Treatment & Services
One of the most common problems orthodontists treat is the discrepancy that occurs when the upper teeth protrude beyond the lower. Orthodontists call this a “Class II Malocclusion”. Class II Malocclusions can be corrected using headgear, elastics, extractions of teeth, jaw surgery, or with appliances like the Herbst. The Herbst has become the favorite appliance of many orthodontists for correcting major Class II Malocclusions. The Herbst positions the lower jaw forward, using your own gentle muscle forces to encourage the upper teeth, with their surrounding bone, to move back and the lowers to move forward, correcting the Class II Malocclusion, and often resulting in a stronger looking chin.
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.
As with braces, patients with Herbst appliances need to be careful about what they eat. For more information, see the “Foods to Avoid” section of the website.
Your Herbst appliance will be checked and adjusted at your appointments. If, sometimes between appointments, you develop some sore areas on the inside of your cheeks, please do not try to adjust the appliance yourself. Call for an appointment so that the necessary adjustments can be made.
Wearing the Herbst Appliance
At first, your mouth will feel unusually full and speaking will be awkward. But if you practice reading aloud, your ordinary speech will return quickly. You may also notice more saliva than normal, but this will decrease as you become accustomed to the appliance.
Forsus™ Class II Correction
The Forsus is a new appliance, similar to the Herbst, which corrects excessive upper protrusion, or Class II Malocclusions. Unlike headgear or elastics, which only work when the patient remembers to consistently wear them, the forsus snaps easily into position and works 24-7 with basically no compliance required by the patient. Its direction of force works like elastics, but without the unwanted side effects elastics have when used to correct Class II bites.
The lip bumper works slowly, but amazingly well at developing the lower arch in all directions. It holds the constricting muscles of the cheek and lip away from the teeth, allowing the expanding muscles forces of the tongue to gently expand and develop the lower arch, making room for unerupted teeth. It allows us to treat more cases without requiring the removal of teeth, especially if we start early, before the last baby teeth are gone.
CROWDING OF THE LOWER ARCH
TREATMENT IN PROGRESS USING A LIP BUMPER
AFTER TREATMENT, SHOWING A FIXED PERMANENT RETAINER
Rapid Palatal Expander (RPE)
Attached to the upper molars and first bicuspids 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 a wider palate, more room for teeth, and a broader, more attractive smile.
Palatal Bar (Transpalatal archwire)
The palatal bar allows us an additional handle to move the upper first molars any direction needed to correct the bite. The upper first molars are generally the largest teeth in the mouth. As they go, so goes the bite. Once they are in proper position, the other teeth tend to fall into place. The palatal bar has a multitude of uses. It can correct posterior crossbites. It can expand or constrict the arch, rotate, tip or move the molars forward or backward. It can support headgear or take its place, or act as a space maintainer or retainer. As anchorage, it is worth six months of headgear wear in correcting a Class II Malocclusion. The Palatal Bar is a great tool for achieving an ideally functioning, harmonious bite.
Habit Breaking Appliance
The rule of thumb is, whenever there is a contest between muscle and bone, muscle always wins. The tongue, lips, thumb and fingers are all capable of exerting forces to move teeth through bone. Usually this becomes evident in protruding upper front teeth and an open bite. If a person has a tongue thrust, or a thumb/finger sucking habit, an appliance can be placed to help break the habit. The Appliance, along with counseling, training, and monitoring is highly successful at breaking a habit which would otherwise doom any orthodontic straightening we might achieve.
Headgear is often used to correct what is often referred to as an “excessive overbite”, which orthodontists call a Class II Malocclusion. The headgear works by placing pressure against the upper teeth and jaw, which can hold the teeth in position to resist forward movement or help move the teeth back into better positions. The severity of the problem determines the number of months headgear needs to be worn. The key to success with your headgear appliance is consistency. Headgear must be worn at least 12 hours per day to be highly effective. Missing a day will set the progress back a lot – as much as five days worth. Getting only 8 hours in one day is much more effective than missing a day all together, and is effective at keeping some progress going. Wearing the headgear extra hours the next day can make up for getting less than 12 hours in one day.
Headgear should not be worn while playing sports and should also be removed while eating or brushing your teeth.
Protraction Face Mask
Often referred to as reverse-pull headgear, the protraction face mask is a removable appliance for patients where the upper jaw is not growing fast enough, resulting in a crossbite or underbite. The device consists of a metal bar attached to pads on the forehead and chin with rubber bands hooked to the face mask and the upper braces to gradually move the upper jaw forward. Patient compliance is extremely important as the face mask must be worn twelve hours per day or more to obtain the desired results. The face mask device is generally worn for 6-12 months.
The face mask is most effective when worn around 5 to 7 years of age, but is still effective at moving jaws up to age 10. Thereafter it can still be useful to move teeth, but not jaws. By wearing it when young enough, jaw surgery to correct an underbite can often be avoided when older.
Bonded Fixed Retainers
Bonded lingual retainers are often indicated to retain the teeth in the straight position we achieved when the braces were removed. It would be truly a sad situation, to go through all these years of braces, only to have the teeth relapse crooked again. The bonded lingual retainer is great at preventing this. Its advantages are, you can’t see it; you can’t lose; you can’t forget to wear it; and the teeth can’t go crooked again. And if you could see it, you would be impressed. It is made of 24 karat gold (plated), and looks like fine jewelry. It is made of five strands of gold twisted together, is very low profile, takes up very little room in the mouth, and can be worn indefinitely, being extremely durable. It helps make all that time in braces worth while and assures you a smile that lasts a lifetime.