How To Use Your Oral Appliance | HD Ortho
Bionator

The Bionator is a  removable, acrylic appliance that is worn full time to correct patient’s improper bite. The Bionator is usually worn 12-14 months depending upon the patient’s cooperation and severity of the malocclusion.  Using the Bionator during the patient’s active growth period allows his/her facial bone structure to grow into the proper alignment, often eliminating the need for more drastic treatment options.

INSERTING/REMOVING YOUR BIONATOR

1.       To insert place the Bionator wire against your upper front teeth and bite into the appliance with your lower teeth.

2.       To remove simply open your mouth and remove.

INSTRUCTIONS:

1.       Start using the Bionator slowly. Wear 30 minutes the 1st day, 1 hour the 2nd day, 2 hours the 3rd day, doubling the time for every day thereafter until 24 hours every day is achieved.

2.       The only exceptions to this 24/7 rule is:

A.)     Eating- you cannot eat with a Bionator. DO NOT wrap your Bionator in a napkin, as it will get thrown out.

B.)     Brushing- Keeping teeth clean and gums healthy is an important part of daily care.

C.)   While swimming- The appliance could fall into the water and get flushed away.

D.)   Playing contact sports- Any sport that requires a fitted mouth guard, or results in bodily contact where your expander can be knocked out your mouth.

3.       If your Bionator is not in your mouth it should be kept ONLY in the case provided. Placing your Bionator in a napkin, backpack, pocket, or a purse will result in a broken appliance. If the Bionator is in the case it should be wrapped in a damp paper towel to keep the acrylic from drying out. There is a fee to replace broken Bionators.

4.       Patients occasionally experience tooth sensitivity while wearing the Bionator. Treat discomfort with over the counter pain medication. Sores may also develop from the plastic rubbing against gum tissue. Treat gum sores with warm salt water rinses (1tspn salt to 8oz of water) 3 times daily. If patient experiences severe pain, contact our office.

5.       Slurring speech is expected and is a necessary drawback to treatment. We will provide the patient with a letter to teachers explaining this.

6.       The patient is wearing the Bionator correctly when his/her teeth are lightly clenched and biting the appliance. Simply having the Bionator rest in the mouth does not promote treatment. Patients will often notice that their “bite” feels different. This is normal and will end once treatment is complete. The patient will quickly get adapt to their new bite.

7.       Bionators should always be kept away from animals, dogs especially because they love to chew them. They should also be kept away from heat sources as this will dry, and distort the acrylic.

8.       Keep your Bionator clean- Brush it as you would your teeth. You can also use a denture cleaner or soak it in white vinegar.

9.       The Bionator often needs adjusted for erupting permanent teeth. DO NOT attempt to adjust at home. Call our office during normal business hours to schedule an adjustment.

10.    Any questions regarding your Bionator appliance should be directed to the orthodontic staff.

Bite Plate - Shell Plate

The bite plate (BP) and shell plate (SP) is essentially the same appliance with two separate functions.  A bite plate is used in conjunction with lower front bonds for a patient with a deep bite. This appliance prevents the patient from biting off the bonds.  The shell plate is an interim appliance which maintains the space created by other appliances such as expanders. The approximate wear duration of both appliances is 3-9 months.

TO INSERT:

·         Place Acrylic behind your front teeth and use your thumbs to push the appliance into the roof of your mouth

TO REMOVE:

·         Use your tongue suction to pop the appliance down and remove. DO NOT FLIP YOUR APPLIANCE UP AND DOWN WHEN NOT REMOVING, AS THIS COULD CAUSE BREAKAGE. There is a fee to replace broken appliances.

 

Wear Instructions:

1.       Your appliances must be worn full time 24 hours a day. Do not reduce wearing time unless directed by the doctor. The bite plate MUST be worn during eating to prevent the patient from accidentally biting off the lower braces.

2.       There are some Exceptions. When BP/SP is not in your mouth keep them safe in your case.

a.       Swimming- Water can flush them out of the mouth if swallowed.

b.       Playing Contact Sports- Any sport that requires a fitted mouth guard, or results in bodily contact where your BP/SP can be knocked out your mouth.

3.       ALWAYS store your BP/SP in the cases provided when they are out of your mouth. Appliances placed into pockets, purses, backpacks will easily get lost or broken.

4.       Wrap BP/SP in a moist paper towel to prevent the acrylic from drying out. Make sure the appliance is clean before wrapping it. Do not reuse the same paper towel. Change it each time.

5.       NEVER wrap your BP/SP in a napkin. Most are lost this way.

6.       Keep your appliance away from pets, especially dogs. Dogs will think they are a chew toy.

7.       Never store your BP/SP near a heat source, in a hot car, or lying out in the sun. This will cause the acrylic to dry out and distort.

8.       There is a fee to replace lost, broken, distorted appliance that is a separate charge from your treatment fee.

9.       Keep your BP/SP clean! Brush it every time they are removed from your mouth. Appliances can accumulate plaque on them if not kept clean. Use your toothbrush and tooth paste to clean them daily. Once a week you can use retainer cleaner, found in many stores, or white vinegar to soak them for a deep clean. (Mix white vinegar: use a small butter dish-  ½ vinegar,  ½ water, soak for 15 minutes, then brush with toothpaste to remove vinegar smell and taste)

10.    Appliances often need adjusting to accommodate erupting teeth. Also sometimes sores can develop from the acrylic rubbing against gum tissues. If you need the appliance adjusted, phone our office during normal business hours to schedule an appointment.

11.    Any questions regarding the BP/SP should be directed to the orthodontic staff.

Carriere Distalizer

The Carriere Distalizer is a fixed appliance used in conjunction with a Lingual Holding Arch prior to the start of full braces or Invisalign in Class II bite correction cases. The Distalizer arms are bonded to the cuspid and first molar on both sides. The lingual holding arch is cemented to the lower first molars by fitted molar bands. Even though these are fixed appliances the patient will still be required to wear removable elastics to achieve bite correction needed during active orthodontic treatment.  Without the patient’s total cooperation, Class II bite correction cannot be achieved.

INSTRUCTIONS:

1.      The elastics are worn 24 hours a day. The duration of wearing your Carrier Distalizer is usually 6 months with full cooperation.

