To successfully complete your orthodontic treatment plan, patients must work together with the orthodontist. Teeth and jaws can only move toward their corrected positions if the patient consistently wears the elastics (rubber bands), headgear or other appliances as prescribed.

Removable Appliances

Upper Expander

An upper expander gently and painlessly helps the palate grow wider. There is a key that is turned 1 or 2 times per week. This appliance is used when there is not enough room to fit the developing permanent teeth - crowding. Narrow upper jaw development has been linked to insufficient nasal respiration(mouth breathers) and is common in children with a history of frequent ear infections, or tonsilitis.

Lower Expander

A lower expander helps to expand and upright the lower teeth to match the newly expanded upper jaw. It also creates room for new permanent teeth and reduces the need for extractions.

Sagittal Appliance

This appliance helps tip the front teeth out if they are leaning too far inward. This is often used when there is an under-bite or a cross-bite that is not growth related. It restores normal position to the front teeth.

Twin Block

This is an orthopedic growth appliance to help encourage a receded lower jaw. It helps correct overbites that are primarily skeletal ( growth related). It can improve the bite as well as improve the facial profile for some patients. Many patient with this problem will require surgical treatment as adults if it goes uncorrected.

Removalbe Appliances - Questions and Answers

Can I eat with them?

Yes, that is an important part of this phase of treatment. A fine mesh is embedded into the acrylic, reinforcing the biting surface. As the patient wears the appliance the acrylic wears down and the mesh sometimes pokes through. If this happens you can use an emery board to file the mesh or call the office.

What do I do if there is a lot of saliva in my mouth or I can't swallow?

Some patients have a sensation that they cannot swallow when they first get their appliance. This is due to an increase of saliva that collects under the appliance pooling in the back of the mouth. We have found that taking small sips of water often helps to overcome this sensation. One of your thoughtless functions now may require some concentration.

Will I talk like myself again?

Yes, the appliance can affect the speech in some patients when they first get their appliance. It may be an adjustment for you to get used to speaking with the appliance. The more you speak and practice the clearer your speech will become. There is no permanent negative effect to the speech by wearing this appliance.

Do I have to eat with it in my mouth?

Yes, it is very important the appliance be worn during meals. There are several reasons for this:

The more time the appliance is worn the more effective it will be.
Taking the appliance out for meals is less time for the appliance to work effectively.
It is easier to forget to put the appliance back in your mouth.
The appliance could get wrapped in a napkin and thrown out, which could be a very costly lesson. There is a $250.00 fee to replace an appliance that is lost.

It is also helpful to eat non-chewy foods the first couple of days. This allows the jaw muscles to get strengthened up and you will be able to eat everything you were eating before. Try to eat foods like mashed potatoes, eggs and soup. You can have any food that you are comfortable eating.

Are there any foods I can't eat?

You can eat just about anything you want except for gum and hard sticky things. You will need to cut certain things up like bagels, apples, etc. If you bite into them they can bend the front wire.

How do I clean my retainer?

Cleaning becomes even more important for you while you are wearing an appliance. Cleaning the appliance with a toothbrush and toothpaste will not get rid of bacteria. Do not put the appliance in very hot water because this could damage it. It is also important for you to rinse or brush your appliance after each meal. The food can get caught under the appliance and it is not healthy to let you teeth sit in the food throughout the day. Gently rinsing the appliance under water will be enough. You will need to make sure that you are brushing the top, sides and back of your teeth really well, because the appliance will be covering these areas most of the time. It is also very important to have routine checkups with the dentist, also sealants if indicated.

How do I turn my appliance?

The turning will start 1 to 2 visits after you initially get your appliance. We will give you a key and show you how to use it. This is a slow, gentle and painless process. The turns are usually one time a week and only 1/4mm each time. Turning the appliance:

take the appliance out of your mouth
make sure the design is facing you (there should be an arrow)
put the key in the hole closest to the front wire
turn always from the front wire to the back of the appliance until the key stops moving
check off the date on the calendar that the turn was made.

What do I do in an emergency?

Please call the office. If no one is at the office, listen for instructions to call the doctor.

Fixed Appliances

Fixed Expander

Used to encourage growth of the upper jaw, slowly and painlessly. Patient will need to keep regular visits with Drs. Klempner and Amram to adjust the expander to get maximum growth. An impression will be taken to ensure proper fitting of the appliance, and then the bands will be cemented around the permanent first molars. The appliance will stay in the patients mouth all the time.

Lingual Holding Arch (space maintainer)

For lower crowding, used to maximize room in the lower arch by preserving space when baby teeth are lost. An impression will be taken to ensure proper fitting of the appliance. Metal rings called bands are cemented into place around the permanent first molars and a wire will run along the inside edge of the patient's teeth to prevent the permanent molars moving forward.

Headgear

Headgear or night-brace is an appliance used when the upper jaw is growing faster than the lower jaw and an overbite is being created. It helps coordinate the upper and lower jaw by slowing down the excessive upper forward growth. It is also used to help create additional space to eliminate healthy extractions.

Things to remember when wearing your headgear are:

Be careful when putting on or removing your headgear. You could injure your cheeks, lips, face or even your eyes.
Do not wear when you are running or playing sports.
Do not allow anyone to grab or pull on your headgear. Other people such as sibling or friend may not understand the dangers.

Modified Tandem Appliance

Is used when the lower teeth are on the outside of the upper teeth. This is called an underbite. There are impressions taken to make the different appliances involved. The first one looks like a fixed expander with a wire in the front. The lower appliance looks like a standard lower expansion appliance with headgear attachments. These appliances help encourage forward growth of the upper jaw as well as slow down growth of the lower jaw. The "tandem" appliance was first developed by Dr. Klempner in 1999 and had been used by hundreds of orthodontists worldwide. Click here to read original article written by Dr. Klempner published in the Journal of Clinical Orthodontics.

Choose Your Expander

1. Penguin
2. Tennis Raquet
3. Racing Stripes
4. Black/White Dots
5. Floral Design
6. Bear Claw
7. White/Red Stripe
8. White/Black Dots
9. Strawberry

10. Tic-Tac-Toe
11. Snoopy
12. New York/New York
13. Kite
14. Piano Keys
15. Yin-Yang
16. Pin Wheel
17. Camouflage
18. Lightning Strikes

19. Black Sunflower
20. Apple Seed
21. Tiger Claw
22. Pair of Dice
23. Zebra Stripes
24. Watermelon
25. Frog
26. Black Daisy
27. Racing Car

28. Life Saver
29. Baseball
30. Pink Pig
31. A B C
32. No To Drugs
33. Golf Green
34. Flower
35. American Flag
36. Black Eye Susans

37. Pink/Purple Sparkles
38. Yellow/Green Sparkles
39. Blue Sparkles
40. Orange/Purple Sparkles
41. Green Sparkles
42. Purple Sparkles
43. Red Glitter
44. Blue Glitter
45. Clear/Pink Glitter

46. Green Glitter
47. Clear/Gold Sparkles
48. Red/Green Sparkles/Hearts
49. Color Combo
50. Rainbow
51. Rainbow Color Combo
52. Rainbow Glitter
53. Multi Glitter
54. Gold Glitter

55. Red
56. Pink
57. Clear
58. Purple
59. Yellow
60. Blue

61. Orange/Glow-in-the-dark
62. Pink/Glow-in-the-dark
63. Red/Glow-in-the-dark
64. Clear/Glow-in-the-dark
65. Green
66. Orange

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