What Appliances Are Used in Reversing Extractions for Braces?

Question

I am about to start Phase II TMJ treatment following 2 x upper bicuspid extraction & maxillary retraction with traditional orthodontics. Dr's who treat this problem : exactly what appliances do you use for expansion? Are removable expanders reliable? Even with night-time only wear? Is 4 months expansion enough time with no retention/stability phase prior to fixed expander removal? Does ALF expansion really work, or is key-turn just as good/better? I want to know from Drs who treat extraction reversal: what appliances do you use? Do you use fixed or removable? ALF or key-turn expansion? Is part-time wear of a removable expander a valid option, or must it be full-time wear? Is expansion stable if the fixed expander is removed after only 4 months (no retention)? Any info appreciated

Ira Shapira, DDS · Answer

Doctors who treat sleep apnea and TMJ disorders frequently find themselves trying to reverse bicuspid extraction orthodontics.Reopening Spaces to lace implants is possible but ideally the goal should be therapeutic correction of physiologic and esthetic issues.  The ALF appliance work with very light forces and can expand an arch but when trying to achieve orthopedic growth the functional Appliances are more effective.  The DNA Appliance and Epigenetic Orthodontics use light forces and is only worn 12-14 hours a day.  The time the appliance is out mimics what happens with normal eruption of natural teeth.It has been shown in clinical cases to cure sleep apnea but large scale studies are early and pending.  The DNA Appliance is very effective in growing the maxilla .  It is most likely to need less long term retention but erring on side of longer retention is never a bad idea.Putting aside the idea of extraction reversal and looking at therapeutic goals is always the best approach.The SARPE procedure with Rapid Palatal Expansion with a Surgical Assist is also a viable option but does need longer retention.Ira L Shapira DDSDiplomate, American Board of Dental Sleep MedicineDiplomat, American Acdemy of Pain ManagementRegent & Fellow, International College of CranioMandibular OrthopedicsChair, American Alliance of TMD OrganizationsThinkBetterLife.com

Robert Waxler, DMD, MS · Answer

Hard to figure out exactly what is going on.  Are you interested in reopening the spaces where the teeth were extracted?  Does that mean that you are seeing a new doctor who disagrees with the initial diagnosis?

	Are you asking about various types of expansion treatment to restore the spaces of the extracted teeth?

	How do you think expansion will help your overjet (the reason upper premolars are usually extracted?

	Have to tell you...the one time I got a transfer patient whose 2nd doctor was reopening extraction sites was a disaster.....yes the spaces were reopened but the roots were destroyed (the second doctor was sued and lost)

	Sounds like you really need to get a few unbiased opinions from orthodontists and skip this internet stuff...way to complicated to get a good answer....good luck!

What Appliances Are Used in Reversing Extractions for Braces?

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What Appliances Are Used in Reversing Extractions for Braces?

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