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The use of removable appliances in modern clinical orthodontic practice can generally be considered an out-dated treatment modality for managing malocclusions. Their use and popularity has declined considerably largely due to their inefficiency at achieving significant quality tooth movement. There are, however, a couple of specific indications where removable appliances come into their own. This article will present and discuss several clinical scenarios where one technique clearly has significant advantages over the other.
CPD/Clinical Relevance: Orthodontists and general dental practitioners (GDPs) should be aware of the situations where removable appliances provide a solution in modern clinical orthodontics practice, but also when the fixed counterpart will provide a much more efficient and effective method of moving teeth.
Article
The majority of removable appliances are advocated for starting orthodontic treatment in the mixed dentition, and are also used as an adjunct to fixed appliances in treatment.1 There are very few significant clinical benefits to the patient as a result of their use; and perhaps few that could not be done better and more efficiently with fixed appliances. In most instances the disadvantages of fitting removable appliances outweigh their potential advantages.
Advantages of removable appliances:
Disadvantages of removable appliances:
Ectopic eruption of maxillary first permanent molars occurs in around 4% of the population. Radiographic examination can reveal the first permanent molar encroaching or impacting upon the distal aspect of the second deciduous molar and this clinical presentation is most commonly encountered in the maxillary arch, either unilaterally or bilaterally.3
This clinical scenario can often lead to:
A number of aetiological factors have been suggested as predisposing to/associated with the ectopic eruption or impaction of first permanent molars:
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