


INSERT INTO `frequently_prescribed` (`fp_id`, `title`, `description`, `status`, `created_at`, `updated_at`) VALUES
(1, 'Simple Removable Appliances  for Preventive Orthodontics', '<p>Excellent removable appliances for patients requiring anterior improvement. These appliances provide the desirable features of esthetics and simplicity of adjustment. The patient will become accustomed to the appliance if it is placed without pressure for the first week. Springs are usually adjusted monthly with a variance of one and one-half millimeters between the active and passive positions. The time required for movement as a result of appliance pressure varies between patients. Lack of movement would usually indicate the need for a more extended period of pressure rather than greater pressure. Minimal spring adjustments avoid appliance displacement.</p>\r\n\r\n<p><img alt=\"Lingual Springs Appliance 1 - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Lingual-Springs-P-81.jpg\" style=\"float:right; height:212px; width:220px\" />Labial movement and/or rotation of the anteriors can be effected by the lingual finger spring; double helical type springs provide greater adjustment range, flexibility, and control. A small #139 Birdbeak plier is usually effective for many of these adjustments. For rotational movements, the round portion of the plier is inserted into the coil, and the spring rotated. By adjusting the second coil in a similar fashion, the spring is positioned for straight-line labial movement of the anterior. The labial arch wire enhances proper arch form.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>.<br />\r\n&nbsp;</p>\r\n\r\n<p><img alt=\"Loop Springs Appliance - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Loop-Springs-P39.jpg\" style=\"float:right; height:206px; width:220px\" />Mesial and/or distal movement of the centrals, laterals or cuspids can be effected by the looped finger springs. One side of the loop is free-sliding. Opening the loop will advance the spring extension against the tooth and provide a constant, gentle pressure to move the anterior in the desired direction. Spring extensions placed near the gingival can minimize tipping. If tight contact points prevent spring extension placement, separators can be inserted one week prior to appliance placement.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Labial Springs Appliance - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Labial-Springs-P41.jpg\" style=\"float:right; height:208px; width:220px\" />Lingual movement of the anteriors can be effected by the finger springs on the labial wire. With the #139 plier supporting the solder joint finger pressure can be used to skew the spring in the direction of movement. The loops in the cuspid areas can be crimped occasionally to keep pace with and retain improvement. Typically, the labial wire will not be adjusted to exert pressure against the anteriors, as this will result in a loss of retention and appliance displacement.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>.</p>\r\n\r\n<p><img alt=\"Modified Hawley Appliance - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Hooks-for-Elastics-P-93.jpg\" style=\"float:right; height:204px; width:220px\" />This modified Hawley removable appliance is frequently the appliance of choice on adult cases with flared maxillary incisors. Elastic hooks are soldered to the labial bow at the omega loops. With two ounce elastic placed from cuspid hook to cuspid hook, a physiologic distal force is placed against the maxillary incisors. Periodic slight reduction of the palatal acrylic controls movement to the distal. Simultaneous removal of acrylic can result in rotational movements.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(2, 'Removable Sagittal Appliances for Arch Development', '<p>Removable Sagittal appliances are frequently prescribed for patients requiring development of the premaxilla and/or distal movement of posterior segments. Many of these patients exhibit buccally displaced cuspids, usually due to a lack of arch length. Most Doctors suggest adjusting the gears one-quarter turn each four days. The patient is instructed to wear the appliance twenty-four hours a day, including at meal time. Wearing during meals is often recommended to take advantage of the forces of mastication on the occlusal bite planes usually included in these appliances. Although models can frequently be marked or occluded to determine the patient&rsquo;s dental occlusion, a bite registration is recommended for appliance construction. This avoids the necessity of most in-office occlusal adjustments to the appliance.</p>\r\n\r\n<p>The Sagittal to advance the premaxilla includes four clasps, two Sagittal gears, occlusal acrylic bite plane, cuspid retractors and/or labial bow. With the models articulated to the Doctor&rsquo;s construction bite, the lower posterior cusps are deeply imbedded into the acrylic occlusal coverage of the upper appliance. The posteriors are thus anchored and provide the stability necessary for the appliance forces to be directed toward premaxilliary development.</p>\r\n\r\n<p><img alt=\"Sagittal Appliance 1 - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Saggital-P3152857.jpg\" style=\"float:right; height:219px; width:220px\" />Lateral arch development capabilities can be included into the appliance. A midline expansion gear is placed in the appliance with the usual sectioning of the acrylic. Most Doctors find that alternating the Sagittal gear and transverse gear adjustments maintains appliance fit and function. Periodic reduction of palatal acrylic is usually recommended to relieve appliance impingement on soft tissue as the case develops. A second midline screw can be included if survey indicates.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Sagittal Appliance 2 - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Saggital-P3152876.jpg\" style=\"float:right; height:207px; width:220px\" />The Sagittal appliance for distal movement of one or both posterior segments is similar to the Sagittal to advance the premaxilla. The anchorage units are altered to maximize anterior anchorage and remove anchorage posteriorly. The posterior acrylic coverage is polished flat while the lower cuspids are indexed into the anterior section of acrylic. Individual color coding of arrows allows the patient to follow the sequence of adjustments when the gears are adjusted alternately, left then right each four days.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Lower Sagittal Appliance - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Gear-to-Regain-Sp-P80.jpg\" style=\"float:right; height:220px; width:220px\" />Lower Sagittal appliances are also prescribed for anterior/posterior arch length discrepancies in the mandibular arch. If occlusal coverage is already included on an upper appliance, it will not be included on the lower Sagittal. Otherwise, the occlusal will be covered to once again take advantage of masticatory forces. As with the transverse development appliances, the appliance may be returned periodically for update to the current condition of the case and adjustment of the expansion gears. A new model is required.</p>\r\n\r\n<p>&nbsp;</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(3, 'Removable Expansion Appliances for Posterior Crossbite', '<p>Depending on clinical survey, unilateral and bilateral posterior crossbites can be approached using different appliance applications. Individual or groups of posteriors involved in a crossbite may be determined to be either dental or functional in origin and each may have a different anchorage requirement. The following appliance approaches are frequently requested for applications indicated.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Schwarz Arch Development Appliance - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Swartz-Expansion-P14.jpg\" style=\"float:right; height:220px; width:220px\" />For unilateral crossbite cases requiring bilateral expansion due to symmetrical constriction of the maxillary arch. Occlusal coverage serves to enhance the action of the appliance while opening the bite. A flat occlusal plane on the posterior section in crossbite eliminates interdigitation that may restrict movement. Lower cusp indents into the occlusal overlay on the opposing posterior segment maintains good function.