Dentistry

• Dental Procedures
• Before and After Pictures
• Sedation
  • Nitrous Oxide Sedation
  • Oral Conscious Sedation
  • General Anesthesia
  • Sedation FAQ
  • Pre and Post operative instructions
• Post Operative instructions
  • After a Filling
  • After an Extraction
  • After a Sedation Appointment
• Special Needs Kids
  • Autism
  • Down Syndrome
• Interceptive Orthodontics
  • Anticipatory Guidance
  • Types of Bites
• Appliances
  • Crown and Distal Shoe
  • Crown and Bar
  • Spring and Wire
  • Nance Appliances
  • Lingual Arch
  • Hawley
  • Lower Spring Aligner
  • Bluegrass Appliance
  • Ectopic Spring Distalizer
  • Palatal Expander
  • "Pedo” Bridge
  • Maxillary Horseshoe Splint
  • Pro-Form Mouthguard
• GURU Online Community!

Appliances

Space Maintenance

Why do we need to maintain space in your child’s mouth?

1. To provide space for erupting permanent teeth
   
2. To prevent teeth from drifting or tipping forward
   
3. To prevent crowding

Note: The best space maintainer is a well maintained primary tooth. But when these important natural space maintainers are lost, it is essential to implement a space management strategy.

Failure to maintain space may result in the following:

1. Drifting / tipping of teeth
   
2. Loss of arch length
   
3. Midline shift
   
4. Crowding of permanent teeth
   
5. Impactions
   
6. Orthodontic intervention including extractions

 

Unilateral Space Maintainers

These are placed just on one side of the mouth, usually "replacing" one tooth. 

• Crown w/ distal shoe
• USE: This is used to prevent first permanent molars from moving forward (mesially) with the early loss of second primary molars.
• DESCRIPTION OF APPLICANCE: The example shown below is a crown with an extension soldered to the crown. The extension is placed into the tissue against the unerupted first permanent molar. The extension, also called a distal shoe, is used when the second primary molars are lost before the eruption of the first permanent molars (i.e., very premature loss).
• DURATION OF WEAR: These are removed when the permanent tooth erupts in the space that was held by the appliance.

 

Crown and Bar

• USE: Early loss of a first primary molar often allows the second primary molar to tip and move forward (mesially).  This appliance is used for holding the space for the erupting permanent tooth. (bicuspid)
• DESCRIPTION OF APPLIANCE: This appliance includes a crown on a primary molar with a band soldered onto it that rests against the canine or cuspid.
• DURATION OF WEAR: These are removed when the permanent tooth erupts in the space that was held by the appliance.

 

Spring and Wire Spacer

• USE: This appliance is used to maintain space of an extracted primary tooth.  
• DESCRIPTION OF APPLIANCE: A wire wraps around a molar and cuspid leaving space for the erupting permanent tooth. 
• DURATION OF WEAR: These are removed when the permanent tooth erupts in the space that was held by the wire.

 

Bilateral Space Maintainers

These are usually cemented with orthodontic bands on the back 2 permanent molars on both sides (bilateral), connected by a soldered wire.  This can only be placed when 6 year molars are fully erupted. In addition, this appliance helps with anterior teeth alignment because the wire rests against the inside of the lower incisors.

• Nance Appliance
• USE: The Nance Holding Arch is used in situations where premature bilateral loss of maxillary primary teeth has occurred.
• DESCRIPTION OF APPLIANCE: This type of space maintainer also is known as a Nance Holding Arch.  Note the small acrylic button that rests against the roof of the mouth.
• HYGIENE NOTE: It is important that patients and parents be instructed to make sure that the patient meticulously flosses under the acrylic button, and brushes around the bands.

