Rapid Palatal Expander (RPE) 

The “Rapid Palatal Expander” (RPE) is an appliance that widens the roof of a patient’s mouth. Initially, this may sound rather odd, but the fact is that the palate in children and teenagers still consists of two parts that are relatively loosely joined together and only knit into bone during adolescence.

The RPE is used when the upper jaw is too small. By pushing the two halves of the palate outwards, the upper jaw broadens. The gap between the two halves of the jaw widens naturally. This becomes visible in the outward migration of the two middle incisors. The space gained prevents having to extract teeth. However, not only the upper jaw broadens, the nasal passages that form part of the upper jaw complex do so as well, which can lead to improved breathing through the nose.

To guarantee the success of the treatment, the RPE appliance has to be turned once a day. With a special key, the designated screws are moved in the direction of the arrow. To stabilise the rapid broadening of the upper jaw in the long run, the RPE device remains in the mouth for approx. another 3 months after the last turn of the key.

Even amongst adults, a palatal expansion is still possible. Although the palatal suture has already become bony, it can be weakened surgically.

Because the RPE device bonds onto the teeth, chewing will be more difficult at first. However, one soon gets used to it.

The teeth and RPE device have to be brushed carefully after every meal. The metal pieces and screws in the palate must also be cleaned thoroughly.

Please contact us immediately, if one of the sides of the RPE appliance comes off the teeth. We will then schedule an appointment as soon as possible to re-fit the device.

 The Quadhelix 

The so-called Quadhelix is another device used when the upper jaw is too narrow and has to be broadened. Its name stems from the four loops that run along the upper jaw. The device is glued into the upper jaw via 2 metal rings (”bands”) on the first thick molars (6th tooth). The special glue releases fluorides that protect the teeth.

At first, it feels unusual for the tongue to share the space with the braces. Still, one should avoid playing around with the tongue on the Quadhelix. Brushing the teeth also appears more difficult than before. It is very important, however, to do so, as fixed appliances require intensive care to prevent any remaining food from getting stuck.

If anything about the Quadhelix is unsettling you, or should one of the bands have come loose, please do not hesitate to contact us immediately.
Usually the Quadhelix is a fantastic appliance – quietly working, invisible to others and effective without troubling the patient.

 The transversal developer/ sagittal developer 

The transversal developer is a fixed expansion brace for the lower jaw. Similar to the expansion plate, the transversal developer widens the lower dental arch by up-righting (expanding) the teeth. In this way, growth is encouraged while avoiding any teeth extraction at a later stage. The transversal / sagittal developer is glued to the first large molars in the lower jaw via two metal rings (”bands”) and can work 24 hours a day, independent of any input from the patient. The special glue releases fluorides that protect the teeth.

If anything about the transversal developer is unsettling you, or should one of the bands have come loose, please do not hesitate to contact us immediately.

 The transpalatal / lingual arch 

The transpalatal / lingual arch stabilises the jaw after an expansion. It acts to preserve space in the “support area” (region of the milk teeth 5, 4 and 3) while the teeth are in their rotational phase. The arch holds enough space for the erupting teeth. The transpalatal / lingual arch is a fixed retainer brace firmly attached to the first large molars.

 The lip shield 

We use the lip shield to treat crowded teeth in the lower dental arch or as a retaining device, after having created space in the lower jaw. It is partially removable and held in place by two bands fixed to the 6th tooth. The lip shield sits between the teeth and lips, and changes the muscle balance between tongue and lips, by keeping the lips away from the teeth. With the cooperation of the patient, the pressure of the tongue can thus eradicate the crowding of the lower teeth without any further orthodontic corrective measures.

If you wear the lip shield regularly, the lips will get used to it very quickly. From the outside it is almost “invisible”.

 The Carrière Distaliser 

The Carrière Distaliser was developed by Dr. Luis Carrière. It is a very refined appliance attached to the lateral tooth area that does not require any additional brackets. There is no aesthetic infringement and cleaning one’s teeth is easy. It comprises a pin with a hook for the elastic springs at one end and a three dimensional joint at the other. The first large molar is moved backwards via the joint, creating space in the dental arch. Treatment proceeds without having to extract teeth, thus avoiding the negative impact this usually has on the facial profile.

With the aid of the latest MIM technology, the Distaliser is made from a mold-injected nickel-free steel alloy. The Carrière-Distaliser is a passive device that is activated only by applying the elastic pulleys that the patients change themselves.
In most cases, we use the Carrière-Distaliser at the beginning of an orthodontic treatment, when the patient’s motivation is very high. Successful treatment often becomes visible as early as three to six months.
We were able to substantiate this short treatment period in our own research studies (Banach et al., Kierferorthopädie 2006; 20(2):105-110 and Wegener et al. 2009 – still being printed -).
Due to the simultaneous movement of the four lateral teeth (en bloc), the treatment period shortens by half, when compared to alternative treatment methods (braces attached to the outside of the teeth or other distalising appliances). Dipping teeth or other undesirable side-effects do not occur.

