Appliances

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Herbst | Distalizers | Space Maintainers | Maxillary Expander | Transpalatal Arch

Herbst

What is the Herbst Appliance?

One of the most common problems orthodontists are asked to treat is when the upper teeth protrude beyond the lower, called a Class II occlusion. When we see a patient with the upper teeth protruding, we tend to think that the upper jaw and teeth are too far forward. However, more often than not this condition is due to a small lower jaw that is further back than it should be.

How does the Herbst work?

The Herbst is fixed to the teeth by crowns (caps) that are cemented to the upper first molars and the lower molars or lower bicuspid teeth. A rod and sheath attached to the upper and lower segments hold the appliance together. These sliding pistons will allow the jaw to open and close, but keep the jaw forward in the desired position.

What can I expect with the Herbst?

At first, the Herbst may feel like a mouthful, but within two weeks it should become quite comfortable. It may irritate the inside of your cheeks initially, but soon the tissue will adapt to the appliance and not be a problem. During this short adjusting period use dental wax as needed to cover the Herbst appliance arms for comfort. Please call us to report any prolonged cheek or tongue irritation.

Chewing may be awkward at first. You may want to stay with softer foods for a day or two. But very soon you will be back to a normal diet (with the exception of sticky and brittle foods, of course).

The Herbst is checked every 8 weeks and can be advanced or moved forward by adding "shims" to the rods. You may have some braces placed while the Herbst is in place. It stays in place for 8 to 12 months to make sure the correction is permanent and then is removed and full braces are placed to continue and finish the straightening process.


Distalizers

Hilgers Pendulum

What is a Hilgers appliance?

The Hilgers Pendulum is a type of distalizing appliance that fits in the roof of your mouth and is attached to your upper teeth.

How does the Hilgers work?

The purpose of this appliance is to push your molar teeth back into an ideal “Class I” position.

What can I expect with the Hilgers appliance?

The appliance is usually in place for about six months. The doctor may also decide to place some braces to align your teeth while the appliance is working. Once your molars are in a Class I position, the appliance is removed and braces are put on the rest of the teeth. The doctor may place a small bar between the molar teeth, called a transpalatal arch, to help maintain the molars in their corrected position.


Space Maintainer

What is a space maintainer?

The lower lingual space maintainer is a wire that runs behind your bottom teeth and connects to a band on the molars.

How does a space maintainer work?

The purpose of a space maintainer is to save or “maintain” space in the lower jaw for permanent teeth as they erupt. The “baby” second molars are larger than the adult bicuspid teeth that replace them. By holding this space with the space maintainer, we prevent the permanent molars from drifting forward and using up this valuable space. The idea is to use this preserved space to resolve crowding later on.

What can I expect with a space maintainer?

The lower lingual space maintainer is fixed in your mouth and can only be removed by your doctor. It stays in place until all of your permanent teeth in the lower jaw erupt.


Maxillary Expander

What is a maxillary expander?

The maxillary palatal expander is an orthopedic appliance used to widen your upper jaw. It is used when the upper jaw is too narrow for the lower jaw resulting in a crossbite of the teeth. The expander is attached to the teeth in the upper jaw by bands cemented to the teeth, or by plastic pads that fit over the teeth.

How does the expander work?

The upper jaw is made up of two separate bones connected by a band of tissue called a suture. While you are still growing, the suture is easily separated by the pressures applied by the expander. This outward pressure stimulates bone formation between the two halves of the upper jaw, increasing the overall width.

The expander has a screw in the middle, which is turned once a day with a special key we provide. It is important to turn the screw as prescribed by your doctor. If you cannot make your appointment for an expansion check, do not keep turning without talking to us first. We do not want you to go too far.

What can I expect with a maxillary expander?

You may feel “tightness” when you turn the screw, but this goes away within a minute or so. As the jaw gets wider, it is normal for a "gap" to develop between the upper front teeth. This space will eventually close on its own after the expansion has been stopped, or it can be closed later on with braces.

Once your doctor has determined that expansion is complete, we will seal the expander to stabilize it. Your appliance then stays in place for another 4 months while bone forms in the sutural area. The expansion appliance is in your mouth for a total of approximately 6 months.


Transpalatal Arch

What is a transpalatal arch?

A transpalatal arch is a wire that fits along the roof of your mouth and is attached on both sides to bands on the molar teeth.

How does a transpalatal arch work?

The TPA is most often used to prevent the molar teeth from drifting forward, for example after a distalizing appliance or after bicuspid extractions. It can also be used as an active appliance to rotate or widen the molars, or to prevent the molar teeth from erupting throughout the course of orthodontic treatment.

What can I expect with a transpalatal arch?

The transpalatal arch is fixed in your mouth and can only be removed by your doctor. It stays in place for anywhere from a few months to the entire course of treatment.