Alikhani M a,b, Sangsuwon C a, Alansari S a, Nervina JM a, Oliveira SP a,c, Teixeira CC d
Figure 1: Characteristics of TADs for CTOR Plates. TADs for CTOR Plates require a platform to support the CTOR Plate and a removable cap that secures the plate in place (A). The design of the TAD allows the CTOR Plate to stay at least 1 mm away from soft tissue, in this example the soft tissue of the palate (B). In addition, CTOR Plates are designed to be secured by two TADs. To allow some flexibility in TAD placement (based on cortical bone quality, accessibility or anatomical limitations), a leeway of 6 mm has been incorporated into the CTOR Plate design (C).
Figure 2: Intrusion Plate (I-Plate) design. The I-Plate has been designed for intruding maxillary posterior teeth (A). This design can be used in combination with buccal TADs, depending on the type of the patient’s problem (B, intrusion forces shown as blue arrows). I-Plates can be connected to posterior teeth through power chain or elastic tread for simultaneous intrusion of several posterior teeth (intrusion forces as black arrows in C).
Figure 3: Intrusion of maxillary posterior teeth using the I-plate. In this adult patient with a severe open bite and Class III skeletal relation, significant intrusion of maxillary posterior teeth was achieved using I-Plates after maxillary expansion.
Figure 4: Mesialization-Plate (M-Plate) design. M-Plates have been designed to protract posterior teeth without significant stress on anterior teeth (A). By incorporating several hooks into the design of the plate, its is possible to adjust force direction according to the center of resistance (B, protraction forces shown as blue arrows). By stabilizing the molars with the M-Plate, we can use the molars as anchor units to protract premolars and canines (C, open coil used to protract premolars).
Figure 5: Protracting posterior teeth using a M-Plate for space closure. In this patient, significant posterior teeth protraction was needed. However, since the anterior teeth did not need significant retraction, we utilized a M-Plate for protraction. First molars were stabilized as anchor units using the M-Plate, while the premolars and canines were protracted. Finally, the molars were protracted directly using the same M-Plate.
Figure 6: Distalization Plate (D-Plate) design. D-plates have been designed for retracting posterior teeth (A). These plates can be used directly for retracting posterior teeth, especially when the patient is missing third molar or even second molars, by simultaneously applying buccal and lingual distalizing forces (blue arrows in B). This plate can also be used to simultaneously apply a lingual force directly to the target tooth, while securing the adjacent tooth (anchor tooth) for application of a buccal force (C, distalization forces shown as blue arrows). By modifying the D-Plate shape, and removing one wing, it can be used for unilateral distalization (D).
Figure 7. Bilateral maxillary posterior tooth distalization to address dental Class II malocclusion. In this patient a D-plate was used to achieve bilateral distalization of maxillary posterior teeth, followed with retraction of the anterior teeth.
Figure 8. Anterior Plate (A-Plate) design. A-Plates have been designed for intruding or extruding anterior teeth without changing posterior tooth position. A-Plates come in three forms. Type I and Type II are designed primarily for buccal placement, while Type III is suitable for palatal usage (A). When a TAD is used to generate vertical forces, a counter-clockwise moment appears on an individual TAD that may significantly jeopardize its stability. By connecting the tube to the A-Plate, and using it for vertical corrections, these moments translate into unidirectional forces that are easily tolerated by the 2 TADs (B, extrusion of anterior, couple shown as straight red arrows and moment on the TAD showed as dashed red arrow, extrusion force shown as blue arrow). Type III A-plates can be used with a one -couple system design for vertical corrections of anterior teeth (C) without need for fixed appliances.
Figure 9: A-Plate used to correct anterior open bite. In this patient, the posterior teeth had proper position, making it preferential to close the open bite without changing the position of these teeth. An A-Plate was used to produce a one-couple system to apply an extrusion force on the anterior segment. A moment produced by a one-couple system can worsen an open bite and, therefore, requires extensive anchorage preparation to prevent TAD destabilization. The A-Plate allows us to apply force without any moment or force on the posterior teeth or jeopardizing the TAD stability.
Figure 10: Elastic Plate (E-plate) design. The E-Plate can be used in any condition when a rubber band is required but an individual TAD is either not stable or not accessible due to anatomical limitations. E-Plates are made in two type (Type 1 and Type II) that can change the accessibility and direction of the force (A). E-Plates can be used to retract maxillary of mandibular teeth (B) or to apply Orthopedics forces, without a need for flap surgery for plate placement or removal.
Figure 11. Application of E-Plate for maxillary protraction using a facemask to correct a Class III skeletal malocclusion. In this teenage patient, an E-Plate was used for maxillary protraction using a facemask, establishing a normal overjet and overbite.