Splints in orthodontics /certified fixed orthodontic courses by Indian dental academy

Splints in orthodontics
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

1

INTRODUCTION
A Splint is a rigid or flexible appliance used to
maintain in position a displaced or movable part or to
keep in place and protect an injured part.
The term splint is used in orthodontics to
describe an appliance that unites the teeth in the
dental arch so that they function as a single rigid
unit.


2

The various splints in orthodontics can be
grouped based on their use:
Splints used for TMJ disorders
Splints used in bi jaw surgery
Maxillary intrusion splint
Splints used for anterior retraction
Posterior anchorage splint
Splints used for intermaxillary elastics
Splints used as mandibular growth
advancers.
Invisalign
Splints used for retention.

3

SPLINTS USED FOR TREATMENT OF TMJ
DISORDERS
There is abundant evidence in both the dental and medical
literature that incorrect restoration and orthodontic procedures
can initiate and even complicate severe Temporomandibular
dysfunction (TMD).
Temporomandibular dysfunction can be due to either
internal derangement or external derangement . Internal
derangement simply means that there is a mechanical problem
within the T.M.J. capsule. External derangement indicates that
there is a problem within the musculo-skeletal system outside of
the T.M.J. capsule.
The use of splints as an initial step in the treatment of
Temporomandibular dysfunction (TMD) is now widely accepted.
Splints are thought to work by reducing the amount of Para
functional activity and limiting the extent of potentially harmful
movements.

4

The most commonly used splints for treatment of TMJ
disorders are :
(1) The Flat Plane Splint
(2) The Repositioning Splint
- Anterior Mandibular repositioning splint
- Gnathological splint
(3) The Pivotal Splint
(4) Soft or resilient splints
The use of the occlusal appliance for treatment of
TMJ disorders may be attributed to the following factors:
1) Alteration of the occlusal condition
2) Alteration of the condylar position-when the
condyles are brought into a musculo-skeletally
stable position ,there is a reduction in TMD
symptoms.

5

3) INCREASE IN VERTICAL DIMENSION

Initiating factors of facial pain and
TMJ disorders (occlusal interferences,
bruxism and emotional stress)

Continuous contraction of
muscle fiber without rest

Increase in vertical dimension
(stretching elevator muscles)

Deceleration of cross-bridge cycling
Between actin and myosin filaments
and decrease in tension

Excessive consumption of ATP
Minimum ATP consumption
(prevention of ATP exhaustion)

Rigor like state
Muscle spasm

Relief of muscle spasm


6

4) Cognitive awareness- A patient who wears the occlusal
appliance becomes more aware of their functional and
Para functional behaviour.
5) Placebo effect
6) Increased peripheral input to the CNSocclusal appliances decrease the CNS activity and
therefore reduces the CNS induced bruxism.
Factors critical for successful splint therapy include:
The patient must eat with the splint in place.
The patient must not clench their teeth when the splint is removed for
hygiene.
The patient should eat relatively soft food placed on the posterior teeth.
The patient should not incise with the front teeth.
The patient must not open their mouth excessively wide.


7

The Flat Plane Splint
The primary use of a flat plane splint is to treat the
acute phase of an external derangement problem.
During this acute phase the muscles of mastication
are in a hyperactive state and prevent the correct
diagnosis of the underlying internal derangement.
The objective is to allow the acute external
derangement to become passive so that the
appropriate appliance for internal derangement can
be fabricated.
The flat plane splint is usually best tolerated by the
patient when it is placed on the lower arch. However,
it is more advantages if it is placed in the upper arch.
The maxillary device is more stable and covers more
tissue, which makes it more retentive and less likely to
break.

8

Minimum thickness for the occlusal acrylic is 1.5
mm clearance between the most posterior teeth.
The splint should be adjusted so that all posterior
teeth are in balanced contact no matter how the
patient occludes. This allows the hyperactive
musculature a chance to rest and become more
passive.
The occlusal appliance is fabricated by various
methods. In the frequently used one the casts are
mounted on an articulator, undercuts are blocked
out, the appliance is developed in wax and the waxed
appliance is invested and processed with heat cured
acrylic resin and is then adjusted for final fit
intraorally. Another common technique is by using
self curing acrylic.


9

Sometimes the patient's acute external derangement
is so severe that they are unable to open their mouth to
make an impression for fabrication of the splint. In this
situation a temporary splint should be constructed chair
side using crown and bridge acrylic. As the treatment
progresses and the patient gains more vertical opening,
a more accurate flat plane splint can be made using
models.


