Abstract:
An orthotic device for redefining an occlusal plane includes a left portion, a right portion including an upper surface, a bite block coupled to either the left portion or the right portion, and a lingual portion coupled to the left portion and the right portion. The orthotic device is configured to engage teeth located along a left portion and a right portion of a mandible. The bite block is disposed along the upper surface of either the left portion or the right portion and extends upward relative to an upper surface of the left or right portion.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims the benefit of U.S. Provisional Patent Application No. 62/325,176, filed on Apr. 20, 2016, entitled “PREVENTIVE ORAL DEVICE (POD)”, U.S. Provisional Patent Application No. 62/325,192, filed on Apr. 20, 2016, entitled “RETAINER APPLIANCE”, and U.S. Provisional Patent Application No. 62/325,185, filed on Apr. 20, 2016, entitled “ORAL ORTHOTIC APPLIANCE (NIGHTBLOCK)”, the entire contents of each of which are incorporated by reference herein. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure relates to apparatuses and methods for protecting a patient&#39;s teeth from damaging parafunctional occlusal forces, such as clenching and grinding. More specifically, the present disclosure relates to oral orthotic inserts which, when positioned in an individual&#39;s mouth, redefine the patient&#39;s occlusal plane to protect the teeth from bruxism and reduce occlusal forces. 
       BACKGROUND 
       [0003]    Orthodontic apparatuses, methods, and procedures can be used to correct a variety of oral health issues. Orthodontic cases (braces) have been used to align an individual&#39;s teeth to repair abnormalities in the individual&#39;s tooth arrangement. Once braces are removed, retainers such as Hawley retainers are fitted for the individual to prevent the individual&#39;s teeth from moving after repositioning. 
         [0004]    To correct other or deficiencies, such as cross-bites, a narrow maxillary or mandibular bone, clenching, grinding, or other oral conditions, apparatuses may be installed temporarily or permanently for varying periods of time to address such conditions, such as palate expanders, mandibular splints and bite plates, or retainers. 
       SUMMARY 
       [0005]    The present disclosure relates to an oral orthotic device for redefining an occlusal plane. The oral orthotic includes a left portion and a right portion including an upper surface, a bite block coupled to either the left portion or the right portion, and a lingual portion coupled to the left portion and the right portion. The bite block is disposed along the upper surface of either the left portion or the right portion and extends upward relative to an upper surface of the left portion or the right portion. The unilateral bite block may be placed at the position of the first mandibular molar and second mandibular premolar. 
         [0006]    In aspects, the bite block extends upward between two and seven millimeters from an occlusal plane defined by teeth of a patient. The orthotic device may further include a first wire enclosed along the lingual portion and configured to apply counter force when torsional force is applied to the orthotic. The orthotic device may further include a second wire braided about the first wire. 
         [0007]    According to aspects, the left portion defines a left arc and the right portion defines a right arc. The left arc is configured to contour to teeth located along a left portion of a mandible, and the right arc is configured to contour to teeth located along a right portion of the mandible. The left arc and right arc may be dimensioned to contour teeth located in a mouth of a patient. 
         [0008]    The present disclosure further relates to a retainer appliance which redefines an occlusal plane. The retainer appliance includes a retainer body including a frame extending therefrom, a left clasp extending from a left portion of the body and configured to couple to teeth located in a mouth of a patient, a right clasp extending from a right portion of the body, and a bite block coupled to either the left clasp or the right clasp. The bite block may enclose either the left clasp or the right clasp and extends toward opposing teeth located in the mouth of the patient. 
         [0009]    According to aspects, the bite block extends toward opposing teeth between two and seven millimeters from an occlusal plane defined by teeth of the patient. The retainer body includes a left portion and a right portion. The retainer appliance may further include a spacer mechanism coupling to the left portion and the right portion of the retainer body. The spacer mechanism may further include a screw configured to expand or contract a gap between the left portion of the retainer mechanism and the right portion of the retainer mechanism. 
         [0010]    The present disclosure also relates to a method of augmenting an occlusal plane with an orthotic device. The method includes providing an orthotic device to a patient, the orthotic device having a left portion, a right portion, a lingual portion, and a bite block positioning the orthotic device in a mouth of the patient, and applying pressure to the orthotic device to cause the left portion and the right portion to engage teeth located along a mandible of the patient. 
