Pediatric Orthodontics: Appliance Types Guide (Braces, Aligners, Myobrace, Lingual Arch, Expander)

What Is Pediatric Orthodontics and When Does It Start?

Pediatric orthodontics is orthodontic treatment applied to developing jaws and erupting teeth. Different from adult orthodontics: treatment is not only tooth movement but also includes **jaw growth guidance**.

The American Association of Orthodontists (AAO) recommends the first orthodontic evaluation at **age 7**. At this age, not all permanent teeth have erupted, but early concerns about jaw development (narrow palate, crowding tendency, beginnings of Class II/III malocclusion) can be detected.

Pediatric orthodontic treatment is planned in two phases: **Phase 1** (ages 7-10, mixed dentition): jaw growth guidance, space management, simple problem correction. **Phase 2** (ages 11-14+, complete permanent dentition): comprehensive orthodontic treatment.

1. Fixed Orthodontic Appliances (Braces)

Brackets bonded to teeth + arch wire apply controlled force. The main treatment of Phase 2 in pediatric orthodontics. **Age:** 11-14+ (all permanent teeth). **Duration:** 12-24 months.

Types: **Metal** (classic, cheapest, fun with colored elastics), **Ceramic** (tooth-colored, aesthetic), **Lingual** (on the tongue side, invisible, less preferred in pediatrics), **Self-ligating (Damon)** (no elastics, claims slightly shorter duration).

Advantages: Suitable for all cases, clinician-controlled, cheaper. Disadvantages: Visible, hygiene difficult, hard/sticky food restrictions.

**Detail:** /en/blog/when-should-children-get-braces and /en/blog/braces-vs-clear-aligners-children-comparison guides.

2. Clear Aligners (Invisalign First / Teen)

Sequential use of custom, removable clear acrylic aligners designed by digital scanning. Each aligner is worn 1-2 weeks, gradually moving teeth toward the target position.

**Invisalign First (ages 6-10, Phase 1):** Arch expansion, space management, simple alignment during mixed dentition. Phase 1 alternative.

**Invisalign Teen (ages 11+, Phase 2):** Comprehensive orthodontic treatment during full permanent dentition — alternative to braces.

Advantages: Aesthetic (invisible), removable (easy hygiene), dietary freedom. Disadvantages: Must be worn 20-22 hours daily (compliance critical), expensive, limited for complex cases.

**Detail:** /en/blog/invisalign-first-children-clear-aligners guide.

3. Lingual Arch (Space-Maintainer Function)

A thin arch fixed with bands to both lower first permanent molars, passing behind the tongue in the lower jaw. Used **as a space maintainer** — preserves the gap from an early-lost primary tooth and prevents neighboring teeth from shifting.

**Age:** 6-10 (mixed dentition). **Duration:** Until the permanent premolar erupts (1-3 years).

Advantages: Cannot be removed, so cooperation is not an issue. Fixed + discreet. Foundation for Phase 1 additional treatments.

Disadvantages: Plaque accumulation risk on the banded molar — regular hygiene and 6-month follow-up are required.

**Detail:** /en/blog/space-maintainer-after-early-baby-tooth-loss (Brief #13 publication).

4. Functional Appliances (Myobrace, Twin-Block, Frankel)

Jaw growth guidance appliances. NOT tooth movement — they reposition the jaw forward/upward. **Age:** 6-12 (growth period). **Duration:** 12-24 months.

**Myobrace:** Soft silicone appliance. Worn at night + 1-2 hours daytime. Indication: Class II malocclusion (lower jaw retruded), disorders from thumb-sucking/tongue-thrust habits, mild crowding. Compliance is critical.

**Twin-Block:** Two separate upper-lower plates that guide the bite. A classic functional treatment for Class II. Worn full-time (except for meals).

**Frankel:** A buffer appliance acting on cheek/lip muscles. Less used but effective in certain cases.

Advantages: Guides jaw growth instead of moving teeth — less surgery/orthodontic need later. Disadvantages: Does not work without the child's compliance. Additional braces may be needed for complex cases.

5. Expansion and Maintenance Appliances

**Palatal expander (RPE — Rapid Palatal Expander):** A fixed appliance that transversely expands the palate in the upper jaw. Indications: narrow palate (maxillary constriction), crossbite, space shortage. **Age:** 6-12 (while the suture is open). **Duration:** 2-4 weeks active + 4-6 months passive retention. The user or parent does daily tiny screw turns.

**Removable appliance (Hawley, biteplate, Schwartz plate):** Removable acrylic plate. Phase 1 light alignment, bite plate, post-treatment retainer. **Age:** 6+. **Duration:** Variable.

**Headgear (extra-oral appliance):** External appliance taking support from the neck or head. Class II or Class III jaw growth guidance. Less used in pediatrics due to adolescent compliance difficulty; functional appliances preferred as alternative.

This category is usually the main treatment of Phase 1 — continues with braces/aligners in Phase 2.

Age × Appliance Matrix (Clinical Decision Guide)

**Ages 5-7:** Generally no treatment needed yet (most cases). If there is early Class III, crossbite, or severe thumb-sucking habit, a functional appliance or palatal expander may be considered.

**Ages 7-10 (Phase 1):** Mixed dentition. Palatal expander (narrow palate), lingual arch (space loss), Myobrace (Class II + habit), limited braces (severe rotation).

**Ages 10-12 (transition):** Final stage of primary teeth, permanent teeth fully erupting. Mostly monitor + wait; limited retainer use.

**Ages 11-14+ (Phase 2):** All permanent teeth in place. Comprehensive orthodontic treatment — **braces or aligners** decision point (detail: /en/blog/braces-vs-clear-aligners-children-comparison).

**Ages 16-18+:** If treatment completed → retainer phase; if not → approaching adult orthodontics — growth guidance opportunity decreases.

Treatment Duration Table and Cost Overview

Typical treatment durations by appliance type (clinical averages):

Palatal expander: 2-4 weeks active + 4-6 months passive

Lingual arch (space maintainer): 1-3 years (until permanent tooth erupts)

Myobrace/Twin-Block: 12-24 months

Braces treatment (Phase 2): 12-24 months

Invisalign First (Phase 1): 8-14 months

Invisalign Teen (Phase 2): 12-18 months

**Cost comparison:** In Turkey, private dental fees cannot be advertised under regulation (Law 1219). General comparison (metal braces 100% baseline): palatal expander ~30-50%, lingual arch ~20-30%, Myobrace ~50-70%, ceramic braces ~130%, lingual braces ~180%, Invisalign First/Teen ~140-180%.

**Public coverage (SGK):** State hospitals cover orthodontics with limited indications (severe malocclusion, cleft lip/palate). Aesthetic treatment is not covered.

Pediatric Orthodontics in Ataşehir — Our Approach

At our clinic in Flora Residence, an orthodontic evaluation is recommended at age 7+ (AAO standard). First visit + panoramic radiograph + cephalometric analysis determines jaw development and appliance needs.

Our approach is "decision transparency": all appliance options (advantages/disadvantages, duration, cost, clinical realism) are discussed in detail with the child and family. Rather than a single appliance, the most appropriate **combination** for the case is recommended.

Appliance production and follow-up: digital scanning (intraoral scanner), 3D planning software, certified laboratory chain. Certified for Invisalign First/Teen and fixed orthodontics.

You can schedule an appointment for an orthodontic evaluation of your child; first visit + treatment plan completed in a single session.