Steven G. Garrett DDS, Orthodontist Winchester, Front Royal and Stephens City, VA :: Offering adult orthodontics, braces for kids, braces for adults, clear braces, Invisalign invisible aligners, orthodontists in Virginia

Smiles of Shenandoah Valley - Dr. Steven G. Garrett, Orthodontist

Demand Recall Retainers | Recommended Retainer Wear
Expanders | Appliances | Retainers Home

E-Arch (Expansion Arch)
The E-arch is used to widen the upper and/or lower jaws to make room for permanent teeth. The appliance has two crowns or bands usually positioned on the baby molars or permanent 6-year molars. From the crown on one side is an L-shaped sleeve; on the opposite side is an L-shaped arm, which is attached to the opposing crown. Between the two "arms" is a spring, which widens the arch by "gently” adding force. The patient is seen about every 8-10 weeks. The arch width is measured and the spring is usually re-activated by adding "crimp stops" to hold the compressed spring in place. This appliance is very effective and requires little attention other than keeping it and surrounding gums and teeth very clean. Dr. Garrett recommends a fluoride rinse every night. Sometimes the teeth on which the E-arch is attached may loosen allowing the arms of the appliance to position themselves over the biting surface of the teeth. If this should happen, please call our office for an adjustment. Occasionally, the teeth to which the appliance is attached may come out, if this should happen, remove any parts possible and call us. Fortunately, in most cases, the E-arch has usually served its purpose by the time this could happen.

It is recommended that wax or EZO denture pads be placed around any parts that may be irritating.

Reinforced Palatal Anchor (R.P.A.)
This appliance is used in much the same way as the Distal Jet; except it is usually used in the lower arch and the springs are on the "sides" of the teeth and not in the "bottom" or tongue side of the mouth. Bicuspid "bands" are placed and attached to the front acrylic button; "bands" are put on the molars as well. Small wires are then added from the molar bands to the bicuspid band with a well-compressed spring in the middle. The wires are left longer than usual so those molars will have s track on which to be pushed. The patient is seen about every 8-10 weeks to check the movement. Usually "crimp stops" are placed on the wire to hold the compression of the spring. After the molars are moved back, the bicuspids are moved back as well, then front braces are applied for alignment.

The Distal Jet
This appliance is a fixed appliance used to distalize (move back) molars to alleviate crowding. By making room to straighten the teeth, it allows Dr. Garrett to straighten the teeth without having to extract teeth. The appliance has 4 "bands", which are rings of metal that fit over 2 bicuspids and 2 molars. The Front bicuspids are attached to an acrylic "button" which fits into the roof of the mouth as an "anchor", from the anchor there are two more "arms" which have springs that push against the button to move the molars back. The patient is seen about every 8-10 weeks and the springs are activated by adding, "crimp stop" to hold back the compressed springs. Once the molars are in position, the bicuspids will be pulled back and then front braces are applied for overall alignment. As with all fixed appliances, the important issue is good oral hygiene. It is extremely important to keep the appliance, teeth and surrounding gum tissue very clean to prevent infection. It is also important to keep the tissue under the acrylic button clean. Once the appliance is placed; the technician will give instructions on how to clean under the button and around all the parts. The acrylic “button” may cause a transient speech impairment. We recommend that you slow down and concentrate on pronouncing your words carefully. It is a good idea to read aloud to improve much more rapidly. As always, Dr. Garrett recommends the use of a fluoride rise every night.

Rapid Palatal Expander (R.P.E.)
The R.P.E. is an all-metal expansion appliance able to deliver expansion up to 12 mm in the upper arch in a short period time. The appliance is turned, or activated daily with the use of a small wrench. The appliance is usually attached to either 2 or 4 teeth. After the insertion of the appliance the patient is instructed on the care and cleaning of the appliance. Soft foods are recommended for the first couple of days. It is recommended that foods be cut into small pieces, so that food will not get "caught" in the appliance and cause gagging such as spaghetti dangling down the throat. It is recommended that wax or EZO Denture pads are placed over any irritating parts and warm salt water is used to soothe the gums, should they become irritated. It is quite common for a large gap to develop between the upper front teeth. This is normal. The appliance will be checked every 3-4 weeks until desired expansion is achieved.