The MARA appliance (Mandibular Anterior Repositioning Appliance) is an effective way to correct overbites, and an improvement over headgears, which was often how comparable overbites used to be treated. Everything is inside the mouth so patients are less self-conscious during treatment. Also the Mara appliance cannot be removed, which means that patients won’t forget to wear it and slow down or disrupt treatment.
Anyone can thrust their lower jaw forward on their own. What MARA does is bring the lower jaw to this forward position, and then over time the mouth’s skeletal and muscular structure gradually adjusts to the new placement. With MARA, a metal device is attached to molars on both the upper and lower jaws. The lower appliance has short protrusions that slide along “elbows” in the upper appliance. MARA guides the lower jaw forward whenever the patient bites or closes their jaw. Patients will start to notice results almost immediately, but MARA is typically worn for 15 to 18 months to give time for the lower jaw to permanently grow into its new position.
The first few weeks of wearing MARA may feel a little strange, but patients get used to it rather quickly. MARA is used in conjunction with traditional braces, but it is only used about half the time of the full treatment time in braces.
The Herbst appliance is used to correct overbites by bringing the lower jaw forward and allowing it to grow into its new position. The most distinctive feature of this appliance is two rods that connect the upper and lower arches. These rods, which fit inside tubes attached to the upper molars, are what draw the jaw forward over the months the appliance is worn, and the way the rods cleverly fit into the tubes allows the patient to open and close their mouth easily.
The Herbst appliance also has a palatal expander that’s attached to two upper molars and goes across the roof of the mouth. On a regular schedule, the patient or a parent/ adult uses a key to turn the expander. Gradually, the top of the mouth will widen, and when the upper jaw is wider, it will relieve overcrowding and give teeth the space to fit in with one other comfortably.
All in all, wearing the Herbst appliance means the patient will have a fair amount of metal in the mouth, and it typically takes a few weeks of getting used to it. The metal parts can irritate the inside of the cheeks or other parts of the mouth, but dental wax will provide a buffer. The tongue needs to get used to sharing the space with the expander, so talking and eating can be difficult at first. But after the mouth adjusts to the device, the problems typically will disappear and soon enough, the patient will be rewarded with a proportional, well-aligned jaw.
The Forsus device is used to treat overbites that are too pronounced to be corrected by rubber bands or similar methods. Nevertheless, the Forsus appliance is relatively lightweight, hard to notice, and can mean reduced time in braces. Also, unlike a headgear or elastics, the appliance is always in the mouth, so the patient doesn’t have to worry about following the orthodontist’s instructions carefully on a regular basis. The Forsus appliance is most often used during a patient’s teenage years when the jaw is growing rapidly.
The most distinctive aspect of a Forsus appliance is the spring that connects the upper and lower jaws. More specifically, the lower arch wire has a push rod that goes into the springs, and this arrangement moves the lower teeth forward while bringing the upper molars back. It doesn’t require adjustments. Once it’s in, it applies a light but continual pressure that moves the mouth to where it needs to go.
The Forsus appliance is worn in conjunction with braces. It can correct an overbite fairly quickly, within 3 to 6 months, and can help a patient avoid expensive and unpleasant jaw surgery. While it might take a few days to get used to eating and talking with the Forsus in your mouth, it’s fairly unobtrusive, and patients get used to it quickly.
Sometimes as children grow up, their upper teeth don’t touch their lower teeth counterparts. Instead, they will close into the inside of the lower teeth on one side of the jaw or the other. This condition is a common type of malocclusion called a crossbite and can be caused by inherited factors, by adult teeth that didn’t displace baby teeth properly when they grew in, or by large tonsils. Whatever the cause, a crossbite should be corrected for both cosmetic and medical reasons.
The palatal expander (named so because it widens the palate, or roof of the mouth) is an appliance frequently used to correct crossbites and widen narrow arches. The expander is attached to upper molars on either side of the palate with metal bands or plastic bonds. The patient or a parent uses a special key that fits into the expander to turn it once every night, or in some cases once in the morning and once at night. The turning of the key causes the arms of the expander to spread slightly. Over time, the bone will grow into its new, wider position.
After each turn of the key, the patient may experience discomfort, but a palatal expander doesn’t cause much pain. As expansion is ongoing, the upper teeth will develop spaces between them, but these spaces will fill in naturally once the expansion process ends. As with any orthodontic device, the patient may have trouble talking or eating at first but these issues go away quickly.
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