Mandibular Anterior Repositioning Appliance
A Mandibular Anterior Repositioning Appliance or MARA is a functional appliance that postures your lower jaw forward over the period of a year. This appliance is used to correct a severe overbite relationship where the lower jaw is underdeveloped. Optimizing the growth of the lower jaw can significantly improve a profile where the lower jaw is considered “weak”.
A MARA appliance consists of four bands attached to the permanent first molars. A u-shaped elbow butts up against a pad attached to the lower molar crown and positions the lower jaw in a more forward position. This forward positioning over a period of months encourages lower jaw growth, forward movement of lower teeth, and backward movement or distalization of upper teeth. In this way the gap between the upper and lower jaw is minimized and the profile is improved.
Adjustment to the MARA:
- Eating may present with some difficulty the first week but your mouth and jaw will be accustomed to the appliance.
- Cut up your food into smaller pieces to make eating easier as your teeth and jaws adjust. A few days will pass and the appliance will feel like it belongs In your mouth.
- If you develop any sore areas make sure you use your wax. Gargling with warm salt water or using a topical anesthetic like Orajel™ may also help ease the discomfort.
- Remember to brush and floss three times per day for 2 minutes each time.
A Nance appliance is a type of space maintainer. It consists of two orthodontic bands seated on the permanent maxillary molars and a wire that extends forward to an acrylic button that rests on the palatal tissue. A Nance anchors on the molars and prevents posterior molars from erupting forward when primary teeth are lost prematurely or extracted early to help maintain space for the erupting bicuspids. Permanent teeth in the front are larger than the baby teeth so there is often a space discrepancy that results in crowding. The beautiful thing about posterior baby teeth is that they are larger than the permanent teeth that replace them. Thus, when a space maintainer is placed and posterior space is held, crowding in the front can be unraveled into the extra space resulting into sufficient space overall.
Care of a Nance:
- Continue to brush your teeth as you did before your appliance was place. The bands may have attachments on them so they need to be brushed a little more carefully.
- Continue to floss daily.
- Stay away from gooey, sticky things like caramels, gummy bears, tootsie rolls and jolly ranchers. If a band becomes loose, simply push it down and call our office as soon as possible so that we can replace the band.
- If an area becomes “pokey” use wax as directed.
A removable expander can have one, two or three screws depending on where the spacing is desired. It is a functional appliance and is used to stimulate bone growth at the mid-palatal suture and flare anterior teeth. The expansion screws are positioned m palatal and on the palate slightly in front of the permanent posterior molars. The doctors will instruct the parent to open the screws according to what needs to be changed; mid-palatal expansion or flaring of the front teeth. Once expansion is completed, the appliance will be worn far approximately four to six months as a retainer to facilitate proper healing and retention of the new bone growth.
Care of a Removable Appliance
- Brush the appliance as you would your teeth; with a toothbrush and toothpaste.
- Wear your appliance all the time with the exception of brushing and eating.
- Remember to ONLY remove your appliance IF you have a case to store it in. Pets love retainers because they taste like bones but smell like you. Never put your retainer in a napkin because they usually get thrown away and they are expensive to replace!
- Retainers are uncomfortable to wear at first but within a few days they feel like they belong in your mouth. Speech can be difficult at first but with practice you will notice little difference when your retainer is in or out.
- Retainers can break. Bring your broken retainer in with its parts. Sometimes your retainer can be repaired and the fee for such is less that a new retainer!
In some cases where an underbite is present, we may recommend using reverse headgear (face mask) as part of the treatment plan. This appliance is designed to fix the discrepancy between your upper and lower jaws by moving the upper jaw forward to correct the malocclusion.
For the results to be successful, patient compliance is of the utmost importance. It may take several days to become accustomed to the appliance. With practice, it will become easier to place and remove the reverse headgear. We will determine the length of time you should wear your headgear, but it is generally 10-14 hours per day, which can include wearing while you sleep. You should not wear your headgear while participating in sporting activities.
