Braces and Invisalign get most of the attention, but many orthodontic treatments use other appliances too. They can widen the upper jaw, guide the lower jaw forward, correct the bite before braces go on, or hold teeth in place afterward. If Dr. McCabe has recommended an appliance for you or your child, this page explains what it does, how long it’s usually worn, and how to take care of it.
Why Some Treatments Need More Than Braces
Braces are excellent at moving individual teeth. Some problems, though, involve how the jaws grow and fit together, not just how the teeth line up. A narrow upper jaw, a lower jaw that sits too far back, or upper teeth that have erupted too far forward can be easier and more stable to correct with an appliance designed for that job. This is especially true while a child is still growing.
That is part of why the American Association of Orthodontists recommends a first orthodontic evaluation by age seven. At that age most children have a mix of baby teeth and permanent teeth, which lets Dr. Russell McCabe spot jaw and bite problems early and, when it helps, use an appliance to guide growth. You can read more about this approach on our interceptive orthodontics page.
Appliances We Use at McCabe Orthodontics
| Appliance | What it does | Typical use |
|---|---|---|
| Palatal expander | Widens the upper jaw | Adjusted over a set period, then left in for several months to hold the expansion |
| MARA | Encourages the lower jaw to develop forward | Typically about 12 months, before, during or after braces |
| Carriere Distalizer | Moves upper back teeth back to correct the bite | Worn with elastics before upper braces are placed |
| Elastics | Improve how the upper and lower teeth fit together | Worn as prescribed during braces treatment |
| Separators | Create space for orthodontic bands | A short time before bands are placed |
| Positioners | Complete the final tooth movements | About four to eight weeks near the end of treatment |
| Retainers | Hold teeth in their new positions | After braces or aligners come off |
Palatal Expander
A palatal expander widens the upper jaw by putting gentle pressure on the upper molars each time it is adjusted. A narrow upper jaw can cause crowding and crossbites. Your orthodontist will show you when and how to adjust the expander at home. Once the desired expansion is reached, the appliance stays in place for several months to solidify the new width and prevent it from relapsing.
MARA (Mandibular Anterior Repositioning Appliance)
The MARA helps the lower jaw develop in a forward direction, which is one way to correct an overbite caused by a lower jaw that sits too far back. The upper and lower parts of the appliance are bonded to your child’s molars, with a connection between them. By adjusting that connection, Dr. McCabe controls where the lower jaw sits in relation to the upper teeth while your child grows. Typical treatment time with a MARA is about 12 months, and braces can be worn before, during or after it.
Because the MARA works with jaw growth, timing matters. That’s one more reason an early evaluation is worthwhile, even if your child doesn’t seem to need braces yet.
Carriere Distalizer
The Carriere Distalizer corrects a bite without removing permanent teeth when teeth have erupted incorrectly. It has an effect similar to headgear, but without a bulky appliance. First, an anchor point is created in the lower arch, most commonly with a lower Essex appliance, a passive lingual arch, a full lower fixed appliance or mini-screws. A Distalizer arm is attached to the upper teeth on both sides, and an elastic runs from it to the lower back molars. The elastic is worn at all times except when eating. With good elastic wear, the bite can often be corrected in a matter of months, depending on the case. When the arms come off, upper braces finish aligning the teeth.
Elastics (Rubber Bands)
Elastics improve the fit of the upper and lower teeth. They work far more efficiently when they’re worn exactly as prescribed. Skipped days slow progress and can lengthen treatment.
Separators and Positioners
Separators are small rubber rings placed between teeth to make room for orthodontic bands at your next visit. They’re removed before the bands go on. Avoid sticky foods, toothpicks and floss around them. Positioners are used near the end of treatment to complete the final tooth movements. With good cooperation, a positioner is usually needed for only four to eight weeks.
Headgear
Some patients are prescribed headgear. Most discomfort comes from not wearing it enough, and it hurts less the more it’s worn, so be sure to get in the prescribed number of hours. If the facebow (the metal piece) gets bent, call our office.
Retainers
Every treatment ends with retention. Retainers may be removable or fixed, and they hold teeth in their new positions. See our retainers page for wear and care tips.
Living With an Appliance
- Expect some tenderness at first. Teeth may be sore for a few days after an appliance is placed or adjusted. A soft diet and a warm saltwater rinse (one teaspoon of salt in eight ounces of warm water) can help.
- Protect it from damage. Damaged appliances can lengthen treatment. Avoid hard, sticky and chewy foods, and don’t chew on pens or ice.
- Keep it clean. Food collects around appliances, so brush carefully after meals.
- If something pokes, place orthodontic wax on the part that’s bothering you.
- If something comes loose, save any piece you can remove in a bag or envelope and bring it to your next visit.
After easing any discomfort, call us as soon as possible to schedule a repair. Leaving an appliance damaged for a long time can disrupt your treatment plan. Our patient resources include more tips for common problems.
Will My Child Need an Appliance?
Not every patient does. Many treatments use braces or Invisalign alone. Whether an appliance makes sense depends on your child’s growth stage, jaw relationship and bite, which is exactly what Dr. McCabe evaluates at the first visit. He uses digital X-rays and iTero 3D digital scans to see the full picture, then walks you through the recommendation and answers your questions.
Dr. McCabe earned his dental degree and Master of Science in Orthodontics at Indiana University, is a member of the American Association of Orthodontists, and co-directs a local dental study club focused on interdisciplinary treatment of complex cases. Meet Dr. McCabe.
Schedule a Free Consultation in Columbus
McCabe Orthodontics is located at 3551 Rocky Ford Rd. in Columbus, IN. Call or text (812) 376-9425 or request a free consultation to find out whether an appliance, braces or both are right for your child.
Orthodontic Appliance FAQs
Do orthodontic appliances hurt?
Most patients feel pressure or tenderness for a few days after an appliance is placed or adjusted. It fades as the mouth adjusts. Soft foods and a warm saltwater rinse help.
How long will my child wear an appliance?
It depends on the appliance and the case. For example, a MARA is typically worn about 12 months, and an expander stays in for several months after the expansion is complete.
Can my child wear braces and an appliance at the same time?
Often, yes. Braces can be worn before, during or after a MARA, and a Carriere Distalizer corrects the bite before upper braces are placed.
What should I do if an appliance breaks?
Cover anything sharp with wax, save any loose pieces, and call our office so we can schedule a repair.