Orthodontic Appliances

In situations where the teeth overlap to such a degree that the edges of the lower front teeth actually bite into the hard palate, orthodontists recommend the bite plate appliance.This is a removable device that looks like a conventional retainer in most cases. A bite plate appliance is worn full-time (except when eating and brushing) for six months to a year.

Correcting a deep bite as early as possible will favorably affect long-term stability and eliminate unnecessary pain, discomfort, ulcers, etc. When growth is modified while a person is still growing, the change becomes more permanent. One of the first things to relapse in a finished orthodontic case is the overbite. Thus, correcting a severe overbite is one of the first important corrections that needs to be made while growth is still occurring.

Bite turbos are small acrylic pads typically bonded to the upper front teeth. They are used to correct excessive deepbites and overbites, and can lessen the amount of time spent in braces.

After bite turbos are placed, you will notice that the back teeth do not meet properly when chewing. This is temporary. Eating soft foods like mashed potatoes or macaroni and cheese will help you adjust to your new bite. Your tongue may be irritated the first three to five days. You may also have difficulty speaking, eating and swallowing. This should improve within a week or two.

Be sure to brush between the turbos and the gums. Although it is not likely that a bite turbo will come off, if it does, it's no problem. If you happen to lose them, give us a call, so we can replace them if needed.

The bite turbos will be removed when the desired correction is achieved.

ImageImage Attached to the upper molars through bonding or by cemented bands, the Bonded Maxillary Expander is an orthodontic device used to create a wider space in the upper jaw. It is typically used when the upper jaw is too narrow for the lower jaw or when the upper teeth are crowded or blocked out of the dental arch.

When patients are still growing, their connective tissue between the left and right halves of their upper jaw is very responsive to expansion. By simply activating the expander through turning a screw in the center, with a special key we provide, gradual outward pressure is placed on the left and right halves of the upper jaw. This pressure causes an increased amount of bone to grow between the right and left halves of the jaw, ultimately resulting in an increased width.

The Cetlin appliance works in conjunction with headgear to create space when there is not enough room for the upper permanent teeth to erupt. This removable appliance helps to push the upper molars back.

The Cetlin must be worn 24 hours day in order for it to be effective. You can remove the appliance to eat or drink, but must place it back in your mouth afterward. Proper wear is essential.

Each day, always examine the appliance to make sure the back wires are in front of the molar bands. The wires help the headgear to push the molars back.

Your teeth may be sore for the first few days of wear. Initially, speaking may be difficult, but the more you talk with the appliance in, the quicker speaking will become normal again. Increased saliva the first few days is also normal.

Be sure to brush your appliance each day. You can also soak it in denture cleaner a few times a week. Immediately after brushing, put the appliance back in your mouth.

Heat can warp the Cetlin appliance. Do not attempt to clean the appliance by placing it in hot water or in the microwave. Do not leave it near an oven or in the car.

When you are not wearing your appliance, be sure to keep it in your case.

Clear removable appliances can be used to effectively straighten your teeth without metal wires or brackets. They are customized for your bite using 3-D computer imaging technology. Each set of removable appliances is worn for 2 weeks. You should only remove them to eat, drink, brush or floss. As you replace each set of clear aligners with the next set in the series, you'll notice your teeth gradually move, week by week, until the desired correction is achieved. You'll visit the office every 6 weeks to ensure your treatment is progressing as planned.

Accurate placement of brackets is a significant factor in successful orthodontic treatment. Using direct bonding, each bracket is cemented to teeth one at a time. During the procedure, the orthodontist uses tweezers or other hand instruments to accurately position a bracket on a tooth. Once the bracket is in its precise location, it is firmly cemented.

Elastics are a vital part of treatment and are also contingent upon patient compliance. They add extra pressure to the braces to help move the teeth. Generally worn at all times (excluding eating and brushing your teeth), elastics should be changed at least three times a day. They come in various sizes as they are each used for a specific purpose. We will provide you with the appropriate size.

