patient cooperation with the Tandem
Appliance, combined with the ability to control the vertical
dimension, protract the maxilla, and benefit from the Class III elastic
dentoalveolar effect, makes this appliance extremely valuable in
nonsurgical Class III treatment.
JCO vol 14, issue 6, 2011
149. ORTHODONTICS PRINCIPLES AND PRACTICE- GRABER TM
REMOVABLE ORTHODONTIC APPLIANCES- GRABER NEUMANN
TEXTBOOK OF PEDIATRIC DENTISTRY- DAMLE
DENTOFACIAL ORTHOPEDICS WITH FUNCTIONAL APPLIANCES-
GRABER RAKOSI PETROVIC
REMOVABLE ORTHODONTIC APPLIANCES – M. S. RANI
ORTHODONTICS THE ART AND SCIENCE- SI BHALAJI
TEXT BOOK OF PEDODONTICS - SHOBHA TANDON
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