COMBINED CIRCUIT BREAKER AND DISTRIBUTION SWITCH
A combined orthodontic appliance for maxillary expansion and distalization reduces treatment time and discomfort by integrating expansion and distalization functions in a single device, using a single impression, thus addressing the inefficiencies of sequential appliance use.
Patent Information
- Application Number
- FR2023011909
- Authority / Receiving Office
- FR · FR
- Patent Type
- Patents
- Current Assignee / Owner
- Filing Date
- 2023-11-01
- Publication Date
- 2026-02-13
- Estimated Expiration
- 2043-11-01
AI Technical Summary
Combining maxillary expansion and distalization treatments in orthodontics requires separate appliances, leading to increased treatment time and patient discomfort due to sequential use of a palatal expander and distalizer, necessitating multiple impressions and a prolonged stabilization period.
A combined orthodontic appliance that integrates a central retractor with expansion screw and symmetrical retention arms for maxillary expansion, followed by distalization through a single device without requiring removal or additional impressions, utilizing a single impression for both functions.
Simultaneously addresses maxillary expansion and distalization, reducing treatment time and patient discomfort by eliminating the need for sequential appliance use and prolonged stabilization periods, while being cost-effective.
Smart Images
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Abstract
Description
Title of the invention: COMBINED CIRCUIT BREAKER AND DISPLACER FIELD OF INVENTION
[0001] The present invention relates to an orthodontic device that combines both the functions of a breaker and a distalizer. EARLIER ART
[0002] The jaws are two opposable bony structures that form the mouth.
[0003] In mammals, the lower jaw or lower maxillary dental arch corresponds to the mobile component, we speak of the “mandible”.
[0004] The upper jaw, or maxillary dental arch, is more or less attached to the skeleton. This is called the "maxilla" and is composed of two bones fused along the midline by a suture. The maxillary bones form the roof of the mouth, the floor.
[0005] In some cases, this upper jaw may be too narrow. This is the case, for example, with a high-arched palate, which is a malformation associated with a narrow, deep palate that constricts the nasal passages. Such a malformation can result from genetic disorders such as Crouzon syndrome, Down syndrome (trisomy 21), or Turner syndrome. It should be noted that, in addition to the aesthetic issue for the patient, such a malformation can also affect the quality of their breathing.
[0006] To remedy such a narrow maxillary arch, maxillary expansion is performed, which restores the balance between the width of the jaws (maxilla and mandible) and, simultaneously, facilitates the passage of air into the nasal cavity. In adults, this maxillary expansion is performed using a surgical technique called Surgically Assisted Rapid Palatal Expansion (SARAP). Now, this maxillary expansion is also possible in children through an orthodontic procedure without surgical intervention due to the palatal suture not yet being healed. The technique used in children relies on an orthodontic appliance called an intermaxillary expander or palatal expander.
[0007] This palatal expander is fixed to the right and left permanent molars of the maxillary arch by bands. The right and left bands of the palatal expander are connected, by retention arms, to a central retractor incorporating an expansion screw allowing its activation (i.e., its retraction).
[0008] Activation of the palatal expander generally occurs 1 to 2 times per day and generates a force that separates the two palatal bones at the intermaxillary suture, at a rate of approximately 1 to 2 mm per day. This period The activation phase typically lasts 2 to 4 weeks and is followed by a retention period (approximately 3 months) during which the appliance remains in the mouth, but without further activation of the expansion screw. This retention period is essential to allow calcification of the intermaxillary suture opening area and thus stabilization of the maxillary expansion.
[0009] Figure 1 shows a palatal expander of the anterior artery consisting of two bands (B) positioned at the level of teeth 16 and 26 (first molar), to which retention arms (BR) are welded. These retention arms bear on the palatal surface of the teeth. These retention arms allow coupling between the bands (and the bearing surfaces on the teeth) and a central retractor (E) comprising an expansion screw (VE). The central retractor (E) is progressively and periodically activated by means of a key that turns the expansion screw (VE) of the central retractor (E), thus separating the maxillary arch (AM). It should be noted that, in some cases, the palatal expander may comprise not two, but four bands positioned at the level of teeth 14 and 24 (first premolar) and teeth 16 and 26 (first molar).
[0010] Now, it is sometimes necessary to perform other corrections to the maxilla in addition to this disjunction. It may thus be necessary to improve the relative position of a series of teeth. Such a correction is, in this case, achieved using a distalizer, which is a separate orthodontic appliance designed to move one or more teeth back. Distalization techniques will differ depending on the tooth or teeth to be treated, with dedicated orthodontic devices for each.