2.      The ONLY exception is, they may be removed if the patient needs to wear a mouth guard for contact sports.

3.      Elastics should be changed 4 times a day. A good rule is to change them at breakfast, lunch, dinner and bedtime. If your elastics break, replace them immediately.

4.      Eat with your elastics if possible. Eating exercises the jaw. If you are unable to eat with your elastics in, remove to eat, then immediately replace after eating.

5.      Don’t run out of your elastics. If you need elastics before your next appointment, call our office and they can be mailed out, or you can stop by our office during normal business hours to pick some up.

6.      DO NOT rock your Distalizer arms back and forth as this will cause breakage.

7.      DO NOT play with the Distalizer or Lingual Holding Arch with your fingers or tongue, as this will cause breakage.

8.      A patient should not experience tooth pain from a lingual holding arch. This is a passive appliance holding space.

Forsus

Forsus is a fixed appliance used to gain additional bite correction. These springs are often used when the bite correction needed is more easily achieved with the Forsus, or when a patient has not been cooperative with elastic wear and more bite correction is needed to finish active orthodontic treatment.  Unlike elastics, the Forsus is not removable by the patient, but without the patient’s total cooperation, treatment cannot be finalized.

INSTRUCTIONS:

1.      Forsus are worn 24 hours a day. The duration of wearing your Forsus is usually 6 months with full cooperation.

2.      DO NOT rock your jaw back and forth while the Forsus are in as this will cause breakage.

3.      DO NOT play with the Forsus with your fingers or tongue, as this will cause breakage.

4.      DO NOT eat hard, crunchy, sticky, chewy foods. These will cause the Forsus or molar band to come loose.

5.      If a molar band or Forsus comes loose, phone our office for an appointment. Loose molar bands and Forsus can cause injury and prolong your orthodontic treatment.

6.      Even after the Forsus are removed, you may be required to wear elastics to get the final corrections needed.  Your cooperation will help finish your treatment.

7.      Any questions regarding your Forsus should be directed to the orthodontic staff.

HAAS Expander

The RapidPalatal Expander(RPE)is used to widen the upper arch thus creating more space for the patient’s permanent teeth. It is an acrylic appliance which is cemented to the upper molars. The RPE will be activated by turning front to back1 turn for 1-28 days. DO NOT OVERTURN THE EXPANDER. IF YOU HAVE LOST TRACK OF YOUR TURNS, PLEASE STOP AND HAVE A DOCTOR CHECK. He will advise you on what to do. After the turning of the expander is completed, it will stay in the patient’s mouth for the next three months. It is during this rest period that the palatal bone matures. At the end of the four months, the Hyrax will be removed the doctor will advise what the next step in your child’s treatment will entail.

INSTRUCTIONS:

1.       Turn the RPE appliance front to back1 turn each day(unless otherwise instructed) with the key provided. Do not reverse the turn or it will not expand.It is recommended to do turns at bedtime, since teeth do most of their moving immediately following the activation

2.       Patients occasionally experience tooth sensitivity while wearing an expander. This is normal since the function of the appliance is to move the teeth and widen the palate.Treat discomfort with over the counter pain medication. If patient experiences severe pain, contact our office.

3.       Initially the bands on the Hyrax may cause sores by rubbing against the inside of the cheeks. Use Peroxyl or warm salt water rinses (1tspn per 8oz water) three times daily to sooth. Place wax over the offending bracket. Eventually calluses will form where the sores are.

4.       Patients will often notice that their “bite” feels different. This is normal and will end once expansion is complete. The patient will quickly get adapt to their new bite.

5.       Make sure the appliance is kept clean.Brushing and flossing the banded molars is important! It is recommended to use a Water-Pik to aid in cleaning the appliance. If the gum tissues begin to swell around the appliance because of poor hygiene, contact our office.

6.       If the appliance should become loose, usually from a broken band, call our office immediately. DO not continue to turn the appliance if any looseness is visible.

7.      If the patient feels no tightening in the mouth after the expander is turned, stop turns and contact our office during normal office hours to be checked.

8. Any questions regarding your RapidPalatal Expander appliance should be directed to the orthodontic staff.

FOODS TO AVOID:

1.       Hard, Crunchy Foods such as: Hard pretzels, nuts, jaw breakers, hard candy, ice.

2.       Gummy, Sticky Foods such as: Gum, gummy bears, caramels, Jolly Ranchers, licorice, Fruit Roll-ups, Jelly Beans, Taffy, etc. If it sticks to your teeth, just avoid it.

3.      Popcorn! Popcorn kernels often wedge between the expander and the palate, or under the gums at the molar bands. This can cause irritation and inflammation of the gum tissue. It is difficult to remove them with brushing and flossing.

Hayes Nance

The Hayes Nance appliance, (HNA), is a fixed, wire and acrylic appliance used as a retainer to hold space while the permanent teeth are still erupting.

 INSTRUCTIONS:

1.      A patient should not experience tooth pain from a Hayes Nance appliance. This is a passive appliance holding space.

2.      Slurring speech is expected and is a necessary drawback to treatment, but will subside within a day or two.

3.      Keep your Hayes Nance appliance clean- Brush it as you would your teeth. Using a Water Pik to clean the acrylic button is helpful to flush foods and debris out. If bands or the appliance is not kept clean, inflammation and soreness can occur.

4.      If a sore of the gum tissue occurs, use warm salt water rinses (1tsp salt in 8oz water), 3 times daily for 1 week. Any severe irritations should be brought to our attention.

5.      If a band would come loose. Keep the area clean, and call our office during normal business hours to have the Hayes Nance appliance re-cemented.  There may be a fee to replace if the band is broken and a new Hayes Nance appliance is needed.

6.      Any questions regarding your HNA appliance should be directed to the orthodontic staff.

DO NOT:

1.      Do not eat sticky, chewy, gummy foods. They are hard to clean off the HNA, and may cause a band to come loose.

2.      Do not eat hard and crunchy foods. These will cause the cement seal to be broken and the band(s) to loosen or break.

3.      Do not play with the HNA with your tongue as this could cause a sore to develop.

4.      Do not neglect your brushing! Bands and HNA acrylic button and wires must be kept clean to avoid inflamed gum tissue.