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Nord Appliance  - Click to Enlarge\" src=\"https://www.ordont.com/images/problem-solution/Unilateral-Posterior-Crossb.jpg\" style=\"float:right; height:217px; width:220px\" />The Nord appliance is employed where a true unilateral crossbite requires movement in one posterior segment only. Increased anchorage is provided by an acrylic flange added to the occlusal coverage on the side opposite the crossbite. The flange extends to the lingual of the lower posteriors. The cut in the acrylic can be sectioned to include only that segment.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Double Gear Appliance  - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Double-GearExpansion-P-83.jpg\" style=\"float:right; height:215px; width:220px\" />Two expansion screws are typically included in appliances for bilateral crossbite applications. Occlusal coverage with flat bite planes allows transverse development free of posterior occlusal interferences. As the case progresses, the screws may need to be reset for additional expansion. The labial bow can be adjusted away from the anteriors at each visit to avoid impingement.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Bilateral flanges extending to the lingual of the lower posterior segments will exert pressure to develop both arches. This appliance is preferred where patient cooperation with two removable appliances is doubtful and a lower fixed appliance is not feasible. A registration bite is recommended for any appliance having occlusal coverage to provide proper fit and function.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(4, 'Removable Expansion Appliances for Arch Development', '<p>On young patients, Removable expansion appliances are intended to develop the arches to their full potential, providing room for all teeth to attain proper alignment and occlusion. Expansion screws are adjusted in the same manner as described previously. However, the frequency of adjustment can vary with application. Appliances are ideally worn twenty-four hours a day and, may also be worn at meal time. Lack of retention on subsequent visits may indicate a need for additional wearing time. Patient education and cooperation are essential to successful improvement with removable appliances. The patient (and parents) should understand that improvement depends directly on faithful and consistent wear.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Schwarz Arch Development Appliance - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Swartz-Expansion-P14.jpg\" style=\"float:right; height:220px; width:220px\" />The Schwarz arch development appliance utilizes a large expansion screw mid-palate. The acrylic is sectioned in the center to exert an equal and opposite bilateral force. Expansion screws are usually adjusted once each week by the patient or parent. Patient education and calendar books are helpful tools to assist the patient in proper cleaning and adjustment frequency. At each visit of the patient, the labial bow is relieved from contact with the anteriors to avoid impingement.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Double Gear Expansion - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Double-GearExpansion-P-83.jpg\" style=\"float:right; height:215px; width:220px\" />On permanent dentition cases or when second molars are present, a second expansion screw can be added for increased stability. Pressure for expansion can be evenly distributed both interiorly and posterior. Adjusting both expansion screws with the same frequency prevents binding. Periodic removal of the palatal acrylic in the deepest portion of the vault may be necessary to keep pace with arch development.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" style=\"width:100%\">\r\n	<tbody>\r\n		<tr>\r\n			<td>Three-dimensional expansion&nbsp;<br />\r\n			gears can provide both a posterior bilateral force as well as pressure for anterior development. The expansion gear is provided with two sets of adjustment openings, allowing independent action in each direction. This appliance approach is used extensively on cases involving insufficient cuspid space. Can be made for the upper or&nbsp;<br />\r\n			lower arch.</td>\r\n			<td><img src=\"https://www.ordont.com/images/frequently-prescribed/3D-Gear_Upper-and-Lower.jpg\" style=\"height:250px; width:220px\" /></td>\r\n		</tr>\r\n	</tbody>\r\n</table>\r\n\r\n<p><img alt=\"Hinge Gear Expansion appliance - Click to Enlarge\" src=\"https://www.ordont.com/images/problem-solution/Hinge-Gear-P3152898.jpg\" style=\"float:right; height:210px; width:220px\" />The Fan or Hinge Gear expansion appliance is a frequent appliance choice to create intercanine space in cases of minor crowding. With the hinge positioned adjacent to the molars, the greatest appliance opening occurs at the anterior. Although finger springs can be included, Doctors often find the anteriors align as the acrylic places pressure on the lingual, while the labial bow serves as a fulcrum.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(5, 'Removable and Fixed Appliances for Arch Development for the Lower Arch', '<p>Appliance selection for lower arch development is often determined by the type of arch constriction and patient compliance factors. Where some patients will wear and can tolerate two removable appliances, there are many times that a lower fixed appliance is preferred in combination with an upper removable arch development appliance to minimize the cooperation factor. The following are just a few of the more frequently prescribed lower arch development appliances.</p>\r\n\r\n<p>The Lower Schwarz is always a popular appliance choice due to the ease of placement and adjustment. Many doctors find that intercanine arch development can be obtained with the appliance but that limited molar width changes are achieved. The lower Schwarz is frequently used in combination with the upper Fan or Hinge appliance.</p>\r\n\r\n<p>The Lower Jackson is an excellent appliance choice for lower arch development. The main expansion body wire transmits the pressure effectively to the molars, premolars and cuspids. Lap springs are included for anterior development as the case progresses. The lower Jackson is most often used with an upper Schwarz appliance to develop both arches in young patients.</p>\r\n\r\n<p>Lower arch development with a fixed appliance is common in combination with a removable upper Schwarz when patient compliance with two removable appliances is questionable. The lower 3D Quad Action Mandibular is a frequent choice. The appliance is a modular fixed/removable for easy adjustment and allows the active appliance to be replaced with a holding arch without changing anchor bands.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(6, 'Fixed Jackscrew Appliances for Space Regaining', '<p>The jackscrew and the cemented band provide individual control of the teeth and the most precise method of calculating pressure at each adjustment. The 120 threads per inch provide minute adjustments &ndash; one complete turn of the nut will move the teeth one quarter of a millimeter when the pressure is expanded. Each adjustment will exert pressure and then retains the improvement. The intermittent pressure thus provides for periods of movement and rest. Proper circulation and minimal discomfort is assured&nbsp;<br />\r\n<br />\r\nFor unilateral applications, where premature loss of second primary molars has resulted in insufficient space for the second premolar. Jackscrew appliances are always under control and will only open the space to the point of adjustment of the nuts. After improvement, the appliance can be locked in position to retain.