APPLIANCE THERAPY

The Rick-A-Nator Appliance

Dr. Brock Rondeau, D.D.S., I.B.O., D.A.B.C.P.
he Rick-A-Nator is a fixed-functional appliance that is utilized to advance the mandible 3 mm. to correct the overjet and can also correct a deep overbite. This appliance can be utilized in either the mixed dentition or permanent dentition. The Rick-A-Nator consists of two maxillary molar bands attached to an anterior bite plate using two .045 stainless steel connector wires. This anterior bite plate is transformed into an anterior repositioning appliance by the addition of an incisal ramp 2 3 mm. long.

overjet, 1 mm. overbite. Place Triad or composite to stabilize this mandibular position on either side of the midline. 6. Inject with polyvinyl siloxane between posterior teeth. 7. Send upper and lower working models to the lab with the two upper molar bands. 8. Place separators mesial and distal to maxillary first molars. After the Rick-A-Nator with the incisal ramp has been inserted in the mixed dentition it is critical to build up the mandibular primary molars with composite.

When the Rick-A-Nator is relined it is important to reline the incisal ramp so that the patient has a 1 mm. overjet and 1 mm. overbite.

Rick-A-Nator Composite Buildups, Lower Primary Molars.

Rick-A-Nator Incisal Ramp.

The mandibular deficiency problem is solved when the incisal ramp is fabricated to advance the mandible 3 mm. If you need to advance the mandible more than 3 mm. in the mixed dentition the appliance of choice is the Twin Block. The photo below shows a deep overbite with an overjet of 4 mm. This is an ideal clinical case for the Rick-A-Nator.
Rick-A-Nator Overbite 1 mm. Composite Buildups Primary Molars.

The incisal ramp can be fabricated by the lab or by the clinician with Triad, and contacts the lingual of the maxillary central and lateral incisors. Approximately 80% of Class II malocclusions have retrognathic mandibles and a significant number of these patients suffer from TM Dysfunction. The Rick-A-Nator does an excellent job of solving both the mandibular deficiency, as well as the vertical deficiency, in a short period of time with very stable results. Since it is a fixed appliance, cooperation and success rate is extremely high. The technique for fabricating a RickA-Nator appliance is as follows: 1. Place separators mesial and distal to the upper first permanent molars. 2. Remove separators after 1 week. Fit two maxillary molar bands. 3. Remove molar bands. 4. Take upper and lower impressions. Pour working models in yellow stone. 5. Position the mandible so skeletal midlines are properly aligned, 1 mm. 24

It is very important to support the TMJ and to help the patient to chew their food. If their teeth are not built up with composite the patient will be left with a posterior open bite. Then with no posterior support the condyle will seat more posteriorly in the fossa, causing compression of the nerves and blood vessels in the bilaminar zone with subsequent pain and discomfort. When the patient presents with a 6 mm. overbite, they also can often have headaches due to TM Dysfunction.

Overjet 4 mm. Retrognathic Mandible.

Rick-A-Nator Overjet 1 mm. Incisal Ramp Mandible Advanced. Overbite 6 mm. Headaches.

After the Rick-A-Nator has been inserted, it is important for the patient to be instructed to have their lower incisors bite in front of the ramp when swallowing. If the patient occludes anterior to the ramp 2,000 times a day while swallowing the mandible will stay permanently forward in its correct Class I position after six months. Early Orthodontic treatment is the key to proper treatment in an effort to avoid extractions of permanent teeth and orthognathic surgery. Ideally in mixed dentition if clinicians can correct the overjet and overbite as well as Class II dental and Class II skeletal problems, then this reduces the time in fixed braces. Younger patients would much prefer to wear a Rick-A-Nator and composite buildups at age 8 10 and then straight wire for 9 12 months rather than start fixed orthodontics for 2 3 years when they are in high school.

One of the main advantages of the Rick-A-Nator is that it takes the control of the wear time out of the hands of the patient and therefore ensures maximum cooperation.
One of the main advantages of the Rick-A-Nator is that it takes the control of the wear time out of the hands of the patient and therefore ensures maximum cooperation. Due to the fact that the Rick-A-Nator appliance is so compact compared to other functional appliances the patient has no trouble speaking or eating with the appliance. The correction of the skeletal Class II malocclusion with a normally positioned maxilla and retrognathic mandible is ideally treated with functional appliances in the mixed dentition. A retrognathic mandible is clearly not a dental problem but rather a bone (orthopedic) or skeletal problem that must be addressed as soon as possible. In the pre-treatment photo it is quite evident that this 10 year old male patient has a deficient lower jaw.

The treatment of choice, if the overjet is 4 mm., would be to advance the mandible 3 mm. with the Rick-A-Nator in the mixed dentition. After placement of the Rick-A-Nator the profile significantly improved. The patient went from a Class II Skeletal (normal maxilla, retrognathic mandible) to a Class I Skeletal (normal maxilla, normal mandible). The Rick-A-Nator is an excellent functional appliance that can help solve mandibular as well as vertical deficiencies in patients with slight overjets and deep overbites. It has been estimated that as many as 70% of children have some form of malocclusion. The Rick-ANator is an important appliance to help these children, not only to solve the malocclusion but also can dramatically improve their profile. It can also significantly reduce the signs and symptoms of TM Dysfunction, which can be present in many of our children who have Class II Skeletal malocclusions. For more information on courses in your area regarding Orthodontics, TMD and Sleep Dentistry please call Rondeau Seminars at 1-877-372-7625 or visit www.rondeauseminars.com.
Dr. Brock Rondeau is one of North Americas most sought after clinicians, who lectures over 100 days per year. He is a master senior certified instructor for the International Association for Orthodontics, and the past president. Over 19,000 dentists have attended his courses and study clubs in the United States, Canada, China, Australia, England and Poland. He has an extremely busy practice limited to the treatment of patients with orthodontic, snoring and sleep apnea and TMJ problems. Dr. Rondeau is a Diplomate of the International Board for Orthodontics, and a Diplomate of the American Academy of Craniofacial Pain.

Class II Molar Overbite 6 mm.

When the Rick-A-Nator is placed the mandible is advanced 3 mm., which corrects the overjet and moves the molar from Class II to Class I, as well as corrects the overbite. When the posterior open bite is corrected with the composite buildups on the mandibular primary molars this leaves a space between the first permanent molars. In mixed dentition the lower first permanent molars will passively erupt in approximately 3 months to help to permanently correct the deep overbite.

Pre-Treatment Headaches Retrognathic Profile.

Rick-A-Nator Class I Molar Overbite 1 mm. Rick-A-Nator No Headaches Straight Profile.

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