         [0011]    According to aspects, the method may further include removing the orthotic device from the mouth of the patient, augmenting a height of the bite block. The height of the bite block may be adjusted in response to visual inspection of the orthotic when located in the mouth of the patient. 
         [0012]    Additionally, the present disclosure relates to a method of augmenting an orthotic plane with a retainer appliance. The method includes providing a retainer appliance to an individual, the retainer appliance having a retainer body including a frame extending therefrom, a left clasp, a right clasp, and a bite block enclosing either the left clasp or the right clasp, positioning the retainer appliance in a mouth of a patient, applying pressure to the retainer appliance to cause the left clasp and the right clasp to engage teeth located along a maxilla of the patient. 
         [0013]    According to aspects, the method further includes removing the retainer appliance from the mouth of the patient, and augmenting the height of the bite block. The height of the bite block may be adjusted in response to visual inspection of the orthotic when located in the mouth of the patient. 
         [0014]    It will be understood that various modifications may be made to the embodiments of the present disclosure. Therefore, the above description should not be construed as limiting, but merely as exemplifications of embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present disclosure. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0015]      FIG. 1  is a perspective view of an orthotic positioned along the mandible; 
           [0016]      FIG. 2  is a top plan view of the orthotic positioned along the mandible of  FIG. 1 ; 
           [0017]      FIG. 3  is a front plan view of the orthotic positioned along the mandible of  FIG. 1 ; 
           [0018]      FIG. 4  is a rear plan view of the orthotic positioned along the mandible of  FIG. 1 ; 
           [0019]      FIG. 5  is a cross-sectional view of the orthotic positioned along the mandible, taken along section line  5 - 5  of  FIG. 2 ; 
           [0020]      FIG. 6  is an exploded perspective view, with parts separated, of the orthotic and mandible of  FIG. 1 ; 
           [0021]      FIG. 7  is a top plan view of the orthotic of  FIG. 1 ; 
           [0022]      FIG. 8  is a perspective view of a retainer appliance according to the present disclosure; 
           [0023]      FIG. 9  is a bottom plan view of the retainer appliance of  FIG. 9  located along a maxillary bone; 
           [0024]      FIG. 10  is a perspective view of another retainer appliance according to the present disclosure; 
           [0025]      FIG. 11  is a bottom plan view of the retainer appliance of  FIG. 10  located along a maxillary bone; and 
           [0026]      FIG. 12  is a perspective view of another retainer appliance according to the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0027]    The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure. 
         [0028]    Embodiments of the present disclosure are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. 
         [0029]    As used herein, the term “clinician” refers to a doctor, nurse, or other care provider and may include support personnel. The term “patient” refers to an individual being treated by a clinician. The term “distal” refers to the portion of the component being described which is further from a clinician, while the term “proximal” refers to the portion of the component being described which is closer to the clinician. The term “left” refers to the left portion of an anatomical structure, such as a mandible, as viewed by a clinician. The term “right” refers to the right portion of an anatomical structure as viewed by the clinician. The term “parafunctional” is defined herein to refer to habits such as bruxism (e.g., clenching of the teeth or jaw), and other habits which are unrelated to eating or speaking. 
         [0030]    As will be described in detail below, provided are embodiments of an orthodontic insert or orthotic. The orthodontic insert includes a left portion, a right portion, and a lingual portion. The orthotic may be inserted into a patient&#39;s oral cavity (hereinafter “mouth”) and retained in the mouth for varying periods of time. In embodiments, the orthotic may be attached to an upper portion of the mouth, along the maxilla. In additional embodiments, the orthotic may be attached to a lower portion of the mouth, along the mandible. As a clinician or the patient positions the orthotic in the patient&#39;s mouth, the left and right side of the orthotic are inserted into the mouth, and the clinician or patient holds the lingual portion of the orthodontic insert. The individual then applies pressure to seat the orthotic in the mouth of the individual. 
         [0031]    Referring initially to  FIGS. 1-7 , one embodiment of an orthotic is shown, and designated generally  10 . For purposes of clarity, the orthotic  10  will be described as associated with the mandible of a patient, however the orthotic  10  may likewise be adapted to be positioned along the maxilla of the patient. The orthotic  10  includes a left portion  22 , a lingual portion  20 , and a right portion  12 . An occlusal plane  4  is defined by teeth attached to the upper surface of a mandible  2 , further defining a left occlusal plane  4 A and a right occlusal plane  4 B. The lingual portion  20  is dimensioned to contour an arch defined by the mandible. When inserted into the patient&#39;s mouth, the orthotic  10  attaches and is positioned adjacent to the mandible  2 . 
