We use a range of other orthodontic appliances, most commonly for our younger Phase 1 patients but they are sometimes required for adults too. These appliances are generally focussed on improving the alignment of the jaw and lay the foundation for future orthodontic treatment.
One of the most common problems we address is the discrepancy that occurs when the upper teeth protrude beyond the lower teeth – referred to as a Class II malocclusion. 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 like to encourage the lower jaw to catch up in growth, and often use an appliance to correct this. A Class III malocclusion, on the other hand, is characterised by upper teeth that fit behind the lower teeth in the front as well as the back teeth. The cause of this bite is a maxilla (upper jaw) that is not growing fast enough to keep up with the mandible (lower jaw) and we can use an appliance to address this.
There are many different orthodontic appliances and each one is designed to address different concerns. Below are some examples of the orthodontic appliances we use in our office. Which one is right for your child will depend on their unique circumstances and will be determined by Dr Siva following a thorough assessment.
A Bionator is a functional appliance resembling a retainer. It is often prescribed when a patient has a mismatch of dental arches resulting from a smaller lower jaw. It is used to stimulate growth of the lower jaw in actively growing patients.
The Face Mask has the widest range of application and produces the most dramatic results in the shortest period for the treatment of Class III malocclusions in the developing dentition.
It aims to protract and widen the upper jaw whilst guiding the lower jaw down and back. The ideal time to commence treatment is typically after the eruption of the permanent front teeth, around age 8 years.
A Face Mask is often worn in conjunction with a palate expander and facilitates the accelerated growth of the upper jaw not only in width but in length, thus correcting the underbite and producing a pleasing facial result.
The Twin Block is made up of an upper and lower plate, which work together to correct the bite. It is like wearing two appliances, one which fits the upper jaw while the other fits the lower jaw. These two pieces work together to bring the lower jaw forward and improve the overall appearance of a patient’s face.
The Twin Block can be highly successful is correcting bite problems but it is entirely dependent on the diligence of the patient in wearing the plates full time. Whilst the Twin Block plates can move the lower jaw forward, they cannot influence the individual position of the teeth, so this is done at a later stage with braces.
The Herbst Appliance is a functional appliance used in some growing patients to stimulate growth of the lower jaw. The Herbst Appliance consists of crowns cemented over your back teeth. The upper crowns have tubes attached to them that are connected to two rods on the lower crowns. This postures your lower jaw forward. The arms are screwed in place to the crowns allowing you to move your jaw forward, open and close your jaw, but not move it back. This orthopaedic appliance helps correct jaw and tooth imbalances in which there is an underdevelopment of the lower jaw relative to the upper jaw. The Herbst appliance is usually worn for about 9 to 12 months, followed by an additional period of time in braces.
Forsus is a fixed appliance that is used for dental asymmetry corrections when higher force is needed. This appliance is designed to hold your teeth and lower jaw in a different relationship than you usually posture, while still allowing you to open and move your jaw freely. The objective is to allow the teeth to develop and erupt into a correct biting relationship, thereby eliminating the existing “overbite”.
The Distal Jet is an appliance used on the upper teeth to fix a Class II bite. The Distal Jet sits on the palate of the mouth and is banded to the molars. A spring is attached to the acrylic body of the Distal Jet and applies continuous force to the molars. This force is what moves the teeth to the back of the mouth. The treatment time for the Distal Jet is shorter than for other appliances that do the same job because it is a fixed appliance and maintains continual force against the teeth.
Headgear guides the teeth into a better position or helps stop them moving forward when they’re not meant to. Headgear uses the top of the head as an “anchor” to correct this relationship. It connects in the mouth with two bands placed on upper first molars.
Headgear is usually one of the first appliances placed as it works most effectively when no other upper appliances have been placed.
The RME is used to widen the upper jaw. This expansion is designed to treat crowded or overlapping teeth, cross bites and narrow smiles.
It works by gently widening the upper arch (palate) by stretching the center palatal connective suture in a growing person. Once widened, the suture knits together and growth continues. An RME is a Phase 1 appliance and only prescribed for a patient who is still growing. The RME is adjusted or “turned” on a daily basis in accordance with our instructions and until the palate has been widened enough. It is then left in place for about four to six months without further adjustment while new bone fills the centre palatal suture or healing occurs.
An RME will permanently widen constricted upper arches, increase the space available to align crowded teeth and restore facial harmony.
An upper removable appliance (URA) consists of a removable orthodontic plate that fits the upper teeth and palate. It may include springs to move individual teeth around and a wire to push some teeth back. However its main aim is to expand the upper arch and make room for the developing teeth to come through in a better position.
The Hawley is a retainer that can hold, close or open a space between teeth, depending on what needs to be done. The design consists of wires and clasps embedded in a relatively thick plastic body that covers over the roof of the mouth or lies along the tongue side of the lower teeth. The clasps grasp selected teeth so the retainer is anchored securely. The retaining “bow” wire arches across the front side of the teeth and holds and maintains their alignment.
A functional appliance is designed to hold the lower jaw in a different relationship to that which it is accustomed to. The objective is to allow the jaws to develop in a relationship that more closely approximates what is considered normal. This will also allow the teeth to develop and erupt into a better relationship.
A lower lingual arch or transpalatal arch (TPA) is used during Phase 1 treatment at the end of the “mixed dentition period”, a time when remaining baby teeth are about to be lost. Either appliance (or both) may be used to hold the permanent molars in their current positions so that these teeth will not move forward after the baby teeth in front of them are lost. These appliances can also hold the molars in their current position or to rotate the molars into a correct orientation. Occasionally, a TPA is needed immediately after the removal of a bonded expander, particularly in patients in whom some of the baby teeth are lost when the expander is removed. Both arches are cemented in place and cannot be removed by the patient.
A Pendulum appliance is designed to expand the upper arch, push the molars backwards and provide adequate space to later straighten the patient’s teeth. The Pendulum typically serves to correct crowding and, in some cases, flaring of the front teeth.
A Quad Helix is an appliance which is designed to expand the upper jaw, correct crossbites and provide adequate space to straighten teeth at a later stage. It is attached to the molars by two bands and helix springs that widen the upper arch of the mouth to make room for crowded teeth.
TADs or “mini-implants” are simple, small screws that are placed in the jaws to facilitate tooth movements during orthodontic treatment. Often this tooth movement occurs in a manner that could not be accomplished with only traditional orthodontic mechanisms, or would require alternative treatments (head-gear, extractions, surgery etc.) and longer, more complex treatment mechanisms. The placement of a TAD is a brief, minimally-invasive process that has three parts: anesthesia, placement and the attachment of orthodontic forces.
A thumb sucking appliance is used to help stop finger or thumb sucking habits that move the teeth out of line. This appliance is fixed and becomes a constant reminder to help stop a certain habit. As your child gets used to the appliance, eating and speaking will become easier.