[0011] Distalizer-type devices intended to move back a succession of several teeth from a molar are thus known and are described in particular in European patents EP 1 433 435 Bl, EP 1 649 824 Bl, EP 1 681 033 B1 and EP 3 560 453 B1 and in French patent FR 2 979 225B1.
[0012] For patients requiring intermaxillary disjunction and maxillary distalization, practitioners will therefore have to combine these two appliances (disjunctor and distalizer). However, such a combination, besides requiring an impression for each appliance, will primarily result in a significant increase in treatment time. Indeed, it will be necessary to complete the intermaxillary disjunction, leaving the palatal disjunctor in place until the intermaxillary suture area has calcified, before removing the palatal disjunctor and inserting the distalizer to initiate the distalization.
[0013] It goes without saying that the consecutive placement of two devices and the associated treatment time constitute significant inconveniences for patients.
[0014] SUMMARY OF THE INVENTION
[0015] Faced with this problem, the inventor has now developed a new device that combines the functions of a breaker and a distalizer. The device is capable of performing a disjunction and then, once this has been completed, of performing distalization without compromising the immobilization of the maxillary arch necessary for calcification of the opening of the intermaxillary suture.
[0016] The device according to the invention makes it possible to treat these two orthodontic problems simultaneously, which were usually treated one after the other using a palatal expander and then a distalizer. Treatment time is thus reduced, as distalization can be initiated without having to wait for the end of the maxillary expansion stabilization period, which lasts at least 3 months. Consequently, discomfort for the patient is significantly reduced.
[0017] The device according to the invention is also less expensive than the two devices. It requires only one initial impression by the practitioner and no removal of this device is necessary when transitioning from disjunction to distalization.
[0018] Consequently, a first object of the invention relates to an orthodontic appliance, suitable for fitting onto the maxilla of a patient, comprising:
[0019] A) at least one central retractor incorporating an expansion screw allowing its retraction and the subsequent retraction of the patient's maxillary arch, which central retractor is integral with:
[0020] A1) A first symmetrical pair of posterior retention arms, each retention arm of which is coupled to a ring of a first pair of rings allowing the device to be fixed to the right and left permanent molars of the patient's maxillary arch,
[0021] A2) At least one symmetrical pair of anterior retention arms that comes in support on the palatal surface of teeth in front of the right and left molars to which the first pair of right and left rings are fixed;
[0022] Characterized in that:
[0023] - the device further comprises A3) A second symmetrical pair of retention arms posterior, each of whose retention arms is formed of two distinct segments with a first segment coupled to a ring of the first pair of rings and a second segment coupled to the central spreader, which first and second segments are associated by a joint;
[0024] And
[0025] - at least one of the rings of the first pair of rings also constitutes the distal element of an assembly for the distalization of a succession of several teeth from the molar on which this ring is fixed, which assembly comprises at least two elements.
[0026] Advantageously, the device further comprises at least B) a distalization assembly comprising at least two elements.
[0027] A second object of the invention relates to a kit comprising a device as described above, at least one retainer element for attachment to a mandibular tooth, and at least one return element for coupling the distalization assembly and the retainer element to enable distalization. DESCRIPTION OF FIGURES
[0028] Fig. 1 shows a palatal expander according to the prior art.
[0029] Figure 2 shows an embodiment of the apparatus according to the invention, after its placement on the patient's maxilla, and before starting the first phase of disjunction.
[0030] Fig. 3 shows the same embodiment of the device according to the invention, at the end of the first phase of disjunction.
[0031] Figure 4 shows the same embodiment of the apparatus according to the invention, at end of the first phase of disjunction.
[0032] Figure 5 shows a preferred embodiment for the distalization assembly to be integrated into the orthodontic appliance according to the invention. DETAILED DESCRIPTION OF THE INVENTION
[0033] Retractors adapted for disjunctive maxillary arches are well known to those skilled in the art and take the form of a jack. As explained previously, these retractors (e.g., HYRAX retractor; DENTAURUM) consist of two parts (right and left) connected by an expansion screw. This expansion screw has at least two holes (generally four, spaced 45° apart). Inserting a wrench into the accessible hole of the expansion screw allows the expansion screw to be moved by rotating the wrench, which activates the retractor and thus widens the maxillary arch. Examples of such spacers include those described in PCT applications WO9302629, WO9520924, WO9810708A1, WO03071976A1, WO2008141314A1, WO 2012 / 120447 and WO2016120897.
