Expanders / Rapid Palatal Expander
Attached to the upper molars through bonding or by cemented bands, the Rapid Palatal Expander is an orthodontic device used to create a wider space in the upper jaw. It is typically used when the upper jaw is too narrow for the lower jaw or when the upper teeth are crowded or blocked out of the dental arch.
When patients are still growing, their connective tissue between the left and right halves of their upper jaw is very responsive to expansion. By simply activating the expander through turning a screw in the center of the palatal expander, with a special key we provide, gradual outward pressure is placed on the left and right halves of the upper jaw. This pressure causes an increased amount of bone to grow between the right and left halves of the jaw, ultimately resulting in an increased width.
The Mandibular Anterior Repositioning Appliance (MARA) is suitable for treating class II malocclusions, which are characterized by protrusion of the upper front teeth or a lower jaw and or teeth that are positioned back in regard to the upper jaw and or teeth. Using MARA, class II malocclusions are treated more effectively. The MARA is reliable and reduces treatment time.
Generally, the appliance is secured to the patient’s first molars via stainless steel crowns, which are easy to fit and retain more, compared to bands. The appliance features no removable parts, which means patient compliance is not an issue. Also, the orthodontist can more accurately predict the length of treatment.
The upper “elbows” can be removed; which facilitates comfort and advanced adjustments. The appliance can be advanced on one side or both sides.
Sore spots are minimal. Initially, it may feel strange to hold your jaw forward while eating, but within two weeks, chewing will become more natural. We recommend you eat soft foods initially.
Do not chew on the elbows. Avoiding candy, hard foods, etc. throughout treatment will help prevent breakage of the appliance.
MARA is generally worn between 15 to 18 months. Your improvements will be noticed immediately!
One of the most common problems orthodontists treat is the discrepancy that occurs when the upper teeth protrude beyond the lower. Ordinarily, when we see a patient with the upper teeth protruding, we tend to think that the upper jaw and teeth are too far forward; but, more often than not, this condition is due to a small lower jaw that is further back than it should be. With these patients, we would like to encourage the lower jaw to catch up in growth, and braces like the Herbst appliance help this happen.
Even though the Herbst appliance prevents the lower jaw from moving backward, opening and closing movement still occur easily, and patients do not have any problems learning to chew their food with their lower jaw in this new position.
As with all kinds of braces, patients with Herbst appliances need to be careful about what they eat. For instance, cold foods such as ice slushes, Popsicles and ice will freeze the cement and make the brace loosen. Sticky foods such as caramels, bubble gum and candy suckers will pull the brace away from the teeth. Hard foods like crisp vegetables and hard candies will bend and loosen the Herbst appliance, too. So stay away from these foods during your orthodontic treatment.
Your Herbst appliance will be checked and adjusted at your appointments. If, sometimes between appointments, you develop some sore areas on the inside of your cheeks, please do not try to adjust the appliance yourself. Call for an appointment so that the necessary adjustments can be made.
Elastics are a vital part of treatment and are also contingent upon patient compliance. They add extra pressure to the braces to help move the teeth. Generally worn at all times (excluding eating and brushing your teeth), elastics should be changed at least once a day. They come in various sizes as they are each used for a specific purpose. We will provide you with the appropriate size.
It is important to wear them consistently or treatment setbacks may occur. If only one day is missed, it could cause your teeth to shift back to their original position!
Headgear is often used to correct an excessive overbite. This is done by placing pressure against the upper teeth and jaw, which would hold the teeth in position or help move them into better positions. The severity of the problem determines the length of time headgear needs to be worn. The key to success with your headgear appliance is consistency. Headgear must be worn a certain number of hours per day, and if not, it must be made up the following day.
Headgear should never be worn while playing sports and should also be removed while eating or brushing your teeth.
In some cases where an underbite is present, we may recommend using reverse headgear (face mask) as part of the treatment plan. This appliance is designed to fix the discrepancy between your upper and lower jaws by moving the upper jaw forward to correct the malocclusion.
For the results to be successful, patient compliance is of the utmost importance. It may take several days to become accustomed to the appliance. With practice, it will become easier to place and remove the reverse headgear. We will determine the length of time you should wear your headgear, but it is generally 10-14 hours per day, which can include wearing while you sleep. You should not wear your headgear while participating in sporting activities.
Sometimes your chin may get irritated from the headgear. If this happens, you should always keep the area clean and often change the insert in the chin cup. If the skin becomes very dry, the use of moisturizing cream twice a day can be helpful. If your jaw joints are extremely sore or you cannot open and close your mouth without difficulty, stop wearing the appliance and contact us for further instructions as we may need to fit you with a different appliance. Also, if your headgear breaks or is bent, call us so we can fit you in with a repair appointment so your treatment will not be delayed.
One of the many important advances in orthodontics has been the development of temporary anchorage devices, or TADs. Made of a bio-compatible titanium alloy, TADs are miniscrew anchors which are inserted into specific places in the mouth to be used as a fixed point from which teeth can move. Before TADs, orthodontists who wanted to move some teeth while keeping others still, or to achieve orthodontic movement in a mouth with missing teeth, had to rely on headgear for their fixed point. But TADs now provide an option for that fixed point that is smaller, more discrete, more efficient and requires significantly less work for the patient.
Temporary anchorage devices may not be recommended for everyone, and in fact, anchorage devices at all may not be needed in all cases. Contact us if you’d like to know more about TADs and how they can potentially prevent you from needing orthodontic headgear.