Removable appliances, unlike conventional braces, are used to retain teeth in their corrected positions and in some cases, influence growth of the jaws in order to affect changes in facial structure. In addition, they are often used before and in conjunction with fixed appliances.
Removable appliances are not utilized to treat all orthodontic problems. It takes skill and expertise to recognize conditions that will respond favorably to removable appliances. Timing of such therapy is also very important.
Although removable appliances can easily be taken out by the patient, there may be a tendency not to wear them as we have prescribed. This means your teeth, jaw and muscles may move back toward their original positions.
While the hard work is over and your braces have been removed, you’re not quite done yet. Because teeth can move after braces are removed, we will be giving you retainers to wear every day. Depending on your treatment, you will be instructed to wear the retainers either every night or all day long. While we almost never tell our patients to stop wearing retainers, they are especially important in the first year after your braces were removed and while you are still growing.
There are two main types of retainers: removable and bonded.
Bonded retainers are placed on the tongue-side of the lower teeth in cases that start with moderate to severe crowding. Since they are bonded to the back surfaces of the teeth, maintaining proper oral hygiene is critical. After nine months to a year, we may wish to remove the bonded retainer and replace it with a removable nighttime retainer.
Removable retainers come in and out of your mouth and are generally worn at nighttime only. It is important to wear them daily as well as keep them clean. You can brush them with antibacterial soap or toothpaste. It’s also a good idea to use denture cleaner (like Efferdent or Polydent) a few times per week to help keep them clean.
Remember – Take good care of your retainers. “Keep them in your face, in their case and no other place!”
Lower Bonded Retainer
Lower Clear Retainer
Long-standing oral habits, such as thumb sucking or tongue thrusting, can have adverse effects on the dentition. Habit appliances, like the tongue crib, are often used as a part of early interceptive treatment in an effort to halt (and often reverse) the ill-effects of oral habits, which have affected the teeth.
Tooth positions are subject to the forces that act upon them. Both the tongue and the lip cause forces that can alter the position of the teeth. The lip bumper is attached to the molars posteriorly. A pad contacts the lower lip and cheeks. The bumper removes excessive lip pressure from the teeth allowing the tongue to apply gentle force to the teeth. Space can be regained as the teeth straighten naturally by uprighting or “blossoming” due to these forces without the use of braces.
Because of its ability to regain space, the bumper is often used as a part of early or interceptive treatment in an attempt to avoid extractions later in treatment.
The Schwartz Appliance is often used as a part of early interceptive treatment. It is often used when a patient has a narrow dental arch in the upper jaw. The appliance can be gradually widened by Dr. Buttner so the upper teeth can fit over the lower teeth more appropriately. The stainless steel bow and acrylic portions may also aid in guiding the erupting teeth into place, thereby allowing for some “natural” straightening of the teeth without the use of braces.
Upper Schwartz Appliance
Occasionally, the upper jaw bones are too narrow for the lower jaw. In such instances, expansion appliances can be used to orthopedically expand the teeth and bones such that the top teeth can fit over the lower teeth. Only when this relationship is obtained, can an appropriate and more stable occlusion be obtained. The expansion appliance is fitted and sealed to the upper teeth. Expansion is done over several weeks, and the appliance remains in the mouth for a period of several months after the expansion to maintain the new position of the teeth and bones. During that time, new bone forms across the palate.
Headgear (Night Brace)
Headgear is often used to correct an excessive overbite. This is done by placing pressure against the upper teeth and jaw, which would hold the teeth in position or help move them into better positions. The severity of the problem determines the length of time headgear needs to be worn. The key to success with your headgear appliance is consistency. Headgear must be worn a certain number of hours per day, and if not, it must be made up the following day.
Headgear should never be worn while playing sports and should also be removed while eating or brushing your teeth.
There are two different kinds of headgear:
Pull Forward Headgear
This is used in cases where the upper jaw fits behind the lower jaw (underbite). It is used to bring the upper jaw forward to a better position just in front to the lower jaw. In some cases, the use of the pull forward headgear eliminates the need for more drastic treatment like extractions or even jaw surgery.
Push Back Headgear
This is used in patients that have a moderate to severe “overbite” where the lower teeth fit quite far behind the upper teeth. Push back headgear pushes the upper teeth and jaw back slightly while braces and rubber bands are used to bring the lower teeth and jaws forward slightly. Again, the use of push back headgear can help Dr. Buttner avoid removing permanent teeth or even jaw surgery!
Lower Holding Arch
Did you know that most people gain a bit of space on the lower jaw when certain baby teeth fall out? As the primary or baby molars fall out and the adult bicuspid teeth come in, most people will gain approximately two or more millimeters of space on each side. A lower holding arch can be fitted to the 6-year molars to hold onto this important space in patients that have very crowded teeth. This important tool helps Dr. Buttner avoid tooth removal in many patients. A lower holding arch can also be used in patients that lose a baby tooth prematurely to avoid “drifting” of the adult teeth into the empty spot.
Lower Holding Arch
Like a lower holding arch, a palatal bar is often used to hold space when a primary tooth is lost too early. It is sealed to the 6-year molars and stops them from migrating forward too early. It can also be used as an anchor if Dr. Buttner is trying to shift the front teeth toward the back.
Upper Palatal Bar