Appliances

Facemask

A facemask is the most effective appliance to correct an anterior crossbite (lower front teeth positioned in front of upper front teeth when back teeth are touching) in the young child. Without early intervention, anterior crossbite can develop into a more permanent bite problem in the teenage or adult patient, sometimes requiring jaw surgery for correction. The facemask consists of a metal framework held in place by stretching elastic bands from loops on the framework to hooks on an appliance that is cemented to the upper teeth.

Regular wear of the facemask will help correct the anterior crossbite to correctly position the upper front teeth ahead of the lower front teeth.

Headgear

The headgear is an extraoral traction device which helps to push the upper teeth and jaw backwards, to allow better alignment with the bottom teeth and jaw.

The headgear features a metal bow that fits into braces cemented to the upper permanent first molar teeth. The bow is held in place with an elastic strap that fits around the back of the neck or the top of the patient’s head. Dr. Korne generally uses this device for adolescent treatment only.

Frankel

The Frankel is a classic removable functional appliance that is used when the upper teeth are protruding forward of the lower teeth. Removable means that the appliance can be removed from the mouth for cleaning, meals and periods of rest; functional describes a device that alters the form of the mouth by first modifying its function.

The appliance consists of an intricate metal and acrylic design that fits inside the patient’s mouth. The Frankel appliance positions the lower jaw in an artificial, forward-biting position. An increase in jaw muscle activity delivers forces to both jaws and all the teeth, resulting in backward movement of the upper teeth and jaw, and forward movement of the lower teeth and jaw. These movements help to reduce the protrusion of the upper teeth and noticeably improve the bite and aesthetics of the child’s face and smile.

MARA

The MARA (or mandibular anterior repositioning appliance) is a relatively new appliance that is used when the upper teeth are protruding forward of the lower teeth. Unlike the Frankel appliance, this device is cemented into the patient’s mouth and cannot be removed. The MARA has been developed with many advantages over earlier appliances in its class, such as increased patient comfort, easier adjustability and a simpler design.

The appliance consists of stainless steel crowns which are cemented to the upper and lower first permanent molar teeth. The upper and lower parts have smooth projections which serve to position the lower jaw in a forward-functioning position. The patient is encouraged to bite and chew in this artificial position.

An increase in jaw muscle activity delivers forces to both jaws and all the teeth, resulting in backward movement of the upper teeth and jaw, and forward movement of the lower teeth and jaw. These movements help to reduce the protrusion of the upper teeth and noticeably improve the bite and aesthetics of the child’s face and smile.

Crossbow

A crossbow is a new appliance that is used when the upper teeth are protruding forward of the lower teeth. Like the MARA and unlike the Frankel appliance, this device is cemented into the patient’s mouth and cannot be removed.

The crossbow has been developed with many advantages over earlier appliances in its class, such as increased patient comfort, easier adjustability and a simpler design.

The appliance consists of bands that are cemented to the upper and lower first permanent molar teeth. Special springs are positioned to connect the top and bottom parts of the appliance: these springs deliver gentle forces to both jaws and all the teeth, resulting in backward movement of the upper teeth and jaw, and forward movement of the lower teeth and jaw. These movements help to reduce the protrusion of the upper teeth and noticeably improve the bite and aesthetics of the child’s face and smile.

Lingual Arch (Space Maintainer)

A lingual arch is used to help resolve crowding for the lower teeth in children or teenagers. Contrary to popular belief, the space available for the teeth does not expand during the child's growth in stature. The lingual arch works by preserving the space difference between the larger primary second molars, which fall out, and the smaller permanent second premolars which follow. With the aid of this space difference, the front teeth will have more space for their correct placement in the arch.

The lingual arch consists of metal bands (braces) that are cemented to the lower permanent first molars. A wire connects the two bands and rests just behind the lower front teeth. The lingual arch usually stays in place until the lower permanent second premolars fully erupt into the mouth.

Lip Bumper

A lip bumper is used in crowding situations in the lower jaw to regain space for the proper placement of the teeth to avoid permanent tooth extractions, maximize chewing efficiency and contribute to long-lasting stability of the position and alignment of the teeth.

The lip bumper consists of a U-shaped metal wire that inserts into braces cemented to the lower first permanent molar teeth. The wire can be removed, but needs to be worn all day except for eating and toothbrushing. The front of the wire is designed to rest slightly in front of the lower front teeth, displacing the lower lip forwards and away from touching the surfaces of the teeth.

RME (Rapid Maxillary Expander)

A rapid maxillary expander (RME) is used for patients whose upper jaw is narrow. It gently widens the upper arch (palate) by stretching the central suture. Once widened, the suture knits together. Another person, most often a parent, adjusts the rapid maxillary expander daily as instructed for about 2-3 weeks, until the palate has been adequately widened. It is then left in place for six months without further adjustments so that new bone fills in and stabilizes the movement.

Thumb Crib

A thumb crib is used for children who have difficulty breaking a finger sucking habit. The most common finger is the thumb. Finger sucking occurs often in children up to the age of three years. Thereafter, most children naturally stop sucking. However some continue the habit with untoward effects that include moving the teeth and/or jaws out of line. This may require complex orthodontic treatment at a later age.

It is important to keep in mind that the thumb crib is not a punishment: rather, it should be viewed as a gentle, constant reminder to keep the finger out of the child's mouth.