[0034] Advantageously, the expansion screw of the retractor includes a stop. Such a stop prevents disjunction once the desired retraction value for the maxillary arch is reached and, preferably, prevents dislocation of the retractor.
[0035] Advantageously, the spreader may include a non-return system. Such a non-return system ensures safe and effective disconnection by preventing improper handling of the expansion screw.
[0036] The spreader may further include a visual marker indicating to the user the direction of rotation of the expansion screw. Such a visual marker may be simply materialized by an arrow. Such an arrow can be made during the manufacture of the spreader or, subsequently, by laser marking.
[0037] The retention arms used in circuit breaker-type devices are well known to those skilled in the art. They are rigid elements in the form of metal wires of a suitable cross-section (diameter 1 mm or more). During device placement, the practitioner can easily adjust the shape of the retention arms by bending them.
[0038] Advantageously, each retention arm of the first symmetrical pair of posterior retention arms shall include one or more predetermined breaking points along its length. Preferably, each of these retention arms shall include at least two predetermined breaking points, with the first located near the central retractor and the second located near the ring to which this retention arm is coupled. In this way, and once the disjunction value is reached, the practitioner may remove this retention arm to enable distalization. Following this removal of the first symmetrical pair of posterior retention arms, the practitioner may, simply and using the instruments at their disposal, eliminate the sharp edges of the breaking point(s) used, so as not to risk injuring the patient.
[0039] The bands of the first pair of bands are advantageously fixed to teeth 16 and 26 (first molar). The size of these bands is defined, for each patient, according to the size of the tooth to be encircled. Each band is then forced onto the teeth by the practitioner and adjusted around the corresponding molar.
[0040] Advantageously, and as reinforcement, the left (posterior and anterior) retention arms and / or the right (posterior and anterior) retention arms are connected by a palatal reinforcement wire. Such a palatal reinforcement wire typically takes the form of a rigid metal wire (e.g., REMALOY wire, romanium, 0-1.0 mm) which is attached (e.g., by laser welding) to the left and / or right (posterior and anterior) retention arms. Preferably, this palatal reinforcement wire rests against the palatal surface of the adjacent teeth. Such support allows for a better distribution of the expansion forces and improves the effectiveness of the corresponding orthodontic appliance.
[0041] Advantageously, and in the case where the device according to the invention incorporates such a palatal reinforcement wire, this palatal reinforcement wire will include one or more predetermined breaking points along its length. Preferably, this palatal reinforcement wire includes at least two predetermined breaking points, with the first located near the posterior retention arm and the second located near the anterior retention arm. In this way, and once the disjunction value is reached, the practitioner can remove this palatal reinforcement wire at the same time as installing the distalization device. This removal is indeed essential to make the distalization. Following this removal of the palatal reinforcement wire, the practitioner can, simply and with the aid of the instruments at his disposal, eliminate the angles of the point(s) of rupture used, so as not to risk injuring the patient.
[0042] In connection with the support of the anterior retention arm pair, such support may take the form of a second pair of bands, in this case generally fixed to teeth 14 and 24 (first premolar). This support will preferably take the form of a rigid metal wire, typically an extension of the palatal reinforcement wire in front of the anterior retention arm when such a palatal reinforcement wire is present. This rigid metal wire typically rests on the palatal surface of teeth 14 and 24 (first premolar) and may extend onto the palatal surface of teeth beyond (at least 13 and 23). Preferably, each anterior retention arm is coupled to a rigid metal wire (e.g., by welding), corresponding to an extension of the palatal reinforcement wire when present, which rests on the palatal surface of at least one tooth in front of this anterior retention arm.
[0043] In cases where the support of the anterior retention arm pair on the palatal surface of teeth anterior to the right and left molars to which the first pair of right and left bands are attached takes the form of a rigid metal wire, this palatal support may be coupled to a complementary occlusal support (on the top of the teeth). This occlusal support prevents the appliance from sinking (apically) into the tissues. Preferably, each rigid metal wire that rests on the palatal surface of at least one tooth anterior to the anterior retention arm is coupled to at least one second rigid metal wire (e.g., by welding) which constitutes an occlusal support. To further improve the retention of the appliance according to the invention, such an occlusal support may be bonded to the tooth.
