Securing the ALF in the Patient's Mouth

Strategic Placement of Resin Ledges 

There is a fine line between keeping the ALF securely in the patient’s mouth and making it a struggle to get it out. You know what I am talking about …

GENERAL TIPS ABOUT RESIN LEDGES 

• Place resin BEFORE activating/adjusting the ALF. It is easier to bond ledges against a body wire that is passive.
• Material: I like Premise Flowable because it flows easily yet holds its shape.
• Thickness: the ledge should be covering the wire when you look straight down and taper off towards the occlusal/incisal surface.
  
• After placing a resin ledge, the body wire gets stuck to the resin. Take an instrument and push the wire away from the resin. You will hear a little "click" sound and should see the wire moving. Unless you do this, the wire sometimes causes the resin to pop off. (You don't have to do this for a resin ledge which holds a crib in place). 

You need to secure the ANTERIOR as well as the POSTERIOR part of the appliance.

POSTERIOR

• Most of you probably place resin ledges buccal on the cribbed teeth. That’s a good start. 
  
  
• Here is what can make a huge difference:
  Add resin ledges on the lingual surface of the teeth adjacent to the cribbed teeth.
     
  
  

ANTERIOR 

• A long, unsupported wire span between the cribs and the incisors will cause the anterior part of the body wire to slide along the cingula towards the incisal edges. You will not achieve the anterior arch development needed.
  
  Let's look at two scenarios:
• 1. If the appliance does not have retentive canine crescents, place resin ledges on the canines.
     
• 2. If your design has three anterior loops, place resin on the canines and either central or lateral incisors.
     
  Placing that many resin ledges makes for a long session. Schedule time accordingly. Depending on the stamina of your patient, deliver one appliance at a time.

 REMOVAL

• Start by dislodging the body wire lingually from underneath the resin ledges on the teeth adjacent to the cribbed teeth.
  
  Next, dislodge the body wire lingually from underneath the resin ledges on the anterior teeth.
  
  

  Finally, lift the cribs from the lingual to disengage them from the buccal resin dot, one side at a time.

  
  
  
  

Ledge Placement on Pedo Appliances

• These are suggestions - modify as you see fit.
     

                Ljuba Lemke

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The ALF online seminar is now also available to osteopathic physicians and orofacial myofunctional therapists at a reduced price. Please inquire about the discount coupon.