Orthodontic Appliances

Quad Helix

The Quad Helix is a fixed orthodontic appliance used for upper arch expansion. Bands are cemented to your back molars to keep the appliance in place while four helix springs help widen the arch. This appliance is ideal for patients with crowding in the upper arch or to correct a posterior crossbite.

It is important to maintain a good oral hygiene regimen while wearing the Quad Helix. Patients should brush around and under the appliance and also floss and rinse thoroughly to remove any food particles.

Rapid Palatal Expander (RPE)

The RPE appliance will widen the upper arch. The roof of the mouth and the floor of the nose are the same bone. RPE has been shown to improve the breathing for patients with mouth breathing and snoring. It not only creates a beautiful, full smile for the patient, it also helps us open up spaces so we do not have to extract permanent teeth in most of our patients with crowding. In addition, when patients get their braces on, the spaces reduce the discomfort of their teeth.

It needs to be opened as instructed, with the key you have been given. The key is inserted in the front hole (closest to front teeth) and brought to the back of the mouth causing the next entire hole to appear.

Some patients may experience an itching or tingling sensation in or around their mouth. Don't worry. This is normal as the tissues there stretch and expand. You may have some difficulty swallowing, but within a few hours you will get used to the appliance and swallowing will be easier.

As the appliance is activated, a space will probably occur between the two upper front teeth. This is normal and will be closed as treatment progresses. You may notice a difference in your speech. Some words will be harder to pronounce than others. Help yourself to speak more clearly by reading slowly out loud when you get home. After the palate has been widened enough, the appliance will remain in place for four months for the new bone to fill in.

Cleaning is very important. After eating, rinse your mouth vigorously with water. This will dislodge any large particles of food that may be trapped in the RPE screw. As you brush your teeth, move the toothbrush to the roof of your mouth and brush the appliance and the supporting wires as well as the tissue. Remember to stay away from hard and sticky foods, especially gum and ice cubes. If the appliance should break or loosen, call us for an appointment.

Treatment Schedule for Orthodontics with RPE

1. Upper expander (RPE) is placed in the mouth and activated for 6-8 weeks. During this activation period we will see you every 1-3 weeks. These appointments are very critical to your treatment. During activation, the bone is being broken and the palate is connected by threads.
2. It is considered negligence to allow a break and fuse cycle to occur. Strict adherence to activation is required to allow for healthy expansion and avoid painful break and fuse cycles.
3. When the expansion is completed the RPE will be locked in place and no more activation will be done.
4. Once the RPE has been locked for a period of 8 weeks the upper braces will be placed.
5. The upper bone takes 4 months to heal after the RPE has been locked. The RPE will be removed approximately 4 months after being locked.
6. Generally, the lower braces are placed about 1 year after the upper braces go on.

This is an approximate guideline for your orthodontic progress. Times may vary from patient to patient. If you have questions and/or concerns, please call our Treatment Coordinator. We look forward to working with you and a future of happy smiles!

Face Mask

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 6-12 months.

Purpose

This appliance is used to slow down the growth of the lower jaw bone and help to pull the upper jaw bone forward.

Instructions

• Patient must wear it 12-14 hours each day (in bed and around the house).
• Keep track of your wearing time on the scorecard, and please bring your card to each visit.
• Wash your face each time before putting it on.
• Place cotton balls inside the face mask if tissue becomes red.
• If the facemask is lost or broken, the replacement cost is $200, so always keep the facemask at home.

DO NOT WEAR THE APPLIANCE WHILE PLAYING SPORTS OR ANY ROUGH PLAY!

Lip Bumper

This is a removable appliance hooked on the lower molars to expand the lower arch naturally. It makes room for the present crowded teeth and the erupting teeth. This appliance should be worn 24 hours a day (eating, drinking, brushing teeth, etc; at all times).

About the Appliance

This appliance is worn 6-12 months if worn properly. Patients should brush up to 4 times a day (breakfast, lunch, dinner and before bedtime). Try not to remove the appliance unless you are participating in sports or experience severe pain. This will loosen the lower bands, requiring emergency visits to the office to have them cemented back into place. The appliance works by removing cheeks and the lower lip off of the lower teeth so that the tongue can naturally expand the arch to make room for the crowded teeth. The appliance sets 1 to 2 mm. off of the patients’ teeth and gums, giving the lower lip a bulging look. The appliance is inserted into the larger holes of the bands in the back of the mouth on the lower arch. The patient must use his or her lip to keep the appliance in place by pulling it over the rest.

What is considered an emergency with the lip bumper?

If the bands the appliance slides into come off or are loose, causing pain.

What is not an emergency?

Lost lip bumpers, bumpers which pop out or slides out of the tubes, or patients having a difficult time finding holes or placing the appliance back into the mouth if/when it comes out.

What should I do if it pops or slides out?

If the appliance pops/slides out, place it back into the tubes shown to you at insertion. It may be tight for the first few days, but then it should slide in and out pretty easily. Call the office at 631-2166 if any other situation occurs. Remember, the more you wear it, the sooner you are done!

Headgear

Headgear is a removable orthopedic appliance that is placed in the upper molar band worn 12 to 14 hours a night to slow down the growth of the upper jaw bone and accelerate the growth of the lower jaw bone.

Bite Turbos

What are Bite Turbos?

Bite turbos are resin attachments placed behind the upper front teeth, to open a patient’s bite.

When does a patient get bite turbos?

When a patient with a deep bite gets lower braces, they will usually get bite turbos to prevent them from breaking the lower braces.