Head Gear

Head gear appliance is used to gain space or arch length for the upper teeth and to correct the malocclusion by shifting the molar teeth back.  It is used most in patients that are still actively growing and often in conjunction with “braces.” The head gear is simply a strong wire inserted into the tubes of molar bands which exerts pressure on the molars moving them back to gain needed space.

Wear Instructions:

1.       Start wearing the head gear slowly: ( ½ hour the 1st day,  1 hour the 2nd day), doubling the wear time daily thereafter until the desired total of 12 hours a day has been achieved.

2.       The 12 hours daily can be cumulative during the day. They do not need to be consecutive. Wearing the head gear more than 12 hours a day will help the appliance work faster.

3.       Wear your head gear during quiet, non-active times. Examples: home work, reading, watching TV, sleeping, playing video games.

4.       The head gear should NEVER be worn during these activities: Riding in a car, Playing sports, Rough housing with friends, anything active that could cause injury.

5.       The neck strap for your head gear should always be worn on the 3rd hole. Do not adjust the neck strap unless directed by the doctor.

6.       Patients occasionally experience tooth sensitivity while wearing the head gear. This is normal and usually subsides in a week. Treat any soreness with an over-the-counter pain medication. If severe pain occurs, phone our office.

7.       Sores from the band tubes rubbing against the cheeks, or from the wire rubbing against the lips may occur. Sores from the bands can be treated by using warm salt water rinses (1tsp per 8oz water) twice daily and placing wax over the offending band tube.  Lip sores can be avoided by having the patient use Chapstick or a lubricant on lips before inserting the head gear. Any severe sores should be brought to our attention.

8.       Never pull up or down on your head gear as this could break the band cement causing a band to come loose. If the band feels/comes loose, STOP wearing the head gear and contact our office during normal business hours to have the band re-cemented. Bring the head gear to be adjusted if necessary.

9.       ALWAYS bring your head gear to appointments. It is important for the doctor to check and adjust the appliance.

10.    ALWAYS store your head gear in the case provided when it is out of your mouth. There is a fee to replace a lost or broken head gear.

11.    Keep the head gear and bands clean. You can use a wash cloth to wipe off the face bow (the hard wire part). The cushioned neck strap can be hand washed only. Keep your bands clean by brushing them after every meal.

12.    Any questions regarding your head gear should be directed to our orthodontic staff.

To Insert:

(1)     Insert one end of the wire face bow into the tube of the molar band.

(2)     Slide the wire straight back until you feel it stops.

(3)     Line the other side of the face bow wire as done in step (1). You may need to apply some inward pressure to the wire to make it slide in easier.

(4)     Once both sides of the face bow are in the tubes, have the patient hold the center of the facebow and place the neck strap on. Make sure you are using the 3rd hole on each side. (**It is extremely important that the face bow is held securely so the spring tension of the neck strap does not pull it out and cause injury.)

 

 To Remove:

(1)     While holding the face bow securely in the center, remove the neck strap from one side.

(2)     Pull the face bow straight out of the molar tubes. Do not angle it up or down as this will break the cement seal.

(3)     Clean off face bow and place into case.

DO NOT:

1)       Do not eat with the head gear on. Remove it for eating. Hard, crunchy, sticky, chewy foods should be avoided since these can break the cement seal on the molar bands.

2)       Do not pull on the face bow while wearing as this could cause injury. If enough pressure is applied incorrectly to the face bow, the tension modules on the side will disengage. Simply remove the neck strap and reattach the tension modules to the clips.

3)       Do not force your head gear face bow into molar band tubes. Contact the office during regular hours to be checked.

4)       Do not try to angle the face bow wire into the tubes. It will only go in when lined up straight.

5)       NEVER PLAY WITH THE HEAD GEAR IN!!

Hyrax Expander

The HyraxPalatal Expander is used to widen the upper arch thus creating more space for the patient’s permanent teeth. It is an all metal appliance which is cemented to the upper 6 year molar sand sometime the upper first bicuspids. The hyrax can be used in conjunction with full orthodontic treatment in older, actively growing patients.The Hyrax will be activated by turning front to back1 turn for 1-28 days. DO NOT OVERTURN THE EXPANDER. IF YOU HAVE LOST TRACK OF YOUR TURNS, PLEASE STOP AND HAVE A DOCTOR CHECK. He will advise you on what to do. After the turning of the expander is completed, it will stay in the patient’s mouth for the next three months. It is during this rest period that the palatal bone matures. At the end of the four months, the Hyrax will be removed the doctor will advise what the next step in your child’s treatment will entail.

INSTRUCTIONS:

1.       Turn the expander appliance front to back1 turn each day(unless otherwise instructed) with the key provided. Do not reverse the turn or it will not expand.It is recommended to do turns at bedtime, since teeth do most of their moving immediately following the activation

2.       Patients occasionally experience tooth sensitivity while wearing an expander. This is normal since the function of the appliance is to move the teeth and widen the palate.Treat discomfort with over the counter pain medication. If patient experiences severe pain, contact our office.

3.      Initially the bands on the Hyrax may cause sores by rubbing against the inside of the cheeks. Use Peroxyl or warm salt water rinses (1tspn per 8oz water) three times daily to sooth. Place wax over the offending bracket. Eventually calluses will form where the sores are.

4.       Patients will often notice that their “bite” feels different. This is normal and will end once expansion is complete. The patient will quickly get adapt to their new bite.

5.      Make sure the expander is kept clean. Brushing and flossing the banded molars is important! It is recommended to use a Water-Pik to aid in cleaning the appliance. If the gum tissues begin to swell around the appliance because of poor hygiene, contact our office.

6.       If the appliance should become loose, usually from a broken band, call our office immediately. DO not continue to turn the appliance if any looseness is visible.

7.       If the patient feels no tightening in the mouth after the expander is turned, stop turns and contact our office during normal office hours to be checked.

8.       Any questions regarding your RapidPalatal Expander appliance should be directed to the orthodontic staff.

FOODS TO AVOID:

1.       Hard, Crunchy Foods such as: Hard pretzels, nuts, jaw breakers, hard candy, ice.

2.       Gummy, Sticky Foods such as: Gum, gummy bears, caramels, Jolly Ranchers, licorice, Fruit Roll-ups, Jelly Beans, Taffy, etc. If it sticks to your teeth, just avoid it.