[0044] Regarding the second symmetrical pair of posterior retention arms, its two articulations (one for each arm of this second pair of posterior retention arms) are essential for the distalization phase.
[0045] Once the disjunction phase is complete, the practitioner removes the first pair of posterior retention arms (and any associated palatal reinforcement wires). This removal allows the braces on the two joints of this second, symmetrical pair of posterior retention arms to be unfrozen. These two joints then provide the appliance with an additional degree of freedom (allowing articulation at the level of the bands) necessary for distalization, while maintaining the maxillary arch spacing required for the disjunction retention phase.
[0046] Advantageously, each joint takes the form of a ball joint and, preferably, a spherical ball joint.
[0047] Regarding distalization, it has been previously specified that at least one of the rings of the first pair of rings constitutes the distal element of an assembly for the distalization of a succession of several teeth from the molar on which this ring is fixed, which distalization assembly comprises at least two elements.
[0048] Such distalization assemblies comprising at least two elements and intended to move back a succession of several teeth from a molar are well known to those skilled in the art and are described in particular in European patents EP 1 433 435 B1 and EP 3 560 453 B1 and in French patent FR 2 979 225B1.
[0049] In order to perform the distalization, a return device is attached to the anterior part of the distalization assembly (generally an elastic band closed on itself) and to a retention element (generally a plate with a hook) fixed to a tooth of the mandible according to a known classic arrangement.
[0050] According to a first embodiment, and based on the teachings of patent EP 1 433 435 Bl, such a distillation assembly would comprise:
[0051] 1) a distal element comprising a ring fixed to the molar with, on its face vestibular, a coupling box, and
[0052] 2) a mesial element which can be fixed by its base to a canine (e.g. glue or cement) in front of the molar, which mesial element comprises an anterior projection having an external part that allows the retention of an elastic element (to which this assembly is associated to allow distalization) and an arched posterior projection ending in a spherical joint at its end,
[0053] Where the spherical joint of the mesial element is introduced into the coupling housing of the distal element.
[0054] The details of the possible structures of the mesial element and the coupling housing are described in detail in patent EP 1 433 435 Bl and are therefore not described further here.
[0055] According to a second embodiment, and based on the teaching of French patent FR 2 979 225B1 (the following numerical references are those used in this French patent), such an assembly for distalization would comprise:
[0056] 1) a distal element, corresponding to the rear head of the distalization assembly, including a ring fixed to the molar and provided, on its vestibular surface, with a mounting accessory which includes a sheath;
[0057] 2) a front fixing head which includes an adapter plate on a canine tooth and an angled rod that supports this plate; and
[0058] 3) an intermediate element comprising an anteroposterior arm and two joints opposite each other on the anteroposterior arm, one joint of which connects the anteroposterior arm with the anterior fixation head and the other The articulation connects the anteroposterior arm with the mounting accessory fixed to the vestibular face of the ring.
[0059] In this embodiment, a portion of the bent stem opposite the intermediate element is globally projecting and forms an attachment hook for a return element of the overall distalization assembly towards the rear.
[0060] The following examples are provided for illustrative purposes only and shall not limit the scope of the present invention.
[0061] Performing a successive disjunction and distalization on the maxilla of a patient
[0062] In a first phase, the practitioner takes an impression of the patient's maxilla.
[0063] This impression allows the production of an orthodontic appliance according to the invention (1) having the dimensions adapted to be placed at the level of this maxilla and, also, to allow the desired disjunction and distalization.
[0064] Once the orthodontic appliance (1) has been made, the practitioner will place it on the patient's maxilla.
[0065] Figure 2 shows an orthodontic appliance according to the invention (1) for the first phase of distalization. This appliance consists of two bands (3) positioned at the level of teeth 16 and 26 (first molar), to which are welded a first symmetrical pair of posterior retention arms (5) and a second symmetrical pair of posterior retention arms (6), each of which includes a ball joint (7). These retention arms (5, 6) allow coupling between the bands (3) and a central retractor (2) comprising an expansion screw (4). The central retractor (2) is integral with a symmetrical pair of anterior retention arms (8) which bear against the palatal surface of teeth anterior to the right and left molars to which the first pair of right and left bands (3) are fixed. A palatal reinforcing wire (9) connects the arms of the first symmetrical pair of posterior retention arms (5) to the arms of the symmetrical pair of anterior retention arms (8).An extension of the palatal reinforcement wire (10) in front of the anterior retention arm rests against the palatal surface of the teeth. This extension of the palatal reinforcement wire (10) is coupled to an occlusal rest (11) in the form of a rigid metal wire. The central retractor (2) is progressively activated daily by means of a key that turns the expansion screw (4) of the central retractor (2), thus widening the maxillary arch (MA) until the desired value is reached.
