Palatal Expander | Quad Helix | Nance Holding Arch | Lingual Arch | Thumb/Tongue Crib | Herbst Appliance | Protraction Facemask | Retainers

Palatal Expander

pe1.gifThe Palate Expander is a specially made device used to expand the upper arch or roof of the mouth. There are several reasons to widen the dental arch. First, when there is a crossbite, widening the arch will allow the upper teeth to line up better with the lower teeth giving the patient a normal bite. Second, widening the palate in crowded cases can make more room for the teeth to align better. Third, a high palate and narrow arch restricts breathing passages and expanding the palate may widen the air passages so the patient can breathe more easily through their nose.

pe2.gifThe expanding action of the appliance gently separates the elastic membrane in the center of the palate. Once the palate has been expanded fully, new bone tissue fills that space. The upper arch is usually expanded enough in 15 to 20 days. However, the appliance needs to remain in the mouth for at least 6 months while new bone is generating in the expanded arch. The expanders are usually cemented to the teeth but on rare occasions they can be removable.

Expect the Following:

  1. Dr. Hoagburg and his staff will go over how the expander is activated. Widening the palate temporarily causes a space between the two front teeth. In some patients a large space may develop. Do not be alarmed! This space partially closes again naturally.
  2. Pressure on the roof of the mouth may cause a tingling sensation at the bridge of the nose and the corner of the eyes. Usually an aspirin will effectively control the discomfort. If it does not, call the office so we can check the appliance carefully.
  3. For most people, this procedure is not painful, though there may be some initial discomfort and some feeling of “pressure” as the arch expands. This pressure may cause a tingling itch under the appliance.
  4. If while turning the appliance the prescribed number of turns is too painful or there is too much pressure, then decrease the number of turns per day and notify our office.
  5. You may have difficulty with your speech at first. Practice reading out loud for a few days and your speech should improve.
  6. Eating may also be difficult in the beginning. Eating soft foods or cutting up your food into small pieces may help.
  7. Be sure the appliance is carefully cleaned each time you brush. This and the use of an oral irrigation device (Water Pik) and mouthwash will keep the appliance free of food and prevent irritation.

Quad Helix


These fixed appliances are used to gain expansion in younger children who don’t have all their adult teeth. They are anchored to the permanent molars and can be made active to expand the dental arches to make room for all the permanent teeth. They can be made for both the upper and lower arches.

Nance Holding Arch


The Nance Holding Arch is a plastic button that is adjacent to the palate and is attached to the back molar teeth by heavy wires. This appliance is used when the molar teeth have to be held in their current positions to keep the molars from drifting forward prematurely which can lead to dental crowding.

Lingual Arch


The Lower Lingual Arch is a curved metal bar that is attached to the lower molar teeth on both sides. It can be used on young children who have lost primary teeth too early to keep the molars from drifting forward prematurely which can lead to dental crowding. It can also be used as an anchor for using rubberbands during treatment and as well as a retainer while we are waiting for the remaining permanent teeth to erupt.

Thumb/Tongue Crib


A thumb or tongue crib is used to help correct tongue thrusting and/or thumb sucking which are harmful oral habits. A wire is soldered to bands which are usually cemented on the upper molar teeth. This wire helps keep the tongue from thrusting between the front teeth during swallowing and keeps the thumb from entering the mouth – both of which cause an insufficient overlap of the front teeth, or openbite.

Herbst Appliance

herbest.gifOne of the most common problems orthodontists are asked to treat is the discrepancy that occurs when the upper teeth protrude beyond the lower. Ordinarily when we see a patient with the upper teeth protruding, we tend to think that the upper jaw and teeth are too far forward; but, more often than not, this condition is due to a small lower jaw that is further back than it should be.


The Herbst appliance is very effective in correcting large overbites in patients that are still growing. The Herbst appliance encourages lower jaw growth in a forward direction by pushing the jaw forward and holding it there for nine to eighteen months. This appliance is cemented to the back upper and lower first molars allowing it to work 24 hours a day. The Herbst also can work in conjunction with braces as well as expanders.

Even though the Herbst appliance prevents the lower jaw from moving backward, opening and closing movement still occur easily and patients do not have any problems learning to chew their food with their lower jaw in this new position.


At first, your mouth will feel unusually full and speaking will be awkward. But if you practice reading aloud, your ordinary speech will return quickly. You may also notice more saliva than normal, but this will decrease as you become accustomed to the appliance. Patients may notice some tenderness to the teeth and/or cheeks. This is normal and should subside within a week. Rinsing with warm salt water and using an over the counter pain reliever for a few days will help take away this tenderness.

Your Herbst appliance will be checked and adjusted by Dr. Hoagburg. If sometimes between appointments you develop some sore areas on the inside of your cheeks, please do not try to adjust the appliance yourself. Call for an appointment and let Dr. Hoagburg make the necessary adjustments.

Protraction Facemask

A Protraction Facemask is a removable appliance that is used in conjunction with rubberbands to move the upper teeth and jaw forward. This appliance is used in children who tend to have a skeletal discrepancy in which the upper teeth are inside of the lower teeth. This is called an underbite.

This appliance consists of a forehead rest and chin cup which is connected by a wire framework. Rubberbands are hooked from the framework to either an expander or the back braces. The facemask is usually worn about 14 hours per day and depending on the severity of the jaw discrepancy it may alleviate the need for surgery in the future.

Without excellent cooperation there can be little if any underbite improvement. Teamwork between the patient, parent and orthodontist is essential for best results.



r1Once the active period is completed, your braces are removed. The next step is called retention. Retainers are utilized to hold your teeth in their new positions until your bone, gums, and muscles adapt to the new teeth positions. You must wear your retainer as instructed, otherwise your teeth may move toward their original positions and the benefit of wearing your braces will be lost.

r2Dr. Hoagburg will determine how long you need to wear your retainer. Time varies with each patient. Some people may need retainers for an extended period of time in order to eliminate shifting of the teeth. In some cases, permanent retention may be necessary.

The retention period is an important part of your overall treatment and should not be neglected!

r3Remember, wear them in your mouth, not in your pocket. Retainers work when you follow our instructions.

Clean your retainers! After meals, clean all parts of the retainer with a brush.

Handle your retainers with care. Retainers are easy to lose. If you take your retainers out, always place them in your retainer case for safety.

Lingual Bonded Retainer

A bonded retainer is used to retain severely crowded and rotated teeth once they have been straightened by orthodontic appliances. These severely rotated teeth have a tendency to move back to their original positions very rapidly once the braces are removed. A very fine wire is bonded with glue behind the upper and lower front teeth. Good oral hygiene including flossing is necessary to keep these areas clean.

Certain foods such as carrots, celery sticks, pretzels and candies that can be incised by the front teeth should be avoided so as to not cause the retainer to break loose. If one or more of these bonded areas break free, please contact our office immediately to repair them before the teeth start to shift.