3.       Popcorn! Popcorn kernels often wedge between the expander and the palate, or under the gums at the molar bands. This can cause irritation and inflammation of the gum tissue. It is difficult to remove them with brushing and flossing.

Interim Guide (IG)

The Interim Guide, also called an IG, is a removable, rubber appliance that is worn as a retainer part-time to hold the correction and space made during the initial phase of orthodontic treatment to help guide permanent teeth are still erupting.

INSERTING/REMOVING YOUR IG

1.       To insert place IG on your upper teeth and push up to seat.

2.       Bite into the IG to seat your lower teeth.

3.       To remove simply open your mouth and remove.

 

INSTRUCTIONS:

1.       Wearing your IG properly will help lessen the amount of time needed in second part of orthodontic treatment once the permanent teeth have finished erupting.

2.       The IG can be worn either of the following ways:

A.)     While Sleeping- this is preferred if possible

B.)     During Daytime hours-If unable to sleep with the appliance wear it a minimum of 4 hours during daytime hours while reading, watching TV, doing homework, playing video games

3.       If your IG is not in your mouth it should be kept ONLY in the case provided. Placing your IG in a napkin, backpack, pocket, or a purse will result in a broken appliance. There is a fee to replace broken IG.

4.       Patients occasionally experience tooth sensitivity while wearing the IG. Treat discomfort with over the counter pain medication. Sores may also develop from the plastic rubbing against gum tissue. Treat gum sores with warm salt water rinses (1tspn salt to 8oz of water) 3 times daily. If patient experiences severe pain, contact our office.

5.       Slurring speech is expected and is a necessary drawback to treatment.

6.       The patient is wearing the IG correctly when his/her teeth are lightly clenched and biting the appliance. Simply having the IG rest in the mouth does not promote treatment. Patients will often notice that their “bite” feels different. This is normal and will end once treatment is complete. The patient will quickly get adapt to their new bite.

7.       Interim Guides should always be kept away from animals, dogs especially because they love to chew them. They should also be kept away from heat sources as this will dry, and distort the rubber.

8.       Keep your IG clean- Brush it as you would your teeth. You can also use a denture cleaner or soak it in white vinegar.

9.       ALWAYS bring the IG appliance to your check up appointments. The doctor needs to check the fit each time.

10.    Any questions regarding your IG appliance should be directed to the orthodontic staff.

Invisalign

Congratulations on choosing Invisalign to create your smile!  Invisalign is different from conventional braces when it comes to patient wear and care. Like conventional braces you will end treatment with a beautiful smile when full patient cooperation is used.  Following the instructions is critical for successful treatment outcomes.  Lack of patient cooperation will keep you from reaching your full Invisalign results.

Wear Instructions:

  1. You will receive your initial sets of Aligners at your first appointment.  At the second appointment you will have attachments bonded to selected teeth along with new sets of Aligners.  Elastics may be started at this appointment to start bite correction.
  2. The Invisalign attachments are used to help facilitate movement of selected teeth. Each attachment shape has a special function in correcting your smile. If one of your attachments comes loose, please phone our office during regular office hours to have it re-bonded. DO NOT stop wearing your aligners.
  3. Your Invisalign Aligners must be worn full time-22 hours a day as directed by the doctor.  Do not reduce wearing time unless directed to do so.
  4. There are some Exceptions. When Aligners are not in your mouth keep them safe in your case.
    1. Eating foods- Your Aligners should NOT be in your mouth while eating. This could easily break the aligners.
    2. Drinking Liquids- With the exception of water, you should remove the aligners before drinking or try to use a straw. If you choose to keep Aligners in while drinking it is suggested to remove them afterwards to rinse and/or brush.
  5. You will change your Aligners every  week. Each Aligner and bag has a number, proceed to the next higher number. If you are unsure which aligner you have, look for the number marked.
  6. Chewies are an essential part of your treatment success. Chewies are white cylindrical shaped cushions used to fully seat your Invisalign Aligners. Chewies should be used 5 times a day for a few minutes each time. This will ensure your Aligners are fully seated.  A Chewie should also be kept in your case and every time your Aligners are removed, you should make a few passes with one to ensure they are fully seated.
  7. Your aligners may feel snug when inserting, this is normal and will go away in a day or two. You can use any over-the-counter medications as directed to relieve the discomfort.
  8. If your Aligners are not seating fully, use the Chewies you were given to help seat them. If the aligners are still ill-fitting, phone during regular office hours, and continue wearing the previous set of Aligners.
  9. If an attachment or button comes off your tooth, please call our office. This is not an emergency, and should be replaced during our regular office hours. Continue to wear your Aligners. In the case of a button coming loose, stop your elastics on that side only until the button is replaced, then return to regular wear of elastics.
  10. If you notice a rough spot on your aligners, use an emery board to smooth the area. If a sore develops, use warm salt water rinses- 1tsp salt to 8oz of water for a few days to sooth the area.
  11. Sometimes elastics, rubber bands, are used during your Invisalign treatment. Elastics should be worn full-time when Aligners are in the mouth. Elastics should be changed 4 times a day,ie: Breakfast, Lunch, Dinner, Bed time. If you think you are going to run out of your elastics, you may stop by during regular office hours and pick some up, or phone the office and they will be mailed out to you.
  12. ALWAYS store your Aligners in the cases provided when they are out of your mouth. Aligners placed into pockets, purses, backpacks will easily get lost or broken.
  13. NEVER wrap your Aligners in a napkin. Most Aligners are lost this way.
  14. Keep your Aligners away from pets, especially dogs. Dogs smell the proteins from saliva and will think they are a chew toy.
  15. Never store your Aligners near a heat source, in a hot car, or lying out in the sun. This will cause the plastic to soften and distort.
  16. Keep your Aligners clean! Brush them every time they are removed from your mouth. Aligners can accumulate plaque on them if not kept clean. Use a soft or child size toothbrush and non-abrasive tooth paste to clean them several times daily. You may also use Hydrogen peroxide to soak Aligners for 10 minutes a few times a week. Once a week you should use a cleaner found in many stores, or white vinegar to soak them for a deep clean. (Mix white vinegar using small dish-½ vinegar, ½ water, then soak the Aligners for 15 minutes. Brush with toothpaste to remove vinegar smell and taste).
  17. New Restorations: NEW Fillings, Crowns, Implants, Partials, Bridges may cause your aligners not to fit. Call our office to schedule an appointment a possible rescan to fabricate new aligners.

