The MARA Appliance

The most common problem presented to orthodontists is correction of skeletal class 2 malocclusions. In the past most malocclusion have been corrected with surgical procedures, headgear and/or elastic therapy. In most cases, the improper bite is caused by a lower jaw that is too far back in relationship to the rest of the face. A good indicator of this type of malocclusion would be a case where the upper lip is balanced with the rest of the face by sliding the lower jaw forward, thus creating a more pleasing profile. When the patient is growing its possible to accelerate the lower law to catch up with the upper part of the face using the MARA.

The MARA is a functional appliance because it postures the patients lower jaw in a forward direction. Over a period of months this forward posture of the lower jaw usually promotes growth in the same direction. Because MARA’s are permanently attached to the teeth for the duration of the treatment, they address the lack of success that removable functional appliances have experience in the past due to patient noncompliance. when the patient tries to bite in class II, the fixed lower arms interfere with closing, allowing them to one close in class I.

The patient is forced to bite forward and is guided by the appliance to habitually hold the jaw in a class I relationship. opening and closing movements occur easily and patients adjust to the appliance in about a week. MARAs work well with all different types of dental and skeletal class II problems, especially brachfacial (low angle) deep bite class II cases. However, cases with extremely short Rami (height of mandible) may not grow sufficiently, and high angle cases may get more vertical face heigh increase as the class II is corrected, unless some steps are taken to prevent it such as wearing cervical collar at night. It is a little more difficult to use in the early mixed dentition because there is insufficient room in the cheek area. Although many successful class II treatments have been reportedly utilising the primary first molars as anchorage.

The appliance is mostly used in the late mixed dentition stage of development all the way through advanced adulthood. The MARA device is used for the Correction of skeletal class II / deep bites / deficient (small) mandibles. It is worn with braces to save time with leveling and aligning of teeth and can be advanced incrementally. MARA (Mandibular Anterior Repositioning Appliance) is used to achieve Class II correction treatment goals in the “noncompliant” patient.

For the MARA patient to close his / her mouth and occlude the teeth, they must posture the jaw forward into the desired Class I occlusion. With the MARA, the mandible is held forward in Class I occlusion by the labs positioning of the buccal attachments on the molars.

The MARA is anchored to the molars.