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  • Appliances

    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!

    A Lower Lingual Arch acts as a space maintainer to keep the molars from drifting forward, and prevent them from blocking the space where permanent teeth will eventually erupt. This appliance is commonly used in cases of premature loss of baby tooth or when the lower teeth of a growing child are slightly crowded and no permanent teeth are extracted to correct the problem.

    You should expect soreness the first day or two, and it may hurt to chew. We recommend a soft diet initially. You may take Advil or Tylenol to relieve the pain. Avoid sticky or hard foods, and please monitor how many foods you eat that are high in sugar.

    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 varies. We will monitor the eruption of new teeth and make adjustments. Generally, the Lower Lingual Arch is removed following the eruption of all the permanent teeth.

    We like to avoid pulling teeth as often as possible, so we use lip bumpers on our patients who need to create more room for their crowded teeth. The lip bumper is a wire on the lower jaw that extends from one molar to another and keeps lips and cheeks from touching your teeth. When you move your mouth or speak, your lips and cheeks push on the bumper, and the bumper applies pressure to the teeth. This pressure pushes the molars back, creating more space for overcrowded teeth.

    If you have a lip bumper, please remember to leave it in while eating, but do not eat hard or sticky foods. Proper, thorough brushing should remove any food that gets stuck in your lip bumper.

    Tongue thrusting occurs when the patient presses his or her tongue against the front teeth, usually when swallowing, speaking or resting the tongue. If thrusting is constant, this can cause problems with teeth alignment and must be fixed.

    We prefer to correct tongue thrusting by giving patients a tongue thrusting appliance. This appliance, similar to a mouth guard, is usually worn at night. Other times, a more permanent appliance is prescribed and can be only be adjusted by our office.

    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.

    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. If one of the four upper front teeth is lost early, the space will stay open on its own until the permanent tooth comes in.

    A space maintainer is made of stainless steel and/or plastic. Some space maintainers are removable, which 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 acts as a space maintainer to keep the molars from drifting forward, and prevent them from blocking the space where permanent teeth will eventually erupt. This appliance is commonly used in cases of premature loss of baby tooth or when the lower teeth of a growing child are slightly crowded and no permanent teeth are extracted to correct the problem.

    You should expect soreness the first day or two, and it may hurt to chew. We recommend a soft diet initially. You may take Advil or Tylenol to relieve the pain. Avoid sticky or hard foods, and please monitor how many foods you eat that are high in sugar.

    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 varies. We will monitor the eruption of new teeth and make adjustments. Generally, the Lower Lingual Arch is removed following the eruption of all the permanent teeth.

    A Band-and-Loop Maintainer is made of stainless steel wire. 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.

    A Distal Shoe Appliance is a type of fixed space maintainer that is inserted under the gums. It is used when a child loses the baby tooth in front of a 6-year molar that has not yet come in. Because this molar has not come in yet, there is not a tooth to hold a band-and-loop space maintainer in place, therefore a metal wire has to be inserted under the gum in order to keep the space from closing.

    Distal shoe appliances have to be checked frequently by your orthodontist because the erupting tooth can easily become blocked by the appliance.

    Custom-Made Space Maintainers

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

    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.

    A night guard is a hard plastic retainer placed over either the top or bottom row of your teeth. It is designed to help prevent or slow the damage done to teeth by grinding or clenching. Nighttime grinding and clenching can wear down the tooth enamel, eventually leading to major dental procedures such as root canals, tooth extractions, crown placements and oral surgery. Night guards can also help sufferers of disorders of the temporomandibular joint (TMJ). With a properly designed night guard, the wear on this enamel is decreased, therefore slowing the damage to the teeth.

    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.