Any questions regarding Invisalign and their fit and use should be directed to the orthodontic staff.

Lip Bumper

The Lip Bumper appliance is used to gain space or arch length for the lower teeth in patients that are still actively growing.  The lip bumper is simply a strong wire inserted into the tubes of molar bands which exerts pressure on the molars moving them back to gain needed space.

 Wear Instructions:

1.       Start wearing the lip bumper slowly: ( ½ hour the 1st day,  1 hour the 2nd day), doubling the wear time daily thereafter until the desired total of 12 hours a day has been achieved.

2.       Wear your lip bumper during quiet, non-active times, and eating. Examples: home work, reading, watching TV, sleeping, playing video games.

3.       The lip bumper should NEVER be worn during these activities: Playing sports, rough housing with friends, anything active that could cause injury.

4.       Patients occasionally experience tooth sensitivity while wearing the lip bumper. This is normal and usually subsides in a week. Treat any soreness with an over-the-counter pain medication. If severe pain occurs, phone our office.

5.       Sores from the band tubes rubbing against the cheeks, or from the wire rubbing against the lips may occur. Sores from the bands can be treated by using warm salt water rinses (1tsp per 8oz water) twice daily and placing wax over the offending band tube.  Lip sores can be avoided by having the patient use Chapstick or a lubricant on lips before inserting the head gear. Any severe sores should be brought to our attention.

6.       Never pull up or down on your lip bumper as this could break the band cement causing a band to come loose. If the band feels/comes loose, STOP wearing the lip bumper and contact our office during normal business hours to have the band re-cemented. Bring the lip bumper to be adjusted if necessary.

7.       ALWAYS bring your lip bumper to appointments. It is important for the doctor to check and adjust the appliance.

8.       ALWAYS store your lip bumper in the case provided when it is out of your mouth. There is a fee to replace a lost or broken lip bumper.

9.       Keep the lip bumper and bands clean. You can use a wash cloth to wipe off the lip bumper (the hard wire part). Keep your bands clean by brushing them after every meal.

10.    Any questions regarding your lip bumper should be directed to our orthodontic staff.

Lower Lingual Holding Arch

The lower lingual holding arch, (LHA), is a fixed, wire appliance that is used to hold space while the permanent teeth are still erupting.

INSTRUCTIONS:

1.      A patient should not experience tooth pain from a lingual holding arch. This is a passive appliance holding space.

2.      Slurring speech is expected and is a necessary drawback to treatment, but will subside within a day or two.

3.      Keep your LHA clean- Brush it as you would your teeth. If bands or the LHA is not kept clean, inflammation and soreness can occur.

4.      If a sore on the tongue occurs, use warm salt water rinses (1tsp salt in 8oz water), 3 times daily for 1 week. Any severe irritations should be brought to our attention.

5.      If a band would come loose. Keep the area clean, and call our office during normal business hours to have the LHA re-cemented.  There is a fee to replace if the band is broken and a new LHA is needed.

6.      Any questions regarding your LHA appliance should be directed to the orthodontic staff.

DO NOT:

1.      Do not eat sticky, chewy, gummy foods. They are hard to clean off the LHA, and may cause a band to come loose.

2.      Do not eat hard and crunchy foods. These will cause the cement seal to be broken and the band(s) to loosen or break.

3.      Do not play with the LHA with your tongue as this could cause a sore to develop.

4.      Do not neglect your brushing! Bands and LHA wires must be kept clean to avoid inflamed gum tissue.

Positioner

The Positioner is a removable, rubber intra-oral appliance much like a sports guard. It is used to make minor adjustments to your teeth, which completes your active orthodontic treatment. The Positioner is used for approximately 3-9 months, after which standard retainers are usually prescribed.

When the Positioner is first inserted, it will feel as if it doesn’t fit correctly. This is normal as the Positioner was fabricated to your final result at the end of wear and treatment. Active exercise with the appliance will move the teeth into the corrected position. Failure to wear and exercise with the Positioner can result in poorly aligned teeth and the possibility of further treatment in braces.

INSERTING/REMOVING YOUR Positioner

1.       To insert place Positioner on your upper teeth and push up to seat.

2.       Bite into the Positioner to seat your lower teeth.

3.       To remove simply open your mouth and remove.

INSTRUCTIONS:

1.       Initially the Positioner should be worn the 24hrs/day continuously the first 3 days. After the first 3 days the Positioner should be worn for 4hours-daytime and 8 hours nighttime for a total of 12 hours/day.

2.       The Positioner should not be worn for either of the following:

A.)     Eating- Keep it in the case provided. DO NOT wrap it in a napkin! There is a fee to replace lost appliances.

B.)     Swimming- Keep it in the case provided. There is a fee to replace lost appliances

3.       Active exercise with the Positioner should be for 10 minutes every 30 minutes of wear. Exercise consists of biting hard into the positioned and holding for 10 seconds then relaxing for 10 seconds. Longer exercise sessions will result in faster tooth movement.

4.       Patients occasionally experience tooth sensitivity while wearing the Positioner. Treat discomfort with over- the-counter pain medication. Sores may also develop from the plastic rubbing against gum tissue. Treat gum sores with warm salt water rinses (1tspn salt to 8oz of water) 3 times daily. If patient experiences severe pain, contact our office.

5.       Slurring speech is expected and is a necessary drawback to treatment.

6.       Simply having the Positioner rest in the mouth does not promote treatment. Patients will often notice that their “bite” feels different. This is normal and will end once treatment is complete. The patient will quickly get adapt to their new bite.

7.       Positioners should always be kept away from pets, dogs especially because they love to chew them. They should also be kept away from heat sources as this will dry, and distort the rubber.

8.       Keep your Positioner clean- Brush it as you would your teeth. You can also use a denture cleaner or soak it in white vinegar.

