Growth Appliances: Non-surgical Solutions for Underbites, Overbites, and TMJ Problems

Many patients have been advised that jaw surgery is necessary to correct their TMJ pain, underbites, overbites, and facial asymmetry.  This is not always the correct tmj treatment and is not always needed.  In fact, it is often not the best treatment and is certainly not predictable.  The two treatments below are in so many cases, alternatives to surgery:

RAGGA:   Removable Anterior Growth Guidance Appliance

The removable growth appliance is designed for help children with orofacial growth, usually 6-10 years of age. This appliance is designed to expand the upper jaw in all dimensions in order to lay down the foundation and to allow eruption of permanent teeth as well.  Before treatment begins, the airway, tongue, and breathing are assessed.  If any issues are present, they are also addressed as proper airway, tongue posture, and nasal breathing are paramount to long term success and health.   If a tongue thrust, mouthbreathing, or an aberrant swallow pattern are present, it is sometimes necessary to have Myfunctional Therapy to help correct these problems in conjunction with treatment.  Airway obstructions sometimes often need to be referred to an ENT.

This a functional appliance, which means it works as you function with this, eating and wearing it 24/7.  There is also a dimple in the nasopalatine area which trains the tongue to go to the roof of the mouth as well. These appliance worth by acting on the bodies growth centers.

This photo shows a 9 year old who presented with TMJ pain and inability to open her mouth or chew her food.  After stabilizing her TMJ issues, a RAGGA was used to develop her upper and lower jaw as well as the airway.  Note the significant change in the growth of her upper jaw and how the lower jaw has developed with forward growth as well.

Treatment is planned out carefully to assess the position of the upper jaw and airway too. If there is a midface deficiency, then the growth appliance is often recommended.  If there is no midface deficiency, usually braces can help as long as it is not retraction mechanics methods.

After completion of the RAGGA, sometimes, braces are required to straighten the teeth, however, there will room for the teeth due to the results of the RAGGA.  Often,  a FRLA, which is a type of retainer (inside wire) can be inserted until the desired time for braces if needed.

FAGGA:  Fixed Anterior Growth Appliance

It is usually never too late to treat patients with underdeveloped upper jaws.  It is an accepted practice to expand dental arches and treating without extractions is truly the way to consider treating.  There are many different dental expanders that do work, however, most do not expand the maxilla (upper jaw) anteroposteriorly.  This is often the most important parameter when involving airway and TMJ issues.  Utilizing maxillary expansion helps create more tongue space, help improve airway, develop the anterionasal complex, improve TMJ issues, and many times improve esthetics and facial profiles. It is easy to see that more is involved than just straightening teeth or trying to widen an arch.  The Fixed Anterior Growth Guidance Appliance (FAGGA) develops or remodels the maxilla, or upper jaw to the determined place.  At the same time, the technique used allows the lower jaw to follow the upper, correcting the issues.

After treatment, a lingual wire which stays in place to make sure the teeth do not move back to their original position. Braces are then placed on upper and lower teeth to move the back teeth forward to close the spaces and to sometimes straighten the teeth.
This is not conventional braces treatment as the teeth are being moved forward as opposed to retracting them. Treatment time is often less as the proper spaces are already there.

Treatment is not painful and is non-surgical.


Orthodontic care often offers benefits of straighter and more esthetic teeth.  Sometimes more is needed than just to straighen  teeth.  In these cases, the one of the jaws are often somewhat underdeveloped and affects patient’s airway, cause TMJ pain and headaches, and a poor profile.  These growth appliances are a conservative alternative to treating many cases non-surgically even in adults.

If you have any questions about Houston TMJ Treatment or Underbite and Overbite Treatment, please feel free to contact our office, Ronald W. Konig DDS, FAGD, LVIF, FIAPA, 713-668-2289.

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