THE READERS' CORNER
Topic include arch expansion and divorced parents.
1. What appliance do you use for rapid palatal expansion? What is your usual treatment regimen (adjustment amount and frequency, duration, retention, etc.)? What are your criteria for case selection, and timing and amount of expansion? Have you had any success with adult cases? Do you see a difference between rapid and slow palatal expansion?
Diagnosis
Posterior crossbites of skeletal origin, shape of the palate, facial form, and respiratory habits were frequently mentioned criteria for expansion. Also mentioned was the need to expand the maxilla to ensure normal transverse relationships when the mandible is advanced with functional appliances.
Rapid vs. Slow Expansion
Readers overwhelmingly preferred rapid palatal expansion, particularly when the patient was in the permanent dentition. For patients under 11 or 12 years old, several readers preferred slower expansion using quadhelix appliances or bonded appliances. Several practitioners mentioned that they had had little success with patients over 15 years old. Expansion was rarely suggested for adults--and then only with an all-wire appliance, to avoid the possibility of the acrylic causing pressure necrosis of the mucosa if the suture failed to open and the appliance continued to be activated. Comments included:
Appliance Type
Banding the maxillary first molars and first bicuspids, with a lingual wire connecting these teeth, was the most popular method. Several clinicians used acrylic bonded appliances, particularly in the mixed dentition.
Treatment Regimen
Turning the expansion screw twice daily, once in the morning and once in the afternoon, was the
almost universally recommended treatment. Most readers reported active treatment times of two to three weeks. Some said they continued expansion until the buccal inclines of the maxillary lingual cusps were contacting the lingual inclines of the mandibular buccal cusps.
Retention
Those who used an RPE reported a retention period of about three months. Longer periods of retention, commonly six months to a year, were suggested for patients older than 14 or 15. The appliance itself was the most commonly used retainer.
2. In cases of child patients with divorced parents, how do you handle the case presentation, fee presentation, and delinquency of payment or cooperation?
Many practitioners reported doing a case presentation only for the parent who brought the child in for treatment. Some insisted on both parents being present; if this was not possible, the other parent was given a "telephone consultation". Other suggestions included:
JCO wishes to thank the following participants in this month's column:
Dr. Iren M. Baker, Louisville, KY
Dr. Helen P. Delivanis, Louisville, KY
Dr. Philip M. Campbell, Huntsville, TX
Dr. Ronald L. Gallerano, Houston, TX
Dr. David B. Kennedy, Vancouver, BC
Dr. Mladen M. Kuftinec, Louisville, KY
Dr. George W. Lundstedt, Lynnfield, MA
Dr. Barry D. McNew, Greenville, TX
Dr. Kevin J. Showfety, Louisville, KY
Dr. Barton H. Tayer, Brookline, MA