         [0032]    The left portion  22  includes an outer portion  22 A, an upper portion  22 B, and an inner portion  22 C. The outer portion  22 A, upper portion  22 B, and inner portion  22 C define a left arch which is dimensioned to align with contours of teeth located along the left portion  2 A of a patient&#39;s mouth. The left arch extends along the upper surface of the left occlusal plane  4 A between a left first molar and a left first bicuspid. It is contemplated that in embodiments, the left arch may extend between a left cuspid and a left second molar or varying positions therebetween. The upper portion  22 B and the inner portion  22 C connect to a left portion of the lingual portion  20 . 
         [0033]    The lingual portion  20  extends along the arch defined by the mandible  2  between the left first bicuspid and a second portion of the right first bicuspid. The lingual portion  20  includes a lingual arch  18  which encloses a first wire  20 A and a second wire  20 B. The first and second wire  20 A,  20 B are braided in a helical fashion to support the lingual arch  18 , thereby applying forces in opposite directions when forces are received by either the left portion  22  or the right portion  12  of the orthotic  10 . The first and second wire  20 A,  20 B additionally apply counter forces to torsional forces applied to the orthotic  10  along either the left portion  22  or right portion  12 . The lingual portion  20  connects to the right portion  12  of the orthotic  10 . The first and second wire  20 A,  20 B are constructed of stainless steel. In embodiments the first and second wire  20 A,  20 B is constructed of a material with greater rigidity than the material selected to enclose the first and second wire  20 A,  20 B. It is further contemplated that, in embodiments a resilient member e.g., may be located in place of the first and second wire  20 A,  20 B. 
         [0034]    The lingual portion  20  further defines a lingual guide plane  20 E and an oral guide plane  20 D. The lingual guide plane  20 E is offset from the anterior portion of the teeth located along the arch of the patient&#39;s mandible. As a result, the lingual portion  20  does not come into contact with the anterior portion of the patient&#39;s teeth, thereby reducing the potential to reposition the right and left cuspids, lateral incisors, and central incisors. Additionally, due to the offset between the lingual portion  20  and the anterior portion of the patient&#39;s teeth, the chance of gingival irritation is also reduced. The oral guide plane  20 D redirects the patient&#39;s tongue when the tongue is advanced toward the lingual portion  20 . 
         [0035]    The lingual guide plane  20 E further defines an indent  20 C located along the lingual portion  20 . More particularly, the indent  20 C is located along the lingual portion  20  between the central incisors of the patient when the orthotic  10  is located in the patient&#39;s mouth. The indent  20 C is configured to receive a lingual frenulum of the patient when the orthotic  10  is located in the patient&#39;s mouth. 
         [0036]    The right portion  12  includes an outer portion  12 A, an upper portion  12 B, and an inner portion  12 C. The outer portion  12 A, upper portion  12 B and inner portion  12 C define a right arch which is dimensioned to align with a contour of teeth located along the right portion  2 B of the mandible  2 . The right arch extends along an upper surface of the right occlusal plane  4 B between a right first molar and a portion of a right first bicuspid. It is contemplated that in embodiments, the right arch may extend between a right cuspid and a right second molar, or varying positions therebetween. The upper portion  12 B and the inner portion  12 C connect to a right portion of the lingual portion  20 . 
         [0037]    A bite block or block  14  is positioned above the right portion  12  and defines an augmented occlusal plane. The block  14  extends between at least a portion of the right occlusal plane  4 B upward toward the patient&#39;s maxillary (not shown), thereby defining a portion of the augmented occlusal plane, the augmented occlusal plane extending parallel to the occlusal plane. The block  14  includes an outer portion  14 A, an upper portion  14 B and an inner portion  14 C. The block  14  extends from the upper portion  12 B a predetermined distance toward the maxillary bone “A”. In embodiments, the predetermined distance which the block  14  extends toward the maxilla may be between two to seven millimeters. 