9.       If needed, the doctor may advise the use of fluoride with your Positioner. Follow directions as prescribed.

10.    ALWAYS bring the Positioner appliance to your check up appointments. The doctor needs to check the fit each time.

11.    Any questions regarding your appliance should be directed to the orthodontic staff.

Retainers

Retainers are used to maintain the corrected position of the teeth after braces have been removed. Teeth are still subject to move even after orthodontic treatment, especially from pressure due to developing wisdom teeth, and maturation. For the first 6-12 months you will wear your retainer(s) 24 hours a day. Only after the doctor directs, should a patient start wearing them less time.

Wear Instructions:

1.       Your retainers must be worn 24 hours a day to keep teeth from shifting. Do not reduce wearing time unless directed by the doctor.

2.       There are some Exceptions. When retainers are not in your mouth keep them safe in your case.

a.       Swimming-Water can flush them out of the mouth if swallowed.

b.       Playing Contact Sports-Any sport that requires a fitted mouth guard, or results in bodily contact where your retainers can be knocked out your mouth.

c.        Eating hard foods-These could easily break the acrylic or bend the wires

3.       ALWAYS store your retainers in the cases provided when they are out of your mouth. Retainers placed into pockets, purses, backpacks will easily get lost or broken.

4.       Wrap retainers in a moist paper towel to prevent the acrylic from drying out.Make sure the retainers are clean before wrapping them. Do not reuse the same paper towel. Change it each time.

5.       NEVER wrap your retainers in a napkin. Most retainers are lost this way.

6.       Keep your retainers away from pets, especially dogs. Dogs will think they are a chew toy.

7.       Never store your retainers near a heat source, in a hot car, or lying out in the sun. This will cause the acrylic to dry out and distort.

8.       There is a fee to replace lost, broken, distorted retainers that is a separate charge from your treatment fee. Retainers last many years with proper care and storage.

9.       Keep your retainers clean! Brush them every time they are removed from your mouth. Retainers can accumulate plaque on them if not kept clean. Use your toothbrush and tooth paste to clean them daily. Once a week you can use retainer cleaner, found in many stores, 3% hydrogen peroxide, or white vinegar to soak them for a deep clean. (Mix white vinegar: use a small butter dish – ½ vinegar, ½ water, soak for 15 minutes, then brush with toothpaste to remove vinegar smell and taste)

10.    Retainer Checks are usually semi-annual. This is to monitor your orthodontic stability. It is important to bring retainers to each of these appointments, so the doctor can check the fit and adjust as needed.If your retainers become ill-fitting, please call our office to have them checked. Do not wait for your next appointment.

 

TYPES OF RETAINERS:

types of retainers

1)       Maxillary Hawley: (acrylic retainer with a wire placed across the front of teeth for Top teeth)

To Insert:

(1)     Place the wire against the front teeth

(2)     Use your thumbs to seat the acrylic into the roof of your mouth

  To Remove:

(1)     Slide your finger nail under the rear metal clasps and pull the retainer off the back teeth

(2)     Remove the retainer

 

2)       Mandibular Hawley: (acrylic retainer with a wire placed across the front of teeth for bottom teeth)

To Insert:

(3)     Place the wire against the front teeth

(4)     Use your thumbs to seat the acrylic into your mouth

 To Remove:

(1)     Slide your finger nail under the acrylic wither in the back of your front teeth or along the molars and dislodge the retainer.

(2)     Remove the retainer

DO NOT:

(1)     Do not use tongue suction to “pop” the retainer in and out repeatedly, This weakens the retainer and wires, causing breakage. This can also cause the wire to wear a groove into the enamel of your front teeth.

(2)     Do not pull on the front wires to insert of remove the retainer. This will distort and break the wires.

Fixed Lingual Retainers: (a wire or special bar bonded to the back of your front teeth on top or bottom)

(1)     Floss under the bonded wire by using a Floss Threader and floss to prevent plaque build-up.  Brush well around the bonded wire.

(2)     AVOID  gum chewing, or eating any type of sticky, chewy foods that could loosen your fixed retainer.

(3)     A loosened fixed retainer needs to be re-cemented  as soon as possible to prevent movement of teeth and possible decay of teeth under the wire or  bonding pads.

5)      Tru-Tains (or) Essix Retainers:

clear brackets

To Insert:

(1)     Insert your Tru-Tain or Essix by placing it on the chewing surface of your front teeth and running your finger along from front to back to seat the retainer.

To Remove:

(2)     To Remove the Tru-Tain or Essix, first lift it off the molar teeth then around to the incisor teeth.

(3)     Remove the retainer

Retainer Fit:

1)       If your retainers feel snug, or painful when inserting, it means you still need more wear. Go to full-time 24 hour wear, until the ease of fit is achieved.

2)       If your retainers are not fitting, call our office to schedule an appointment for an adjustment. The longer you wait the less chance there is to make the retainers fit.

3)       Restorations: NEW Fillings, Crowns, Implants, Partials, Bridges can cause your retainers not to fit.Call our office to schedule an appointment for and adjustment, or possible fabrication of a new retainer.

Any questions regarding retainers and their fit and use should be directed to the orthodontic staff.

Reverse Head Gear

The reverse head gear appliance is used to correct the malocclusion by shifting the maxilla forward.  It is used most in patients that are still actively growing and often in conjunction with “braces.”

Wear Instructions:

1.       The head gear must be worn a minimum of 12 hours daily.

2.       The 12 hours daily can be cumulative during the day. They do not need to be consecutive. Wearing the head gear more than 12 hours a day will help the appliance work faster.

3.       Wear your head gear during quiet, non-active times. Examples: home work, reading, watching TV, sleeping, playing video games.

4.       The head gear should NEVER be worn during these activities: Riding in a car, Playing sports, Rough housing with friends, anything active that could cause injury.

5.       Patients occasionally experience tooth sensitivity while wearing the head gear. This is normal and usually subsides in a week. Treat any soreness with an over-the-counter pain medication. If severe pain occurs, phone our office.

6.       Sores from the band brackets rubbing against the cheeks, or from the elastics rubbing against the lips may occur. Sores from the bands can be treated by using warm salt water rinses (1tsp per 8oz water) twice daily and placing wax over the offending band bracket.  Lip sores can be avoided by having the patient use Chapstick or a lubricant on lips before using the head gear. Any severe sores should be brought to our attention.

7.       If one of the molar bands feel/come loose, STOP wearing the head gear and contact our office during normal business hours to have the band re-cemented. Bring the head gear to be adjusted if necessary.

