Your child has a maxillary orthopedic appliance — a device designed to guide the growth of the facial and jaw bones during childhood. This guide explains what it is, how to care for it, and what to expect during treatment.

What is maxillary orthopedics and how is it different from orthodontics?

Maxillary orthopedics uses appliances to modify the growth of facial bones during childhood, taking advantage of the fact that the facial skeleton is still developing. Orthodontics moves teeth. Orthopedics moves and shapes bones. Both can be used together, but they work on different tissues.

The window of opportunity for orthopedics is limited — it works while bones are actively growing (generally between 6 and 14 years depending on the appliance and the child’s sex). After that age, the same problems may require orthognathic surgery.

Most common maxillary orthopedic appliances:

Bionator / Functional activator: Class II — mandibular retrusion — Removable acrylic appliance that repositions the mandible forward to stimulate its growth. Used mainly for Class II (retrognathic mandible). Has clasps and springs.
Active Hawley plate / Expansion plate: Moderate expansion, tooth position correction — Removable acrylic plate with expansion screw and/or springs. Can expand the arch, close diastemas, correct simple crossbites, or maintain space.
Headgear / Extraoral appliance: Skeletal Class II — maxillary protrusion — Partially extraoral appliance that applies forces to the upper jaw from outside. Available in high-pull (occipital), cervical-pull (neck), and chin-cup variants. Used to slow excessive upper jaw growth.
Facemask / Protraction headgear: Class III — maxillary hypoplasia — Extraoral appliance with supports on the forehead and chin, connected to hooks on the upper teeth. Brings the maxilla forward. Used for Class III (retruded maxilla).
Lip bumper / Labial arch: Lower arch expansion, lip habit correction — Appliance that uses lip or cheek pressure to widen the dental arch. Generally fixed to the molars, with an arch that stands away from the front teeth.
Bite plate: Deep bite, bite correction — Plate with a ramp or platform that modifies bite position. Can open the bite, correct deep anterior bite, or guide the eruption of specific teeth.

The right age for each appliance depends on the type of problem and the child’s skeletal development. The dentist or orthodontics/orthopedics specialist determines the optimal timing through bone development X-rays. Starting too early or too late can reduce effectiveness.

How Many Hours Should the Appliance Be Worn

Cooperation is the number one factor in success

Unlike braces that work 24 hours, removable orthopedic appliances only work when worn. Wear time is literally treatment time.

Bionator / Functional activator · Minimum 12-14 hours: Mainly nocturnal — worn while sleeping and at home. Some cases require daytime use too.
Active Hawley plate · 20-22 hours: Only removed for eating and brushing. The more time it’s worn, the faster treatment progresses.
Headgear · Minimum 12-14 hours: Generally nocturnal and at home. Dentist specifies exact force and anchorage.
Facemask · Minimum 12-14 hours: Nocturnal and at home. May be supplemented with daytime home use as indicated.
Lip bumper · Variable by type: If fixed, works all the time. If removable, generally nocturnal and home use.

Every hour the appliance is not in the mouth is lost treatment time. A child who wears the appliance 8 hours when 14 were indicated will take nearly twice as long to finish — or may not complete it.

What to do if the child refuses to wear it?

Explain in simple words: ‘This appliance helps your jaw/teeth grow correctly. If you don’t wear it, we’ll need a more uncomfortable one or surgery when you’re older.’
Establish the routine from day one — same time for placement, same storage location
Record wear time on a calendar with weekly rewards
Let us know if the child has strong resistance — there may be physical reasons (poorly fitting appliance, real discomfort) we can resolve

Adapting to the Appliance

The first weeks are the hardest — and the most important

Day 1-3 · Normal · Very strange sensation: The appliance feels large, uncomfortable and strange in the mouth. There may be more saliva, difficulty speaking and mild initial nausea. All normal and improves notably within a few days.
Day 3-7 · Normal · Affected speech: Pronunciation changes temporarily. The child may speak with difficulty or different sounds. Practicing speaking normally accelerates adaptation. Don’t constantly correct — it creates anxiety.
Week 2-3 · Improving · Progressive adaptation: The child starts getting used to it. The strange sensation decreases. Speech improves. Use becomes more natural, especially at night.
Month 2+ · Good · Routine use: The appliance is now part of the routine. The child places and removes it on their own. Cooperation stabilizes.

To help with speech:

Read aloud 10 minutes daily with the appliance in
Practice specific words with ‘s’, ‘r’, ‘n’ which are most affected
Sing familiar songs — makes the brain process the sound differently
Patience — speech adaptation usually completes in 2-3 weeks

About discomfort:

Mild pressure and tension in the teeth or jaw are normal — especially after appliance activations. Pediatric pain reliever (acetaminophen or ibuprofen at weight-based dose) can provide relief the first days. Intense pain or pain at a specific point is NOT normal.

