Below is a list of appliances commonly used at AvA Orthodontics. For each appliance, there are detailed instructions about how to take care of it at home. If you want to know more about the appliance and why Dr. Amin Movahhedian and Dr. Hamed Vaziri utilize them, please contact our office.

Nance

It consists of bands around the first permanent molars on each side, a thin acrylic button that rests on the palate of the mouth, and two arms connecting the parts.

Space Maintainer – Nance

It is a fixed appliance, which means you cannot take it out. There is minimal maintenance required. Brush the acrylic button regularly to keep it free of food debris. Brush and floss the teeth that have bands with extra caution.

You may have a lisp for a few days right after the delivery of the appliance. It will go away in a few days without any action, however, if you want to get rid of it even faster, talk more or read books aloud to allow your tongue to get used to the appliance.

It is used for the following reasons:

  • Space Maintainer: To prevent the back teeth from coming forward after a premature loss of the baby teeth. If we don’t have a nance in place, the permanent molars will come forward and close the space that needs to be available for the eruption of the permanent premolars.
  • Anchorage: To correct the position of the teeth sticking out, an orthodontist will decide to pull two teeth and utilize the space gained to push the front teeth back. However most of the time we don’t want the back teeth to come forward at all. In order to hold the back teeth from moving, to allow us to retract the front teeth as much as possible, the nance is used.

Lingual Arch

It consists of bands around the first permanent molars on each side and an arm connecting the bands.

It is a fixed appliance, which means you cannot take it out. There is minimal maintenance required. Brush the metal bar regularly to keep it free of food debris. Brush and floss the teeth that have bands with extra caution.

It is used as a space maintainer for the lower teeth. If baby teeth are lost and the permanent teeth that are replacing them won’t erupt soon, there is a high chance that the back teeth will move forward and occupy the empty space partially or fully. This could cause impaction of the permanent teeth or crowding. In order to reserve the space for the future permanent teeth and hold the back teeth where they are, a Lingual Arch will be necessary.

Space Maintainer – Lingual Arch

RPE – Hyrax Type

Palatal Expander

The common names for it: Rapid palatal expander or RPE, Maxillary expander. It is a butterfly looking appliance that consists of the following parts:

  • A keyhole
  • Bands on the first molars
  • Two arms adjacent to the palatal surface of the teeth on each side
  • Connectors that hold the pieces together
  • A key for activation

It is used to widen the upper dental arch when the palate is constricted. Each turn of the key increases the width of the appliance 0.2mm. Because we can modify the bone on young and growing patients, it will have the most effective orthopedic result. While the upper jaw widens, some space may develop between the front teeth. Usually, for each millimeter increase in the back, we expect .3mm of space in the front which shows as space between the two front teeth. The space usually closes by itself or we close it with braces. After the expansion is complete, we keep the expander in place for a few more months to make sure what we have achieved is stable. Sometimes there may be some level of discomfort after each turn, however, the feeling of pain is quite uncommon.

It is a fixed appliance which means you cannot take it out. Activate the keyhole with the key provided. We recommend turning it right before going to bed. Make sure the keyhole is fully exposed after each turn otherwise the next time you will have a difficult time activating it. After activation, when you want to take the key out make sure that you don’t turn the keyhole back to its original position. It is a common mistake. If it happens, you deactivate the RPE right after activating it. The result is no activation.

Brush the appliance regularly to keep it clean. Floss the teeth that have bands with extra caution. You may have a lisp for a few days right after the delivery of the appliance. It will go away in a few days without any action, however, if you want to get rid of it even faster, talk more or read books aloud to allow your tongue to get used to the appliance.

Instructions for Activation: One turn a night before bedtime for 2 weeks. After that, stop activation until your next visit, even if your appointment is in the next few months.

Expander – Lower Schwartz Type

Lower Schwartz Expander

It is either removable or fixed. The fixed expander looks like a lingual arch with the keyhole right in the middle. The removable appliance looks like a lower Hawley retainer with the keyhole right in the middle.

Activate the keyhole with the key provided. Make sure the keyhole is fully exposed after each turn otherwise the next time you will have a difficult time activating it.

It is used to widen the lower dental arch. The expansion allows us to make more room for the remaining permanent teeth that haven’t erupted or for correcting crossbite. Unlike the maxillary expander, there will not be any orthopedic expansion.

After activation, when you want to take the key out make sure that you don’t turn the keyhole back to its original position. It is a common mistake. If it happens, you deactivate the expander right after activating it. The result is no activation.  

Brush the appliance regularly to keep it clean. Floss the teeth that have bands with extra caution. 

