Positioner / Orthodontic

Positioners as a routine finish in full treatment orthodontics

In our office, the goal of comprehensive treatment is to not only align the teeth and achieve correct dental function, but to achieve a coordination between the function of the teeth and the jaw joint. Our functional goal, with respect to the dentition, is a mutually protected occlusion. Because this includes posterior disclusion in protrusive excursions and cuspid guidance, a fully interdigitated Class I occlusion in Centric Relation is essential. Otherwise, a full seating of the condyle in CR will lead to a slight openbite Class II bite, and render a mutually protected occlusion impossible.
Because patients begin to function in their maximum intercuspal position as soon as the dentition is well aligned, it becomes impossible to make the fractions of a millimeter changes that are necessary to settle the teeth into a proper bite while maintaining a Centric Relation condylar position. Therefore, we do not consider a patient finished until having undergone a positioner wear regimen.
Our typical deband sequence is as follows:
1) Patient appears “done,” in that the teeth occlude in a manner meeting Andrews’ six keys of optimal occlusion, including a solid Class I canine relationship. (Note that we do not use the positioner to do any of the work that should be accomplished with the braces themselves.) The patient is scheduled for the next 4 appointments.
2) Molar bands removed. Upper and lower impressions taken. Centric Relation wax bite registration taken. Facebow transfer, and mounting of the models on a SAM II articulator. Tie patient back in with steel ties on the now sectionalized 5-5 wires.
3) Fabrication of positioner.
4) Debond patient, deliver positioner. Positioner instructions.
5) After 3 weeks of positioner wear, impressions for upper circumferential retainer, lower Hawley retainer. Final records impressions and radiographs.

Our positioner instructions are as follows:
1) Initial 3 days of full time wear, with a total of 4 hours of clenching time. The clenching is to push the teeth into the positioner so the teeth settle into the CR bite. We tell the patients to clench for 20 minute intervals, and then take a break (not to try to do all four hours at once). We also instruct patients that they are not to grind, only clench, into the positioner. Also, it is emphasized that the efficacy of the positioner decreases rapidly with time, so the full time wear over the initial 3 days is essential. Additionally, we give the waxed positioner models to the patient in case they lose their positioner.
2) After the initial three days, the patients are to wear the positioner in the evening and at night for an additional two and a half weeks. The four hours of clenching are still to be done.
3) At the end of the three week period, we evaluate the bite for function (by checking excursive movements) and alignment. If there is a need for further wear, we delay the retainer impressions for another week or two.

Since the alignment of the teeth reinforces their function, and vice versa, we believe that achieving a maximum intercuspal position while in CR is of the utmost importance. For this reason, we use Interamerica positioners exclusively. We have tried other labs in the past, and consistently found positioners that were not made to the CR position. As a consequence, those patients developed a slight Class II relationship and open bite. Further, the esthetics of the teeth are beautiful in those patients who have had the benefit of a positioner from Interamerica.

Our philosophy regarding positioners, and our choice in using Interamerica, is not unique. In northern California, those practices with a high standard of patient care mirror our use and choice of positioners.

Positioner

THE INTER-AMERICA GNATHOLOGICAL POSITIONER


WHAT IS YOUR POSITIONER?

This appliance was made from models of the most recent impressions of your mouth. However, the plaster teeth in these models were moved into new, more ideal positions. Faithful wearing of your positioner will complete your orthodontic treatment and provide an excellent final result.


HOW IMPORTANT IS YOUR POSITIONER?

Your positioner is a valuable appliance made especially for you. Don’t loose it and always store it in the plastic case as it will be expensive to replace.

Although you may feel your teeth are straight after braces are removed, proper wearing of your positioner will provide an even better finished result!
The back teeth that you can not see need to be guided into a stable position in relation to your jaws. Your positioner can effectively accomplish these final tooth movements, which might otherwise take months to achieve with braces.
The positioner will also maintain your teeth in these new positions, much like a retainer and prevent possible relapse.


WHEN SHOULD YOU WEAR IT?

You should wear your positioner all day and all night (except while eating or brushing) during the first 48 hours following initial placement.
If this is done, nearly all of the desired changes will take place and wearing time may be decreased. After the initial 2 days, your positioner should be worn for at least two hours during the day and at night while you sleep.

It is essential that you exercise your teeth when wearing the positioner. Use a straight up and down biting motion. This clenching into the positioner should continue in 20 second intervals, every 10 to 15 minutes. (DO NOT USE A CHEWING OR SIDEWAYS MOTION). Your teeth will be sore at first, however, this means the positioner is working and that your teeth are moving into their positions.
It is very important to maintain the aligned position of your teeth for the bone to heel and grow around the root of your teeth. But, if you allow your teeth to be become crooked, you can start the process again and they will re-align. Wear the positioner full time until they are straight.


HOW DO YOU CARE FOR YOUR POSITIONER?


It is important to thoroughly clean your positioner after wearing by scrubbing it with a stiff tooth brush; otherwise it may discolor and have a bad odor and taste. You may use mild dish soap occasionally. Be sure to rinse the positioner well to remove all residue of the cleaning solution, as it may irritate the sensitive tissue in your mouth. You may also boil the “Inter-America” positioner in a sauce pan for 15 minutes to sterilize it. Do not let the positioner lay on the bottom of the pan and do not let the water boil away as temperatures over 350 degrees will burn and therefore damage the appliance. Your Inter-America tooth positioner will last for many years and will not distort with the proper care.

Brush your teeth prior to wearing your positioner to prevent any food particles in your mouth from becoming imbedded in your gums.



WARNING!!!

DOGS LOVE TO CHEW ON POSITIONERS!

BE SURE TO KEEP YOUR POSITIONER IN A SAFE PLACE!

ALWAYS SHAKE OFF ANY EXCESS WATER AND PUT YOUR POSITIONER IN THE PLASTIC CASE WHEN NOT WEARING IT.

FAILURE TO WEAR YOUR POSITIONER WILL RESULT IN YOUR TEETH GOING BACK TO THEIR ORIGINAL CROOKED POSITIONS.

****I have been work for a while, Inter_America Lab, San Rafael, CA, USA