Removable Appliance Hygiene

A dirty appliance can cause cavities, bad odor and infections

Acrylic orthopedic appliances are porous — they accumulate bacteria and fungi if not properly cleaned. A dirty appliance smells bad, can irritate gums and increases cavity risk in contact areas.

Rinse when removing it: Immediately after removing the appliance, rinse it under cold running water. This removes saliva and food residue before they adhere.
Brush with soft brush and neutral soap: Use a soft brush (the child’s own or one dedicated to the appliance) and neutral liquid soap. Brush all surfaces: the acrylic, metal clasps, springs and any screws. DO NOT use toothpaste — its abrasives scratch the acrylic and weaken the material.
Full rinse with cold water: Rinse very thoroughly to remove all soap. Residual soap tastes bad and can irritate mucosa. Always COLD water — hot water can deform the acrylic.
Weekly disinfection with effervescent tablet: Once a week, soak the appliance in cold water with half a dental effervescent tablet (Corega, Polident or similar) for 15-20 minutes. Rinse very well afterward. This removes accumulated tartar and deep disinfects.
Correct storage: When not in the mouth, store it in its case with a little cold water. The appliance should not be stored dry — acrylic can dry out and crack. Also not in empty airtight bags for extended periods.

When the child removes the appliance to brush, make sure they brush the whole mouth well — especially the areas of contact with the appliance clasps, where more plaque accumulates.

Never:

Don’t wash with hot water — deforms the acrylic
Don’t use toothpaste — scratches and weakens the material
Don’t put in microwave or dishwasher
Don’t let it air dry for a long time
Don’t use bleach, pure alcohol or harsh products
Don’t store in napkins, pockets or cardboard boxes

Special Care for Extraoral Appliances

Headgear, facemask and chin cup — additional instructions

⚠️ Headgear safety — CRITICAL

NEVER sleep with headgear if the springs can unhook — risk of serious eye or facial injury
Headgear must have a quick-release safety mechanism that the dentist will have activated
Never use during physical activities, sports or rough play
Child should not put on or remove headgear without adult supervision at first
Check that support pads are properly positioned before sleep

Facemask / Chin cup:

Place the appliance carefully: first the forehead support, then the chin
Elastics must have the indicated tension — not more, not less
Skin under the supports may irritate with prolonged use — apply gentle moisturizer in those areas if redness appears
If there are red marks or skin lesions, let us know to adjust the appliance
Hair should be tied back or away from straps to avoid tangling

Periodically check that the elastics or springs have the correct tension. With use, they may loosen. If you notice the appliance isn’t exerting force or the elastics are very loose, let us know.

Eating with Orthopedic Appliances

Simple rules that protect the appliance

With REMOVABLE appliances (bionator, plate, etc.):

Always remove the appliance for eating — no exceptions.

Remove before any meal or drink other than water
Store in the case while eating — never in napkins
Rinse teeth or brush before putting it back in
Sugary drinks with the appliance in cause cavities rapidly

With appliances that have a fixed part (lip bumper, etc.):

Very hard or crunchy foods: ice, nuts, chips — can bend or break the arch
Very sticky foods: gum, chewy candies — can stick and damage the appliance
Biting directly with front teeth — cut into pieces

Always safe

Soft foods: pasta, rice, soups, purees, eggs
Soft fruits: banana, melon, peach in pieces
Dairy: yogurt, soft cheese, milk
Soft well-cooked meats
Soft bread without very hard crust

The Appliance in the Child’s Daily Life

Managing treatment at school and activities

At school: Inform teachers and cafeteria staff about the appliance. With removable appliances: the child must be able to remove it for eating and store it in its case. Never in napkins — appliances are constantly lost or broken in school cafeterias.
Sports and physical activity: Removable appliances: generally can be worn for non-contact sports. For contact sports (football, martial arts), remove and use mouthguard. Headgear and facemask: NEVER during sports. Dentist will indicate what to do during specific physical activities.
Music classes and wind instruments: Removable appliances may temporarily make it harder to play wind instruments. Adaptation generally occurs in 2-4 weeks. If the child has an important performance coming up, consult the dentist in advance.
Social aspect: Some appliances like the facemask or headgear may generate comments at school. Talk positively to the child: ‘You wear it at night and at home, nobody sees it. When treatment is done, your face will be perfectly developed.’ Parental confidence is transmitted to the child.

If the Appliance Gets Lost, Breaks or the Child Stopped Wearing It

What to do in each situation

Appliance was lost: Let us know immediately. Each day without the appliance can lose treatment progress. Depending on how long it wasn’t worn, it may need adjustment or remaking.
Appliance broke: Save all fragments. Don’t try to repair with household glue — can be toxic or not work. Bring it to the clinic for evaluation. Depending on damage, it may be repaired or need remaking.
Child stopped wearing it for several days: Let us know before they try to put it back on alone. After several days without use, teeth and bones may have partially shifted and the appliance may not fit correctly. Requires evaluation.
Appliance no longer fits or feels too tight: Sign that bones and teeth are moving — may be a good sign (treatment progressing) or the appliance needs adjustment. Don’t force it. Let us know.

