A simplified splint with protraction hooks

  • Dr. Mohammed Rizwan BDS, MDS.Senior Lecturer. Department of Orthodontics and Dentofacial Orthopaedics, Dayananda Sagar College of Dental Sciences, Bangalore. Karnataka, India.

  • Dr. Sandeep Shetty BDS, MDS Professor, Department of Orthodontics and Dentofacial Orthopaedics,Yenepoya University, Mangalore.Karnataka, India.

  • Dr. Hemanth M. BDS, MDS Professor, Department of Orthodontics and Dentofacial Orthopaedics,Dayananda Sagar College of Dental Sciences, Bangalore.Karnataka, India.

  • Dr. Patil G.S. BDS, MDS Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics,Dayananda Sagar College of Dental Sciences, Bangalore.Karnataka, India.

    Corresponding Author:
    Dr. Mohammed Rizwan. No. 1217, 2nd Main Road, 1st Stage, 3rd Block, H.B.R Layout. Bangalore - 560043 Karnataka, India. +91 9886818922 dr_rizwanm@yahoo.com
Para efectos de referencia bibliográfica este trabajo debe ser citado de la siguiente manera: Rizwan, M., Shetty, S., Hemanth M. Patil G.S.

"A simplified splint with protraction hooks."

Revista Latinoamericana de Ortodoncia y Odontopediatría "Ortodoncia.ws edición electrónica Diciembre 2011. Obtenible en: www.ortodoncia.ws. Consultada,…/…/…


Abstract:
Introduction - The most commonly applied mechanics in the treatment of Class III skeletal cases with maxillary deficiency is, a protraction head gear in conjunction with Hyrax appliance.

This paper introduces a simplified splint for protraction of maxilla in young patients , where not much of maxillary expansion is required.

The mere opening of the "U" loop brings about (a fan shaped opening) loosening of the circum-maxillary sutures, which inturn aids in the protraction of the maxilla.

Materials and method - The appliance comprises a pre fabricated TPA of the measured size, which is bent to adapt to the contours of the occlusal of the posteriors and finally ending as a hook, to which the orthopedic elastics are attached. The appliance is ready for use after acrylization.

Conclusion - This simple technique, proves efficient and economical, especially in simple cases and young non compliant patients.


Resumen
Introducción: la mecánica más comúnmente aplicada en el tratamiento de casos esqueléticos de clase III con deficiencia maxilar es un aparato de tracción alta de cabeza combinado con un expansor de Hyrax

Este documento presenta una férula simplificada para la protracción del maxilar en pacientes jóvenes, donde no serequiera mucha de expansión maxilar

La mera apertura del asa en forma de "U" trae consigo (una abertura en forma de ventilador) aflojamiento de las suturas circum-maxilares, que inturn ayuda en la protracción del maxilar.

Materiales y método: el dispositivo comprende un TPA pre fabricada al tamaño medido, que se pliega para adaptarse a los contornos de la oclusión de las posteriors y finalmente final como un gancho, al que se adjuntan las piquetas ortopédicos. El equipo está listo para su uso después de acrylization.

Conclusión: esta técnica sencilla, resulte eficiente y económica, especialmente en casos sencillos y pacientes jóvenes no conformes.


The most commonly used device in conjunction with a protraction Face Mask is an acrylic splint with hooks, to which the orthopedic elastics are engaged.

This splint comprises of a Hyrax device, wire frame work encompassing the upper posteriors and hooks. The hyrax device is adapted to the palatal contour and soldered to the wire frame work on the palatal aspect and the hooks which are individually bent are soldered on the buccal side.

This skeleton of the wire framework with soldered joints is concealed in acrylic. The height of the acrylic is slightly exaggerated to behave as a bite block.


Design and construction of simplified splint with protraction hooks

A preformed TPA (Trans Palatal Arch) is adapted across the palate extending from one side to the contralateral side. The open end of the 'U' Loop of the TPA is kept facing fowards. (Fig 1).

In a mixed dentition patients, this wire can be made to pass through notches, made on the occlusal surfaces of deciduous molars at the junction of their distal and mesial marginal ridges so that the wire and appliance remains firmly retained within the boundries of the strong enamel.(Fig 2 and 3).

The bent TPA is stabilized on the cast with stick wax and separating media is applied on the cast. (Fig 4). Once the separating media dries acrylization is started.

Self cure acrylic is mixed into adough and adapted over the occlusal surfaces of posteriors extending onto the palatal and buccal surfaces of all the posterior teeth just short of the gingival margins. The height of the acrylic blocks is maintained uniform on both sides. The set acrylic appliance is trimmed and polished and now ready to be cemented/bonded to the teeth. (Fig 5 and 6).

Once a thorough bonding is confirmed the orthopedic elastics can be engaged from the protraction hooks intra-orally to the horizontal rods of the Protraction Headgear extra-orally. (Fig 7 and 8).

Advantages of Simplified Splint with Protraction Hooks
  1. A very simple design.

  2. The device is relatively hygienic as just a simple wire spans the palatal region instead of a bulky Hyrax device.

  3. Less wire bending is involved and does not require any special pliers.

  4. The appliance can be fabricated by the clinicians themselves and do not require the assistance of an expert lab or dental technician.

  5. No soldered joints are present; therefore solder failures are not a matter concern. (Solder failures are encountered in certain cases at the Hyrax-frame work interface or Hook-frame work interface).

  6. Very economical as compared to the appliance containing a Hyrax device.

  7. Slow palatal expansion can be achieved with opening up the central 'U' Loop.
Limitations
This device is not applicable to cases with severe transverse skeletal discrepancy, where a larger span of palatal expansion is indicated. But, this simplified splint can be used in such cases as retainers, post transverse skeletal correction.

Figure 1
Prefabricated Transpalatal Arch.

Figure 2
Notches made at the junction of the marginal ridges of deciduous molars.

Figure 3
TPA adapted across the palate and passing through the Notches made at the junction of the marginal ridges of deciduous molar

Figure 4
Separating media applied after stabilization of the TPA and before acrylization

Figure 5
Acrylized appliance with TPA and acrylic bite blocks

Figure 6
Finished and polished appliance.

Figure 7
Orthopaedic elastic engaged to protraction hooks.

Figure 8
Orthopaedic elastic engaged from protraction hooks to the Face Mask.