</p>\r\n\r\n<p><img alt=\"Jackscrew Design 1 - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Fixed-Jackscrew-Sp-Reg.jpg\" style=\"float:right; height:210px; width:220px\" />When distal movement of the first permanent molar is required with no movement of the first premolar, a lingual retaining arch can be included in the jackscrew design. Where tight contact points prevent band placement, rubber or wire separators can be placed one week prior to appliance insertion. This opens the contact points for band placement.</p>\r\n\r\n<p>Bilateral distal movement of first molars can be effected by a double jackscrew configuration. Anchorage is provided by a soldered lingual arch. Alternating the jackscrew adjustments, left then right, will provide cross-arch anchorage. The distal nut is rotated gently toward the tube until contact is made and slight pressure is exerted. The first nut is then held firmly in place with one wrench, while the second nut is carefully turned until it locks against the first.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Jackscrew Design 2 - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Fixed-Jackscrew-w-Reg.jpg\" style=\"float:right; height:214px; width:220px\" />Jackscrew Lingual Sagittal appliances are preferred for labial movement of lower anterior segments. The tube and sliding wire combination prevent any ride-up effect on the lingual of the anteriors. The nuts are usually adjusted twice each month. For each adjustment, the distal nut should be held firmly while the lock nut is loosened. Then, the distal nut may be gently rotated one full turn to reactivate the appliance. Avoid turning both nuts at the same time as this will strip the threads.</p>\r\n', '', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(7, 'Expansion Screws for Minor Tooth Movement and Space Management', '<p>Expansion Screws are frequently the auxiliary of choice due to their versatility, durability and precision. The gear mechanisms usually have expansion ranges from five to ten millimeters, depending on application. Many Doctors instruct their patient to adjust the gears at home, with the usual adjustment one-quarter turn or 90 degrees activation which is equal to &frac14; mm. Arrows indicate direction of adjustment for each gear. When subsequent visits of the patient display lack of appliance retention, the gear should be reversed slightly. The patient is instructed to increase wearing time to keep pace with adjustments or reduce the frequency of adjustments.</p>\r\n\r\n<p><img alt=\"Labial Movement of an Individual Anterior - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Anti-Crossbite-with-Gear---.jpg\" style=\"float:right; height:204px; width:220px\" />Labial movement of an individual anterior can result from pressure provided by a small, but effective, expansion screw. The gear is placed immediately lingual to the tooth to be moved. As the gear is activated, the acrylic is displaced labially against the tooth. Reciprocal anchorage is provided by the main body of acrylic and retentive clasping.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Labial Movement of Two or More Anteriors - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/P3152873.jpg\" style=\"float:right; height:217px; width:220px\" />Two or more anteriors can be moved to the labial by selectively sectioning the acrylic. A larger gear may be used depending on available space and number of teeth to be repositioned. The loops on the labial bow can be periodically opened to allow advancement of the anteriors and avoid restriction of movement. Typically, one millimeter of space is provided between the labial bow and the anteriors at each visit of the patient.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Distal Movement of an Individual Posterior - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Distalization-with-Gear.jpg\" style=\"float:right; height:218px; width:220px\" />Distal movement of an individual posterior can be effected by positioning the screw as detailed. In this instance, the clasp remains part of the sectioned acrylic, providing sufficient grasp of the tooth necessary to overcome appliance displacement. Depending on survey, bite blocks or planes may be included to enhance retention and/or to remove interferences.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><br />\r\n&nbsp;</p>\r\n\r\n<p><img alt=\"Distal Movement of an Individual Posterior 2 - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Gear-to-Regain-Sp-P80.jpg\" style=\"float:right; height:220px; width:220px\" /></p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Individual or groups of posteriors can be moved to the buccal by an expansion screw positioned and sectioned accordingly. When more movement is required on a particular tooth, the acrylic can be removed from the lingual of adjacent posteriors at the outset of treatment. Once the single posterior has advanced sufficiently, all posteriors will continue to move as a unit to complete the case.</p>\r\n', '', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(8, 'Bionator and Corrector Appliances for Arch Relationships', '<p>The Bionator and Orthopedic Corrector appliances offer an alternative to first bicuspid extraction on Class II cases with arch relationship discrepancies. The Bionator is designed to reposition the mandible forward, improving patient profile. Additionally, these appliances are intended to effect improvement in the patient&rsquo;s vertical; to close an anterior open bite, or, to open a deep bite. A construction bite is essential to the proper fabrication, fit and function of the appliance. The appliance is constructed to duplicate the mandibular repositioning and vertical opening achieved clinically with the wax bite. Again, patient cooperation is the key to successful improvement.</p>\r\n\r\n<p><img alt=\"Boinator to Open the Bite - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Bionator-to-Open-P-86.jpg\" style=\"float:right; height:236px; width:220px\" />The&nbsp;<em>Bionator to Open the Bite</em>includes a labial bow, midline screw, coffin wire, lingual wire and anterior acrylic cap. The anterior cap retards further anterior development while the posteriors are void of occlusal contact, free to develop vertically. Interproximal acrylic projections are intended to break the contacts posteriorly to further encourage vertical development. The midline gear extends the acrylic tongues interproximally on adjustment once each week.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>The Orthopedic Corrector to Open the Bite will include two additional gears positioned on each side of the appliance. This allows the mandible to be repositioned forward in stages as the patient may not be able to reach the desired position initially. When the case has progressed to the point that the gears are to be activated, the interproximal acrylic should be removed from the lower portion of the appliance that might prevent proper seating on reinsertion.</p>\r\n', '', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(9, 'Basic Space Maintenance with Fixed Appliances', '<p>Simple space maintainers can prevent adverse mesial movement of molars. The molar position can also be retained to allow use of the leeway space in cases of insufficient arch length. Modifications to the basic space maintainer can allow for minor Simple space maintainers can prevent adverse mesial corrections for molar distilization, or anterior advancement. Retainers can be constructed with lingual removable arch wires for ease of adjustment or for periodic removal and cleaning.</p>\r\n\r\n<p><img alt=\"Band and Loop Solution - Click for Larger Image\" src=\"https://www.ordont.com/images/frequently-prescribed/Band-&amp;-Loop-P3152.jpg\" style=\"float:right; height:221px; width:220px\" />The&nbsp;<em>Band and Loop</em>&nbsp;posterior&nbsp;<br />\r\nspace maintainer with a crib wire is effective on cases where the first and/or second deciduous molars have been lost. It anchors on the tooth mesial or distal of the space, and the horizontal sections of the wire are adjustable to assure&nbsp;<br />\r\na snug fit.