(All cases below were treated by Dr. Angolkar over the last 15 years)
EARLY TREATMENT
(Usually given a Phase I treatment):
Thumb crib: This simple device given to address severe thumb/finger sucking habit. It involves using a wire crib attached to two back braces and fixed. Although a little aggressive, it prevents placement of thumb in the mouth and corrects thumb sucking in few weeks. It is important to address this habit especially if continued after 3 years as it not only affects the teeth position but also may push the jaw bones out of alignment causing a skeletal problems needing major treatment like jaw surgery. This simple device is an excellent preventive device as shown in the example of Patient below.
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| Thumb Crib - (Patient 1 Photos Before and After) |
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| Before |
After |
Niteguide: A removable device used to guide teeth in proper position. This device can be given as early as 6-7 years and its simplicity is amazing. All the patients have to do is use it 12-14 hours a day, which means most hours after school. Generally many primary (baby) teeth are present and permanent teeth are guided into position as they erupt. This treatment, if successful, makes room, prevents extraction of teeth and saves braces time later (if needed).
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| Niteguide |
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| Before |
After |
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| Before |
After |
Expander: A fixed device given to expand or stretch the upper jaw. At a growing age the upper jaw is not one piece of jaw bone but divided into two parts at the middle of the roof of the mouth. The expander stretches the suture in this area. This treatment is used to gain space (to prevent extraction) as a wider arch means more room. It also corrects cross bites and creates wider beautiful smiles. It is better to do the expansion as early as possible. Expander is generally given on the upper teeth only as the upper jaw covers the lower. Also, as upper jaw is expanded the lower follows the upper and expands naturally most of the times.
Lip Bumper: Given in the lower arch to create space and expand the lower teeth. Many times it is given in conjunction with upper expander. This simple device consists of two bands on the lower molar and a wire going around the teeth. The lips gently press on this wire and tip the back molars to create space. In addition, the lower arch is naturally expanded by the tongue as the outside cheek pressures are kept away by the lip bumper. Check out the spaces created for the blocked teeth in growing patients below.
Herbst Appliance: This treatment is given to address large overjets/overbites caused by skeletal (jaw) discrepancies. This device has generally replaced headgears which are also given to address such situations. The Herbst appliance has helped us to stop using headgears in our office for the last several years.
The Herbst appliance consists of hydraulic like devices that go on the crowns cemented on back molars. This fixed device propels the lower jaw forward and pushes the upper back to address the antero-posterior jaw discrepancies. Again, earlier this treatment is given, better the response of growth achieved.
Early treatment finished to completion by Phase II (Braces) treatment: Most patients who go through Phase I treatment will need Phase II treatment with braces to finish once all permanent teeth erupt. Following are some of the examples of Phase I treatment finished following Phase II treatment. There are a small percent of very successful Phase I treatments that do not require Phase II treatment.
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