It is important to wear them consistently or treatment setbacks may occur. If only one day is missed, it could cause your teeth to shift back to their original position!

Class II

Class III


A Fixed Mandibular Expander is used as an alternative to the removable Schwarz appliance. It can be used on the upper or lower arches to expand the arch and create needed additional space for the permanent teeth. The appliance features a miniature version of an RPE screw. A Fixed Mandibular Expander is a good option when patient compliance may be an issue.

The canine teeth are the first teeth that meet when the jaws close. They help to guide the remaining teeth into the proper bite. After wisdom teeth, the upper canines are the second most common teeth to become impacted. Impacted canine teeth must be surgically exposed to help them erupt.

Surgical options can vary based on the patient's case, but treatment is typically a team effort for an orthodontist and an oral surgeon.

Typically, before the surgery, the orthodontist places braces on the teeth. A space is opened for the impacted canine to be moved into its proper place. The oral surgeon will then perform surgery to remove some of the gum tissue and bone covering the tooth, to expose the tooth. A bracket and gold chain is bonded to the tooth, so the orthodontist can initiate treatment for repositioning it into its proper place.

With indirect bonding, we can ensure your brackets are positioned at the perfect place with computer precision. First, we will create a model of your teeth, and then study each tooth to determine the ideal position and angle for the bracket to be placed. After all locations are decided upon, we will attach the brackets to the model, and cover them with a soft, flexible tray material, creating a cast of your teeth with the braces attached. We will then apply the bonding solution to each of the brackets. After that, it's simply a matter of fitting the tray onto to your teeth and applying a little pressure – bingo! Perfectly placed brackets every time! Indirect bonding benefits our patients immensely by minimizing discomfort and making orthodontic treatment as efficient as possible.

Interproximal recontouring refers to a procedure in which we will reshape your teeth by sculpting the sides of the teeth. This can correct cracked, chipped, crooked or misaligned teeth. Instead of braces, crowns or veneers, you can choose to have interproximal recontouring to change the shape and look of your teeth to enhance your smile!

service imageA Lower Lingual Arch acts as a space maintainer to keep the molars from drifting forward, and prevent them from blocking the space where permanent teeth will eventually erupt. This appliance is commonly used in cases of premature loss of baby teeth or when the lower teeth of a growing child are slightly crowded and no permanent teeth are extracted to correct the problem.

You should expect soreness the first day or two, and it may hurt to chew. We recommend a soft diet initially. You may take Advil or Tylenol to relieve the pain. Avoid sticky or hard foods, and please monitor how many foods you eat that are high in sugar.

Brushing and flossing daily is very important. Be sure to clean around the bands that are connected to the molars and the wire on the tongue side. This will prevent the formation of cavities or infection of the gums.

The duration of wear varies. We will monitor the eruption of new teeth and make adjustments. Generally, the Lower Lingual Arch is removed following the eruption of all the permanent teeth.

service imageThe Nance Appliance is used to prevent upper molars from rotating or moving forward after you've worn a headgear, a Wilson's arch or any other appliance to move your molars back. Some patients wear the Nance Appliance while they are awaiting their bicuspids to grow into place.

The appliance is made of two bands that are cemented onto the first molars and a wire spans the roof of the mouth from one molar to the other. An acrylic pad or "button" covers the wire that touches the roof of your mouth directly behind your front teeth.

Patients should always brush around the bands daily. Do not eat sticky, chewy candy as it can loosen your appliance.

A power chain is a continuous band of elastics attached to your brackets. Orthodontists use these to close a gap between the teeth. By exerting extra force, a power chain helps move the teeth faster. Because they hold your teeth closely together, a power chain can also be used to ensure that your teeth do not move apart.