10

The forces of occlusion
should be directed axially,
therefore the contacting
surface in the anterior area is
determined by the long axis of
the mandibular anterior teeth.
The acrylic on the labial
surface of the incisors can be
cut back to 1 millimeter for
improved esthetics and
patient comfort.


11

CANINE PROTECTED SPLINTS
It is a modified flat plane splint. The splint is
designed to prevent disturbing influences to the
neuromuscular system from occlusal contacts
on mandibular closure and movements.
The canine-protected splint is particularly
effective when lateral movements are to be
greatly limited within the splint design, so that
the patient opens the mouth almost straight
vertically. Thus, provisions are made for smooth
gliding mandibular movements and the
elimination of centric and eccentric occlusal
interferences.

12

Inclines are positioned labial to the cuspid
centric occlusion contact to provide cuspid guidance
during lateral and protrusive excursions. The only
tooth in contact with the splint during working
excursions is the cuspid tooth on the working side.
Only two teeth (cuspids) contact the splint in a
straight forward protrusive movement .

13

THE REPOSITIONING SPLINT
THE ANTERIOR MANDIBULAR REPOSITIONING SPLINT

They are also known as" pull - forward splints"
The anterior positioning appliance cause the mandible
to assume a forward position, creating a more favourable
condyle-disc relationship, providing the opportunity for
the tissues to repair and adapt.
The goal of the treatment is not to alter the mandibular
position permanently but only to change the position
temporarily so as to enhance adaptation of retrodiscal
tissues.

14

The appliance is used primarily to stabilise the
muscle hyperactivity and disc derangement
disorders (patients with joint sounds and chronic
or intermittent locking of the joints) so that the
patients true centric relation can be registered and
a suitable appliance can be fabricated.
The construction bite is taken at an edge to
edge relationship of the upper and lower incisors
with a 4 mm vertical thickness between the
incisors. This routine mandibular position is
sometimes modified through clinical experience,
transcranial radiographs, and electromyography, but it is a very practical starting
position for most T.M.D. patients suffering from
self-reducing anterior displacements of the
menisci.The maxillary appliance is preferred
since the anterior guiding ramp can easily be
fabricated.

15

The appliance is fabricated with acrylic resin.The acrylic
covering all of the teeth is fully indexed to allow the patient
only vertical motion. This is an extremely important point. If
the patient is wearing a pull forward splint, there should be no
rotary motion of the mandible when the patient is in full
occlusion. Any rotary motion will irritate the lateral head of
the pterygoid muscle and make the external derangement
more acute.


16

GNATHOLOGICAL SPLINT
The ideal condylar position is the commonly referred to as
Centric relation. Centric relation can be defined as the maxillomandibular relationship in which the condyles articulate with the
thinnest avascular portion of the their respective discs with the
complex in anterior superior position against the slopes of the
articular eminence, independent of tooth contact.
True centric relation of the mandible is the stable position of
the condyles against the articular discs, that can be captured
clinically and reproduced time and again.

Normal condyle fossa
relationship


17

Once a patient has been stabilized , any good centric
registration technique will yield identical and verifiable
centric positions of the mandible. Without first stabilizing
the mandibular position, different types of centric
registrations will yield different mandibular positions, True
centric can be stabilized if there are no degenerative joint
changes.
The objective in making the gnathological splint is to
achieve maximum neuromuscular release and eliminate all
occlusal proprioceptive interferences with an accurate
registration, also to seat the condyles in the most superior
position possible on every visit, and to adjust the occlusal
surface of the splint to achieve maximum intercuspation at
this position of the mandible at the most closed vertical
dimension obtainable.
The splint is constructed on the maxillary arch with the
help of an anatomical articulator.


18

PIVOTING APPLIANCE

The pivoting appliance is a hard acrylic device that
covers one arch and usually provides single posterior
contact in each quadrant. This contact is established
as far posteriorly as possible. This creates a fulcrum
aound the second molar area and thereby pivoting the
condyle downward and away from the fossa.
However for the pivoting action to occur the forces
that close the mandible should be located anterior to
the pivot, but since the elevator muscles are located
posterior to the pivot , extra oral force pulling the chin
upward should be provided . The efficacy of this
appliance is still debated.


