Other Orthodontic Appliances

Palatal Expanders

Most commonly, palatal expanders are used in growing patients. They can be used much more slowly with adult patients or sometimes in combination with a surgical procedure (aka: surgically assisted rapid palatal expansion). Expanders are cemented usually but can be made in a removable form too (if you promise not to lose it!). The expander has a small keyhole, that when turned backwards will expand the roof of your mouth out laterally. This is considered an orthopedic correction, used to treat crossbites.

There are expanders for the lower teeth if indicated, as well.

Lower Holding Arch

This appliance is used to prevent drifting of back molar teeth when the baby teeth in front of them fall out. A lower holding arch is designed to maintain and preserve the length of the dental archform, so it is a great method to prevent crowding. It is glued in and just sits passively in floor of the mouth.

Nance or Transpalatal Arch

This appliance is basically the upper version of the lower holding arch. The Nance design has a plastic button that rests on the roof of your mouth, while the transpalatal arch runs across but doesn't reach that far up. Similarly, for the most part, these are made to prevent forward drifting of adult molar teeth.

Headgear/Facebow Treatments

Yup, I said it. Headgear. These appliances are orthopedic correctors (aka changing the way you grow) in the side/profile dimension. Because they are worn outside of the mouth, you only have to wear at home and to bed. Unless you really like the look, go for it!

Facebow treatments can be designed to restrain the upper jaw while the lower keeps growing in skeletal Class II malocclusions. On the other hand, protraction facemask designs are used to try and treat skeletal Class III malocclusions. They pull the upper jaw forward, with hopes to outcompete the growth in the lower jaw.

Functional Appliances

There are several devices that aim to encourage lower jaw growth, and have what we like to call a "headgear effect". Many are removable, so again you really have to wear it if you want it to work. In case you didn't realize, these are also intended for patients that are in the growing phases of their lives.

Elastics

These are pretty much rubber bands that are worn across a series of teeth to improve the position and relation of the teeth. If worn FULL-TIME, you can be out of treatment in no time! There are many different designs, but here are a few:

Class II: designed to combat against the Class II Malocclusion, pulling the lower jaw forward and upper jaw back

Class III: total opposite, to combat against the Class III Malocclusion, which pulls the upper jaw forward and lower jaw back

Triangle: these are designed to sock in your bite on the sides

Box or vertical: these are often used to close your bite in the front if it is mildly open

Crossbite: these are worn from the inside of the top teeth to outside of the bottom back teeth to combat a posterior crossbite

Sleep Apnea Mandibular Advancement Splints

These appliances are essentially functional appliances for non-growing adults. There are two main designs:

Herbst is one unit, with a top and bottom plastic covering for your teeth. There is a lever arm that attaches the two components and advances the lower jaw forward.

Biobloc is two separate pieces of plastic that also cover your teeth. The units have a "dorsal fin" attachment, which lock in and reposition the lower jaw forward, as well.

The levels of advancement can be increased and titrated to your individual needs

Through advancing the lower jaw, the tongue is advanced and the pharyngeal airway is opened. Through this mechanism, sleep apnea events may be decreased.

Removable Retainers

Congratulations, you made to the end of your treatment. Or so you think. Once your pearly whites are all straight, we give you retainers to wear, which do one thing: they retain. As long as you wear your retainers consistently, your teeth should hold their newly aligned position.

In the beginning, full-time wear is encouraged, which is transitioned into night-time wear.

There is a plastic/metal bar design, and a clear aligner-like Essix design. While the metal design is a bit more sturdy and allows the teeth to naturally settle in, the clear design is considered more esthetic.

Fixed Retainers

Fixed retainers have a similar function to the removable, and are often made alongside with the removable option. A fixed retainer is a tight-fitting metal wire that is glued on the tongue-side of the front teeth. It is usually done from canine-to-canine on the bottom and across the incisors on the top. These are especially useful for people who may have had severe spacing or crowding to start with.

Benefits: definitely not visible and doesn't require your cooperation since it's pretty much stuck!

Downsides: flossing is a pain (still need floss threaders), so hygiene is the biggest concern. Tartar builds up on them quite easily, as well.

Common Ortho Problems