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><br />\r\n<img alt=\"Fixed Lingual Retainer Solution - Click for Larger Image\" src=\"https://www.ordont.com/images/frequently-prescribed/Lingual-Space-Maint-P.jpg\" style=\"float:right; height:210px; width:220px\" />The&nbsp;<em>Fixed Lingual Retainer</em>&nbsp;is often preferred for both unilateral and bilateral space maintenance. This appliance affords superior retention without the possibility of loss of anchorage due to exfoliation of deciduous detention. Wire stops can be included to contact the distal of cuspids or laterals thus increasing the anchorage unit.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Nance Button Solution - Click for Larger Image\" src=\"https://www.ordont.com/images/frequently-prescribed/Nance---P3152910.jpg\" style=\"float:right; height:215px; width:220px\" />The&nbsp;<em>Nance Button</em>&nbsp;appliance is usually prescribed where the anterior section cannot provide anchorage either due to premature loss of deciduous anteriors or the existence of a deep bite prevents placement of the lingual wire. The lingual wire is contoured to the deepest portion of the vault and an acrylic button is processed to provide stability without compromising hygiene. The appliance illustrated, uses the 3D Modular fixed/removable attachment for cleaning.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Adjustable Loops Solution - Click for Larger Image\" src=\"https://www.ordont.com/images/frequently-prescribed/Lingual-w-Adj-Loops.jpg\" style=\"float:right; height:205px; width:220px\" />Adjustable loops can be added to the lingual arch design. Opening the loops individually can provide slight distal pressure on the molars. Simultaneous activation of both loops can slightly advance the anterior segment. The lingual wire can be constructed to allow the doctor to remove the arch for adjustments without removing the anchor bands. The Mershon attachments shown, incorporated a single post-sleeve arrangement for maximum stability and ease of placement.</p>\r\n', '', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(10, 'Appliances for Finger and Tongue Habit Control', '<p>Young patients exhibiting thumb and/or tongue habits can be encouraged to discontinue the habit by using a reminder appliance. The appliance assists in compliance by making the child more aware of a finger habit that has become second nature. Improper posturing of the tongue can be approached by a guard that guides the tongue to the proper position in the vault and protects the anteriors from further malalignment.</p>\r\n\r\n<p><img alt=\"Fixed Palatal Guard - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Fixed-Thumb-Habbit-P-65.jpg\" style=\"float:right; height:215px; width:220px\" />Many Doctors prefer a fixed appliance for finger habits. The most comfortable variation appears to the&nbsp;<em>Fixed Palatal Guard</em>. This appliance does not keep the digit out of the mouth, but prevents finger contact with soft palatal tissue. The satisfaction derived from sucking and tissue contact are removed, thus discouraging the habit.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Fixed Palatal Fence - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Fixed-Tongue-Hab-P-71.jpg\" style=\"float:right; height:210px; width:220px\" />The&nbsp;<em>Fixed Palatal Fence</em>prevents the finger from being placed in the mouth and therefore provides a solid reminder of the habit to the child. The appliance is usually anchored to bands cemented to either the second primary or first permanent molars. Both the Fixed Palatal Guard and the Fixed Palatal Fence are non-punitive approaches. This appliance will also serve as a tongue fence.</p>\r\n\r\n<p>The&nbsp;<em>Hayrake Palatal Guard</em>&nbsp;adds the additional aspect of projections to provide a more potent reminder of tongue and finger habits. This therapy is considered a punitive approach and is used when previous attempts have been unsuccessful in eliminating the persistent habit.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Fixed Palatal Fence - Click to Enlarge\" src=\"https://www.ordont.com/images/frequently-prescribed/Removable-Habit-Brk-P.jpg\" style=\"float:right; height:210px; width:220px\" /><em>Removable Tongue Habit</em>applications can be effective on cooperative patients or on adult cases. The wire fence protects the anterior segment and guides the tongue to the proper position in the vault. Doctors will also request a small hole in the deepest portion of the vault, providing an additional incentive for tongue positioning.</p>\r\n', '', '0000-00-00 00:00:00', '0000-00-00 00:00:00');


CREATE TABLE `problem_solution` (
  `ps_id` int(11) NOT NULL,
  `title` varchar(500) NOT NULL,
  `problem` varchar(1000) NOT NULL,
  `solution` longtext NOT NULL,
  `status` enum('0','1') NOT NULL DEFAULT '0',
  `created_at` timestamp NOT NULL DEFAULT CURRENT_TIMESTAMP,
  `updated_at` timestamp NOT NULL DEFAULT '0000-00-00 00:00:00' ON UPDATE CURRENT_TIMESTAMP
) ENGINE=InnoDB DEFAULT CHARSET=utf8;


INSERT INTO `problem_solution` (`ps_id`, `title`, `problem`, `solution`, `status`, `created_at`, `updated_at`) VALUES
(1, 'Anterior Crossbite', '\"Dear Ordont: I have a young patient with an anterior tooth in crossbite. I prefer to use a removable appliance with a finger spring. What is the usual spring design and size most often prescribed for labial advancement of an anterior?\"', '<p><strong>SOLUTION:</strong>&nbsp;When calculations indicate a deficiency in the space available through stripping, a review of the arch form may provide the key to alternate approaches. Often these cases display a pronounced collapse of the arch width anteriorly, resulting in a &quot;V&quot; shaped arch form. An arch width analysis shows a considerable deficiency in the first premolar and cuspid widths. By &quot;fanning&quot; the intercanine area, the arch length can often be increased to provide the necessary space for improvement without effecting the posterior occlusion.</p>\r\n\r\n<p><img alt=\"Anterior Crowding Solution - Click for a Larger Image\" src=\"https://www.ordont.com/images/problem-solution/Hinge-Gear-P3152898.jpg\" style=\"float:right; height:210px; width:220px\" />When presented with minor crowding and a &quot;V&quot; arch form in the adult dentition, many doctors prescribe an upper Removable Expansion Appliance with a Hinge-Gear. When activated, the gear opens the appliance in the anterior while the hinge, which is placed at the distal-most portion of the acrylic, holds the posterior closed.</p>\r\n\r\n<p>The patient is instructed to activate the appliance once each week. An arrow imbedded in the appliance indicates to the patient the direction in which the gear should be adjusted. Each adjustment provides one-quarter millimeter of activation. At each visit, the adjustment loops on the labial bow should be opened slightly to keep pace with the expansion.</p>\r\n\r\n<p>The labial bow serves as a fulcrum for rotations and as a guide for final alignment as the anteriors are moved by the acrylic on the lingual. However, finger springs are often included to assist in improving rotations. As the case progresses, slight stripping may be considered to finish the case and flatten the contact points for long-term stability.</p>\r\n\r\n<p>Expansion on adult cases often requires and indefinite retainer schedule. After active treatment, a retainer is usually worn for at least nine months and is re-inserted approximately once each month thereafter as a &quot;check guide&quot; against relapse. If it is difficult to seat, indefinite nighttime retainer wear is usually indicated.</p>\r\n\r\n<p>&nbsp;</p>\r\n', '0', '2018-09-14 18:30:00', '2018-09-15 15:06:53'),