19

This appliance loads the joint if extraoral force
is not applied. Distraction occurs when
extraoral force is applied anterior to the
elevator muscles


20

SOFT OR RESILIENT APPLAINCE
The soft appliance is a device fabricated with resilient
material that is usually adapted to the maxillary dentition.
Treatment goal is to achieve even and simultaneous
contact with the opposing teeth .However, Since most of the
soft materials do not adjust readily to the exact
requirements of the neuromuscular system it is difficult to
achieve the treatment goals.
It is most commonly indicated as a protective device for
persons likely to receive trauma to their dental arches


21

PRESSURE FORMED SPLINT
A protective splint used as a temporary
anti-bruxism splint. Especially useful for
patients who suffer from chronic sinusitis,
that result in sensitive posterior teeth. These
splints are made from 3mm durable
polyethylene material.


22

SPLINT FOR BI-JAW SURGERY
Whenever bi-jaw surgery is planned, and both
jaws are to be sectioned from their articulations with
the cranium, a base of reference must be maintained
so that the orientation of these bones in space is not
lost.
This is accomplished by osteotomizing the
maxilla, thereby losing its articulations with the
cranium, and establishing its predetermined position
by use of the mandible, with its cranial articulations
intact via the condyles.
Once the maxilla is then secured to the cranium,
the mandible is sectioned and repositioned to the
maxilla.


23

Preoperative Planning
The patient's maxillary and mandibular dental casts
are mounted on a semi-adjustable articulator using a
facebow transfer and a centric relation interocclusal
registration.
The articulator enables the operator to evaluate the
existing relationship more critically, and to transfer the
planned relationships to the patient at the time of
surgery more carefully and precisely.


24

The maxillary model surgery is performed, and the
freed maxilla is repositioned on the articulator to a planned
location determined by preoperative clinical and
radiographic analysis. This may include translatory and
rotational movements in all three planes of space.
If segmental surgery in the maxilla is required, it is also
performed at this time and the segments are secured to the
remaining maxillary cast and mounting ring.
The deformity on the articulator at this point is usually
much worse in appearance, due to the relationship of the
repositioned maxilla with the preoperative mandibular cast.
The mandibular dental cast and mounting ring are now
removed from the articulator. A second mandibular cast is
then articulated with the repositioned maxilla in the
planned final occlusal relationship and mounted on the
articulator.


25

Any necessary mandibular segmental surgery must be
accomplished on this mandibular dental cast prior to
articulating it with the repositioned maxilla, in order to
obtain the proper postoperative occlusal relationship.
The occlusal vertical dimension is then increased by
opening the articulator with the incisal pin. The vertical
dimension opening should be limited to a thickness
adequate for the needed strength of the acrylic resin splint.


26

FINAL SPLINT FABRICATION:
The final splint is fabricated of cold-cure acrylic,
with indentations of the maxillary and mandibular teeth
in the planned occlusal relationship. The lingual surfaces
of the maxillary teeth and a portion of the cusps should
be incorporated into the splint. Extending laterally from
the splint is a buccal flange in which holes are drilled to
accommodate both the wires around the maxillary
orthodontic brackets (or circumdental wires) and the
suspension wires (for both superior suspension of the
maxilla and mandibular suspension). The splint is then
finished and polished.
The initial preoperative mandibular cast is then
replaced on the articulator and the final splint secured to
the repositioned maxilla. If interference exists between
the maxillary splint and the pre-operative mandibular
cast, the occlusal vertical dimension can be altered. If
excessive space exists, the vertical dimension should be
closed.

27

A second (interpositional) acrylic splint— as thin as
possible— is made to cover the occlusal surfaces of the
mandibular teeth and index with the entire exposed
surface of the final splint, with the exception of the
buccal flange.
In the anterior region, however, the interpositional
splint extends forward and keys with the maxillary
splint. Areas of this anterior extension of the
interpositional splint must be relieved to avoid potential
interferences where the maxillary dental wires will
have been twisted through the buccal flange of the
final splint during the operation.


28

The interpositional splint will interdigitate with
the final splint on the lingual, posterior, and anterior
aspects, and relate the freed maxilla to the
unoperated mandible with precision and accuracy.
At surgery, the maxilla is down-fractured and
segmentalized as planned. The final splint is wired to
the maxillary teeth. The interpositional splint is
placed between the mandibular teeth and the final
splint. The mandible is temporarily wired to the final
splint with the interpositional splint in place.


