In combination with fixed appliances the use of a functional appliance is sometimes of great benefit. A functional appliance is usually a clip in, customized removable brace that is worn both in the upper and lower arches. The two parts of the braces are worn at the same time and help to reposition the lower jaw in a more forward or protrusive position.

Over a 6-9 month period this encourages movement of the upper teeth back and the lower teeth forwards and encourages growth in the lower jaw, whilst restraining the upper jaw. The overall effect is to reduce the prominence of the upper teeth. In many instances this avoids the need for teeth to be extracted and in extreme cases the need for jaw surgery later in life.

This treatment is completed during a persons growth spurt during the teenage years and the success of the treatment is all down to how much the appliance is worn. For maximum effects this should be around 23 hours in the day. The most commonly used functional appliance is the Twin Block.

In modern orthodontics the use of removable appliances is usually limited to helping with fixed appliance treatment. Removable appliances are custom made to each patient.

The tissues around the tooth roots take time to adjust to the new tooth positions and there is a particular risk of relapse in the early months after the brace is removed. Even in the longer term some risk remains and the best advice is to continue a reduced retention regime indefinitely if at all possible. This is to avoid tooth movement due to ageing effects. Retainers are usually worn full time in the early stages and then reduced to part time wear. Your orthodontist will give you advice with regard to how often you should wear them. You will usually be seen for 1 year after your brace is removed and then given verbal and written advice about the future wear if your retainers.

FIXED RETAINERS

Fixed or bonded retainers take the form of a small wire that is cemented behind your front teeth. It is totally invisible from the front of the mouth. This type of retainer can be used on its own or in combination with removable retainers. It is designed to stay attached to the teeth indefinitely, although damage to the retainers can occur. Any retainer placed at Clarendons will be carefully looked after and repaired if needed within the first year.

REMOVABLE RETAINERS

The Essix retainer or vacuum formed retainer is the most commonly used retainer. It is easy to wear and it’s clear colour makes it an excellently tolerated retainer.

The Hawley retainer is used less commonly in contemporary orthodontics, but is extremely effective when width stability, the addition of a prosthetic (false) tooth or retention around inflamed gums is required.