Some Lesser-Known Orthodontic Appliances for Kids

The name ‘orthodontia’ has always conjured up an image of wires and brackets.

If you go to a dentist and they suggest you need orthodontic treatment, the first thought in our minds is that we are getting braces. But orthodontics is not only about brackets and braces.


Orthodontics is concerned with correcting all kinds of malocclusion in the dento-facial region. This involves more appliances other than brackets and braces.

These appliances, such as nance, lingual holding arch, twin blocks, etc., can change and alter the way your mouth ‘works’.

Some of these appliances help in guiding the jaw growth in the proper direction. As many people are unfamiliar with these other appliances and how they can be used, they may end up suffering from a problem that an orthodontist could have fixed.

Here are some of the lesser known orthodontic appliances and their application,

Nance appliance

Nance appliance is a maxillary arch which is used as a space maintainer due to the premature loss of primary molars or during orthodontic treatment.

This appliance prevents the forward movement of the permanent first molars and the backward collapse of anterior teeth when the first deciduous molars are missing. (1)

It doesn’t contact the anterior teeth but approximates the anterior palate. A classic Nance appliance consists of two bands cemented on the first permanent molars or second deciduous molars.

It is connected with stainless steel wire and also incorporates an acrylic button in the anterior region that contacts the palatal tissue.

A Nance appliance not only prevents any unwanted movement from molars, but it can also manipulate the teeth into moving to the desired position.

The Nance appliance comes in two forms: removable and cemented into place. It is usually used on children, and it is considered most effective when children are still growing.

It is advisable to wear the Nance appliance as often as possible, but children with removable appliance should remove it during sports activities.

A proper oral hygiene routine is vital to maintain while wearing this appliance. The steel bands can accumulate food debris, which may cause tooth decay and affect your orthodontic treatment.

If the appliance is not cleaned correctly, it can also cause gum inflammation and irritation.

As the Nance appliance is fitted on the roof of your mouth, you can develop a temporary lisp, when it is first installed.

Carbonated drinks, sticky foods, and hard and crunchy foods should be strictly avoided while wearing this appliance as they can damage it.

Lingual holding arch appliance

The lingual arch is the most efficient appliance for space maintenance in the lower arch.

It is comprised of stainless-steel rings or bands around the lower primary molars and a stainless steel wire that passively contacts the inside surface of the mandibular anterior teeth.

This appliance is used to preserve and create space in the lower arch and to aid in uprighting of the molars. It also helps in maintaining the arch perimeter. (2)(3)

This appliance is contraindicated before the eruption of permanent lower incisors. The lingual arch is fixed to the teeth and is passive.

It is essential to maintain proper oral hygiene with this appliance, as it can’t be removed for cleaning.

You can notice a slight speech impediment when it is first placed due to some tongue obstruction. Your speech will come back to normal as you get used to the appliance.

Twin Blocks appliance

Twin blocks appliances are simple bite blocks that comprise of separated upper and lower units which are not joined together.

They are designed for full-time wear and used to align the upper and lower jaws of growing children properly.

The forces of occlusion are used as the mechanism to correct the malocclusion. The appliance achieves rapid functional correction of the malocclusion by transmitting favorable occlusal forces to occlusal inclined planes that cover all posterior teeth. (4)

The appliance consists of two blocks with one block placed behind the upper teeth and the other block behind the front lower teeth. When the two blocks come together, it comes in a position that corrects the jaw position. (5)

A twin block appliance is usually worn 9-12 months before braces being fitted. After the treatment is finished with twin blocks, retention phase is followed with an upper anterior inclined plane appliance.

The appliance is worn only during night time when proper occlusion has been established.

Twin block appliances are more comfortable than other appliances as there are fewer wires involved as is easy to remove. It is recommended that the device is worn for at least 18 hours a day.

You can notice some overproduction of saliva, when the appliance is first fitted, along with some pain and discomfort. This is only temporary and lasts for just a week or two.

Maintain proper oral hygiene with the twin block appliance. It is essential to clean the device after every meal with a toothbrush and toothpaste.

You can also clean your appliance by keeping it in a glass of water with a denture cleaner for about 15-20 minutes.

You should visit your orthodontist every 2-3 months so that they can check on the appliance and the progress of the treatment.

Fixed Palatal Crib

A fixed palatal crib is an orthodontic appliance used to correct tongue thrusting habit in children.

Usually, tongue thrusting corrects on its own when the permanent front teeth start to erupt, around the age of 2-4 years. If the habit is continued beyond this age, it can cause malocclusions of the anterior teeth.

If your child has tongue thrusting habit after the permanent front teeth have erupted, you should visit your dentist.


A fixed palatal crib consists of semi-circular stainless steel wires that are attached to the primary molars using steel bands. The appliance sits behind the upper front teeth so that it is not visible.

This appliance is very useful and can correct the tongue thrusting habit within one month of use.

Take away message

There are many different orthodontic appliances which can be used to correct various types of malocclusions.

With the evolution of dental knowledge, it is essential that you be familiar with the kind of orthodontic appliance your child may need.


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