Appliances
Herbst
When the upper teeth are too far forward of the lower teeth this is called excess overjet. One way to treat this problem in patients where there is still growth is the Herbst appliance. This appliance works best in patients during their pubertal growth peak. Used in combination with full braces, the Herbst positions the lower jaw forward and restricts the growth of the upper jaw. This process allows the lower jaw to catch up to the upper jaw.
The Herbst is cemented to the upper and lower first molars. The lower jaw is positioned forward through the utilization of sliding pistons that are attached to cylinders. The pistons allow the jaw to open and close while it is kept forward in the proper position. The Herbst usually remains in place for 12 months.
Maxillary Palatal Expander
Attached to the upper molars by cemented bands, the Maxillary 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 turning a screw in the center of the palatal expander, once a day - 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.
Transpalatal Arch (TPA)
The Transpalatal Arch (TPA) is an orthodontic device consisting of heavy wire, extending across the roof of the mouth, that is banded to the two upper first molars. It is used, most often, to keep the molars from drifting into the extraction spaces left behind from bicuspid extraction. The heavy wire between the bands ties the molars together preventing any unwanted movement.
In addition to holding the molars in place, the TPA can also be used to move teeth into the desired position. By placing bends in the wire, the molars can be widened, moved backward or rotated. The loop at the top of the TPA can even be used to teach proper tongue position in patients with poor tongue posture.
Space Maintainer
The Space Maintainer is a wire that runs behind the front teeth and is connected by a band on the left and right side. It maintains space in the jaw for teeth that haven’t erupted yet.
A space maintainer is frequently used when baby teeth are prematurely lost. Because a baby second molar is almost 2-3 millimeters larger than an adult premolar, the space that is left when the baby molar is lost can be used to help resolve any crowding problems later on. When a space maintainer isn’t used, the permanent first molars can drift forward and occupy the space left by the baby molar.
Facemask treatment
Facemask therapy is a type of treatment used on growing patients with a class III malocclusion (meaning a deficient upper jaw, strong lower jaw, and/or anterior crossbite). The appliance works best on younger patients because their bony sutures are still open and able to be widened and altered. Facemask treatment consists of 3 basic components: 1) the facemask; 2) a maxillary splint (usually an expander); and 3) elastics.
The facemask is extraoral (outside of the mouth) and is taken on and off by the patient. It has a forehead pad and chin pad connected to a rod which is attached to the expander with elastics, putting a downward and forward pull on the upper jaw. This pull is what brings the upper jaw into a more forward position and in better alignment with the lower jaw.. This treatment can prevent jaw surgery in compliant patients. Facemask therapy is most efficient when the facemask is worn 14-16 hours per day.