         [0038]    The orthotic  10  is fabricated with a standard block  14  that is five millimeters in height unless a different size block  14  is requested based on the patient&#39;s oral vertical dimensions. A person who has a collapsed vertical occlusal dimension from dental attrition, may require a seven millimeter block to compensate for the lost vertical dimension. Alternatively, a person with little to no occlusal vertical dimension loss may require a two millimeter block. After fabrication, the block can be reduced with dental burs or increased with dental acrylic if necessary. It is contemplated that in embodiments, the augmented occlusal plane may be angled such that the augmented occlusal plane tilts, or is angled relative to the occlusal plane. An augmented angle may be necessary to accommodate the opposing dentition and can be assessed during fabrication with a model of the counter arch. The block bite plane is configured to define an occlusal plane for engaging the opposing lingual and buccal cusps of the first molar and second premolar. The occlusal plane angle from mesial to distal, or from lingual to buccal, may be altered to accommodate the opposing cusps. 
         [0039]    The upper portion  12 B extends between a right first molar to a portion of a right first bicuspid. The width of the upper portion  12 B is defined by the width of the occlusal plane associated with the upper portion  12 B, e.g., the right first molar, the right second bicuspid, and the right first bicuspid. It is contemplated that, in embodiments, the upper portion  12 B may be wider or narrower than the portion of the occlusal plane above the respective tooth or teeth which the upper portion  12 B is positioned above. 
         [0040]    Depending on the needs of the patient, the block  14  may be adjusted or augmented by the clinician. For example, to adjust the height during delivery and/or during treatment, the clinician may remove material from the block  14  by grinding, cutting, or otherwise removing material from the outer portion  14 A, the upper portion  14 B, or the inner portion  14 C. Alternatively, the clinician may add material to the outer portion  14 A, the upper portion  14 B, or the inner portion  14 C to increase either the height or width of the block  14 . Material may be added to more accurately define the augmented occlusal plane defined by the block  14 , or to repair the block  14  should deformation occur while used by the patient. 
         [0041]    The position of the block  14  above the first molar, the second bicuspid, and the portion of the first bicuspid aligns the block  14  with a fulcrum of the maxillary suture system which is defined by motion of maxillary bone relative to the mandibular bone. As a result, when a patient applies force by biting on the block  14 , the maximum amount of force is received by the block  14 , and the maximum counter-force is received by teeth opposing the block  14 , e.g., a first molar, a second bicuspid, and a portion of a first bicuspid positioned on the maxillary bone. 
         [0042]    The left portion  22 , lingual portion  20 , and right portion  12  may be fabricated from dental acrylic, methyl methacrylate, pressure molded material, resin polymers, or other similar materials. Additionally, the left portion  22 , lingual portion  20 , and right portion  12  may be fabricated of materials capable of use in three-dimensional (3D) printing such as acrylonitrile butadiene styrene (ABS) plastic, thermoplastics such as polylactic acid, polyamide, polycarbonate, and/or other materials known in the art for use in 3D printing. In embodiments, it is contemplated that the orthotic  10  may be fabricated with other similar compatible materials. The first and second wire  20 A,  20 B are fabricated of surgical steel, or other similar materials. 
         [0043]    During manufacture, an impression is taken of the patient&#39;s teeth, along the mandible bone. The impression is then used to create a mold to form the orthotic  10 . Dental acrylic is then poured into the mold, and the acrylic takes the form of the orthotic  10  illustrated in  FIG. 1 . Prior to hardening of the dental acrylic, the first and second wire  20 A,  20 B are twisted about each other into a helical shape. The first and second wire  20 A,  20 B are subsequently placed into the dental acrylic, and are positioned along the lingual portion  20 . After the orthotic  10  is formed to the mold, the orthotic  10  may be removed from the mold, and the edges of the orthotic  10  augmented to repair any rough or improperly formed surfaces. Notably, once the orthotic  10  is removed from the mold, a clinician may add or remove material to and from the block  14  as desired during the duration of the patient&#39;s treatment. 
         [0044]    While located in the patient&#39;s mouth and while a parafunctional occlusal force is applied (hereinafter “force”), the block  14  receives force on the upper portion  14 B when the patient bites down, intercepting forces which would normally be received by the patient&#39;s teeth along the mandibular bone. As a result, the force is distributed from the block  14  to the teeth positioned near the block along the mandibular bone, e.g., the right first molar, second bicuspid, and the portion of the first bicuspid. Additionally, as the patient bites down to the block  14 , a parafunctional occlusal counter-force (hereinafter “counter-force”) is applied by the block  14  to opposing teeth which come in contact with the block  14  along the maxillary bone, e.g., a right first molar, second bicuspid, and a portion of a first bicuspid positioned along the maxillary bone. As a result, force is received along the augmented occlusal plane and is focused along a subset of teeth positioned along the maxillary bone and mandible bone. 
