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, and 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 to 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 the 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 cushions be placed around any parts that may be irritated.
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 a track on which to be pushed. The patient is seen about every 8 to 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. Front braces are then applied for alignment.
The Distal Jet
This appliance is a fixed appliance used to distalize (move back) molars to alleviate crowding. By making room, it allows Dr. Garrett to straighten the teeth without having to extract them. The appliance has four “bands”, which are rings of metal that fit over 2 bicuspids and 2 molars. The front bicuspids are attached to an acrylic “button” that 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 to10 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.
As always, Dr. Garrett recommends the use of a fluoride rinse 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 of time.
The appliance is turned, or activated daily with the use of a small wrench and 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 it. Soft foods are recommended for the first couple of days and should 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 cushions be placed over any irritating parts and warm salt water be used to smooth 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 to 4 weeks until desired expansion is achieved.
The Herbst Appliance is used in the treatment of jaw discrepancy (i.e., overjet, when the upper front jaw protrudes over the lower front jaw). In growing patients, it allows lower jaw growth. In older patients, it retrains the action of certain muscles. The average treatment time is approximately 9 months to 1 year, during which time the lower jaw is advanced initially about 3-4mm, and then incrementally, until the desired resting position is achieved.
The Herbst has “sleeves” which are attached to 4 crowns, the lower portion of the Herbst have “arms” which slide into the sleeves. When the appliance is initially cemented into the mouth, it will have the lower jaw in an advanced position. Dr. Garrett will measure the progress approximately every 8 to 16 weeks and most likely continue to advance the appliance by adding “shims” to the arms to keep the jaw forward for continued correction.
Shims are small sleeves (or rings) of metal between 1 and 3 mm in length. The appliance is unhooked and the shims will slide on the arms for advancement and then the appliance is put back together.
There are times when a patient may open too wide and cause the arms to come out of the sleeves, if this should happen, the patient need only to open wide again and put the arms back. This may be a little tricky the first time or two, but most patients become proficient at this.
It is also recommended that the screws on the upper and lower portion of the Herbst be checked once a day to make sure they remain in place. This can be done with a small screwdriver, even your fingernail or the allen wrench provided.
When the Herbst is initially cemented, there is an adjustment period of about one-week. The limited range of motion for the jaw becomes “annoying” at first until the patient learns how to eat and talk with the Herbst.
Sometimes, there is extra saliva for a couple of days until the brain figures out that this is not food and then the extra saliva will subside.
The Herbst has some protrusive parts that may cause irritation, with the help of wax, cheek pads (which we provide) or EZO Denture Cushions. The initial discomfort can be managed with some helpful hints.
The most important item to remember with the Herbst appliance is cleanliness. It is extremely important for patients to brush the appliance, their teeth, and gums. Leaving any plaque on the teeth will result in irritation and infection. A nightly fluoride rinse is recommended.
Lip bumpers are used (with the force of the lip), to push back the molars in order to alleviate crowding. The wire consists of several adjustment loops, which can be adjusted by Dr. Garrett to add more “force” for continual movement of the molars.
The lip bumper is usually removable, but can be “tied-in” upon request. Wearers must be conscientious about keeping wax or EZO Denture cushions on the adjustment loops to prevent the wire from embedding into the lower lip causing soreness.
Did you know wiggling your lip bumper up and down will loosen molar bands?
Did you know the more you wear your lip bumper, the less time during treatment you will have to wear it?
Lingual Arch or Palatal Bar
This wire is usually attached to the permanent 6-year molars. It can be removable, but it is sometimes soldered to the molar bands. It is used primarily to “anchor” the molars while continuing the change and correcting the teeth bite.
Did you know flicking the lingual wire up and down with your tongue could break the wire and possibly loosen bands?
The Tongue Crib is used to inhibit the tongue from “pushing” the anterior teeth when speaking. It is used to “retrain” the tongue posture in conjunction with speech therapy to aid in permanent correction. It also helps to break a thumb sucking habit.
Did you know playing with the tongue crib can cause the solder joints to break? OUCH!
The Bonded Bite Plane
The bonded bite plane is used to prevent the lower front teeth from “biting” into the tissue behind the upper front teeth thus causing damage to the tissue and teeth. By “opening” the bite in the front of the mouth, it allows the back teeth to erupt more in order to correct this problem.
The bonded bite plane is also used to correct a severe over-bite (the upper front teeth closing too far over the lower front teeth) in the same way.
The bonded bite plane is made by placing a small amount of bonding material to the backside of the upper teeth to create a triangular plane. After correction, the doctor removes the plane by “polishing” it away with a special high-speed instrument.
It is important for patients to keep the tissue area surrounding the bite planes very clean. Watching out for hard foods that could break off these planes is also important. There are times when one of the planes may come off. This is okay, because as long as there is one remaining, the job can be accomplished.
Posterior Bite Plane
The posterior bite plane is used in cases where the front teeth form an anterior open-bite when the teeth are in a biting position. The posterior bite plane opens the posterior by the use of a plastic retainer- like appliance, which is built in the molar and pre-molar area to allow teeth to erupt into a corrected position.
Rubber bands or elastics contribute a lot to straighter teeth. They are marvels of physics. Attached to your braces, elastics exert the force that creates the right amount of pressure to move teeth in directions that the braces alone can’t. They don’t work without you. It’s important to wear your elastics as prescribed.
The best-known type is the Hawley retainer, which includes a metal wire that surrounds the teeth and keeps them in place. Named for its inventor, Dr. Charles Hawley, the labial wire, or Hawley bow, incorporates 2 omega loops for adjustment. It is anchored in an acrylic arch that sits in the palate (roof of the mouth). The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue moving teeth as needed