1. UPPER REMOVABLE APPLIANCE (URA)
GROUP 1

2. Removable appliances 
Work by simple tipping movements of the crowns of the teeth about a fulcrum close to the middle of the tooth also allow differential eruption of teeth, for example by using bite planes. They differ from fixed appliances, which are capable of complex movements of multiple teeth, including bodily movement, root torque and rotation.

3. Classification Active (produce tooth movement/growth modification)
Removable appliance
Active (produce tooth movement/growth modification)
Mechanical appliances
Functional appliances
Passive
Retainer
Space maintainer

4. Function/Role Interceptive treatment during mixed dentition
Eg : crossbite correction
space maintainer
expansion to reopen space
Facilitate of distal movement of the molars using headgear.
As an adjunct to fixed appliance tx.
Eg : anterior bite planes for overbite reduction
Maxillary restrain
Eg: maxillary intrusion splint
Assess motivation and compliance before more complex tx.

5. INDICATIONS &CONTRAINDICATIONS
Growth modification during mixed dentition
Limited (tipping) tooth movements desired (arch expansion, individual tooth mal position).
Retention following orthodontic treatment
Adjunct to fixed orthodontic appliances,
Interfere with (or prevent the development of) abnormal orofacial habits
Severe skeletal discrepancy
Upper and lower arch correlate treatment
Severe rotation
Bodily movement needed
Vertical discrepancy
Severe crowding
Very dense bone

6. ADVANTAGES & DISADVANTAGES
Removable for social function
Suitable for simple malocclusion
Smaller anchorage requirement
Uncompromised oral hygiene
Short chair-side time
Ease of adjustment
Require less training for management
Dependent on patient compliance
Less precise control of tooth movement
Unable to perform complex tooth movement
Difficult to control space closure
Fewer tooth movement
More difficult to correct rotation
Affect speech
Retention poor in lower arch
Prone to breakage and loss

7. RETENTIVE ANCHORAGE BASEPLATE ACTIVE
URA DESIGN PRINCIPLES
RETENTIVE
Clasp
ANCHORAGE
Simple
Reciprocal
Stationary
Intermaxillary
BASEPLATE
Heat cure
Cold cure
Autoresin
ACTIVE
Springs
Screws
Elastics

8. Springs Screws Elastics
ACTIVE COMPONENTS
Springs
Screws
Elastics

9. Z-spring Stainless steel wire 0.5mm diameter Function:
-proclination of 1 or 2 incisors
-to correct mild rotation if only 1 helix is activated

10. T-spring For incisor, 0.5mm diameter stainless steel(SS) wire
For premolar, 0.6mm diameter SS wire
Function:
-for proclination of incisors or premolar

11. Finger spring For incisor, 0.5mm SS wire
For canine and premolar, 0.6mm SS wire
Function:
-for mesial or distal movement

12. Labial bow 0.7mm diameter SS wire Function:
-for retraction of anterior teeth

13. Split labial bow 0.7mm diameter SS wire Function:
-retraction of anterior teeth
-to close diastema

14. Robert retractor 0.5mm diameter SS with sleeve Function:
-retraction of anterior teeth

15. Buccal canine retractor
0.7mm diameter SS wire
Function:
-palatal and distal movement of mesially angulated canine

16. Coffin spring 1.25mm diameter SS wire Function: -transverse expansion
-buccal crossbite correction

17. Screw Function: -for expansion of arch
-for distalization of molar teeth
1 turn / week = 0.25mm(1/4 turn)

18. Elastics Rubber or latex rings Function: -extra-oral traction
-inter-maxillary traction
However, it depends largely on the patient cooperation

19. RETENTIVE COMPONENTS Clasps Adam’s clasp
C-clasp (Circumferential clasp)
Lingual extension clasp
Ball clasp

20. Adam’s Clasp The most useful clasp in removable appliances.
It is designed to engage the MB, DB undercuts of posterior teeth.
Advantage, it does not separate teeth and has excellent retention.

21. Adam’s Clasp fabrication
Components of Adam’s Clasp
1- Arrow heads
2- Bridge
3- Tags
4- Retentive parts
It is made of 0.7 mm diameter hard St. round wire

22. Adam’s Clasp Design modifications Long bridge One arrow head
Solder a HG tube to the bridge
Solder hook to he bridge

23. Adam’s clasp adjustment
1. To tighten/loosen: Adjust the arrowhead to grip the undercut of the tooth. Hold arrowhead with pliers at A and bend using finger inwards in direction shown.

24. 2. To adjust the height: Hold adams clasp wire the wire exits the acrlyic at pint B and bend the wire up or down to adjust verical position of arrowhead.

25. Circumferential clasp
Useful for second molars and canines
Easier to keep it out from occlusal contact
It is only supportive, not as retentive as Adam’s clasp
It can be adequate for a retainer, but not for an active appliance

26. Ball Clasp Ball Clasp It like Adam, extends across the embrasure
Uses buccal undercuts for retention
Easy to fabricate
It is stiff that could not be extended deep into the undercuts

27. Lingual Extension Clasp
It works only from the lingual aspect without crossing the occlusal surface or embrasures
Short loop of (0.4 mm) wire
Can be placed in the first molar second premolar lingual embrasure
Difficult to adjust
Break easily
May cause tissue irritation
Can separate teeth if active
Can be used for retainers,
not for active appliance

28. ANCHORAGE
Resistance to unwanted tooth movement BY equal in magnitude and opposite in direction

29. Types of intra-oral anchorage
Simple-active movement of few teeth versus several anchor teeth
Reciprocal-when 2 teeth or 2 sets of teeth move to an equal extent in an opposite direction
Stationary-bodily movement of 1 group of teeth against tipping of another
Intermaxillary- when the anchorage units situated in 1 jaw used to provide the force required to move teeth in opposing jaw

30. BASEPLATE It must be: -hold components
-clear acrylic = heat cure, cold cure polymethyl-methacrylate, autoresin
-comfortable
-good fit
-can be active as additional functions-act as bite plane

31. References http://www.retainerlab.com/Pages/Springs.htm
Lecture by Dr. Norzakiah(principles of removable appliance therapy-part 1)
Lecture by Dr. Fitri Octavianti(types of orthodontic appliances)