Rationale For Using The Loudon Chateau Repositioning (LCR) Appliance Many factors help the clinician decide which appliances he wishes to use in functional treatment. During diagnosis and treatment planning, the order of importance should be: 1. T.M.J. 2. Esthetics 3. Habits and etiological Problems 4. Functional treatment 5. Fixed treatment Since the LCR Appliance is used mostly in children under 16 years of age, and since repositioning depends on remodeling and growth, many temporomandibular problems are not only prevented, but proper positioning of the condyles is obtained with the added benefit of permanent mandibular advancement and subsequent fossa and condylar remodeling. Thus satisfying T.M.J. health requirements. Esthetics are also a vital objective of orthodontics and here we need to be very careful in using our skills to obtain maximum correction with the accent on developing beautiful faces. When we know that the maxilla is in the proper position while the mandible is retruded, can we judge to protrude the mandible placement with a mandibular repositioning appliance. Careful records, analysis, skill, judgement and treatment planning are needed in planning for mandibular advancement.
Laboratory Procedure (for orthodontic lab)
Figure 14 28
1. Mount models with the retruded bite using a flexible, open posterior spring single articulator (lower mandibular plaster model must have enough flexibility to come ahead and reach the cingulum of the maxillary centrals). 2. Fit maxillary bands to place. Four anchors are desired. 3. Bend and fit .045 wire to the lingual of the maxillary centrals and touching the lingual of the maxillary centrals in the desired ramp position (figure 10). 4. Bend and fit anterior Chateau .030 wire, cut off and flatten portion which will fit onto .045 skeleton. Also, the area of attachment to the .045 wire should be flattened for easier welding. The two wire loops should be no more than 8 mm long. 5. Spot weld the anterior .030 wire to the .045 wire (centered) in back of the centrals. These welds will be soldered later. 6. Sticky wax as shown and solder at junction of .030 ramp wire and bands (Figure 11). 7. Finish and polish solder joints. 8. Put beeswax box around anterior .030 wire. 9. Puff in, cure and finish anterior acrylic guide plate (Figure 6). Note the thin (3 to 4 mm) as well as the narrow anterior acrylic plate is usually no wider than the middle of the maxillary laterals. The posterior tip of the acrylic pad must be behind the furthermost retruded position of the mandibular centrals and laterals as the patient closed. The ramp needs to be tapered slightly as it extends occlusally (Figure 13 and 14). 10. Finish and polish the appliance. 11. 3M, MIA attachments, other lingual Mershon sheaths, attachments, etc., can be used. However, the author has found that the soldered appliances are very stable, durable and stay very firmly in place the necessary 10 months of fixed wear. The soldered .045 wire is preferable because of its strength. 12. The appliance can easily be made with the Wilson 3D-DYS 3 mm modules. However, the base wire needs to be increased (soldered) from .040 to .045, and the occlusal wire also needs to be changed (soldered) to .045. IJO