Braces

Like most people, you are probably familiar with braces, but you may not know how they work. An orthodontist uses carefully planned, light forces to straighten the teeth. The individual parts of braces work together to gently guide the teeth into alignment. The components of braces include:

  • Archwires: Thin wires that guide the teeth into their final positions.
  • Bands: Metal braces that attach the braces to the back teeth.
  • Brackets: Small squares that are used to attach the archwires to each tooth.
  • Ligature Ties: Fine wires or rubber rings that secure the archwires to the brackets.
  • Elastics: Rubber bands that help move the lower teeth against the upper teeth to achieve proper fit of individual teeth.

Stainless steel braces are the most common. They have become smaller, more aesthetically pleasing, and more comfortable over time. You can choose the color of your brackets if you like. There are other types of braces to accommodate different treatments and aesthetic preferences, as well.

Carriere Motion Appliance® (CMA)

The CMA® is used for those who desire an alternative way to treat misaligned back teeth before braces or Invisalign® treatment begins. This appliance utilizes a gentle force to rotate or move the molars backward as a unit. Treatment time takes six months, on average, to complete and can improve and simplify the outcome of orthodontic therapy.

The CMA uses an appliance called a distalizer, which attaches to the permanent first molar and canine tooth on each side of the mouth. The appliance is custom sized and bonded to the buccal (check side) surface of the first molars and cuspids using a composite resin. A tooth on either side of the opposing arch will be used as an anchor, and an elastic band will connect the distalizer to the anchor tooth.

Banded Palatal Expander

If the upper jaw needs to be broadened, the Banded Palatal Expander may be utilized. Lateral pressure is applied to the two halves of the maxilla (upper jaw). Bone then grows in the middle, thus allowing the upper jaw to attain the proper width. Expanding the upper jaw can also help allow space for the eruption of permanent teeth.

The Banded Palatal Expander is made up of stainless steel rings, which are placed around the permanent first molar teeth, and an expansion mechanism on the roof of your mouth.

Bonded Lingual Retainer

The Bonded Lingual Retainer is used to either maintain the results of a previous orthodontic result or prevent undesirable teeth movement. Usually, retention appliances are worn full time for about a year after orthodontic treatment. This allows your bones and gums to stabilize. After the first year, retention appliances are used at night to maintain the orthodontic results.

A Bonded Lingual Retainer is usually a braided, stainless steel wire that connects to the back surfaces of the front teeth. Composite resin is used to attach the appliance.

Bonded Palatal Expansion Appliance (BPE)

To slowly broaden the upper jaw, the Bonded Palatal Expansion Appliance can use used. Lateral pressure is applied to the two halves of the maxilla (upper jaw) in patients who have a narrow upper jaw. Bone grows in the middle, thus allowing the upper jaw to reach the proper width. Expanding the maxilla can also help allow space for the eruption of permanent teeth.

A Bonded Palatal Expansion Appliance uses clear acrylic bite blocks that are molded to the primary teeth and an expansion mechanism on the roof of the mouth that is connected to palatal bars. Protraction hooks or headgear tubes may be used (as needed) to allow the BPE to be worn with the suitable headgear.

Mandibular (Lower) Lingual Holding Appliance (LLHA)

The Lingual Holding Appliance (LLHA) may be recommended to preserve or create space in the lower arch and to help upright the molars. The LLHA is used on the lingual side (inside) of the lower teeth. The lower baby molars are generally larger than the permanent teeth to follow. This appliance helps us to utilize the space to the patient’s best advantage.

The LLHA is made up of stainless steel rings that are placed around the posterior teeth and a stainless steel wire that sits against the lingual surfaces of the teeth.

Nance Holding Appliance (NHA)

The Nance Holding Appliance may be suggested to hold the upper molars in place to stabilize the position of the teeth after the desired tooth movement has been accomplished or during the movement of other teeth. This appliance can also be used to rotate the molars into their desired positions.

The NHA consists of stainless steel rings that are placed around the upper posterior teeth (usually molars) and a looped stainless steel wire that sits against the front of the palate, with an acrylic “button,” usually about the size of a quarter.

Standard Stainless Steel Braces

Stainless steel braces consist of small stainless steel brackets that are bonded to the surfaces of the teeth with a composite resin. A layer of protective sealant is applied to help ensure safe placement and removal of the braces, thus preserving the tooth enamel. Bands are often placed on the back teeth for appliance retention. The braces allow wires and other accouterments to affect the tooth movement, as desired.

Temporary Anchorage Devices (TADS)


If desired tooth movement is in need of a boost, TADS may be recommended. These appliances are hooked to the braces to assist in space closure, midline correction, bite closure, and so on. In many cases, TADS are used to supplement or substitute for elastics. TADS are mini screws that are carefully placed in the bone to help affect the desired tooth movement.

We invite you to contact Hawaii Smile Designs today to learn more about our fixed orthodontic appliances in Hawaii, and to schedule an appointment with our orthodontists, Dr. Aaron Miyai and Dr. DeMeo.