EXPLORING the First Two Keys of Class II Correction: By Randy K. Newby, DDS Maxillary Arch Development & Maxillary Molar Position Fig. 1 Fig. 2 I n the Spring 2014 issue of the JAOS, my friend and mentor Leonard J. Carapezza, DMD wrote an article titled: Six Keys to Early Mixed Dentition Class II Correction: A Quantified Approach to Diagnosis and Treatment. 2 Dr. Carapezza’s article gives an overview of many important aspects of Class II treatment. In the next several issues of the JAOS, I will use the Six Keys described as an outline to explore each in depth. This article will focus on the first two keys: Maxillary Arch Development and Maxillary Molar Position, describing techniques utilized in my practice and when I use them. A potential biomechanical problem exists when expanding transversely across the maxillary arch. This will be discussed and possible solutions to minimize or avoid it are offered. Many of the techniques described apply not only to the maxilla but to the mandible as well and also to Class I and Class III malocclusions. FICD. 13 Fig. 1 demonstrates the appliance in the mouth. In the maxilla the Big Daddy inserts into the headgear tubes. From the headgear tubes the appli-ance steps down and proceeds anteriorly where it is secured to the archwire by three ligature ties. If the appliance is to be used in the mandible the appliance inserts into the lip bumper tubes and is secured simi-larly as in the maxilla. Figs. 2-5 demonstrate fabrication and activation of the Big Daddy. Six mm of activation is programmed into the appliance. Before insertion into the mouth the appliance is heated with a flame to a straw color to increase its stiffness. Move the flame evenly around the appliance. If the appliance is heated too much it will become dead soft and is not effective. Upon activation in younger patients the response can be rapid. In adults there may be no visible response for a few months, but in time the desired expansion will occur. 8 Mulligan Mechanics in the Horizontal (Transverse) Plane Big Daddy The .032 stainless steel overlay arch was aptly named the Big Daddy by William Wyatt, DDS, FACD, 14 Fall 2014 JAOS
Journal of the American Orthodontic Society Fall 2014: Page 14
