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.

Herbst Appliance

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.

Wearing a Herbst Appliance

At first, your mouth will feel unusually full and speaking will be awkward. But if you practice reading aloud, your ordinary speech will return quickly. You may also notice more saliva than normal, but this will decrease as you become accustomed to the appliance.

Forsus Appliance

The Forsus appliance is used in order to help move the upper molars back while moving the lower arch forward. Composed of a spring coil rod, the appliance is used while a patient is currently wearing braces. It runs from the upper first molar band down to the lower archwire.

You may notice some discomfort initially, so we recommend a soft food diet for the first few days after the appliance is placed. It is important to keep the appliance clean; you may do this by carefully brushing the coil and other metal pieces of the appliance. Also, we recommend that patients not open their mouths very wide, as the appliance may come apart.

If your Forsus appliance breaks, please contact our office immediately to schedule a repair appointment.

Space Maintainers

Baby teeth act as a guide for the permanent tooth that will eventually replace it. If a baby tooth is lost too early, the permanent tooth will not erupt correctly. Frequently, neighboring teeth will drift into the vacant spot.

Reasons Baby Teeth are Lost too Early:

  • Being knocked out in an accident
  • Extracted early due to decay
  • Birth defects
  • Early childhood sickness that leads to tooth loss

What are Space Maintainers?

Space maintainer keeps the vacated space open until the permanent tooth is ready to come in. Not every tooth that is lost too early requires a space maintainer.

A space maintainer is made of stainless steel and/or plastic. Some space maintainers are removable, fixed space maintainers are cemented into the patient’s mouth.

There are two general types of space maintainers:

  • Removable Space Maintainers
  • Fixed Space Maintainers

Removable Space Maintainers

Removable space maintainers are typically used for older children who can reliably follow instructions for caring for their appliance. They look much like a retainer, and an artificial tooth fills the space vacated by the missing baby tooth.

Fixed Space Maintainers

There are several kinds of fixed space maintainers.

A Lower Lingual Arch (Bilateral Mandibular Holding Arch) is used in the lower (mandibular)arch and is made of two metal orthodontic bands and a wire connecting them. This appliance is commonly used in cases of premature loss of a baby tooth or when the lower teeth of a growing child are slightly crowded and no permanent teeth are extracted to correct the problem. This appliance may also be utilized with braces to anchor the posterior teeth as the front teeth are moved orthodontically.

A Nance Appliance is a space maintainer used in the upper (maxillary) arch and is made of two metal orthodontic bands with a wire connecting them and plastic that rests against the front of the hard palate. Its uses are similar to the uses of the lower lingual arch.

A Band and Loop Maintainer can be used in either arch. The maintainer is held in place by an orthodontic-type band around one of the teeth next to the open space, generally the six-year-molar. A wire loop is attached and sticks out across the space where the tooth is missing, just touching the tooth on the opposite side of the space, allowing the permanent tooth enough room to come in.

Every space maintainer is custom-made in a lab. Impressions of your teeth will be sent to the lab where a removable or fixed space maintainer is made especially to fit you!

Living with your Space Maintainer

Removable Space Maintainers may feel funny at first, but you will get used to them! They may initially affect speech, but as a child gets used to the new appliance, this side-effect will disappear. It is critical that your child brushes regularly to keep the gum tissue healthy.
Fixed Space Maintainers should not be played with. Do not push on them with your tongue or fingers, as this could loosen them. Avoid gum or chewy candy, as this could also loosen the fixed appliance. If a fixed space maintainer comes loose, there is a risk of swallowing or inhaling them, so it is important that you follow these instructions. It is critical that you brush regularly to keep the gum tissue healthy.
Brushing and flossing daily is very important. Be sure to clean around the bands that are connected to the molars and the wire on the tongue side. This will prevent the formation of cavities or infection of the gums.
The duration of wear for Space Maintainers varies. We will monitor the eruption of new teeth and make the necessary adjustments.


Cervical-Pull Headgear

Cervical-Pull Headgear uses a cervical neck strap as anchorage, thus directing the reaction force away from the oral cavity. Cervical-Pull Headgear is appreciated for its extra-oral anchorage. It is easy to wear and not as visually apparent as other forms of headgear. Disadvantages include extrusion of the upper molars, which could lead to an open bite that would need to be addressed. Monitoring from your orthodontist and being faithful to your appointments can prevent this.

Posterior High-Pull Headgear

Posterior High-Pull Headgear is used in the treatment of open bite or edge-to-edge bite or intrusion of the posterior teeth by increasing the vertical effect on the posterior teeth. Your orthodontist may also choose to try a Bite Blocker Appliance in this instance. The primary advantage of the posterior high-pull headgear is that it will cause no extrusion of the upper molars, which could lead to an open bite that would need to be addressed.

Reverse-Pull Headgear

Often referred to as Reverse-Pull Headgear, the protraction face mask is a removable appliance for patients where the upper jaw is not growing fast enough, resulting in a crossbite or underbite. The device consists of a metal bar attached to pads on the forehead and chin with rubber bands hooked to the face mask and the upper braces to gradually move the upper jaw forward. Patient compliance is extremely important as the face mask must be worn a set number of hours per day or more to obtain the desired results. The face mask device is generally worn for six to 12 months.