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 The Beneslider 

The Beneslider (distalisation appliance) is an excellent “non-compliance” alternative to the Carrière Distalizer.
1-2 mini-implants (also see “anchor pins“) are inserted into the palate as anchor points. An impression of the teeth and implants is taken and sent to the laboratory where the distaliser is made. In a second appointment, we glue the appliance in firmly. Because the distaliser works 24 hours a day, the teeth move backwards continuously via the build-in screws. This creates room for e.g. blocked-out canines in the region of the front dental arch.
Within a short space of time, the success of the treatment becomes visible, as gaps form. Once the teeth are distalised sufficiently (moved backwards), the whole appliance is taken out and the mini-implants can be removed.

Even a one-sided distalisation or a combination with brackets is possible.

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 The Herbst appliance 

The Herbst appliance was first introduced in 1909, by the German orthodontist Emil Herbst. After sinking into obscurity for many years, it was rediscovered in the 1970s through the works of Dr. Pancherz. Today, it is almost impossible to think of modern orthodontics without this method, especially in the treatment of difficult distal bites. Since 1979, many national and international studies have shown that the Herbst appliance stimulates growth in the lower jaw.

The Herbst appliance is bonded into the upper and lower jaw. Both parts are connected via a telescopic joint that guides the lower jaw forward into the desired position. Once the muscles adjust, the desired growth change takes place, so that the lower jaw can be stabilised in its final position.
Since the Herbst appliance is glued onto the back teeth, it is almost invisible from the outside. All movements like chewing, talking and biting can be done without problems. At the same time, the glue releases fluoride and strengthens the tooth.

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In the first few days after fitting the Herbst appliance, biting and closing the mouth is more taxing than before. This is due to the unfamiliar bearing of the lower jaw and can lead to muscle ache and tensions. The muscles first have to get used to the new bite situation.
By using the triple telescope, we pretty much eliminate any chances of disturbing the mucous membranes. Initially, the screws of the Herbst appliance can cause discomfort to the lips, in which case we supply the patient with wax sticks. These are formed into small “balls” and pressed into the parts causing the irritation. In addition, you can place cotton pads between the appliance and the cheekbone at night, to protect against pressure points.
Should something about the Herbst appliance seriously trouble you beyond this initial adaptation phase, we will be glad to assist.

The advantage of the Herbst appliance is that it works 24 hours a day, independent of the patient’s cooperation. This warrants a short treatment period of between six and nine months.
The Herbst application is effective in children and teenagers, as well as adults.
Even in patients with problematic jaw-joints, the Herbst appliance can contribute towards recovery i.e. the disappearance of complaints (Ruf and Pancherz, 2000).

 The Functional Mandibular Advancer (FMA) 

In terms of effectiveness, the Functional Mandibular Advancer (short FMA) is identical to the Herbst appliance (see above). Since both devices are glued to the teeth, they stimulate maximum growth in the lower jaw in a short space of time.
The FMA constitutes two components that are attached in the upper and lower jaw with a special glue. The glue releases fluoride and strengthens the tooth at the same time. A sloping level attaches to the lower jaw component, while a guide element connects to the upper jaw component. The interaction of the two elements guides the lower jaw forward into the desired position.
The advantage of the FMA is that there are less components attached to fewer anchor teeth. Since the appliance is invisible from the outside, it meets the highest aesthetic demands.

Immediately after inserting the application, the muscles have to adapt to the new lower jaw position. Muscle ache and tension may occur temporarily. After a few days, the patient gets used to the new bite situation.

It takes six to nine months before the lower jaw has stabilised in its target position and the FMA can be removed.

 The tongue crib fixed appliance 

In some children it can be observed that during the normal development in mixed dentition, the child-like swallowing habit (the tongue presses in-between the front teeth) has not changed into an adult swallowing habit (the tongue rests on the palate behind the front teeth during the swallowing excursion). If the child-like swallowing habit persists beyond the fourth year, the wrong positioning of the tongue can lead to tooth and jaw misalignments, as well as developmental irregularities. During growth an open bite can develop.

In our therapy to treat an open bite and change the swallowing habit, we use a tongue crib fixed appliance. The device is bonded to the two first large molars, and in this way guaranteed to work 24 hours a day, even during periods of unconscious swallowing.

The fixed tongue crib is accepted very well, as long as children understand that the appliance is meant to serve as an aid and not a punishment (Proffit, 1993). It is therefore important that as parents you support this measure.

If your child is undergoing speech therapy at the same time, we can discuss with the relevant pathologist whether it is sensible to interrupt the speech therapy, or whether parallel speech training makes sense.