Rich-a-nator Appliance

The Rick-a-nator appliance was developed by Dr. William Reagan ”Rick” Gallaher Jr. Rick practice general dentistry in Knoxville, Tennessee. He originally designed the appliance to treat non-compliance patients who would not wear the Bionator appliance. (See fig#1)

Dr. Rick Gallaher

1952-2012

Fin.#1

The Rick-a-nator appliance is a fixed anterior bite ramp that usually is banded on the maxillary first permanent molars. It is attached to the molar bands with a .036 horizontal palatal sheath. This allow the clinician to remove the Rick-a-nator and chech the occlusion as the treatment progresses. (See fig.#2)

Fig.#2

Fabrication & Placement

The Rick-a-nator if fabrivated using a technique called indiret banding. The clinician makes an upper impression or scan and places separeting elastics at the upper first molars to create the band spacing. The laboratory creates the band space on the model by releiving the adjancent teeth. A blank band is used for the appliance in the mixed dentition. The band has a buccal tube in the permanent dentition to accommodate the arch wire in fixed appliance therapy.

The molar bands are cemented as the first step in placing the Rick-a-nator. The appliance is then inserted into the horizontal sheaths. The 3-Jaw pliers is used to adapt the acrylic bite ramp into firm contact with the maxillary incisors. (See fig.#3)

Fig.#3

The bite ramp on the Rick-a-nator is set chairside to the ideal position of the mandible. The Rick-a-nator is a demand position appliance. The patient should open wide to insure the mandibular condyles are properly positioned on the articular disks prior to setting the anterior bite ramp.This ideal position of the mandible is three dimentional. The mandible is postured forward to eleminate any final Class II overjet. The bite is opened to a the ideal anterior vertical dimension. The skeletal midlines are aligned correctly. Many times this can be accomplished by using marking paper to adjust the prefabricated ramp. If necissary the clinician can use acrylic to reline the ramp. (See fig.#4)

Fig.#4

The Rick-a-nator appliance will correct a very mild skeletal Class II. This malocclusion is sometimed called a pseudo Class I as the mandible is flexed forward into the deep bite. If the patient is able to bite behind the ramp on the Rick-a-nator it will not distract the skeletal Class II mandible. A very good clinicial guide is to evaluate the patient’s over jet. If the bite is deep and opening the deep bite creates the over jet the case is within the range of the Rick-a-nator. If the over jet exists before the deepbite is opened the skelatal Class II is beyond the range of the Rick-a-nator. These patients need to be pretreated with a Bionator in the mixed dentition or with a Twin-Block in the permanent dentition. (See fig.#5)

Bionator Twin-Block

Fig.#5

The Rick-a-nator appliance is used in the mixed dentition as a growth guidance appliance. It will guide the growth of the child in the mixed dention from a pseudo skeletal Class I deep bite into a skeletal Class I correct vertical dimension.

The Rick-a-nator appliance is used in the permanent dentition as a finishing appliance for the pseudo skeletal Class I deep bite patient. It is placed inside of the fixed wire appliance after the anterior torque is completed for the final bite opening and reposition of the mandible.

If the patient is post pubertal the articular disks have matrued from dense fibrous tissue into fibro cartledge. Once this occures the posterior open bite created by the anterior bite ramp must have occlusal composite build ups on the lower second molars. These build ups support the mandibular condyles on the articular disks. The build ups are removed once the posrerior occlusion is fully establiahed anterior to the build ups. This technique is known as tripoding the occlusion. (See fig.#6)

Fig.#6

Modification of the Rick-a-nator

Many patients are slightly deficient in the width of the premaxilla which prevents full repositioning of the mandible forward. One solution to this problem is to place an expansion screw in the Rick-a-nator appliance. The appliance is placed in the routine sequence, but the bite ramp is not set. The screw in the Rick-a-nator is adjusted twice a week until the upper inter canine width is developed so the appliance can be set to the ideal Class I relationship of the mandible. (See fig.#6)

Fig.#6