How do the bite turbos feel?

For the first couple of weeks, your back teeth will not be touching, so it is a little bit difficult to eat or chew on back teeth. However, you will notice better ability to chew in 1-3 weeks time. The back teeth will erupt and your bite will open.

What do I do if the bite turbos break off or come loose?

Most patients will get two bite turbos. In the case where one should break or come loose, the patient will still have one remaining. If both bite turbos have come off and the patient is biting on the lower brackets, please call the office. This situation would be considered an emergency appointment and the patient would need to come in to replace the bite turbos immediately.

Temporary Anchorage Device (TAD)

A TAD is a temporary anchorage device that we position in the mouth. It serves as an anchor for moving specific teeth in the most controlled and predictable way possible. TAD’s are made of a sterile medical-grade titanium alloy. They eliminate cumbersome appliances (e.g. headgear) and allow us to treat cases better and faster than ever before. TAD’s are truly revolutionizing orthodontic treatment.

How exactly is the TAD positioned?

After numbing the area where the TAD is to be placed, we use gentle pressure to insert it through the gums and into the bone between your teeth.

Having a TAD placed sounds painful. Should I be worried?

Absolutely not! While it’s normal to assume that the procedure would be painful, it is actually pain-free. You may feel some slight pressure during insertion but no pain. The entire procedure takes only a few seconds.

Do I need to get a shot?

Depending on where the TAD will be inserted, we may need to use a few drops of anesthesia with the aid of a needle. In some circumstances only topical anesthetic will be used. First, we apply a fast-acting numbing gel where the TAD will be inserted. After the gel desensitizes the area topically, we power-spray the gums with a small amount of local anesthetic that completely numbs it. The entire procedure is totally pain-free.

Will it hurt after the anesthetic wears off?

No. Some patients say they feel a little pressure for a short period afterward. Only a few patients have reported needing to use an over-the-counter medication such as acetaminophen or ibupropen.

What if it aches the next day?

There is no cause for alarm. Minor aching associated with new tooth movement is not only normal, but expected; however, if you have concerns, simply call our office or the after-hours number we provide and we’ll give you instructions and/or make an appointment to see you.

What if the TAD comes loose?

On occasion, a TAD might become a little loose. In most cases this minor mobility is nothing to be concerned about; however, if you feel the TAD is excessively loose, or it is causing you discomfort, call the office and we’ll make an appointment to see you to determine if the amount of give is normal.

How do I keep it clean?

We’ll give you a solution with which you will brush the TAD twice daily with a soft toothbrush.

How long will the TAD need to stay in place?

As the name implies, the anchorage device is temporary and it’s typically removed in a few months when it is no longer needed to assist in tooth movement.

Will it hurt when you remove it?

No. Before we remove it we’ll place numbing gel around the TAD and then back it out gently. The entire process takes only a few seconds.

I’ve never heard of TAD’s before. Are they new?

Not really. Orthodontists have used TAD’s since 1983 and oral surgeons and orthopedists have used miniature screws for decades longer. Recent refinements in the devices and the procedures for their use have propelled the application of TAD’s to a heightened level in orthodontics. With TAD’s, orthodontic treatment options have never been greater. We are proud to be at the forefront of this exciting technology and feel confidant that your experience with it will be comfortable and the results exemplary.

Herbst Appliance

Congratulations, today you are on your way to correcting your teeth and facial features using one of the most modern and innovative appliances in orthodontics. As we explained, the Herbst appliance corrects a bite problem when the upper jaw and teeth are forward (overgrown) and/ or the lower jaw and teeth are too far back (undergrown). The great advantage of the Herbst appliance is it works on the lower jaw where most of the correction is needed and it works faster and is more predictable than other appliances (for instance headgear) because you don't have to remember to put it on. The Herbst appliance will usually result in less overall treatment time in braces and more predictable success without tooth extraction or jaw surgery.

The Herbst appliance works by positioning your lower jaw forward into an overcorrected position giving forward pressures on the teeth, bone, and muscles of the lower jaw; and backward pressures on the teeth and bone of the upper jaw. The lower-jaw muscles will have a tendency to position your lower jaw just slightly forward of where the Herbst holds it. This allows the lower jaw muscles to promote forward growth of the lower jaw to help in the correction. Since the Herbst is working with your growth cycle, it needs to be worn for approximately 8 months as growth is normally a slow gradual process.

As with braces, the Herbst should be handled carefully during eating to avoid breakage. Especially be careful with hard, sticky, or chewy foods. The possibility of the appliance loosening is rare; however, it usually involves abuse by the patient. Please don't play with the appliance with your finger or chew on pens or pencils.

Here is a list of common experiences during Herbst appliance wear:

1. Inability to chew: You may experience difficulty chewing for the first 7-12 days, but this you will quickly adapt to and be chewing fine in time.
2. Appliance rubbing on cheeks: You may get canker sores and cheek irritations initially, and these should be treated with wax, Orabase, and warm salt water rinses. As with braces, the cheeks toughen and callous to the appliance in time.
3. Appliance rocks and tubes disengage: This may happen if you open extra wide ( i.e., yawning) and the tubes and rods need to merely be reengaged.
4. Noticeable face or cheek puffiness: This is dependent on if you're "thin skinned". The appliance may puff out the cheeks and be noticeable. This will gradually diminish as your jaw correction occurs.

Please take care to brush and clean your appliance thoroughly three "3" times daily. Good luck! You are on your way to a terrific improvement in your teeth, bite, and facial features.