Certain types of orthodontic problems are caused by the lack of enough bone growth to accommodate the upper teeth. In other cases, there is room for the upper teeth, but but the palate (roof of your mouth) is so narrow the speech is impaired or made difficult. In still another type, the palate is so high that it actually cuts down on the amount of air that can pass through the nose, so that deep breathing, without opening the mouth, is almost impossible. In all of these cases, an expander device is most helpful.

Well, that sounds pretty drastic, doesn’t it? Surprisingly, it really isn’t. The maxilla (upper jaw) is joined in the center by a suture or joint, which allows it to be painlessly separated and spread. Once this has occurred, the two halves knit back together and new bone is laid down to make the jaw wider.

Now you understand how your expander works! It won’t hurt. Your teeth will be a bit uncomfortable for a day or two. Sometimes about a week after the device is cemented into place, you may feel a little “itching” in the roof of your mouth. Don’t worry. This is normal as the fibers, which are there, stretch and expand. 

We often use expanders in the lower arch as well. While the mechanics and anatomy are a bit different, a lower expander also helps reduce crowding.  


With your expander you will need to stay away from “sticky” foods. Some examples are: gum, taffy and caramels.

Turning Instructions

After the expander is cemented in place, the screw must be turned as we instruct. Usually the upper will be turned once a day while the lower every other day. Insert the key in the hole and push the key all the way to the back of the palate ( toward throat). This will bring the next hole into view, and you have completed your turn. Always keep track of the number of times that you turn both upper and lower expanders, as this will help Drs. Rapp and Brandt get an accurate measurement.

After the arch has been widened enough, it is necessary to hold it so that the new bone will grow into the space.

If you have any questions of concerns, please do not hesitate to contact our main office at (317) 844-4104.

Herbst® Appliance Herbst

The Herbst® appliance is used to adjust the front-to-back relationship of the upper and the lower jaws. The rod and tube (arms) that can also be referred to as a “shock absorber” connects the upper and lower jaw. Your Herbst® appliance does not interfere with opening and closing your mouth or with eating. However, you will find side-to-side movement is restricted.

Things you may need to get used to

The bottom screws may irritate your lip. If this occurs, your lip will toughen up like a callous, but it may take a few days for this to happen. You can place wax over the screws to make them smoother.

When your lower jaw is brought forward, the back teeth may not come together as they did before the appliance was placed. They will normally come together in a week or two – so please be patient!

Most of the time there is no discomfort in the teeth when the Herbst® appliance is placed. Every once in a while, a patient may feel some tenderness (which is normally short lived). If this occurs, it will disappear in a few days; but if necessary you may take ibuprofen. 

Things to look for (but not probable)

If you open very wide, sometimes the rods and tubes (arms) can come apart. If they do, just open wide and place the rods back into the tubes. If you cannot get them together, then you can leave them apart and call for an appointment so that we can put them back together for you. If the rod and tubes, when they are apart, are not causing any pain, it can wait (until our next scheduled patient day) because the muscles will hold the jaw in position. If they are causing pain, please call our main office at (317) 844-4104 and we will put them back together as soon as possible. If you are having problems with the rods and tubes disengaging on a frequent basis, please call our office to schedule an appointment to make an adjustment so this does not keep happening. Keep in mind that we don’t want to move your jaw too far or too fast because it grows better if we move it gradually.

Occasionally a screw may come loose. If this happens, you will have a rod or tube dangling in your mouth and the other piece will come out. Please save any pieces that come out of your mouth so that we can make necessary repairs when you come into the office. If this is causing pain, please call our office and we will put it back together as soon as possible. If it is not causing pain, it can wait (until our next scheduled patient day) to be put back together, the same as if the rod and tubes disengaged. 

Infrequently, the Herbst® appliance can become loose or break; there is nothing indestructible that we can put into your mouth. If you have a problem with something coming loose or breaking, please call our office. If it is not causing you pain and you can function, it is OK to wait until our next scheduled patient day to have the repairs made. However, if you cannot function normally, and/or there is pain, please call our main office at (317) 844-4104 so that we can make the repairs as soon as possible.

We believe the Herbst® appliance is the quickest and best appliance to correct certain jaw relationships. It is fully contained within your mouth and does not show. Anytime something new is placed in the mouth it takes time to adjust so please be patient during the adjustment period. It will be over before you know it!


With your Herbst® appliance you will need to stay away from “sticky” foods. Some examples are: gum, taffy and caramels.

Bite Plane

The removable Bite Plane is used to open deep bites and to prevent “biting off” lower braces.

When the appliance is first delivered, there is an immediate bite change where only the lower front teeth touch the plastic. Over time, as the overbite corrects, the back teeth will come closer together. In the meantime, eating patterns and food choices may have to change slightly.

With this new appliance, there will also be an initial speech change. Most people adjust to this within a few days and speech returns to normal.

Bite Plane instructions

  1. Insert the bite plane by first placing the front against the backs of your upper front teeth. Then, place one of the arms up and over the hook on the molar band and so the same on the other side. When the bite plane in fully seated, it should not move when you bite down.
  2. Wear your bite plane all the time, including when eating. The only time you should remove it is to brush your teeth, and you will brush your bite plane as well. IF you don’t wear it full-time, your top teeth will “bite off” your lower braces. Loose braces can and will extend your treatment time and add to the cost of your orthodontic treatment. 
  3. Clean your bite plane by removing it and brushing it with toothpaste and cool water. To deep clean your appliance you may soak it in denture cleaner for 15 minutes once a week 

If you have any questions or concerns, please so not hesitate to contact our main office at (317) 844-4104.


Orthodontic headgear is a very important part of the treatment for some patients. Headgear creates forces that guide the growth of the face and jaws. It also is used to move teeth into better positions or to prevent teeth from moving.

Maintaining constant use of your headgear will achieve the best results. If instructions on usage are not followed, treatment will take longer and our treatment plan may have to change.HG

  • Always be careful when removing your headgear. If the headgear is removed carelessly, the part that fits in your mouth and attaches to your teeth could injure your lips, cheeks, face and possibly your eyes.
  • Never remove the headgear until the straps have been disconnected.
  • Never lift the headgear over your face.
  • Never wear the headgear when running or playing sports.

Take your headgear with you to EVERY appointment. If it becomes dirty, Drs.Rapp and Brandt will tell you how it should be cleaned.

Your teeth may be tender for the first few days of wearing your headgear. This tenderness will disappear as you adjust to the new pressures.

Let Drs.Rapp and Brandt know if you continue to be uncomfortable for more than a few days. Wearing headgear is necessary for your treatment. Follow the instructions exactly, and you will complete your treatment without any changes in your treatment plan.