         [0045]    The concentration of force causes the patient to realize, either consciously or subconsciously, the application of force to the augmented occlusal plane. Subsequently, the patient reduces or eliminates the application of force to the augmented occlusal plane, which reduces stress applied to the patient&#39;s teeth as well as mandibular condyles. Additionally, teeth located along the mandible are prevented from coming into contact with teeth located along the maxilla, with the only occlusal contact being between the block  14  and teeth located along the maxilla opposing the block. Further, as a result of the reduction of force applied to the mandibular condyles, the associated articular discs receive reduced forces which allow the articular discs to decompress. 
         [0046]    The orthotic  10  can be fabricated in multiple ways. The traditional dental technique of acrylic (methyl methacrylate liquid and polymer) added incrementally on the custom dental model (stone and plaster) is most common. Other dental/orthodontic materials, acrylics and resin polymers may be used to fabricate the orthotic. In addition, the orthotic  10  can be fabricated via additive manufacturing (3D Printing). 
         [0047]    In use, a clinician first takes a mold of the patient&#39;s teeth. The clinician then uses the mold to create the orthotic  10 , the mold being used in conjunction with a block mold to form the block  14  along the orthotic  10 . Once the orthotic  10  is created, the clinician provides the orthotic  10  to the patient, and positions the orthotic  10  in the patient&#39;s mouth. The orthotic  10  is inserted into the patient&#39;s mouth and engages one or more teeth located along the left portion  2 A and the right portion  2 B of the patient&#39;s mandible. Upon visual inspection, the clinician determines whether the block  14  must be extended or shortened. The orthotic  10  is removed from the patient&#39;s mouth, and the clinician adds or removes material to the orthotic  10  as desired. The clinician repeats this process until the orthotic  10  is determined to be ready by the clinician. 
         [0048]    Referring to  FIGS. 8 and 9 , a retainer appliance is shown and designated generally  30 . The retainer appliance  30  includes a retainer body  32 , a left clasp  38 , a right clasp  42 , a plurality of buffer members or springs  34 , a frame  36 , and a bite block or block  40 . The retainer body  32  may be one solid piece, or may be formed by joining a plurality of retainer body pieces (not shown). While the retainer appliance  30  may be configured to be positioned along the maxillary bone or the mandible bone, for purposes of clarity description of the retainer appliance  30  will be with respect to being positioned along the maxillary bone. 
         [0049]    The retainer body  32  is dimensioned to contour a roof of the mouth when positioned along a portion of the maxillary bone. Specifically, the retainer body  32  is dimensioned to extend along a portion of the roof of the mouth, maintaining a gap “G” between the retainer body  32  and teeth of the patient. The gap “G” may be a predetermined distance or may vary depending on the needs of the patient. The retainer body may be made of acrylic or other similar biocompatible substances. The retainer body  32  further encloses a portion of the left clasp  38 , the right clasp  42 , the plurality of springs  34 , and the frame  36  (collectively referred to as the retainer members), which extend outward from the retainer body  32 . As a result of enclosing portions of the retainer members, the retainer body  32  provides structural support to the retainer members when inserted into the patient&#39;s mouth. 
         [0050]    The left clasp  38  and the right clasp  42  extend from the retainer body  32  and are dimensioned to maintain placement of the retainer appliance  30  when positioned in the patient&#39;s mouth. The left and right clasp  38 ,  42  both define a left and right arch  38 D,  42 D, respectively. The left arch  38 D is dimensioned to be fitted about one or more teeth, e.g., the first bicuspid, the second bicuspid, the first molar, and/or the second molar positioned along the left portion of the maxillary bone. Likewise, the right arch  42 D is dimensioned to be fitted about symmetrically opposing teeth positioned on the right portion of the maxillary bone. 
         [0051]    The plurality of springs  34 , or T-Flap springs, connect to the retainer body  32  and extend from the body toward the patient&#39;s teeth. Specifically, the springs  34  extend between the edge of the retainer body  32  and the patient&#39;s teeth, thereby providing structural support to maintain the gap “G” between the retainer body  32  and the patient&#39;s teeth, e.g., the left and right second bicuspids, first bicuspids, cuspids, lateral incisors, and central incisors. The springs  34  include support members  34 B which support spacers  34 A. The support members  34 B are partially enclosed by the retainer body  32  and extend outward relative to the retainer body  32  toward the patient&#39;s teeth. The spacers  34 A are oval shaped, and may be bent as needed by the clinician at delivery or during treatment of the patient. 