29

MAXILLARY INTRUSION SPLINT

In the treatment of a Class II
malocclusion the anteroposterior
discrepancy between the dental arches is of
paramount importance, and in its
correction some or all of the following
objectives, in various combinations, may
be desirable:
(1) inhibition of the forward growth of
the maxillary complex,
(2) inhibition of the normal forward
migration of the maxillary dentition,
(3) reduction in the normal downward
and forward eruption of the maxillary
teeth,


30

(4) posterior translation of the entire maxillary dentition,
(5) enhancement of the horizontal growth of the mandible,
and
(6) acceleration of normal eruption of the posterior
mandibular teeth.
In addition, in some cases the following factors need
consideration:
(1) increased vertical mandibular growth,
(2) forward translation of the entire mandibular dentition,
and
(3) relief of crowding when a true dentoalveolar size
disproportion is present, by the serial extraction of teeth.
Since the maxillary traction splint moves the teeth en
masse, the dentoskeletal changes are due primarily to the
headgear force.


31

Restraint of maxillary growth has been investigated
by many authors, the general consensus of clinical
investigations is that forces applied to the maxilla of a
growing face may result in a more distal relationship
to the skull base than otherwise would occur.
Heavy extraoral forces of approximately 1,000 gm.
per side have been shown clinically to have a profound
and rapid effect on the maxilla and maxillary
dentition.


32

The appliance effectively converts the entire maxillary
dental arch into a rigid unit to which heavy extraoral
forces in the neighborhood of 1,000 to 2,000 gm. on each
side can be applied in an upward and backward direction,
with the direction of the force vector arranged either
anterior to or through the center of resistance of the
maxilla.
The design is intended to allow these forces to be
distributed evenly throughout the maxillary teeth. The
dentition transmits this force to the maxilla and then to the
sutures of the craniofacial skeleton, namely, the
zygomaticotemporal, zygomaticofrontal, frontomaxillary,
zygomaticomaxillary, and pterygopalatine sutures.


33

Compression of these sutures leads to a
reduction and possibly cessation of growth at this
level, and hence forward growth of the maxilla is
inhibited.
If, at the same time, the patient is growing
sufficiently for significant mandibular growth to
take place, a reduction in the anteroposterior dental
base discrepancy is observed clinically.
Several forms of headgear will allow heavy
forces to be applied in an upward and backward
direction .


34

ANTEROPOSTERIOR TRACTION SPLINT
Anteroposterior traction splint can be used for an
advancement of the maxilla by heavy extra-oral posteroanterior traction on an orthodontic mask
The Delaire facial mask uses heavy maxillary traction in
early Class III treatment to open the palatal sutures and the
naso-frontoethmoid complex while influencing the nasal cavity
floor. Forces are usually around l kg, but sometimes as high as
5kg. Anchorage must therefore be quite reliable.


35


36

To construct the splint, place a dry model in the
Biostar and form a l mm Imprelon plate over it for
one minute at 5 bars of pressure.
Trim the plate l mm from the gingival margin.
Affix two .032 " hooks in the acrylic between the
cuspids and the first deciduous molars. An .064 "
x .032 " rectangular wire can be added if a
transpalatal arch is desired.
The splint can be bonded . After about 30
seconds, the elastics can be attached between the
hooks on the splint and the facial mask.
The splint should not be worn for more than six
months.


37

POSTERIOR ANCHORAGE SPLINT
Used for treatment of deep bites in mixed
dentition. Treatment of deep bites is often complicated
by secondary tooth movements. The sooner the deep
bite is reduced, the longer the appliance can act as a
retainer during the remainder of treatment. Also, in
the mixed dentition, it can be difficult to cement
bands to deciduous teeth or to bond labial
attachments on lower incisors.
A thermoformed posterior anchorage splint avoids
these problems. It consists of a 1 mm plate of
polycarbonate Imprelon, formed over the occlusal
surfaces in the Biostar. Solder an .032" Adams clasp
to an .018 " x .025 " or .022 " x .028 " double molar
tube . Fix the tube above the center of resistance of
the anchorage unit with methyl-methacrylate resin. A
lingual arch or transpalatal bar can be added as with
the traction splint.

38

After checking for
occlusal enamel
infiltration, etch the
occlusal surfaces
and bond the splint
as described above.
Once the splint is in
place, the upper and
lower incisors can
be bonded .


39

One or two intrusion springs can later be inserted
into each tube to activate the appliance. A spring bent
at two right angles and inserted into the distal end of
the tube is flexible and can be lengthened if necessary.
The anterior spring can be chosen according to the
desired movement.
Intrusion mechanics with the splint are the same as
with traditional segmented arch mechanics, but
secondary movements are eliminated, especially with
masticatory forces contributing to stability . The splint
can be used in either arch or (rarely) in both, with
bonded labial brackets as desired. Debonding is the
same as with the traction splint.


