Types of Appliances
Herbst
One of the most common problems orthodontics treat is the discrepancy that occurs when the upper teeth protrude beyond the lower. Ordinarily, when we see a patient with the upper teeth protruding, we tend to think that the upper jaw and teeth are too far forward; but, more often than not, this condition is due to a small lower jaw that is further back than it should be. With these patients, we would like to encourage the lower jaw to catch up in growth, and braces like the Herbst appliance help this happen.
Even though the Herbst appliance prevents the lower jaw from moving backward, opening and closing movement still occur easily, and patients do not have any problems learning to chew their food with their lower jaw in this new position.
Rapid Palatal Expander
Attached to the upper molars through bonding or by cemented bands, the Rapid 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 activating the expander through turning a screw in the center of the palatal expander, 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.
Lower Holding Arch
The lower holding arch is successfully used at an early age to help prevent more expensive orthodontic treatment later in life. This appliance creates space for the lower teeth by holding the arch in place. It often can avoid the need for extraction of permanent teeth. The LHA keeps the adult molars from shifting forward when the larger baby molars are lost, thus allowing the permanent teeth to erupt naturally and move into the “held” space.
The LHA is normally worn for 12-18 months, until all the permanent teeth have erupted. It is easy to care for and will not cause any discomfort. Patients should avoid sticky foods such as gum or caramels and hard foods like hard candy or hard, crusty bread while the LHA is in place.
Nance
The Nance is a holding arch that consists of two bands around the back molars on the upper arch and a plastic button that covers part of the roof of the mouth. Wires are connected to the bands and the plastic button to help maintain space as permanent teeth erupt. Patients can choose the color of the plastic button.
TPA Bar
The TPA is a small bar used to move molars that wires alone cannot accomplish. This thin bar follows the curve on the roof of the mouth. It is sometimes used to maintain expansion after expanding the palate. Generally, the TPA is worn for about 4-6 months.
Forsus
The Forsus appliance is used in order to help move the upper molars back while moving the lower arch forward. Composed of a spring coil rod, the appliance is used while a patient is currently wearing braces. It runs from the upper first molar band down to the lower archwire.
You may notice some discomfort initially, so we recommend a soft food diet for the first few days after the appliance is placed. Regular anti-inflammatory medication may help with any pain, if needed. It is important to keep the appliance clean; you may do this by carefully brushing the coil and other metal pieces of the appliance. Also, we recommend that patients not open their mouths very wide, as the appliance may come apart.