8.       Do not run out of the needed elastics. If you are running low before your appointment call our office during normal business hours. We can either send them out or you can stop in to pick up extras.

9.       ALWAYS bring your head gear to appointments. It is important for the doctor to check and adjust the appliance.

10.    ALWAYS store your head gear in the case provided when it is out of your mouth. There is a fee to replace a lost or broken head gear.

11.    Keep the head gear and bands clean. You can use a wash cloth to wipe off the chin rest. The forehead strap can be hand washed only. Keep your bands clean by brushing them after every meal.

12.    Any questions regarding your head gear should be directed to our orthodontic staff.

 

To Insert:

(1)     Place the elastic around the metal bracket of each molar band.

(2)     Place the head gear onto your chin and forehead.

(3)     While firmly holding the head gear, pull each elastic forward and down onto the prongs on the chin rest.

(4)     Adjust the forehead strap for comfort.

 

 

 To Remove:

(1)     While holding the head gear securely in the center, remove the elastics from each prong.

(2)     Remove the elastics from the molar bands.

(3)     Clean off your head gear and place into the provided case.

DO NOT:

1)       Do not eat with the head gear on. Remove it for eating. Hard, crunchy, sticky, chewy foods should be avoided since these can break the cement seal on the molar bands.

2)       Avoid popcorn as the kernels can become trapped between the molar band and gum tissue causing inflamed, sore, swollen gums.

3)       Do not pull on the head gear while wearing as this could cause injury.

4)       NEVER PLAY WITH THE HEAD GEAR IN!!

Schwarz

The Schwarz Expander is a removable, acrylic appliance used to widen the upper arch thus creating more space for the patient’s permanent teeth. Once the expansion is complete, the appliance is often worn to maintain the space. The Schwarz Expander is used mainly in growing patients whose bicuspids have not yet erupted.

INSERTING/REMOVING YOUR SCHWARZ EXPANDER

1.       To insert place the acrylic behind your front teeth and use your thumbs to push the expander into the roof  of your mouth

2.       To remove slide your fingernail under the metal clasps and pull the expander off of your molar teeth and remove from mouth.

3.       (OR) To remove slide your fingernail under the acrylic in an area where there is a gap in your teeth and the appliance and pull down.

INSTRUCTIONS:

1.       Turn the Schwarz appliance in the direction of the arrows 1-2 turns each week as instructed with the key provided. Do not reverse the turn or it will not expand.  It is recommended to do the turns the same day each week at bedtime, since teeth do most of their moving immediately following the activation.

2.       Patients occasionally experience tooth sensitivity while wearing an expander. This is normal since the function of the appliance is to move the teeth and widen the palate. Treat discomfort with over the counter pain medication. If patient experiences severe pain, contact our office.

3.       Patients will often notice that their “bite” feels different. This is normal and will end once expansion is complete. The patient will quickly get adapt to their new bite.

4.       The expander must be worn at all times (24/7), even while eating at school and in restaurants. Never wrap your expander in a napkin; it will easily get thrown out with your trash. There will be a fee to replace a lost expander.

5.       The only exceptions to this 24/7 rule is:

A.) While swimming- The appliance could fall into the water and get flushed away

B.) Playing contact sports- Any sport that requires a fitted mouth guard, or results in bodily contact where your expander can be knocked out your mouth.

If your expander is not in your mouth it should be kept ONLY in the case provided. Placing your expander in a napkin, backpack, pocket, or a purse will result in a broken appliance. If the expander is in the case it should be wrapped in a damp paper towel to keep the acrylic from drying out. There is a fee to replace broken expanders.

6.       Expanders should always be kept away from animals, dogs especially because they love to chew them. Expanders should also be kept away from heat sources as this will dry, and distort the acrylic.

7.       Keep your expander clean- Brush it as you would your teeth. You can also use a denture cleaner or soak it in white vinegar.

8.       If the patient feels no tightening in the mouth after the expander is turned, stop turns and contact our office during normal office hours to be checked.

9.       Any questions regarding your Schwarz Expander appliance should be directed to the orthodontic staff.

Separators/Spacers

The purpose of separators, also called spacers, is to create a small space between the posterior or back teeth: bicuspids and molars. The separators make it easier and more comfortable for the patient when fitting bands at the next appointment.  Separators come in many colors, but this office uses the blue colored ones in two different sizes.

INSTRUCTIONS:

1.      Separators can cause tooth discomfort. This is normal as their job is to separate or push teeth apart. If needed, take an over-the-counter medication as directed for discomfort.

2.      Keep the areas clean by brushing well. Do not floss where the separators are, as this will pull them out.  DO NOT remove your separators.

3.      Avoid sticky, chewy foods, as these may pull the spacers out. ie: Gum, gummy bears, fruit roll-ups, licorice

4.      If your separators fall out more than 2 days prior to your appointment, call our office during regular business hours to have them replaced.

5.      If the separators come out during our “closed” office hours, it is not considered an emergency. Please call the office the next business day to check if replacements are needed.

6.      Any questions regarding your separators should be directed to the orthodontic staff.

Tru-Tain or Essix

Retainers are used to maintain the corrected position of the teeth after braces have been removed. Teeth are still subject to move even after orthodontic treatment, especially from pressure due to developing wisdom teeth, and maturation. For the first 6 – 12 months you will wear your.
retainer(s) _______ hours a day.

Only after the doctor directs, should a patient start wearing them less time.