40

SPLINT FOR INTERMAXILLARY ELASTICS
It is often necessary to hook intermaxillary elastics to a
perfectly aligned arch during part or all of treatment.
A bonded, thermoformed splint, made from a l mm
polycarbonate Imprelon plate, allows the use of intermaxillary
traction without banding or bonding individual teeth in the
arch .
The splint prevents the possibility of premature contacts (for
instance, between upper cuspids and the lower arch when
moving the cuspids distally). It also allows full bonding to be
postponed until the dentition is complete. Vestibular and
lingual support and masticatory forces help avoid unwanted
tooth movements.
For proper function, the labial portion of the acrylic must be
as deep as possible. Also, the embedded elastic hooks must
have a lingual extension for stability.

41


42

BICUSPID RETRACTION SPLINTS
In cases requiring extraction of first-permanent
molars, the extraction sites can be closed either by
mesial movement of the second permanent molars or
distal movement of the bicuspids. If the second molars
are used as anchorage, but treatment requires partial
bicuspid retraction, then two small, thermoformed
splints can be used for headgear retraction without
producing any adverse mesial movement of the second
molars.
An occlusal splint using l mm polycarbonate
Imprelon is made in the Biostar. the bicuspid portions
are cut out , and light .038" headgear tubes are
attached with self-curing acrylic resin. After etching,
bond the splints to the bicuspids with a liquid acrylic
adhesive.

43

Adjust a short extraoral facebow so that the outer bow
corresponds to the centers of resistance of the two bicuspids, as
identified from headfilms. The elastics will apply a diagonal,
superior-posterior force without unwanted secondary tooth
movements


44

ANTERIOR RETRACTION SPLINT
A removable splint offers several advantages over
fixed appliances in the initial phase of anterior
retraction:
• Less risk of caries and gingivitis than with banded or
bonded appliances.
• An opportunity to assess patient cooperation before
bonding.
• Shorter treatment time in the fixed appliance stage,
reducing the possibility of brackets loosening or
breaking.
Before the splint is formed in the Biostar, a silicone
coating must be applied to the molars and bicuspids. The
silicone should fill all the occlusal grooves of the
posterior teeth, except for the labial and lingual aspects
of the bicuspids and the mesolabial, distobuccal, and
lingual cusps of the molars . This provides only a few
points of contact with the splint and prevents retraction of
45
the posterior teeth during anterior retraction.

If the splint contacted the labial aspects of the
posterior teeth, it would hinder the anterior
retraction. This blocking effect can be prevented
by placing a silicone pad a few millimeters from
the edge of the splint and the buccal surfaces of
the posterior teeth on the model in the Biostar.
After thermoforming, trim the splint at the
level of the labial incisor surfaces and polish the
edges. Affix the inner facebow with self-curing
acrylic resin.
The outer bow must be carefully positioned so
that the retraction force is exerted in exactly the
same direction as the centers of resistance of the
anterior teeth, as determined from headfilms.


46

Anterior retraction splint
The thermoformed
appliance is designed only
for initial retraction, since it
cannot perform individual
tooth movements or
detailing.
Treatment will have to be
finished with fixed
appliances

Posterior retraction splint

47

MANDIBULAR GROWTH ADVANCER(MGA)
The MGA is a functional appliance for
mandibular protraction. It is a modified activator.
It is initially composed of two separate splints .
With this appliance, the mandible is advanced
progressively with a mandibular splint.
The objective is to remodel the condyle and
the glenoid fossa in the temporomandibular joint
with concomitant adaptation of orofacial
muscles.it is used for correction of class II div 1
cases in the growth period.
Extraoral forces can be applied making use of
the maxillary splint to restrict the growth of
maxilla.

48

MANDIBULAR GROWTH ADVANCER(MGA)

Upper and lower
splints. Both
surfaces are
flattened parallel to
the occlusal plane .


Acrylic is put at
three points
(arrows; one on
anterior point, two
on posterior point)
to attach both
splints. It is inserted
into the mouth to 49
take a construction

The MGA functions as follows.
1. As the upper and lower splints are made
separately and are fixed by cold-curing
acrylic in a new construction bite within the
oral cavity, the MGA can be fit more easily
and effectively in three-dimensional
mandibular adjustments. In other words, this
appliance achieves an exact construction
position and changes it progressively.
2. To correct a Class II relationship into a
Class I relationship, the mandibular position
must sometimes be overcorrected into a
Class I relationship horizontally, namely, a
Class III relationship. With this appliance, it
is possible to go from a Class II to a Class III
relationship with only one appliance
throughout the treatment period.

