One of the ways that OrthoExpress saves time and money on treating a patient is by stacking the treatment. One example would be correcting a class III tendency in the buccal segments and at the same time widening the maxilla with a Split-Plate (RPE).
The idea is to use the widening of the maxilla to enhance correcting the class III bite. When widening the mid-palatal suture there are also adjustments taking place at the other sutures where the maxilla attaches to the cranial base.
Applying class III mechanics during the widening of the maxilla takes advantage of the fact that all of the sutures are loose. It also takes advantage of the fact that this treatment can be “stacked” with widening of the maxilla which is a time-consuming process. We not only do two things at once, but we take advantage of the loosen sutures in the maxilla. The class III mechanics will result in quicker correction of the bite relationship because of the loose sutures.
So in this case we not only do two things at once but we get a synergistic benefit from the loosened sutures in the cranial base.
The Steps:
Step 1: Put the lower braces on, and get the teeth lined up so that a large enough archwire can be placed to support class III elastics.
Step 2: Place the Split-Plate (rapid palatal expander or RPE) to start widening the upper arch.
Step 3: After the Split-Plate has widened about three millimeters, check the patient again to make sure the mid-palatal suture is widening as planned. Usually you will know if the suture is widening because a space will start to develop between the upper central incisors.
Step 4: If the suture is widening appropriately, start class III elastics full-time to pull the maxilla forward as it continues widening. The elastics that I use place about 200 to 300 grams of force on each side of the mouth. Check the patient in two or three weeks to make sure the maxilla is moving appropriately. You can often get the change you want in 2-3 months. Sometimes you may want to also use a reverse headgear along with the class III elastics.
The stacking of these two treatments, widening the maxilla and moving it forward at the same time, can save a lot of time in treating borderline Class III patients. It is also an example of many ways that OrthoExpress stacks the treatment to save time.
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