(2, 'Anterior Crossbite Case 2', '\"I have a six-year old patient with a single tooth crossbite. Is this too early to address this problem? When do most doctors correct crossbites in young patients and what is the appliance of choice? Once corrected, what procedures should be used to prevent relapse?\"', '<p><strong>SOLUTION:&nbsp;</strong>Most doctors frequently indicate that crossbites should be corrected as soon as they are observed. A single anterior crossbite can, if left untreated, affect not only loss of space in the arch for this tooth, but also the growth pattern of the entire arch. Simple interceptive procedures at an early age can have a dramatic effect on the long-term dental health of the patient.</p>\r\n\r\n<p><img alt=\"Anterior Crossbite Case 2 Solution - Click for Larger Image\" src=\"https://www.ordont.com/images/problem-solution/Anti-Crossbite-with-Gear---.jpg\" style=\"float:right; height:204px; width:220px\" />One of the most frequently prescribed appliances for anterior crossbite is a Hawley Removable Appliance with Mini-Gear. The mini-gear mechanism has the advantage that the patient or parents can be instructed to activate the appliance at home, thus providing continuous pressure between visits. A key is provided with the appliance to activate the gear once approximately each three to seven days. The acrylic is moved labially against the lingual surface of the tooth with each adjustment. One turn of the gear provides approximately one-quarter millimeter of activation. A posterior bite block provides clearance for the lingually locked tooth. Where space has already been lost, appliance modifications can be included to assist in regaining the space needed.</p>\r\n\r\n<p>At the outset, most doctors will schedule their patients once a month to check the progress of the case. An appliance that does not seat fully usually indicates the need for more continuous wear. The gear is reversed until the appliance seats once again and the patient is instructed that the appliance should be worn at all times.</p>\r\n\r\n<p>The labial bow serves as a guide for final labial positioning as the case progresses. Once the anterior is out of crossbite, the appliance can be used as a retainer. The occlusal bite block can be removed and the gear stabilized with ligatures.</p>\r\n', '0', '0000-00-00 00:00:00', '2018-09-15 17:41:52'),
(3, 'Anterior Crowding in Adult Patients', '	   \"On adult cases with minor crowding in the upper anteriors, I often strip the interproximal surfaces for space to allow improvement of the esthetics. Occasionally, this approach does not provide the space needed. What appliance do doctors prescribe most in these situations?\"', '<p><strong>SOLUTION:</strong>&nbsp;When calculations indicate a deficiency in the space available through stripping, a review of the arch form may provide the key to alternate approaches. Often these cases display a pronounced collapse of the arch width anteriorly, resulting in a &quot;V&quot; shaped arch form. An arch width analysis shows a considerable deficiency in the first premolar and cuspid widths. By &quot;fanning&quot; the intercanine area, the arch length can often be increased to provide the necessary space for improvement without effecting the posterior occlusion.</p>\r\n\r\n<p><img alt=\"Anterior Crowding Solution - Click for a Larger Image\" src=\"https://www.ordont.com/images/problem-solution/Hinge-Gear-P3152898.jpg\" style=\"float:right; height:210px; width:220px\" />When presented with minor crowding and a &quot;V&quot; arch form in the adult dentition, many doctors prescribe an upper Removable Expansion Appliance with a Hinge-Gear. When activated, the gear opens the appliance in the anterior while the hinge, which is placed at the distal-most portion of the acrylic, holds the posterior closed.</p>\r\n\r\n<p>The patient is instructed to activate the appliance once each week. An arrow imbedded in the appliance indicates to the patient the direction in which the gear should be adjusted. Each adjustment provides one-quarter millimeter of activation. At each visit, the adjustment loops on the labial bow should be opened slightly to keep pace with the expansion.</p>\r\n\r\n<p>The labial bow serves as a fulcrum for rotations and as a guide for final alignment as the anteriors are moved by the acrylic on the lingual. However, finger springs are often included to assist in improving rotations. As the case progresses, slight stripping may be considered to finish the case and flatten the contact points for long-term stability.</p>\r\n\r\n<p>Expansion on adult cases often requires and indefinite retainer schedule. After active treatment, a retainer is usually worn for at least nine months and is re-inserted approximately once each month thereafter as a &quot;check guide&quot; against relapse. If it is difficult to seat, indefinite nighttime retainer wear is usually indicated.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(4, 'Functional Unilateral  Posterior Crossbite in Children', '\"I have had excellent results with the Schwarz appliance on mixed dentition cases requiring arch development. What modifications would you recommend for improving unilateral posterior crossbite? This case also has a deviation between the upper and lower midlines.\"', '<p><strong>SOLUTION:</strong>&nbsp;The Schwarz Expansion Appliance is frequently prescribed for the type of case. Most doctors indicate that unilateral&nbsp;<img alt=\"Functional Unilateral Posterior Crossbite in Children Image - Click to Enlarge\" src=\"https://www.ordont.com/images/problem-solution/Unilateral-Posterior-Crossb.jpg\" style=\"float:right; height:217px; width:220px\" />posterior crossbites are usually the result of a lateral shift of the mandible due to maxillary bilateral construction. A developed mandible with an underdeveloped maxillary arch results in a cusp-to-cusp posterior bite relationship at the rest position. On closure, the mandible shifts to one side into a bite of convenience or functional crossbite in order to attain interdigitation. This presents the deceiving appearance of unilateral construction and is usually evidenced by a deviation of the upper and lower frenums when fully closed. The upper arch is developed bilaterally so the posteriors can occlude in the proper lingual-buccal relationship. With the lateral shift averted, the labial frenums should align vertically on closure.</p>\r\n\r\n<p>The Schwarz Expansion Appliance is constructed with one or two large expansion gears and bilateral posterior bite blocks. The bite blocks allow use of the forces of mastication to provide positive pressure for development. The occlusal acrylic is ground flat to remove interferences and to allow the mandible to attain its proper relationship. The gears are adjusted once each four to seven days depending on the patient&#39;s initial response to the pressure. Auxiliary springs can be added for anterior alignment.</p>\r\n\r\n<p>Once the crossbite has been improved, the occlusal acrylic can be removed to reestablish good posterior coupling. Although some doctors feel that the occlusion will sustain the development, most will use the appliance as a retainer at night only for approximately six months after active treatment.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(5, 'Mesial Drift of the First Permanent Molar', 'SOLUTION: Most doctors will treat this type of case early to avoid possible adverse effect on developing premolars and second molars. If left untreated, the first molar may prevent the proper eruption of the bicuspids.', '<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Mesial Drift of the First Permanent Molar Solution - Click for Larger Image\" src=\"https://www.ordont.com/images/problem-solution/Distalization-with-Gear.jpg\" style=\"float:right; height:218px; width:220px\" />One frequently prescribed appliance is a Removable Appliance with Adjustable Distalizing Gear. Anchorage is provided by acrylic contact with the palatal vault as well as acrylic coverage on the occlusal. The posterior bite block also serves to avoid restriction of movement from the opposing posteriors.</p>\r\n\r\n<p>The gear is positioned just mesial to the molar to provide pressure to move the molar distally. An adjustment key provided with the appliance is used to activate the gear once each three to seven days. Most doctors will instruct the parents to adjust the appliance at home, thus providing continuous pressure between visits. One 90 degree turn of the gear provides approximately one-quarter millimeter of movement to the distal.