The main problem with this appliance is the fracture of the lower arch. This kind of fracture is very important because it occurs when the patient put too much force on the appliance. To avoid this problem the patient should be pre stimulated before.
The fracture can also occur if the wire was not changed in 3 or 4 weeks. Usually I start with a .017” x .025” SS and I use always a .018” slot on the anterior brackets and .022” on lower molars.
Solution – Change the lower arch. It is possible to change only the half part of the wire broken until the next appointment. With this procedure the time lost is around 5 minutes.
Another problem that can occur is the fracture of the ball pin. This is not common because it is made in .045”SS. However, if the bend is too tight, or if the bend was open and closed few times, a fracture can happen.
Solution – Change the ball pin and make the correct bend in two or three steps. Never forget that the upper part of the Ritto Appliance should be inserted mesial to the upper molar tube.
Lower arch distortion can happen due to improper distal bend, or thin arch (.016” x .016 SS). In this situation the clinician should evaluate if it is necessary to change the arch or not. An improper distal bend will increase the possibility of lower incisors proclination.
Protrusion of lower incisors due to non-cooperation. If the patient is not pre stimulated or do not cooperate, the lower incisors will procline.
Solution – Use the mini stimulator for two months and motivate the patient. The electromyography is a nice tool to evaluate the degree of adaptation to a new position of the mandibule. We can also remove the appliance for one month and motivate the patient. After that we try again. If it doesn’t work, I recommend to change the treatment plan.
The appliance come out of the upper fixation due to improper ball pin bend.
Solution – Avoid any gap between the ball pin and the upper band.
The lock slides along the lower arch due to a thin arch wire or unscrew.
Solution – Change the arch, or place a crimpable hook mesial to the lock.
Bracket debond is not a common problem. We can use lower bands instead of brackets