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Every smile presents a different combination of tooth positions, jaw relationships and available space. Customised orthodontic appliances allow us to address these concerns with a design tailored to the individual patient.
Using a digital scan of the teeth and palate, we can plan an appliance’s shape, position and intended movements. Its framework can then be manufactured using 3D metal printing, with specialised screws, springs or other components incorporated according to the treatment required. These techniques can be used to produce expanders, distalisers, mesialisers and appliances that combine several functions. Learn more about digital appliance design.
What are palatal mini-implants?
Palatal mini-implants are small temporary screws placed in the bone beneath the roof of the mouth. Also called temporary anchorage devices, or TADs, they provide a firm support from which an appliance can work.
This support helps direct forces towards the intended teeth or jaw structures while limiting unwanted movement of other teeth. Depending on its purpose, an appliance may be supported by the teeth, by mini-implants, or by a combination of both. The mini-implants are removed when their role in treatment is complete. Read about orthodontic mini-implants.
Hyrax: widening a narrow upper jaw
A Hyrax is a fixed appliance used to widen the upper jaw and dental arch. It may be recommended when the upper arch is too narrow, particularly where the upper back teeth bite inside the lower back teeth, creating a crossbite.
A small central expansion screw is activated according to Dr Siva’s instructions. In suitable growing patients, this encourages separation at the natural junction between the two halves of the upper jaw, alongside changes in tooth position. The appliance then remains in place for a period to allow the expansion to stabilise.
A conventional Hyrax is supported by the upper teeth. Customised versions can incorporate additional support from palatal mini-implants.
Hybrid Hyrax: combining tooth and palatal support
A hybrid Hyrax combines attachments to selected upper teeth with support from palatal mini-implants. The word hybrid refers to this combination of tooth and bone support.
By transferring part of the expansion force to the palatal bone, this design reduces reliance on the teeth alone. It may help limit unwanted tipping of the supporting teeth while widening the upper jaw. Dr Siva selects the design according to the patient’s anatomy, stage of development and treatment needs. Read about the hybrid Hyrax.
Palatal distalisers: moving upper teeth backwards
A distaliser moves selected upper back teeth towards the back of the mouth. This can create space for crowded teeth and help improve the way the upper and lower teeth meet.
Palatal mini-implants provide support for springs or sliding mechanisms that guide this movement. This helps protect the position of other teeth that might otherwise move forwards in response. Treatment may involve one side or both sides of the upper arch.
Distalisers move teeth within the upper jaw; their purpose is different from treatment intended to influence jaw development. Read about palatal implant-supported distalisation.
Hybrid Hyrax distaliser: combining expansion and space creation
A hybrid Hyrax distaliser brings together two functions: widening a narrow upper arch and moving selected upper back teeth backwards.
This may be useful when a patient needs correction in both directions. Depending on the treatment plan, expansion and distalisation can be undertaken in stages or coordinated within the same appliance. The sequence and amount of movement are carefully planned for each patient. Read about the combined appliance.
Hybrid Hyrax or hybrid Hyrax distaliser with facemask hooks
Some growing children have an underbite partly because the upper jaw is positioned too far back relative to the lower jaw. In selected cases, a hybrid Hyrax can be fitted with hooks that connect to an external protraction facemask using elastics.
The facemask applies a forward-directed force to the upper jaw. Where required, the appliance can also widen the upper arch. A distaliser component may be incorporated when selected back teeth also need to move backwards as part of the overall plan. These are distinct movements: the facemask acts on the upper-jaw relationship, while the distaliser controls tooth position.
Treatment depends on appropriate timing, consistent facemask wear and careful monitoring. Further treatment may still be needed as growth continues. Read about hybrid Hyrax facemask treatment.
Palatal mesialisers: moving upper teeth forwards
A mesialiser moves selected upper back teeth forwards to help close spaces. It may be considered when permanent teeth are missing or when bringing neighbouring teeth into a space forms part of the treatment plan.
Palatal mini-implants provide support for this movement while helping preserve the position of the front teeth. In selected patients, orthodontic space closure may reduce the need for a replacement tooth. Some customised designs can move teeth forwards on one side and backwards on the other to address an uneven bite or dental midline. Read about palatal implant-supported mesialisation.
Are these appliances suitable for adults?
Palatal anchorage can assist tooth movement in children, adolescents and adults. Widening the underlying upper jaw in an adult requires a separate assessment because skeletal maturity changes how the jaw responds.
Some adults may be suitable for mini-implant-assisted expansion, while others require a different approach, including surgical assistance. Dr Siva will assess the available bone, gum health, jaw anatomy and intended movements before recommending treatment. Read about factors affecting adult expansion.
What does treatment involve?
Mini-implants are usually placed under local anaesthetic. Some temporary tenderness or pressure can occur, and speaking and eating may feel different while you become accustomed to the appliance.
Our team will explain cleaning, any required activations and the review schedule. Keeping the appliance and surrounding gums clean is important. Please contact us if a mini-implant or appliance becomes loose, or if discomfort persists.
Following a thorough assessment, Dr Siva will explain which appliance is appropriate, what it aims to achieve and how it fits within your overall orthodontic treatment.
We use a range of orthodontic appliances to improve the way the teeth and jaws fit together. These are most commonly recommended for children undergoing early, or Phase 1, treatment, although some appliances also have a role in adult care. Each serves a particular purpose, from addressing a developing bite problem to establishing a sound foundation for later orthodontic treatment.
One common concern is a Class II malocclusion, often associated with prominent upper front teeth. This appearance may reflect a lower jaw that is relatively small or positioned further back, differences in tooth position, or a combination of these factors. For suitable patients who are still growing, a functional appliance can help improve the bite, principally through changes in tooth position. Its effects on jaw growth vary, so treatment is carefully timed and tailored to the individual.
A Class III malocclusion may present as an underbite, where the lower front teeth sit ahead of the upper front teeth. This can arise from an upper jaw that is relatively small or set back, a larger or more prominent lower jaw, or a combination of jaw and tooth positions. In selected growing children, appliances can help encourage forward development of the upper jaw and improve the bite. Continued monitoring is important as the jaws develop.
Below are examples of the appliances we use in our practice. Following a thorough assessment, Dr Siva will explain which options are appropriate for you or your child, what they aim to achieve, and how they fit within the overall treatment plan.
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.