50

3. While improving the horizontal problem, it
is possible to selectively allow the vertical
eruption of posterior teeth by trimming the
occlusal shelf, as anterior teeth are impeded
by an anterior ledge.
4. Since this appliance is simple, it can be
used concomitantly with a fixed appliance.
Thus tooth irregularity can be corrected
simultaneously with the correction of the
skeletal discrepancy.
After successful
mandibular forward
induction has been
achieved, MGA is again
separated into two splints
to allow further
mandibular forward
induction.

51

Three stages of mandibular forward
induction.

Splint with the facebow
in place for maxillary
growth restriction


52

MANDIBULAR ADVANCEMENT SPLINT (MAS)
Mandibular advancement splints are also used in treatment
of obstructive sleep apnea.
Mandibular advancement appliances,used in the treatment
of OSA, widen the oropharyngeal airway by repositioning the
mandible downwards and forwards during sleep.


53

ESSIX RETAINERS
Essix retainers are fabricated using
thermoplastic copolyester materials.


54

INVISIBLE RETAINERS

It is used either at the end of orthodontic
treatment or as a transitional retainer between
certain stages of treatment.


55

INVISALIGN
It is an orthodontic technique that uses a series of
clear plastic aligners to move teeth. The aligners are
made from thin, see through plastic, which fits over the
buccal, lingual (palatal), and occlusal surfaces of the
teeth.
The aligners are worn for a minimum of 20 hours per
day and are changed (and advanced) on a 2-weekly
basis.
Each aligner is designed to move a tooth or small
group of teeth about 0.25–0.3 mm. These appliances are
worn full time by the patient to move the teeth
according to the programmed stages of movement.


56

REFERENCES

1. JCO 1982 Sep (619-622): Modified Splint Design for
Two-Jaw Surgery
2. AJO-DO, Volume 1983 Nov (361 - 383): Orthopedic
coordination of dentofacial development in skeletal Class ll
malocclusion in conjunction with edgewise therapy - Bas
3. AJO-DO, Volume 1995 Mar (229 - 234): Effectiveness of
splints in TMD treatment -Willis
4. JCO 1990 Jun (351-359): Thermoformed Orthodontic
Appliances - DR. MICHEL AMORIC
5. Research paper by clinical foundation of orthopedics and
orthodontics.
6.AJO-DO 1993 Sep (211-223): Mandibular forward
induction - Yokota, Murakami, and Shimizu

57

REFERENCES
7. AJO-DO

1984 May (376-384): Maxillary traction
splint - Caldwell, Hymas, and Timm.
8. AJO-DO 1982 Jan (65-70): Posteroanterior traction
in maxillonasal dysplasia - Rune et al.
9. Three-Dimensional Diagnosis and Orthodontic
Treatment of Complex Malocclusions With the
Invisalign Appliance-Robert L. Boyd and Vicki
Vlaskalic ( Semin Orthod 2001;7:274-293.)
10. JCO 1981 Feb (100-123): Functional Occlusion for
the Orthodontist - Part 2 .
11. J Clin Orthod. 1993 Feb;27(2):94-5. Gnathological
orientation splint for presurgical orthodontics
12. JCO 1981 Mar (174-198): Functional Occlusion for
the Orthodontist - Part 3 -Finishing To
Gnathological Principles -RONALD H. ROTH, DDS
13.JCO 1989 Nov (756-762): Simplified Bass Appliance
- NEVILLE M. BASS, BDS, LDS, FDS, DOrth RCS.
14. AJO-DO 1993 Nov (484-491): Increase in vertical
dimension alters mechanical properties and isometric
ATPase activity - Paik, Satomi, Saeki, Yanagisawa,

58

15.JCO 1993 Jan (37-45): Essix Retainers: Fabrication and
Supervision for Permanent Retention - JOHN J. SHERIDAN,
DDS, MSD, WILLIAM LEDOUX, DDS, ROBERT
16.JCO 1985 Aug (570-578): Invisible Retainers - JAMES A.
MCNAMARA, DDS, PHD, KAREN L. KRAMER, CDA,
JAMES P. JUENKER


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