</p>\r\n\r\n<p>The patient will become accustomed to the appliance if it is placed without pressure for the first week. After the initial adjustment, slight discomfort and displacement can be expected for approximately one week. The appliance should then seat comfortably.</p>\r\n\r\n<p>At the outset of the case, most doctors will schedule their patients once a month to check the progress of the case. An appliance that does not seat fully usually indicates lack of patient cooperation and the need for more continuous wear. The gear is reversed until the appliance seats once again and the patient is instructed that the appliance should be worn at all times.</p>\r\n\r\n<p>The time required for initial movement in response to pressure varies between individual patients, depending on the patient&#39;s cooperation and reaction to orthodontic pressure. Lack of movement on a given patient would usually indicate a need for a more extended period of pressure rather than a greater amount of pressure.</p>\r\n\r\n<p>Once the molar has been moved to the distal, a simple band and loop or lingual holding arch can be placed to maintain the molar position until eruption of the bicuspids.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(6, 'Mesio-labially Displaced Cuspids', '\"Dear Ordont: I have a case with a mesio-labially displaced upper cuspid. What auxiliaries do other doctors prescribe for moving cuspids disto-lingually when a removable appliance is preferred for realignment of the other anteriors?\"', '<p><strong>SOLUTION:&nbsp;</strong>Many doctors indicate that cuspids can be moved effectively using a removable appliance with direct bond buttons attached to the labial of the cuspids. Pressure for distal movement of the cuspids is exerted by the use of rubber ligatures placed from the buttons and extended distally to hooks on the molar clasps of the removable appliance.</p>\r\n\r\n<p><img alt=\"Mesio-labially Displaced Cuspids - Click to Enlarge\" src=\"https://www.ordont.com/images/problem-solution/P4232926_Mesio-labially.jpg\" style=\"float:right; height:192px; width:220px\" />The cuspid button is usually positioned in the middle third of the crown of the cuspid unless it is considerably tipped to the mesial in which case the button is positioned toward the cusp tip. The labial bow is normally brought from the labial to the lingual intreproximally between the cuspid and bicuspid. However, on cases involving cuspid retraction, soldering the bow to the molar clasps prevents interference with the cuspid, assists in lingual movement of the cuspid and avoids impingement of the ligature on the tissue. The appliance is retained with ball clasps between the bicuspids and adams clasps on the first molars.</p>\r\n\r\n<p>The patient will become accustomed to the appliance if it is placed without pressure for the first week. After the initial activation of the rubber ligatures, slight discomfort and displacement can be expected for approximately one week. The appliance should then seat comfortably.</p>\r\n\r\n<p>Rubber ligature pressure of approximately two ounces (4/16 or 5/16) is usually adequate and tolerable. As the cuspid moves distally, a smaller rubber ligature may be indicated to continue to maintain the same amount of pressure. Most doctors instruct their patients to change rubber ligatures nightly for optimal pressure and hygiene.</p>\r\n\r\n<p>The time required for initial movement in response to ligature pressure varies between individual patients, depending on the patient&#39;s cooperation and reaction to orthodontic pressure. Lack of movement on a given patient would usually indicate a need for a more extended period of pressure rather than a greater amount of pressure.</p>\r\n\r\n<p>Once the cuspid position is improved, the finger springs can be activated for improvement of the remaining anteriors. After active treatment, a retainer is usually worn for at least nine months and is reinserted monthly thereafter as a &quot;check guide&quot; against relapse.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(7, 'Protruded Anteriors  in the Self-Conscious Adult', '\"I have an adult patient who is interested in improving protruded anteriors and closing and accompanying diastema. The lower incisors do not interfere with the proposed movement. The patient is a highly visible professional and desires an appliance that is esthetic. What appliance do other doctors prescribe in this situation and what has been their experience with treatment duration?\"', '<p><img alt=\"Protruded Anteriors in the Self-Conscious Adult Solution - Click for Larger Image\" src=\"https://www.ordont.com/images/problem-solution/Hooks-for-Elastics.jpg\" style=\"float:right; height:205px; width:220px\" /><strong>SOLUTION:</strong>A simple Modified Hawley Removable Appliance with Hooks is frequently prescribed for anterior retraction on adult patients. Many doctors prefer Modified Hawley Removable Appliances for their adult patients because they are esthetic, require minimal chair time and are effective when worn regularly.</p>\r\n\r\n<p>A hook positioned at each cuspid allows the application of an elastic ligature on the labial of the anteriors that provides gentle, continuous movement to the lingual. The patient is instructed to change the ligature nightly for optimum pressure and hygiene.</p>\r\n\r\n<p>At each visit, the acrylic is reduced on the lingual on the incisiors only slightly so that the pace of improvement is controlled, thus providing for periods of movement and rest. The adjustment loops on the labial bow are closed periodically as the case progresses. The labial bow will then serve as a fulcrum for rotations and as a guide for final alignment as the anteriors are moved to the lingual.</p>\r\n\r\n<p>Treatment duration can vary widely as each patient reacts differently to orthodontic pressure. However, many doctors indicate that simple cases of anterior retraction with existing diastemas providing the needed space are often improved within six to nine months.</p>\r\n\r\n<p>After movement is complete, the elastics are discontinued and the loops on the labial bow are adjusted until the wire contacts the labial of the anteriors. The appliance is then worn as a retainer for at least nine months and is re-inserted approximately once each month thereafter as a &quot;check guide&quot; against relapse. If it is difficult to seat, indefinite nighttime retainer wear is usually indicated as a form of splint.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(8, 'Protruded Anteriors  in the Self-Conscious Adult', '\"Spring Retainer appliances are excellent for improving minor anterior rotations and require minimal chair time. However, some patients have difficulty keeping the appliance in place which results in a compliance problem\"', '<p><strong>SOLUTION:</strong>&nbsp;The Spring Retainer is a pre-adjusted appliance intended to improve minor anterior rotations. Pressure is built into the appliance for the desired movement, thus requiring little or no adjustment and minimal chair time. Another advantage of the Spring Retainer is that the active appliance can also serve as a post-treatment retainer, thus making this approach more economical for the patient.</p>\r\n\r\n<p>Before the appliance is constructed, a model is prepared by resetting the rotated anteriors into an ideal arch. Resetting teeth on the construction model can include one or more anterior teeth but is usually limited to the four incisors.</p>\r\n\r\n<p>The appliance is made to fit this new &ldquo;perfect arch&rdquo; with acrylic contacting both the lingual and labial surfaces of all anteriors. A wire &ldquo;spring&rdquo; connects these strips of acrylic to the remainder of the appliance and provides the flexibility needed to allow the appliance to seat properly. For space on cases of minor crowding, most doctors will slightly disk or strip the interproximal surfaces. This is usually done at the time the appliance is inserted to assure optimal use of the space.