Sometimes your chin may get irritated from the headgear. If this happens, you should always keep the area clean and often change the insert in the chin cup. If the skin becomes very dry, the use of moisturizing cream twice a day can be helpful. If your jaw joints are extremely sore or you cannot open and close your mouth without difficulty, stop wearing the appliance and contact us for further instructions as we may need to fit you with a different appliance. Also, if your headgear breaks or is bent, call us so we can fit you in with a repair appointment so your treatment will not be delayed.
Transpalatal Appliance (TPA)
A transpalatal appliance (TPA) is a type of space maintainer. It is basically a bar that spans the palate and is attached to orthodontic bands placed on the maxillary right and left permanent molars. The bar or wire that spans the palate is contoured to fit the palate so that there is little or no discomfort, even at the initial placement. The appliance can serve two functions; one is to maintain needed space for optimal eruption of permanent teeth and the second is to create additional space for eruption of the permanent teeth.
The TPA is used to hold needed space and thus will usually remain in your child’s mouth until all the permanent teeth have erupted OR active orthodontic care is started. The doctors will want to see your child every three months when he or she has an appliance in their mouth. Once any adjustments are made in the office, the TPA may cause pressure or a little discomfort for a few days. The pressure should subside within three to four days.
Care of a TPA:
- Continue to brush your teeth as you did before your appliance placement. Sometimes the bands have hooks and attachments on them so you will need to brush the entire surface of the tooth with a toothbrush and toothpaste.
- Floss every day.
- Stay away from gooey, sticky things like gum, taffy, jelly beans and jolly ranchers.
- Use wax rolled up in a ball and pressed onto the offending area when needed.
- Use collie curve tooth brushes to clean difficult to clean areas.
DO CALL if your TPA becomes loose or the tissue around it becomes wit lamed or uncomfortable.
A lip bumper is a removable appliance that is used in children whose teeth are erupting into a crowded environment. The lip bumper is situated in front of the lower incisor teeth so that when the lip bumps against the acrylic it acts to put pressure that transfers to the attached molars; thus pushing the back molars posteriorly and creating more space. A lip bumper is very effective in children who are less than 12 years of age. It also takes pressure away from the lips so that the lower incisors can flare out and again, create more space to alleviate crowding. The appliance is usually worn 12 to 18 months, although this time period varies due to compliance and spacing requirements.
Rapid Palatal Expander (RPE)
A Rapid Palatal Expander is a type of orthopedic appliance that increases the width of the palate or upper jaw. This expansion is produced by applying a lateral force on the posterior teeth thus producing a separation of the mid-palatal suture. When activated, the RPE produces an increase in arch circumference thereby increasing needed space for erupting teeth.
Orthodontic bands are fit to the maxillary molar teeth. The fixed expander screw is placed in the palatal vault and the arms are then contoured so that they meet the molar bands. Solder joints hold the expansion arms to the molar bands.
The most commonly recognized indication for rapid palatal expansion s correction of a posterior crossbite. Children and young adults have a patent suture and this palatal suture can be widened. A second indication for rapid palatal expansion is to gain additional arch length to accommodate rotated, displaced or impacted teeth. One study estimates that for every 1mm of increase in posterior arch width there is a 0.7mm increase in arch perimeter. This increase in spacing has led to a significant decrease in the number of patients who need teeth removed!
The amount of expansion needed is determined by the treating doctor. The parent will be instructed to turn the expansion screw one or two times a day. Each turn translates into 0.25mm so two turns a day for one week translates to 3.5mm of transverse expansion Once the screw is opened the desired amount, the appliance will continued to be worn for several months. This extended time of wear allows for healing and retention as well as enables further expansion if needed.
Getting use to your appliance:
Talking with your appliance can be different at first, but rest assured, your tongue and mouth will adapt to the palate expander within a few days. Try reading and talking out loud as much as possible so that you adapt more easily.
Brush your appliance just like you would your teeth. The office has special cleaners to help you get the attachments clean.
Use orthodontic wax to smooth over rough or “pokey” areas until you can get in to the office.