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Appliances and Procedures

Palatal Expander

A palatal expander, also known as a rapid palatal expander, rapid maxillary expansion appliance, palate expander or orthodontic expander is used to widen the upper jaw so that the bottom and upper teeth will fit together better. Although the use of an expander is most common in children it can be and has successfully been used in adults, although the effects of expansion are slightly more uncomfortable. Also depending on the amount of correction may result in surgical separation of the top jaw. It is most often followed by braces to straighten out all the teeth now that room has been created.

The expansion process usually results in a large gap between the patient's 2 top front teeth, although this does not always happen. This gap is closed naturally and the teeth may overlap which leads to braces being needed. Sometimes with expanders, the patient has to turn the expansion screw themselves to tighten up the expander.

Although it may vary from person to person, most usually feel slight pressure on their teeth. As the patient turns the expansion screw using the key, a space develops between the front two teeth. Some may notice a larger space while others do not notice a space at all. It usually takes several days to adjust to eating and speaking after first receiving the rapid palatal expander. Patients may experience pain and headaches while wearing palatal expanders and when the screw is turned. They may also feel a sore on their tongue from contact with the expander's metal bars.

Patients who have expanders may experience extra saliva and lisps (pronouncing the letter S as a T sound) or a slight 'hissing' S sound.

When the palatal expander is first removed, patients usually report that their mouth feels extremely big and spacious.

                                                                                     

 

 

Retainers

Orthodontic retainers are custom-made devices, made usually of wires or clear plastic, that hold teeth in position after surgery or any method of realigning teeth. They are most often used before or after dental braces to hold teeth in position while assisting the adjustment of the surrounding gums to changes in the bone. Most patients are required to wear their retainer(s) every night at first, with many also being directed to wear them during the day - at least initially. They should not be worn while eating food or drinking staining or acidic beverages (e.g., Cola products and coffee). There are three types of retainers typically prescribed by orthodontists and dentists: Hawley, Essix, and Bonded (Fixed) retainers.

The best-known type is the Hawley retainer, which includes a metal wire that surrounds the teeth and keeps them in place. Named for its inventor, Dr. Charles Hawley, the labial wire, or Hawley bow, incorporates 2 omega loops for adjustment. It is anchored in an acrylic arch that sits in the palate (roof of the mouth). The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue moving teeth as needed.

                                                                               

Another common type is the vacuum formed retainer (VFR). This is a polypropylene or polyvinylchloride (PVC) material, typically .020" or .030" thick. Essix is a brand name many dental offices are familiar with. This clear or transparent retainer fits over the entire arch of teeth or only from canine to canine (clip on retainer) and is produced from a mold. It is similar in appearance to Invisalign trays, though the latter are not considered "retainers". VFRs, if worn 24 hours per day, do not allow the upper and lower teeth to touch because plastic covers the chewing surfaces of the teeth. Some orthodontists feel that it is important for the top and bottom chewing surfaces to meet to allow for "favorable settling" to occur. VFRs are less expensive, less conspicuous, and easier to wear than Hawley retainers. However, for patients with disorders such as Bruxism, VFRs are prone to rapid breakage and deterioration, especially if the material is PVC, a short chain molecule. This breaks down swiftly as compared to polypropylene, a long chain molecule.

Most removable retainers are supplied with a retainer case for protection. During the first few days of retainer use, many people experience extra saliva in their mouth. This is natural and is due to the presence of a new object inside the mouth and consequent stimulation of the salivary glands. It may be difficult to speak for a while after getting a retainer, but this speech difficulty should go away over time as one gets used to wearing it.
                                                                                      
 
An entirely different category of orthodontic retainers are fixed retainers. A fixed retainer typically consists of a passive wire bonded to the tongue-side of the (usually, depending on the patient's bite, only lower) incisors. Unlike the previously-mentioned retainer types, fixed retainers cannot be removed by the patient. Some doctors prescribe fixed retainers regularly, especially where active orthodontic treatments have affected great changes in the bite and there is a high risk for reversal of these changes. While the device is usually required until a year after wisdom teeth have been extracted it is often kept in place for life. Fixed retainers may lead to tartar build-up or gingivitis due to the difficulty of flossing while wearing these retainers. As with dental braces, patients often must use floss threaders to pass dental floss through the small space between the retainer and the teeth.