</p>\r\n\r\n<p>At the outset, slight discomfort and displacement can be expected for the first week. The appliance should then seat properly. However, when difficulty persists in seating the appliance or the appliance is continually displaced, the teeth may be rotated beyond the ability of the appliance to maintain good anchorage.</p>\r\n\r\n<p>To reduce the possibility of displacement, many doctors will prescribe four clasps on the appliance for superior retention; usually consisting of ball clasps interproximally between the bicuspids and adams clasps on both first molars. This is usually sufficient to overcome retention problems when only one or two teeth have been reset on the construction model.</p>\r\n\r\n<p>When all four incisors have been reset, the degree to which they can be rotated simultaneously is limited by how far the appliance can &quot;stretch&quot; to seat over these malaligned anteriors. When the amount of rotation is more severe, the four incisors can be reset only partially on the initial construction allowing for improvement in stages. Once the initial improvement has been realized, the construction model is modified to reset the teeth to a final ideal arch. The original appliance can be refined and then reinserted for additional movement.</p>\r\n\r\n<p>Once movement is complete, the appliance can then be used as a retainer for nine months and is reinserted approximately once each month thereafter, as a &quot;check guide&quot; against relapse, if it is difficult to seat, indefinite nightime retainer wear is usually indicated.</p>\r\n\r\n<p>&nbsp;</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(9, 'Difficulty Keeping Spring Retainer Appliances in Place', '\"Spring Retainer appliances are excellent for improving minor anterior rotations and require minimal chair time. However, some patients have difficulty keeping the appliance in place which results in a compliance problem\"', '<p><strong>SOLUTION:</strong>&nbsp;The Spring Retainer is a pre-adjusted appliance intended to improve minor anterior rotations. Pressure is built into the appliance for the desired movement, thus requiring little or no adjustment and minimal chair time. Another advantage of the Spring Retainer is that the active appliance can also serve as a post-treatment retainer, thus making this approach more economical for the patient.</p>\r\n\r\n<p>Before the appliance is constructed, a model is prepared by resetting the rotated anteriors into an ideal arch. Resetting teeth on the construction model can include one or more anterior teeth but is usually limited to the four incisors.</p>\r\n\r\n<p>The appliance is made to fit this new &ldquo;perfect arch&rdquo; with acrylic contacting both the lingual and labial surfaces of all anteriors. A wire &ldquo;spring&rdquo; connects these strips of acrylic to the remainder of the appliance and provides the flexibility needed to allow the appliance to seat properly. For space on cases of minor crowding, most doctors will slightly disk or strip the interproximal surfaces. This is usually done at the time the appliance is inserted to assure optimal use of the space.</p>\r\n\r\n<p>At the outset, slight discomfort and displacement can be expected for the first week. The appliance should then seat properly. However, when difficulty persists in seating the appliance or the appliance is continually displaced, the teeth may be rotated beyond the ability of the appliance to maintain good anchorage.</p>\r\n\r\n<p>To reduce the possibility of displacement, many doctors will prescribe four clasps on the appliance for superior retention; usually consisting of ball clasps interproximally between the bicuspids and adams clasps on both first molars. This is usually sufficient to overcome retention problems when only one or two teeth have been reset on the construction model.</p>\r\n\r\n<p>When all four incisors have been reset, the degree to which they can be rotated simultaneously is limited by how far the appliance can &quot;stretch&quot; to seat over these malaligned anteriors. When the amount of rotation is more severe, the four incisors can be reset only partially on the initial construction allowing for improvement in stages. Once the initial improvement has been realized, the construction model is modified to reset the teeth to a final ideal arch. The original appliance can be refined and then reinserted for additional movement.</p>\r\n\r\n<p>Once movement is complete, the appliance can then be used as a retainer for nine months and is reinserted approximately once each month thereafter, as a &quot;check guide&quot; against relapse, if it is difficult to seat, indefinite nightime retainer wear is usually indicated.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(10, 'Active Appliance Removal /  Single-Visit Retainer', '\"What techniques do other Doctors recommend for temporarily retaining improvement once models have been sent out for post-treatment retainer construction?\"', '<p><strong>SOLUTION:</strong>&nbsp;An active removable appliance can usually serve as a temporary retainer after some adjustment. All active components should be removed or deactivated. If the appliance contains an expansion gear, most doctors will use ligature wire to &ldquo;freeze&rdquo; the position of the gear. One end of the wire is passed through the hole in the gear and then threaded around one of the supporting posts. The two free ends are then twisted together, the excess wire is removed and the remaining and tucked away. The arch wire should be adjusted to contact the labial surface of all anteriors. Cold cure acrylic can be processed on the lingual of any teeth where voids might allow relapse.</p>\r\n\r\n<p>On fixed cases requiring temporary retention in preparation for retainers, one particular approach is simple yet effective. At the visit of the patient two to four weeks prior to bracket removal, doctors will remove the arch wire only. The brackets are left intact. Boxing wax is placed over the gingival tie wings and an impression is taken for the retainers. The boxing wax eliminates undercuts and prevents tearing and distortion of the impression. The impression material is removed and the arch wires are replaced to retain the case.</p>\r\n\r\n<p>Models are poured in the office and sent to the lab for construction of the retainers. The lab will remove the tie wings from the models and construct the retainers. Most good orthodontic technicians are familiar with the techniques required to work with these models and will return high quality retainers. The additional cost of prep at the lab is minimal and is well worth the peace of mind because now you can replace your patient&rsquo;s arch wires to temporarily retain the case.</p>\r\n\r\n<p>When the retainers are received from the lab, the patient is scheduled for appliance removal and retainer placement all in the same visit.</p>\r\n\r\n<p><img alt=\"Invisible Retainer - Click for Larger Image\" src=\"https://www.ordont.com/images/problem-solution/Invisible-Retainer.jpg\" style=\"float:right; height:213px; width:220px\" />These are several types of Temporary Retainers that can be made in the office. One type uses special vacuum formed sheets available for this purpose. Another is made to a standard arch form and is then molded in the office to fit each patient after immersion in hot water. Local dental supply companies often carry these items or call Ordont (800-325-3698) for a list of manufacturers.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(11, 'Finger Spring Adjustments', '“I frequently use Simple Removable Appliances on cases needing minor anterior alignment. What instrument do other doctors recommended for finger spring adjustments? What type of spring design is most often prescribed for rotation of an anterior?”', '<p><strong>SOLUTION:</strong>&nbsp;Most doctors recommend a #139 Bird Beak plier for most finger spring adjustments. Double helical finger springs are also recommended on the appliance to provide greater strength, full adjustment range, flexibility and control. The spring is activated by inserting the sharpened round end of the # 139 plier into the spring helical closet to the tooth to be rotated. The plier is rotated clockwise or counter-clockwise, depending on the direction of tooth rotation desired.