CASE REPORT By Randy K. Newby, DDS T he Big Daddy 9 appliance is an .032 stainless steel overlay wire that when activated expands the maxillary arch (Figs. 1 and 2). To fabricate the appliance, a straight section of .032 stainless steel wire is shaped with a torquing turret slightly wider than the maxillary arch being treated (Fig. 3). On one side, a vertical step-up bend is placed just mesial to the headgear tube of the maxillary first molar band (Figs. 4A and B). A horizontal bend is then placed 2-3mm higher than the initial verti-cal bend completing the offset (Fig. 4C). This offset bend allows the wire to fit passively in the molar headgear tube of the maxillary first “These cases have proven to be extremely stable with minimal to no relapse, particularly when a maxillary wrap-around retainer is worn.” molar band. Repeat the bends on the other side (Fig. 4D). The Big Daddy is widened such that there is approximately 6mm of activation (3 mm per side) (Fig. 5A). The appliance is then heated with a flame to a straw color to stiffen it so that it is rigid and thus more effec-tive when widening the maxillary arch (Fig. 5B). The wire ends are placed in the first molar band head-gear tubes and extend beyond the tubes 2-3mm. The appliance is secured to the main archwire with three metal ligature ties (Fig. 2). Turn the ligature ties inward and tuck so that the lip is not irritated. On subsequent visits (4–6 week intervals), remove the Big Daddy to assess the activation remaining in the appliance. Widen the Big Daddy to the original required 6mm of acti-vation and place it back in the patient’s mouth. Repeat until the required widening in the maxillary arch has been achieved. Fig. 2 Fig. 1 6 Fall 2022 JAOS
Journal of the American Orthodontic Society Fall 2022: Page 6
