R-Pouch: An Auxiliary in Thermoplastic Appliance for Easy Removal

Abstract

Sturdy adaptation of the thermoplastic appliances makes it difficult for the patient to remove the appliance from the teeth, often compromising their propensity toward treatment. Multiple aligner removal tools are available in the market to remove these appliances, necessitating the patients’ compliance to carry them. During the appliance removal, the hook of the aligner removal tool may impinge on the soft tissue. Hence, the present article describes a simple modification to the thermoplastic appliances by adding an auxiliary pouch that can out-turn into tool-free quick removal, enhancing patient compliance.

Introduction

Thermoplastic retainers aid in the retention of achieved orthodontic corrections with better esthetics, greater patient acceptance, and a better quality of life. ¹ The efficacy of thermoplastic appliances depends mainly on patient compliance to wear, maintain, and remove the appliance. Some patients find it difficult to remove the appliance from the teeth, thus discouraging them from cooperating with the treatment. Most of the patients either place their nails or hook of aligner removal tool at the buccal border area of the thermoplastic appliance for removal. ² This often pokes the gingiva, and at times the appliance does not come out easily due to the lack of grip to remove, causing great discomfort to the patient. Moreover, patients might even forget to carry their aligner removal tool and face issues while removing the appliance. To overcome this, we have described a simple, user-friendly clinical tip by adding an auxiliary pouch in the thermoplastic appliance for easy removal.

Fabrication

Trim the model’s bottom flat, approximately 5 mm gingival to the most contoured tooth. Using a cast marker, mark the appliance’s desired gingival margin. Draw an equilateral triangle (∼3 mm) bilaterally at the interpapillary zone, in both the anterior (between canine and first premolar) and posterior (between first and second molars) segments with the base directing gingivally, and the apex directing occlusally. Care should be taken to coincide the gingival outline of the appliance with the base of the triangle (Figure 1).

Figure 1.

Working Model with the Border and R-pouch Markings.

Apply and manipulate the blue-blocker material within the shape of the marked triangles without exceeding 1 mm thickness and cure it according to the manufacturer’s instructions (Figure 2A-C). Fabricate a thermoplastic tray over the working cast and trim it along the marked gingival outline such that the base of the triangle stands out 1 mm away (Figure 3).

Figure 2.

(A-C) Blue-Blocker in Position (1 mm in Thickness).

Figure 3.

R-pouches on the Thermoplastic Retainer.

Appliance Insertion

When inserting, advise the patient to start gently by pushing the appliance over their front teeth. Then apply pressure, using fingertips, bilaterally on the occlusal surface of molars (back teeth) until the retainer snap is felt and the appliance is seated in its place.

Appliance Removal

Advice the patient to place the tip of the index finger initially in the posterior auxiliary pouches bilaterally. Slowly, pull the appliance toward the occlusal direction by exerting uniform pressure on both the sides and repeat the same pulling method in the anterior slots (Figure 4).

Discussion

Most of the patients either use their nails or an aligner removal tool (plastic/stainless steel) to remove the thermoplastic appliance from the teeth. ² The nails or the hook of the aligner removal tool are placed between the gingival margin of the appliance and the buccal side of the teeth near the molars and pulled occlusally. ³ This often injures the gingiva, and sometimes the appliance lacks the grip for removal causing great discomfort to the patient. Moreover, it is not always possible for the patients to carry the aligner removal tool everywhere and hence face issues while removing the appliance.

Auxiliary pouches are now incorporated in the appliance at the buccal border area near the canine-premolar, and first to second molars of the thermoplastic appliance, which can be utilized as a convenient place for positioning the nails or tool for easy grip and removal. Auxiliary pouches placed away from the border interface prevent gum injury while taking out the appliance (Figure 4).

Figure 4.

Removal of the Thermoplastic Retainer Using the R-pouch.

Conclusion

R-pouch is a simple auxiliary incorporated into the thermoplastic appliance for hassle-free removal.