</p>\r\n\r\n<p>Example: When rotating the mesial of a right central to the labial, the appliance is constructed with the open end of the spring positioned to the mesial. The # 139 plier is inserted in the helical closet to the tooth and serve as a fulcrum for rotation. Acrylic covering the spring protects it from biting forces and controls the direction of force.</p>\r\n\r\n<p>The spring is activated with a variance of 1 to 1 &frac12; mm between the active and passive positions to provide pressure of approximately two ounces which is usually adequate and tolerable. A series of light pressure adjustments over an extended period of pressure is more effective than a few heavy force adjustments.</p>\r\n\r\n<p>The patient will become accustomed to the appliance if it is placed without pressure for the first week. After the initial activation of the finger springs, slight discomfort and displacement can be expected for approximately one week. The appliance should then seat comfortably.</p>\r\n\r\n<p>After active treatment, a retainer is usually worn for at least nine months and is reinserted monthly thereafter as a &ldquo;check guide&rdquo;&nbsp;<br />\r\nagainst relapse.&nbsp;</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(12, 'Retention / Undercuts', '“Some of my patients, particularly the younger ones, appear to experience occasional retention problems with their removable orthodontic appliances. How do other doctors resolve this situation?”', '<p><strong>SOLUTION:</strong>&nbsp;Lack of retention with removable orthodontic appliances is expected during the first several weeks of treatment while the patient is adjusting to the appliance. For this reason, most doctors will not activate the appliance in this initial period. It should then seat comfortably without displacement, thus assuring patient compliance.</p>\r\n\r\n<p>When the orthodontic forces exerted are greater than the ability of the clasp to retain the appliance, the force is reduced. A series of light pressure adjustments may be required. Lack of movement on a particular case indicates the need for a more extended treatment period rather than increased force. For this reason, the forces can usually be reduced to improve retention with out compromising appliance effectiveness.</p>\r\n\r\n<p>On younger patients, short clinical crowns and minimal undercuts on permanent and primary molars often prevent retentive clasps from being applied effectively even with light forces. In this case, artificial undercuts can be created for the clasp to &ldquo;grasp&rdquo;. One such method involves disking a buccal undercut into the primary molar at the gingival border. If the primary teeth are expected to exfoliate shortly, undercuts on permanent molars are created by cementing a band with a buccal tube or applying a small portion of bonding material to the buccal of the tooth. The clasp can now be adjusted to take advantage of this new undercut to retain the appliance effectively during treatment.</p>\r\n\r\n<p>Retention problems that occur only after months of treatment are usually an indication that the appliance no longer represents the current condition of the case. In younger patients, changes are occurring that require appliance adjustments to keep place with both the orthodontic movement and natural development. This is particularly evident in arch development appliances like the Schwartz Expander. As the palatal vault takes on a more normal shape from the deep vault often seen in the initial stages, acrylic is when the appliance can not be adjusted sufficiently to regain retention, a new model is taken and the appliance and model are sent to the lab for revamp to the current condition. A Temporary Retainer can be placed to prevent relapse until the updated appliance returns (see Problems/Solutions-Relapse/Temporary Retainers).</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00'),
(13, 'Featured Appliance: Spring Aligner', 'Spring Aligner', '<p>Spring Aligned appliances are excellent for improving minor anterior rotations and require minimal chair time.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><img alt=\"Featured Appliance - Spring Aligner - Click to Enlarge\" src=\"http://ordont.com/images/Featured-Appliance_Spring.jpg\" style=\"float:left; height:206px; width:220px\" /></p>\r\n\r\n<p>The Spring Retainer is a pre-adjusted appliance intended to improve minor anterior rotations. Pressure is built into the appliance for the desired movement, thus requiring little or no adjustment&nbsp;<br />\r\nand minimal chair time. Another advantage of the Spring Retainer&nbsp;<br />\r\nis that the active appliance can also serve as a post-treatment retainer, thus making this&nbsp;<br />\r\napproach more economical&nbsp;<br />\r\nfor the patient.</p>\r\n\r\n<p>Before the appliance is constructed, a model is prepared by resetting the rotated anteriors&nbsp;<br />\r\ninto an ideal arch. Resetting teeth on the construction model can include one or more anterior teeth but is usually limited to the<br />\r\nfour incisors.</p>\r\n\r\n<p><a href=\"https://www.ordont.com/Featured-Appliance.htm#\"><img src=\"http://ordont.com/images/FA1-Crooked.jpg\" style=\"height:109px; width:200px\" /></a></p>\r\n\r\n<p>Place your cursor over the image<br />\r\nto see the corrected tooth position.</p>\r\n\r\n<p>The appliance is made to fit this new &ldquo;perfect arch&rdquo; with acrylic contacting both the lingual and labial surfaces of all anteriors. A wire &ldquo;spring&rdquo; connects these strips of acrylic to the remainder of the appliance and provides the flexibility needed to allow the appliance to seat properly. For space on cases of minor crowding, most doctors will slightly disk or strip the interproximal surfaces. This is usually done at the time the appliance is inserted to assure optimal use of the space.</p>\r\n\r\n<p>At the outset, slight discomfort and displacement can be expected for the first week. The appliance should then seat properly. However, when difficulty persists in seating the appliance or the appliance is continually displaced, the teeth may be rotated beyond the ability of the appliance to maintain good anchorage.</p>\r\n\r\n<p>To reduce the possibility of displacement, many doctors will prescribe four clasps on the appliance for superior retention; usually consisting of ball clasps interproximally between the bicuspids and adams clasps on both first molars. This is usually sufficient to overcome retention problems when only one or two teeth have been reset on the construction model.</p>\r\n\r\n<p>When all four incisors have been reset, the degree to which they can be rotated simultaneously is limited by how far the appliance can &ldquo;stretch&rdquo; to seat over these malaligned anteriors. When the amount of rotation is more severe, the four incisors can be reset only partially on initial construction allowing for improvement in stages. Once the initial improvement has been realized, the construction model is modified to reset the teeth to a final ideal arch. The original appliance can be refined and then reinserted for additional movement.</p>\r\n\r\n<p>Once movement is complete, the appliance can then be used as a retainer for nine months and is reinserted approximately once each month thereafter, as a &ldquo;check guide&rdquo; against relapse, if it is difficult to seat, indefinite nighttime retainer wear is usually indicated.</p>\r\n', '0', '0000-00-00 00:00:00', '0000-00-00 00:00:00');


ALTER TABLE `frequently_prescribed`
  ADD PRIMARY KEY (`fp_id`);


ALTER TABLE `problem_solution`
  ADD PRIMARY KEY (`ps_id`);


ALTER TABLE `frequently_prescribed`
  MODIFY `fp_id` int(11) NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=11;


ALTER TABLE `problem_solution`
  MODIFY `ps_id` int(11) NOT NULL AUTO_INCREMENT, AUTO_INCREMENT=15;