[0066] Figure 3 shows this same device (1) according to the invention at the end of the disjunction phase of the maxillary arch (MA).
[0067] As illustrated in [Fig. 4], the practitioner then proceeds to remove the first symmetrical pair of posterior retention arms (5) so as to remove the restraint on the two ball joints (7) of the second symmetrical pair of posterior retention arms (6). The device according to the invention thus maintains the maxillary arch (MA) spacing during the retention phase. The practitioner then removes the palatal reinforcement wire (9) connecting the retention arms of the first pair of posterior retention arms (5) to the pair of anterior retention arms (8). Removing this connection is necessary to allow distalization. To perform this distalization phase, the practitioner sets up the assembly for distalizing a series of teeth, starting with the molar to which the band (3) is attached. This band includes a mounting accessory (13) that connects to an anteroposterior arm (19), which anteroposterior arm (19) is connected to an anterior fixation head (15) fixed to a canine.
[0068] To perform distalization, the practitioner places a retainer on a mandibular molar below the distalization assembly and connects this retainer and the anterior portion of the distalization assembly with a return mechanism to allow distalization. Such a retainer takes the form of a mounting plate with a hook, and the return mechanism takes the form of an elastic band.
[0069] After a period of at least 3 months, which allows the retention phase of the disjunction to be finalized and, simultaneously, the distalization phase, the practitioner can remove the device from the patient's maxilla.
[0070] The preferred embodiment of the distalization assembly (12) is described in [Fig. 5] and includes in detail:
[0071] 1- the ring (3) fixed on the molar, and to which the retractor (2, not represented in this figure), provided on its vestibular face (V) with a mounting accessory (13) which includes a sheath (14)
[0072] 2- a front fixing head (15) which includes an adapter plate (16) on a canine and an angled stem (17) which carries this plate (16). A portion of this angled stem (17) forms a hook (18) for attaching a recall organ of the entire distalization assembly (12) generally towards the rear.
[0073] 3- an intermediate assembly comprising an anteroposterior arm (19) and two joints (20, 21) opposite each other on the anteroposterior arm (19) of which one joint (20) associates the anteroposterior arm (19) with the front fixing head (15) and the other joint (21) associates the anteroposterior arm (19) with the mounting accessory (13) fixed on the vestibular face (V) of the ring (3).
[0074] List of references
[0075] 1: orthodontic appliance
[0076] 2: spreader
[0077] 3: rings of the first pair of rings
[0078] 4: expansion screw of the spreader
[0079] 5: retention arm of the first symmetrical pair of posterior retention arms
[0080] 6: retention arm of the second symmetrical pair of posterior retention arms
[0081] 7: articulation of the retention arms of the second symmetrical pair of arms posterior retention
[0082] 8: arm of the symmetrical pair of anterior retention arms
[0083] 9: palatal reinforcing wire connecting the arms of the first symmetrical pair of arms of posterior retention arms of the symmetrical pair of anterior retention arms
[0084] 10: extension of the palatal reinforcement wire in front of the anterior retention arm, which rests against the palatal surface of the teeth
[0085] 11: occlusal support
[0086] 12: distalization assembly
[0087] 13: mounting accessory
[0088] 14 sheath
[0089] 15: front fixing head
[0090] 16: adapter plate
[0091] 17: bent stem
[0092] 18: attachment hook of a return organ of the distalization assembly formed by the bent stem
[0093] 19: anteroposterior arm
[0094] 20: joint connecting the anteroposterior arm (19) with the front fixing head (15)
[0095] 21: joint connecting the anteroposterior arm (19) with the mounting accessory (13) fixed on the vestibular face (V) of the ring (3).
