The MAD-Appliance

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The MAD-appliance

Jef Nelissen, LTH, TSO     

                                                      Private practice in Antwerp,

                                                      Belgium.

                                                       e-mail:jef@orthodontie.nu

                                                     

 

 

The MADappliance is a molar distalisation device for the maxilla.  The combination of  an S-shaped lip bumper and a thermo-formed plastic retainer  provides maximum  anchorage,  while  0.010" open-closed coil springs (0.046") on Headgear tubes move the molars distally

APPLIANCE DESIGN :

MODELS : An accurate stone model, made with the precision associated with crown and bridge fabrication, of the upper jaw is basically required.

Casts of the mandibular teeth and a thin construction bite in centric relation are optional.

ACRYLIC PLATE : The palate and the upper dentition are covered with a 2mm thick, thermoformed, acrylic plate.  In order to provide maximum anchorage , without inducing discomfort for the patient, the soft palate should be covered as much as possible.  Depending on the tipping of the crowns and their crown-shape (undercuts!),  the upper teeth need to be in-closed until the gingival margins or less.

The retainer-type of plate must still stay removable by the patient!

On the lingual side of the upper first molars, the plate is trimmed straight and parallel to the desired sliding direction that allows the molars to move distally.

E-STOPS : Two e-shaped stops, bended in 0.040" SS-wire, are incorporated in the acrylic foundation.  Both stops are situated left and right, buccally from  the contact-point of the first and second premolars. By spreading conventional 2-component acrylic over the occlusal surfaces of the thermoformed plate the e-stops are adhesed at the defined spots. 

Optional the casts can be mounted in an occludator now, in order to construct a smooth bite plane to prevent mandibular teeth from over-erupting and to give the patient additional comfort.

LIP BUMPER : An adapted version of the flexible lip bumper, in 0.044" SS-wire, to-gether with spot-welded open-closed coil-spring (0.010"/ 0.046") are the "engine" of this distalisator.

The lip bumper is S-bended at the posterior part while touching the e-steps to provide maximum anchorage.

The length of the open coilspring is defined by the distance of the posterior end of the facial Hg-tubes to the posterior side of the e-stop.  The length of the most occlusal part of the S-bended lip bumper-ends is adaptable on the chairside for each patient individually.

Most likely the soldering site is covered with a restorative composite resin ball to prevent disconnection.  It's recommendable to condition this first with a metal-primer.

       

INSERTION, WEARING  and REMOVING : Patients are instructed to insert the lip bumper first, followed by the retainer while pushing the bumper backwards  as much as possible.  Removing the device is easy if the patient respects the opposite order of actions.  The patient is adviced to wear the appliance as often as possible, eating with the MAD-appliance is not mandatory.

CONCLUSION : The Maximum Anchorage Distalisator-appliance provides a quick distalisation of the upper molars by lifting them out of occlusion while pushing them posteriorly.  The niti-coil-springs are very biocompatible and constant in action, no extra-oral extensions are considered.  Hardly any undesired side effects on the anterior-position inclination of the upper incisors or on the total, skeletal vertical dimension are noticable.

The MAD-appliance is easy to use in combination with other auxiliaries in the lower jaw.

  

Acknowledgements : A lot of appreciation and thanks goes to my patient-coŲrdinator Pieter Van Eester and to Henk Osnabrugge and Paul Van Keulen from the orthodontic lab ODONTOS B.V. in Nieuwegein, The Netherlands.

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[1] Nelson, K.R.; Burstone, C.J.; and Goldberg, A.J. : Optimal welding of beta-titanium orthodontic wires, Am. J. Orthodontics : 81, 213-219, 1987

  ≤ Korn, M. ; Shapiro, E. : Flexible lip-bumper for  Arch Development, J.C.O. 28, 43-50, 1994

  ≥ Sheridan, John  J. ;Le Doux, W. ; and Mc Minn, R: Essix retainers : Fabrication and supervision for permanent retainers, J.C.O. 27, 37-45, 1993.