Wear Instructions:

  • 1. Your retainers must be worn _____ hours a day to keep teeth from shifting. Do not reduce wearing time unless directed by the doctor.
  • 2. There are some Exceptions. When retainers are not in your mouth keep them safe in your case.
    • a. Swimming – Water can flush them out of the mouth if swallowed.
    • b. Playing Contact Sports – Any sport that requires a fitted mouth guard, or results in bodily contact where your retainers can be knocked out your mouth.
    • c. Eating hard foods – These could easily break the acrylic or bend the wires
  • 3. ALWAYS store your retainers in the cases provided when they are out of your mouth. Retainers placed into pockets, purses, backpacks will easily get lost or broken.
  • 4. NEVER wrap your retainers in a napkin. Most retainers are lost this way.
  • 5. Keep your retainers away from pet, especially dogs. Dogs will think they are a chew toy.
  • 6. Never store your retainers near a heat source, in a hot car, or lying out in the sun. This will cause the plastic to soften and distort.
  • 7. There is a fee to replace lost, broken, distorted retainers that is a separate charge from your treatment fee. Retainers last many years with proper care and storage.
  • 8. Keep your retainers clean ! Brush them every time they are removed from your mouth. Retainers can accumulate plaque on them if not kept clean. Use your toothbrush and tooth paste to clean them daily. Once a week you can use retainer cleaner, found in many stores, 3% hydrogen peroxide, or white vinegar to soak them for a deep clean. (Mix white vinegar: use a small butter dish – ½ vinegar, ½ water, soak for 15 minutes, then brush with toothpaste to remove vinegar smell and taste)
  • 9. Retainer Checks are usually semi-annual. This is to monitor your orthodontic stability. It is important to bring
    retainers to each of these appointments, so the doctor can check the fit and adjust as needed.
    If your retainers become ill-fitting, please call our office to have them checked. Do not wait for your next appointment.

To Insert:

    • (1) Insert your Tru-Tain or Essix by placing it on the chewing surface of your front teeth and running your finger along from front to back to seat the retainer. NEVER BITE YOUR RETAINERS INTO PLACE AS THEY CAN TWIST AND CRACK/BREAK IF NOT SEATED PROPERLY.

To Remove:

      • (2) To Remove the Tru-Tain or Essix, first lift it off the molar teeth then around to the incisor teeth.
      • (3) Remove the retainer

Retainer Fit:

      • 1) If your retainers feel snug, or painful when inserting, it means you still need more wear. Go to full-time
        24 hour wear, until the ease of fit is achieved.
      • 2) If your retainers are not fitting, call our office to schedule an appointment for an adjustment. The longer you wait the less chance there is to make the retainers fit.
      • 3) Restorations: NEW Fillings, Crowns, Implants, Partials, Bridges can cause your retainers not to fit. Call our office to schedule an appointment for and adjustment, or possible fabrication of a new retainer.

Any questions regarding retainers and their fit and use should be directed to the orthodontic staff.

SDDA

The Screw Driven Distalizing Appliance, (SDDA), is a dual purpose appliance used to gain space or arch length for the upper teeth while correcting the malocclusion by shifting the first molars back. When ready the SDDA will be converted to a holding appliance while the bicuspids are retracted into the corrected positions. It is a metal and acrylic appliance which is cemented to the upper 6 year molars and the upper first bicuspids. The SDDA can be used in conjunction with full “braces” in actively growing patients. The SDDA is activated by turning the side screws 1 turn every 3 days as determined by the doctor.  

INSTRUCTIONS:

  1. Turn the SDDA screws from outside to inside 1 turn every 3 days (unless otherwise instructed) with the key provided.  It is recommended to do turns at bedtime, since teeth do most of their moving immediately following the activation.
  2. Once the molars are moved, brackets will be added to start retracting the second bicuspid teeth into the corrected positions. When the first bicuspids are ready to be moved into the corrected position, the appliance will be converted to a holding appliance. The holding appliance will stay in place until the rest of the teeth are ready for braces.
  3. Patients occasionally experience tooth sensitivity while wearing the SDDA. This is normal since the function of the appliance is moving the molar teeth to correct the malocclusion. Treat discomfort with over the counter pain medication if needed. If patient experiences severe pain, contact our office.
  4. Initially the bands on the SDDA may cause sores by rubbing against the inside of the cheeks. Use Peroxyl or warm salt water rinses (1tspn per 8oz water) three times daily to sooth. Place wax over the offending bracket. Eventually calluses will form.
  5. Patients will often notice that their “bite” feels different. This is normal and will end once distalization is complete. The patient will quickly adapt to their new bite.
  6. Make sure the SDDA is kept clean. Brushing and flossing the banded molars and bicuspids is important! It is recommended to use a Water-Pik to aid in cleaning the appliance. If the gum tissues begin to swell around the appliance because of poor hygiene, contact our office.
  7. If the appliance should become loose, usually from a broken band, call our office immediately. DO not continue to turn the appliance if any looseness is visible.
  8. If the patient feels no tightening in the mouth after the expander is turned, stop turns and contact our office during normal office hours to be checked.
  9. Any questions regarding your SDDA should be directed to the orthodontic staff.

 FOODS TO AVOID:

  1. Hard, Crunchy Foods such as:  Hard pretzels, nuts, jaw breakers, hard candy, ice.
  2. Gummy, Sticky Foods such as:  Gum, gummy bears, caramels, Jolly Ranchers, licorice, Fruit Roll-ups, Jelly Beans, Taffy, etc.  If it sticks to your teeth, just avoid it.
  3. Popcorn! Popcorn kernels often wedge between the acrylic and palate or under the gums at the molar bands. This can cause irritation and inflammation of the gum tissue. It is difficult to remove them with brushing and flossing.
Inactive

Congratulations! You have completed orthodontic treatment in our office. You have retainers which you will continue wearing to maintain your teeth in the corrected position. At this time you have successfully worn your retainers for the last two years and now will be graduated inactive treatment status. This means you no longer have to be seen on a regular basis, but will always be a patient of the practice if you have any future orthodontic needs. The following information is important in maintaining your beautiful new smile!

  • Remember your teeth moved during orthodontic treatment and continue to have the ability to move after treatment too, if retainers are not properly worn to maintain the corrected results.
  • NEVER stop wearing your retainers! You may gradually reduce the wearing time and intervals, as long as your retainers continue to fit PASSIVELY. If you notice your retainers are snug going in or your teeth are sore when removing them, you need to wear them more often.
  • Keep them safe and clean.  Retainers can last several years if they are properly cleaned and stored. If they are not in your mouth, the retainers must be cleaned prior to wrapping them in a damp paper towel and storing them.
  • Do not wait to return if your retainers become ill-fitting. The longer you wait there is lesser chances that we can adjust the retainers.
  • If you need to return in the future for a check-up or replacement of retainers, an office visit plus other applicable fees will apply.

Thank you from the Doctors Hilton and Diminick and our staff for entrusting us with your orthodontic needs. You will always be a patient to us. If you have any future orthodontic needs, please phone our office to schedule an appointment.