You may have a lisp for a few days right after the delivery of the appliance. It will go away in a few days without any action, however, if you want to get rid of it even faster, talk more or read books aloud to allow your tongue to get used to the appliance.  

Instructions for Activation: Two turns a week (Sunday and Wednesday), until further instruction to stop.

TPA

There is minimal maintenance required. It is a fixed appliance which means you cannot take it out. Brush the appliance regularly to keep it free of food debris. Brush and floss the teeth that have bands with extra caution. It is normal to have an imprint of the appliance on your tongue. In this case, try to avoid pushing your tongue on the appliance and rinse with an alcohol-free mouthwash.

Space Maintainer – TPA

It is used for the following reasons:

  • Space Maintainer: To prevent the back teeth from coming forward after a premature loss of the baby teeth. If we don’t have a TPA in place, the permanent molars will come forward and close the space that needs to be available for the eruption of the permanent premolars.
  • Anchorage for impacted canine: Sometimes to bring in impacted canines in the mouth, we need additional force from the molars. In order to minimize side effects on the molars while doing that, we need to hold the molars stationary in their position. Therefore, a TPA is a great appliance used to achieve this goal.

Forsus

Forsus are used when the upper teeth are sticking out in comparison to the lower teeth. This means there is an extended overjet, you may know it as “overbite”. To be able to fix the “overbite”, an orthodontist needs to push the upper teeth backward and the lower teeth forward. It is possible with a few appliances. The most well-known appliance is headgear. Dr. Amin Movahhedian and Dr. Hamed Vaziri are not big fans of headgear because it is an extra-oral appliance and patients do not like to wear it.

Overbite Treatment by Forsus

There is minimal maintenance required. It is a fixed appliance, which means you cannot take it out. Brush the coil spring on each side regularly to keep it free of food debris. Brush and floss the teeth that have bands with extra caution. Do not constrict the coil spring with your fingers. It may cause distortion. Do not open your mouth too wide. It may cause separation of the rod and the coil spring. You may experience minor discomfort at the corner of your lip for the first few days. It will go away soon.

Advantages of Forsus

  • All of its parts are inside the mouth
  • It doesn't restrict jaw movements
  • It doesn't interfere with eating, chewing, speaking, etc
  • It is fixed in place, you cannot take it out

Overbite Treatment – Headgear

It consists of a metal rod with a connector on each end, a coil spring around the rod, and bands on the upper molars. The coil spring along the metal core is clipped to the band around the upper first molar and crimped around the lower wire between the canine and the first bicuspid. The pressure of the spring creates constant and mild pressure which results in moving the upper teeth backward and the lower teeth forward.

Tongue Thrusting Habit

Tongue Crib

There is minimal maintenance required. It is a fixed appliance which means you cannot take it out. Brush the appliance regularly to keep it free of food debris. Brush and floss the teeth that have bands with extra caution.

It is a habit breaker appliance for tongue thrusters. With the help of this appliance, we train the tongue not to come between front teeth during swallowing, speaking, etc. At AvA Orthodontics we use two different designs for this appliance.

Openbite Treatment – Lower Tongue Crib

Lingual arch design: It is placed on the lower teeth. It looks like a lingual arch with vertical bars welded to it in the front area.

Openbite Treatment – Upper Tongue Crib

Nance design: It is placed on the upper teeth. It looks like a Nance (with or without the acrylic button) with vertical bars welded to it in the front area.

3-Way Sagittal

It is used when there is a constricted upper arch along with an underbite. It is mainly a palatal expander with an additional set of keys, by which we can move the front teeth forward and correct the underbite. Like a palatal expander, it works best in young and growing patients. After the expansion is complete, we keep the expander in its place for a few more months to make sure what we have achieved is stable. Sometimes there is some level of discomfort after each turn, however, pain is quite uncommon.

It consists of three keyholes, an acrylic connector plate covering the palate, and a key for activation. Activate the keyhole with the key given. We usually instruct for one turn a day for the side keys and one turn a week for the front key. We recommend activation right before going to bed.  

Make sure the keyhole is fully exposed after each turn otherwise the next time you will have a difficult time activating it. After activation when you want to take the key out make sure that you don’t turn the key back to its original position. It is a common mistake. If it happens, you deactivate the key right after activating it. The result is no activation. 

Brush the appliance regularly to keep it clean. Floss the teeth that have bands with extra caution.  You may have a lisp for a few days right after the delivery of the appliance. It will go away in a few days without any action, however, if you want to get rid of it even faster, talk more or read books aloud so you train your tongue.

Upper 3-Way Expander