Correcting Bites and Making Space in the Mouth

Pendulum, Carriere Distalizer, and Quad Helix Appliances

Orthodontists do much more than straighten teeth with braces or Invisalign. In fact, one of an orthodontist’s primary jobs is correcting bites, also called malocclusions (bad bites). In order to do this, orthodontists use various appliances that can correct bites, widen the jaw, and make space in the mouth.

At Burke & Redford Orthodontists, Dr. Redford and Dr. Burke use a variety of appliances during orthodontic treatment. To educate our patients, we’ve been providing information about some of the lesser known orthodontic devices used in our practice. This article focuses on the pendulum, Carriere® Distalizer, and quad helix appliances.

Pendulum Appliance

A fixed pendulum appliance is primarily used to create space in the mouth for permanent teeth to erupt. The appliance is also used to move the upper molars into the correct positions—thereby correcting a side bite of the teeth. The device can also adjust the front to back position of the front teeth. If used with an expansion device, a fixed pendulum appliance can help widen the upper jaw. It is therefore a very efficient way to correct several layers of issues with just one appliance.

The pendulum appliance is placed in the upper part of the mouth. It consists of several components, including:

• plastic (acrylic) that rests gently on the roof the mouth (palate).
• wires and springs that come out of the acrylic. The wires attach to the teeth’s biting surfaces, while the springs connect to bands placed on the back molars.
• bands (stainless steel rings) that are anchored around the upper back molars with orthodontic cement.

An orthodontist usually incorporates an expansion device into the appliance to help widen the upper jaw. The fixed pendulum appliance is typically worn for 6-8 months. The orthodontist will regularly monitor progress, and the device will be removed once enough space has been created and the molars are correctly positioned. After the molars are in the proper place, a space maintainer (“retainer” that is fixed in the mouth) is used to keep them there.

The fixed pendulum appliance does a similar job as orthodontic headgear, but it is much less obtrusive, works faster, is more versatile, and doesn’t rely on patient compliance to achieve results.

Carriere Distalizer Appliance

A Carriere Distalizer is used to correct a bite (overbites and more rarely, underbites) when permanent teeth have erupted in the wrong way. The device can also decrease the chances of patients needing permanent teeth extracted to correct their bite. It is used with other orthodontic appliances, namely elastics and a clear retainer or a lower lingual holding arch.

This appliance does the same job as headgear—pushing teeth back into the correct positions. However, it isn’t as bulky as headgear, is significantly less visible, and most patients greatly prefer the feel and experience with a Carriere Distalizer. The outcomes are generally better because patient compliance is improved with an appliance that is more compatible with their lifestyle.

The Carriere Distalizer itself consists of a curved bar that is attached to two teeth on each side of the mouth. This curved bar is either clear or metal, depending on patient preference. One end is bonded (cemented) to a canine tooth while the other end is bonded to a molar. The opposite arch (usually the lower teeth) acts as an anchor point for the appliance. This anchor consists of a clear retainer or a lower lingual holding arch appliance. Elastics are used to produce a strong enough force to move teeth into the correct position.

The appliance is typically in place for 6-8 months. Once the bite is corrected, the device is removed, and braces or Invisalign are used to finish aligning teeth and idealizing bite imperfections.

Quad Helix Appliance

Patients sometimes have narrow upper jaws, which can cause problems such as:

• overcrowding
• biting, chewing and speech difficulties
• excessive wear on teeth
• proportion problems

Depending on the amount of expansion needed, patients will need a palatal expander. This is an orthodontic appliance that widens the suture (“growth plate”) in the roof of a patient’s mouth—thereby expanding the jaw. The Quad Helix is used when mild expansion is needed. A rapid palatal expander (RPE) is used when more extensive expansion is required.

The quad helix can correct crossbites, make room for overcrowded teeth, and widen the upper jaw and teeth to make the side teeth bite fit better. It is usually worn for 6 months, depending on how much expansion is needed. This time allows for expansion to be achieved and some additional time to ensure that the expansion “sets.”

The quad helix consists of stainless-steel rings (bands) that are bonded (cemented) to the molars. The appliance has four helix springs positioned discretely near the roof of the mouth that actively widen the arch. Unlike RPEs, the quad helix doesn’t need to be activated (“turned”) daily. Patients visit the orthodontist to have the device adjusted regularly until enough expansion is achieved.

Expectations and Adjustment Period

With the placement of any orthodontic appliance, there will be an adjustment period that lasts a few days. Here are some things to expect and how to deal with them.

• Saliva might increase during the first few days. This is normal and will clear up quickly.
• A patient’s speech might sound a bit funny at first. This happens because the tongue needs to get adjusted to the appliance. To speed up the process, patients should talk, sing, or read out loud as often as possible during the first few days. This will help a patient’s speech get back to normal faster.
• Soft tissue (such as the gums or cheeks) may become irritated by the appliances. If this happens, patients can rinse with warm salt water. An alcohol-free oral rinse can be used if a patient doesn’t like the taste of salt water. Placing orthodontic wax over the areas causing the friction will also provide relief. However, these areas will “toughen up” fairly quickly, and the irritation will disappear.
• The mouth might be sore for the first few days. Over-the-counter pain medication (such as ibuprofen and acetaminophen) can be used. A diet of soft foods may also be helpful during the adjustment period.

Maintenance and Cleaning Tips

All three appliances are low maintenance. However, there are a few rules to follow while they are in place.

• Refrain from picking at or playing with the appliances with the tongue or fingers.
• Use caution when eating hard or crunchy food (such as ice, nuts, popcorn, and hard candy).
• Avoid sticky foods (such as caramel, gum or taffy) and chewy candies (such as gummy bears or Starbursts).
• Avoid drinking carbonated beverages that can wash out the cement.
• If any part of the appliance feels loose or broken, contact the orthodontist’s office immediately.

Extra attention to brushing and flossing will keep the appliances clean. This is particularly important because food can become caught in the appliances—causing irritation and possible gum infection. Here are some cleaning tips.

• Rinse with water after every meal.
• Brush and floss at least three times a day for at least four minutes. Special care should be taken to clean in and around the appliance, including any bands, wires, or “buttons.”
• A floss threader, proxy brush, or water flosser can be used to keep the wires clean of debris.

Although these appliances may be intimidating at first, most patients quickly adjust and get back to normal within a few days.

If you have questions or concerns about the pendulum or quad helix appliances or the Carrier Distalizer for correcting bites, contact Burke & Redford Orthodontists at (951) 699-8011 or fill out the contact form on our website.