Claims
1. Demands A kit comprising an orthodontic appliance (1) suitable for fitting onto the maxilla of a patient, including A) at least one central retractor (2) incorporating an expansion screw (4) allowing its retraction and the subsequent retraction of the maxillary arch (MA) of the patient, which central retractor (2) is attached to: A1) A first symmetrical pair of posterior retention arms (5), each retention arm (5) being coupled to a ring (3) of a first pair of rings (3) allowing the fixation of the device (1) on the right and left permanent molars of the maxillary arch (MA) of the patient, A2) At least one symmetrical pair of anterior retention arms (8) which rests on the palatal face of teeth in front of the right and left molars to which the first pair of rings (3) right and left are fixed; Characterized in that said kit further includes: - at least one distalization set comprising at least two elements, - at least one retaining element intended to be fixed to a tooth of the mandible, - at least one return element intended to couple the distalization assembly and the retention element to allow distalization, in that said A) at least one central retractor (2) of the orthodontic appliance 1) is also integral with: A3) A second symmetrical pair of posterior retention arms (6), each retention arm (6) being formed of two distinct segments with a first segment coupled to a ring (3) of the first pair of rings (3) and a second segment coupled to the central spreader (2), which first and second segments are associated by a joint (7); in that each retention arm (5) of the orthodontic appliance 1) includes one or more predetermined breaking points in its length; in that at least one of the rings (3) of the first pair of rings (3) also constitutes the distal element of an assembly for the distalization (12) of a succession of several teeth from the molar on which this ring (3) is fixed; in that said assembly for distalization comprises: - a distal element corresponding to at least one of the rings (3) of the first pair of rings (3) configured to be fixed on the molar with, on its vestibular face, a coupling box, and a mesial element which can be fixed by its base to a canine in front of the molar, which mesial element comprises an anterior projection having an external part which allows the retention of an elastic element and an arched posterior projection ending in a spherical joint at its end, where the spherical joint of the mesial element is introduced into the coupling box of the distal element; or - 1) a distal element, corresponding to the rear head of the distalization assembly (12), comprising at least one of the rings (3) of the first pair of rings (3) which is configured to be fixed on the molar and provided, on its vestibular surface, with a mounting accessory (13) which includes a sleeve (14);2) an anterior fixation head (15) which includes an adaptation plate (16) on a canine and an angled stem (17) which carries this plate; and 3) an intermediate element comprising an anteroposterior arm (19) and two joints (20,21) opposite each other on the anteroposterior arm, one joint (20) of which connects the anteroposterior arm (19) with the anterior fixation head (15) and the other joint (21) connects the anteroposterior arm (19) with the mounting accessory (13) fixed on the vestibular face (V) of the ring (3).
2. The kit according to claim 1, characterized in that each joint (7) of the orthodontic appliance (1) takes the form of a ball joint (7) and, preferably, a spherical ball joint (7).
3. The kit according to claim 1, characterized in that the left (posterior (5) and anterior (8)) retention arms and / or the right (posterior (5) and anterior (8)) retention arms are connected by a palatal reinforcement wire (9).
4. The kit according to claim 3, characterized in that said palatal reinforcement wire (9) comprises one or more predetermined breaking points in its length.
5. The kit according to any one of claims 3 or 4, characterized in that the support of the pair of anterior retention arms (8) takes the form of an extension (10) of the palatal reinforcement wire (9) in front of the anterior retention arm (8).
6. The kit according to any one of claims 1 to 6, characterized in that the distalization assembly (12) comprises a distal element including a ring (3) fixed to the molar with, on its vestibular face, a coupling housing, and a mesial element which can be fixed by its base to a canine in front of the molar, which mesial element includes an anterior projection having an external part which allows the retention of an elastic element and an arched posterior projection ending in a spherical joint at its end where the spherical joint of the mesial element is introduced into the coupling housing of the distal element.
7. The kit according to any one of claims 1 to 6, characterized in that the distalization assembly (12) comprises: 1) a distal element, corresponding to the rear head of the distalization assembly (12), comprising at least one of the rings (3) of the first pair of rings (3) which is configured to be fixed on the molar and provided, on its vestibular surface, with a mounting accessory (13) which includes a sleeve (14); 2) an anterior fixation head (15) which includes an adaptation plate (16) on a canine and an angled stem (17) which carries this plate;and 3) an intermediate element comprising an anteroposterior arm (19) and two joints (20,21) opposite each other on the anteroposterior arm, one joint (20) associating the anteroposterior arm (19) with the front fixing head (15) and the other joint (21) associating the anteroposterior arm (19) with the mounting accessory (13) fixed on the vestibular face (V) of the ring (3).;
8. An orthodontic appliance (1) as defined in any one of claims 1 to 7.