Like regular elastics, power chains come in a variety of colors and are changed at each orthodontic visit. When the power chain is first placed, there may be a little discomfort until you become accustomed to the fit and feel.

service image The Schwartz Appliance is a removable expansion appliance primarily used on the lower arch in order to expand the arch and create needed additional space for the permanent teeth. Treatment time in the Schwartz Appliance is approximately nine months, but will vary based on individual needs of the patient. If both the upper and lower arches require expansion, we may use the Schwartz along with a Rapid Palatal Expander in order to coordinate the expansion of both arches.

service imageHeadgear is often used to correct an excessive overbite. This is done by placing pressure against the upper teeth and jaw, which would hold the teeth in position or help move them into better positions. The severity of the problem determines the length of time headgear needs to be worn. The key to success with your headgear appliance is consistency. Headgear must be worn a certain number of hours per day, and if not, it must be made up the following day.

Headgear should never be worn while playing sports and should also be removed while eating or brushing your teeth.

Separators are small elastics that fit snugly between certain teeth to move them slightly so bands can be placed around them later. Separators can fall out on their own if enough space has already been created. To determine if it needs to be replaced, slip some dental floss between the teeth; if it gets stuck, that means the separator hasn't created enough room and needs to be replaced prior to your banding appointment.

service imageSpace maintainer keeps the vacated space open until the permanent tooth is ready to come in. Not every tooth that is lost too early requires a space maintainer. If one of the four upper front teeth is lost early, the space will stay open on its own until the permanent tooth comes in.

A space maintainer is made of stainless steel and/or plastic. Some space maintainers are removable, which fixed space maintainers are cemented into the patient's mouth.

There are two general types of space maintainers:

  • Removable Space Maintainers
  • Fixed Space Maintainers

service imageOne of the many important advances in orthodontics has been the development of temporary anchorage devices, or TADs. Made of a bio-compatible titanium alloy, TADs are miniscrew anchors which are inserted into specific places in the mouth to be used as a fixed point from which teeth can move. Before TADs, orthodontists who wanted to move some teeth while keeping others still, or to achieve orthodontic movement in a mouth with missing teeth, had to rely on headgear for their fixed point. But TADs now provide an option for that fixed point that is smaller, more discreet, more efficient and requires significantly less work for the patient.

Temporary anchorage devices may not be recommended for everyone, and in fact, anchorage devices at all may not be needed in all cases. Contact us if you'd like to know more about TADs and how they can potentially prevent you from needing orthodontic headgear.

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Sucking is a natural reflex that relaxes and comforts babies and toddlers. Children usually cease thumb sucking when the permanent front teeth are ready to erupt. Typically, children stop between the ages of 2 and 4 years. Thumb sucking that persists beyond the eruption of primary teeth can cause improper growth of the mouth and misalignment of the teeth. If you notice prolonged and/or vigorous thumb sucking behavior in your child, talk to your dentist.

One solution to thumb sucking is an appliance called a "fixed palatal crib." This appliance is put on the child's upper teeth by an orthodontist. It's placed behind the upper teeth on the roof of the mouth. The crib consists of semicircular stainless steel wires that are fastened to molars using steel bands. The stainless steel wires fit behind the child's upper front teeth, and they are barely visible. The crib usually stops the habit of thumb sucking within the first day of use.

A tongue crib is used to help break bad habits such as tongue thrusting and thumb sucking by retraining the tongue. The crib is a metal appliance that is attached to your upper teeth by fixed bands. It has a block, or a gate, that prevents your tongue from moving forward.

Tongue thrusting can cause an overbite by pushing your front teeth forward. If you are a tongue thruster, the crib retrains your tongue to not touch the front teeth. Thumb sucking can cause an open bite. If your child sucks his/her thumb, the crib blocks the thumb from being inserted.

To have enough time for the tongue to be retrained and the bad habit terminated, the tongue crib is usually left in place for six months to a year.


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189 Kentlands Blvd #206, Gaithersburg, MD 20878

Phone: (301) 330-1400

Email: info@sublimesmiles.com

  • MON - THU9:00 am - 5:00 pm
  • FRIClosed
  • SAT8:45 am - 1:00 pm
  • SUNClosed
Contact Us