APPLIANCE THERAPY

Dr. Brock Rondeau, D.D.S., I.B.O., D.A.B.C.P.

The Rick-A-Nator is a fixed-func-tional appliance that is utilized toadvance the mandible 3 mm. to

correct the overjet and can also correcta deep overbite. This appliance can beutilized in either the mixed dentition orpermanent dentition. The Rick-A-Natorconsists of two maxillary molar bandsattached to an anterior bite plate usingtwo .045 stainless steel connector wires.This anterior bite plate is transformedinto an anterior repositioning applianceby the addition of an incisal ramp2 – 3 mm. long.

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The incisal ramp can be fabricated bythe lab or by the clinician with Triad, andcontacts the lingual of the maxillary cen-tral and lateral incisors. Approximately80% of Class II malocclusions haveretrognathic mandibles and a significantnumber of these patients suffer from TMDysfunction. The Rick-A-Nator does anexcellent job of solving both themandibular deficiency, as well as thevertical deficiency, in a short period oftime with very stable results. Since it is afixed appliance, cooperation and successrate is extremely high.

The technique for fabricating a Rick-A-Nator appliance is as follows:

1. Place separators mesial and distal tothe upper first permanent molars.

2. Remove separators after 1 week. Fittwo maxillary molar bands.

3. Remove molar bands.

4. Take upper and lower impressions.Pour working models in yellow stone.

5. Position the mandible so skeletalmidlines are properly aligned, 1 mm.

The Rick-A-NatorAppliance

overjet, 1 mm. overbite. Place Triad orcomposite to stabilize this mandibularposition on either side of the midline.

6. Inject with polyvinyl siloxane betweenposterior teeth.

7. Send upper and lower working modelsto the lab with the two upper molarbands.

8. Place separators mesial and distal tomaxillary first molars.

After the Rick-A-Nator with the incisalramp has been inserted in the mixeddentition it is critical to build up themandibular primary molars withcomposite.

It is very important to support theTMJ and to help the patient to chewtheir food. If their teeth are not built upwith composite the patient will be leftwith a posterior open bite. Then with noposterior support the condyle will seatmore posteriorly in the fossa, causingcompression of the nerves and bloodvessels in the bilaminar zone with sub-sequent pain and discomfort.

When the patient presents with a6 mm. overbite, they also can often haveheadaches due to TM Dysfunction.

When the Rick-A-Nator is relined it isimportant to reline the incisal ramp sothat the patient has a 1 mm. overjet and1 mm. overbite.

The mandibular deficiency problem issolved when the incisal ramp is fabri-cated to advance the mandible 3 mm. Ifyou need to advance the mandible morethan 3 mm. in the mixed dentition theappliance of choice is the Twin Block.The photo below shows a deep overbitewith an overjet of 4 mm. This is an idealclinical case for the Rick-A-Nator.

Rick-A-Nator Incisal Ramp.

Rick-A-Nator Composite Buildups, LowerPrimary Molars.

Overbite 6 mm. Headaches.

Rick-A-Nator Overbite 1 mm. CompositeBuildups Primary Molars.

Overjet 4 mm. Retrognathic Mandible.

Rick-A-Nator Overjet 1 mm. Incisal RampMandible Advanced.

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Dr. Brock Rondeau is one of North America’smost sought after clinicians, who lectures over100 days per year. He is a master senior certifiedinstructor for the International Association forOrthodontics, and the past president. Over19,000 dentists have attended his courses andstudy clubs in the United States, Canada, China,Australia, England and Poland. He has anextremely busy practice limited to the treatmentof patients with orthodontic, snoring and sleepapnea and TMJ problems. Dr. Rondeau is aDiplomate of the International Board forOrthodontics, and a Diplomate of the AmericanAcademy of Craniofacial Pain.

Rick-A-Nator No Headaches Straight Profile.

Class II Molar Overbite 6 mm.

Rick-A-Nator Class I Molar Overbite 1 mm.

Pre-Treatment Headaches Retrognathic Profile.

After the Rick-A-Nator has beeninserted, it is important for the patient tobe instructed to have their lower incisorsbite in front of the ramp when swallow-ing. If the patient occludes anterior tothe ramp 2,000 times a day whileswallowing the mandible will staypermanently forward in its correct ClassI position after six months.

Early Orthodontic treatment is thekey to proper treatment in an effort toavoid extractions of permanent teeth andorthognathic surgery. Ideally in mixeddentition if clinicians can correct theoverjet and overbite as well as Class IIdental and Class II skeletal problems,then this reduces the time in fixedbraces. Younger patients would muchprefer to wear a Rick-A-Nator and com-posite buildups at age 8 – 10 and thenstraight wire for 9 – 12 months ratherthan start fixed orthodontics for 2 – 3years when they are in high school.

When the Rick-A-Nator is placed themandible is advanced 3 mm., whichcorrects the overjet and moves themolar from Class II to Class I, as well ascorrects the overbite. When the posteri-or open bite is corrected with the com-posite buildups on the mandibularprimary molars this leaves a spacebetween the first permanent molars. Inmixed dentition the lower firstpermanent molars will passively erupt inapproximately 3 months to help topermanently correct the deep overbite.

One of the main advantages of theRick-A-Nator is that it takes the controlof the wear time out of the hands of thepatient and therefore ensures maximumcooperation. Due to the fact that theRick-A-Nator appliance is so compactcompared to other functional appliancesthe patient has no trouble speaking oreating with the appliance.

The correction of the skeletal ClassII malocclusion with a normally posi-tioned maxilla and retrognathicmandible is ideally treated with function-al appliances in the mixed dentition. Aretrognathic mandible is clearly not adental problem but rather a bone(orthopedic) or skeletal problem thatmust be addressed as soon as possible.

In the pre-treatment photo it is quiteevident that this 10 year old male patienthas a deficient lower jaw.

The treatment of choice, if the over-jet is 4 mm., would be to advance themandible 3 mm. with the Rick-A-Natorin the mixed dentition. After placementof the Rick-A-Nator the profile signifi-cantly improved. The patient wentfrom a Class II Skeletal (normal maxilla,retrognathic mandible) to a Class ISkeletal (normal maxilla, normalmandible).

The Rick-A-Nator is an excellentfunctional appliance that can help solvemandibular as well as vertical deficien-cies in patients with slight overjets anddeep overbites. It has been estimatedthat as many as 70% of children havesome form of malocclusion. The Rick-A-Nator is an important appliance to helpthese children, not only to solve themalocclusion but also can dramaticallyimprove their profile. It can alsosignificantly reduce the signs andsymptoms of TM Dysfunction, whichcan be present in many of our childrenwho have Class II Skeletalmalocclusions.

For more information on courses inyour area regarding Orthodontics,TMD and Sleep Dentistry please callRondeau Seminars at 1-877-372-7625 orvisit www.rondeauseminars.com.

One of the main advantagesof the Rick-A-Nator is

that it takes the control ofthe wear time out of thehands of the patient and

therefore ensures maximumcooperation.