CASE REPORT Fig. 20 Fig. 22 Fig. 21 Fig. 23 Fig. 24 of the molars was maintained all the way through to the completion of treatment. The curves of Monson and Wilson 7 are coincident after widening both arches in this case (Fig. 24). Stable Results There are many other techniques to widen maxillary arches. Among them are: Transplatal Bar (TBT) 4 (Fig. 25), Nitaninum Palatal Expander 2 (NPE) 8 (Fig. 26), Hyrax 2 (Fig. 27), and Mulligan Mechanics 7 (Fig. 28). I use the above methods routinely when treating orthodontic cases depending on what the case requires. Most adults prefer the Big Daddy appliance if maxillary widening is to be included in their treatment plan because there is nothing on their palate. The Big Daddy is elegant, streamlined and inexpensive to fabricate. Many clinicians main-tain that surgery is the most effec-tive way to widen a maxilla after the sutures have closed. 3 I have found this to not necessar-ily to be the case. Dr. Bill Wyatt recommends plac-ing buccal root torque in the maxillary rectangular stainless steel archwire starting at the first bicus-pid bracket to counteract the unto-ward effect of buccal crown tipping when employing the Big Daddy appliance. 9 I have found that plac-ing custom buccal tubes at the level of the center of resistance of the maxillary first molars when expanding the maxillary arch with the Big Daddy appliance to be effective and predictable. The maxillary posterior teeth bodily 10 Fall 2022 JAOS
Journal of the American Orthodontic Society Fall 2022: Page 10