         [0052]    The frame  36 , commonly referred to in the art as a Hawley frame, extends outward from and is partially enclosed by the retainer body  32  at two points. The frame  36  is dimensioned to contour to a front surface of the patient&#39;s teeth and apply inward pressure against the patient&#39;s teeth toward the retainer body  32 . The frame  36  includes two frame clasps  36 B which are dimensioned to fit about one or more teeth positioned along the left and right portion of the patient&#39;s maxillary bone. 
         [0053]    The frame  36  and springs  34  are made of surgical steel, though in embodiments it is contemplated that the frame may be made of other suitable biocompatible materials which allow for deformation by a clinician. Additionally, the retainer body is made of a hard acrylic or other similar biocompatible plastic or composite. 
         [0054]    The block  40  is positioned on the right side of the retainer appliance  30  and extends from the right side of the retainer body  32  toward the patient&#39;s teeth. The block  40  encloses a second portion of the right clasp  42 . The block further includes an outer portion  40 A, a lower portion  40 B, an inner portion  40 C, and an maxillary portion  40 D. The maxillary portion  40 D extends along a portion of the maxillary bone, and is configured to be in contact with one or more teeth associated with the maxillary bone. Specifically, the maxillary portion  40 D defines an arch which contours to one or more of the patient&#39;s teeth when the retainer appliance  30 ′ is positioned in the patient&#39;s mouth. As shown, the maxillary portion  40 D extends along the right first molar, second bicuspid, and a portion of the first bicuspid. It is contemplated that, in embodiments, the maxillary portion  40 D may extend along a greater or lesser portion of the patient&#39;s teeth located along the maxillary bone. 
         [0055]    In use, similar to fabrication of the orthotic  10 , the clinician first takes a mold of the patient&#39;s teeth. The clinician then uses the mold to create the retainer appliance  30 , the mold being used in conjunction with a block mold to form the block  40  along the retainer appliance  30 . Once the retainer appliance  30  is created, the clinician provides the retainer appliance  30  to the patient, and positions the retainer appliance  30  in the patient&#39;s mouth. The retainer appliance  30  is inserted into the patient&#39;s mouth and engages one or more teeth located along the left portion and the right portion of the patient&#39;s maxilla. Upon visual inspection, the clinician determines whether the block  40  must be extended or shortened. The retainer appliance  30  is removed from the patient&#39;s mouth, and the clinician adds or removes material to the retainer appliance  30  as desired. The clinician repeats this process until the retainer appliance  30  is determined to be ready by the clinician. 
         [0056]    For a detailed discussion of the construction of a retainer appliance, reference may be made to U.S. Pat. No. 7,314,372, and U.S. Pat. No. 7,357,635, the entire disclosures of which are hereby incorporated by reference. 
         [0057]    Referring to  FIGS. 10 and 11 , an alternative embodiment of the retainer appliance of  FIG. 9  is shown, and designated generally  30 ′. The retainer appliance  30 ′ includes a retainer body  32 ′ which includes a left portion  32 A and a right portion  32 B. The left and right portions  30 A,  30 B are connected by the frame  36  and a spacer mechanism  44 . The spacer mechanism  44  may include a screw  44 A which can be actuated, increasing or decreasing a second gap “G 2 ” between the left portion  30 A and the right portion  30 B. 
         [0058]    Referring to  FIG. 12 , an alternative embodiment of the retainer appliance of  FIG. 9  is shown, and designated generally  30 ″. A retainer body  32 ″ extends along a portion of the roof of the patient&#39;s mouth. The retainer appliance  30 ″ includes a retainer body  32 ″ which is dimensioned to be positioned flush against one or more of the patient&#39;s teeth. As a result, the retainer body  32 ″ extends along a portion of the roof of the mouth, thereby maintaining the position of the retainer appliance  30 ″ relative to the patient&#39;s teeth without the need for springs  34 . 
         [0059]    While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Any combination of the above embodiments is also envisioned and is within the scope of the appended claims. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope of the claims appended hereto.