Warning Signs

When to contact the clinic

Contact the clinic if:

Intense pain at a specific point: General pressure is normal; very intense pain in a specific tooth, joint or bone is not. May indicate the appliance is exerting incorrect force.
Appliance broke or has loose parts: A loose fragment can lacerate the mucosa or be swallowed. Remove the appliance, save the fragments and call the clinic.
Severe irritation or sores on mucosa: Small marks the first days are normal. Non-healing sores, worsening irritation or lesions on palate, cheeks or gums may indicate excessive pressure or material reaction.
With headgear: spring came unhooked: If the headgear springs come unhooked from the tubes, remove the appliance immediately. Don’t try to reconnect them. Call the clinic.
Notable change in bite: If the child suddenly feels they bite differently or teeth don’t fit together as before, let us know for evaluation.
Fever or facial swelling: May indicate tissue infection. Requires urgent evaluation.

This is completely normal:

Pressure or tension in teeth the first days and after adjustments
Difficulty speaking the first weeks
Excess saliva the first days
Mild jaw joint discomfort at the start
Light marks from clasps on gum at first
Appliance feeling different after each adjustment appointment
Child being more irritable the first days of use

Results and Treatment Duration

What to expect and when to see it

The results of maxillary orthopedics are gradual — they don’t appear from one day to the next. The process works on bone growth, which is slow by nature. Significant changes are generally observable after 6-12 months of consistent use.

Active phase · 6-18 months: The appliance is used actively as instructed. When the most important bone changes occur. Cooperation in this phase is fundamental.
Retention / maintenance phase · 3-12 months: Appliance is used less frequently or only at night to maintain the changes obtained while the new growth pattern consolidates.
Transition to orthodontics · Variable: Frequently, orthopedics is the first step. When bones are in better position, orthodontics (braces or aligners) is started to align teeth in the created space.

How to know if treatment is working?

The dentist will verify at each appointment with X-rays and models
Facial changes are progressive — compare photos every 3-4 months
Improvement in bite and tooth relationship when biting
A gap between teeth may appear during treatment — ask if it’s normal
The child’s cooperation is the most important predictor of outcome

Keys to Successful Orthopedic Treatment

Respect the daily wear hours indicated
Always in case — never in a napkin
Clean appliance after every meal
Attend all check-up and adjustment appointments
Let us know if it breaks, gets lost or there’s pain
Supervise use in children under 8 years

Frequently Asked Questions

What exactly does my child’s appliance do?

Each appliance has a specific objective. The dentist should have explained which problem is being corrected. If it wasn’t clear, write to us — we’ll explain in detail what your child’s appliance does and what result to expect.

Does the appliance hurt?

It generates pressure and tension, especially the first days and after each adjustment. This sensation is normal and generally manageable with pediatric pain reliever. Very intense pain or pain at a specific point is not normal — let us know.

Why does my child need to wear it so many hours?

Orthopedic appliances work by applying gentle, constant forces to growing bones. If the force isn’t constant (few wear hours), the bone doesn’t receive sufficient stimulus to change its growth direction. It’s like watering a plant — one day without water won’t kill it, but if rarely watered, it won’t grow.

How long will the complete treatment take?

Depends on the problem and cooperation. The active phase is usually 6-18 months. After that there may be a 3-12 month retention phase. And frequently a braces orthodontic phase follows. The dentist will give you a specific estimate for your case.

Is the appliance visible when the child is at school?

Depends on the appliance. The bionator and plates are invisible when not in the mouth. The facemask and headgear are visible, but are generally prescribed for night and home use only. The lip bumper may be visible, but most children adapt quickly.

Can the child play sports with the appliance?

With removable appliances: yes for non-contact sports. For contact sports, remove and use mouthguard. With headgear and facemask: never during sports. Consult with the dentist based on the specific sport.

What happens if we don’t complete treatment?

Depends on the progress made. With little cooperation: the problem may be partially but not completely corrected, requiring longer treatment or even surgery later. With early abandonment: bone growth may return to the incorrect pattern.

Can the appliance damage permanent teeth?

A properly indicated and adjusted appliance doesn’t damage permanent teeth — on the contrary, it creates conditions for them to erupt in better position. What can cause damage is poor hygiene: cavities in the areas of contact with the clasps.

Can I clean the appliance with toothpaste?

No. Toothpaste contains abrasives that scratch the appliance acrylic. Over time, scratched surfaces accumulate more bacteria and the appliance deteriorates. Use only neutral liquid soap and cold water.

When can the final result be seen?

Bone changes consolidate gradually. Changes in facial profile and bite are usually appreciable at 6-12 months of consistent treatment. The final result is evaluated when facial growth ends — generally at the end of adolescence.

Care with Pediatric Orthopedic Appliances