• Lingual Arch
• USE:  This appliance can eliminate the need for two unilateral spacers.  They are most useful if there is more than one tooth missing we want to prevent the lower incisors from tipping.  Loss of second primary molar in the mandible (counterpart to Nance).  Maintains the tooth space and the leeway space
• An altered form can incorporate a looped lingual arch to actually move the lower incisors forward (straighten them a little too) before maintaining them in a better position.
• DESCRIPTION OF APPLIANCE: The appliance is cemented on the two 6 year molars.  There are adjustment loops in the wire (called activators) that can provide the following movements:
• Anterior-posterior (front to back) arch length increase
• Buccal (toward cheek) expansion
• Distal (toward the back) molar movement
• Molar torque or tip
• Molar rotation

When is it time to remove the space maintainer?

• When the permanent tooth is erupted into the correct position.
• Usually around 1 year after initial placement of the appliance.

 

Retainers

Maxillary Hawley with Finger Springs

• USE: When multiple teeth are lost and space maintenance and chewing (mastication) are of concern. 
• DESCRIPTION OF APPLIANCE: Used for rotation, usually of a permanent tooth needing alignment, or to close anterior space.

• Lower Spring Aligner
• USE: Correcting minor rotation and crowding up to 1-1.5 mm from cuspid to cuspid. The teeth are normally ‘disked’ prior to placing this appliance.
• DESCRIPTION OF APPLIANCE: The spring action helps align the teeth. 
• DURATION OF WEAR: This appliance is worn for 24 hours a day and is used until the teeth are in correct alignment.

 

Harmful Habit

• Bluegrass Appliance
• USE: This appliance is made for children under 6 years of age that are finger or thumb sucking.
• DESCRIPTION OF APPLIANCE: This appliance has a ‘roller’ that prevents the finger or thumb from resting against the palate, or the roof of the mouth.
• DURATION OF WEAR: This is worn until the habit has stopped.

 

Regaining Lost Space

• Ectopic Spring Distalizer
• USE: This appliance is used when a 12 year molar is caught under the 6 year molar.  It prevents the tooth from erupting correctly.
• DESCRIPTION OF APPLIANCE: There is an orthodontic band cemented around the 6 year molar with a spring that is attached to the 12 year molar (ie Distalizer). This will help the tooth erupt into the correct position.
• FOLLOW-UP: Patient’s with this appliance will need to come in every 2 weeks to have the distalizer adjusted.
• DURATION OF WEAR: This appliance will stay in place until the 12 year molar erupts into the correct position.

Crossbite

High Palate Rapid Palatal Expander (R.P.E.)

• USE: A device used to widen the arch of the upper jaw. Outward pressure applied to the plate by screws force the joints in the bones of the palate to open lengthwise, widening the palatal area. Your child’s orthodontist typically prefers this step prior to getting orthodontic treatment.  Parent and patient cooperation is necessary for this appliance to work correctly and efficiently because the appliance needs to be adjusted on a daily basis.
• DESCRIPTION OF APPLIANCE: This appliance comes with a turning key that is inserted into a ‘lock’ that will adjust the pressure exerted against the teeth, widening the palate.
• DURATION OF WEAR: This will be worn for about 4 to 6 months.
• FOLLOW-UP: Dr. Schroeder will need to follow up with your child’s progress every other week.

 

Replacing Missing Teeth

• “Pedo” Bridge
• USE: This appliance is made for children that prematurely lose their front teeth, and are between 2 and 5 years old.
• DESCRIPTION OF APPLIANCE: Two crowns are cemented on the back upper molars connected to 4 anterior acrylic teeth.
• DURATION OF WEAR: This will stay in place until the upper anterior or front permanent teeth erupt.

 

Occlusal Guard: Also called a Night guard

Maxillary Horseshoe Splint

• USE: This is used when a patient grinds or clenches their teeth.
• DESCRIPTION OF APPLIANCE: This appliance covers the biting surfaces of the teeth, preventing the upper and lower jaw from coming together.  This prevents any further wear of the teeth resulting from a grinding or clenching habit.

 

Sports Guard:

Pro-Form Mouthguard

• USE:  Most people wear a mouth guard during sports in an effort to prevent any damage to their teeth. The new generation of mouth guards has been shown to reduce forces that not only protect the teeth but also can prevent concussions, neck injuries, jaw fractures, cerebral hemorrhage and even death. 
• These also come with the option of different colors or a helmet strap.