DOUBLE-HINGED RAPID PALATAL EXPANDER
*This appliance is for Class III correction and is used different from a standard
RPE.
Effective orthopedic maxillary protraction is an innovative technique for
treating maxillary hypoplasia in Class III patients.
Effective orthopedic maxillary protraction includes three components:
1. 2-hinged rapid maxillary expander
for a greater anterior displacement
of maxilla.
2. Protocol of Alternate Rapid Maxillary
Expansions and
Constrictions
(Alt-RAMEC) of maxilla for better disarticulation
of maxilla.
3. Maxillary protraction mask
1. The 2-hinged
rapid maxillary expander is oriented perpendicular to the
intermaxillary suture and is soldered to the molar and premolar bands. Two
anterior extension arms (.040 wire) extend bilaterally from the premolar bands
toward central incisors. The anterior extension arms are sandblasted before
cementation. After cementation of the expander, the anterior extension arms
are bonded to the anterior teeth with composite resin. Please note that the
resin overlying the anterior extension arms should be thick enough to endure
the constriction force from the expander. One day after cementation, the 2-hinged
expander is activated according to the protocol of Alt-RAMEC. Each turn of
the screw is 0.25 mm. Four turns is 1.0 mm. Turning toward the throat is expansion,
and turning toward central incisors is constriction.
2. Alt-RAMEC or “Alternate Rapid Maxillary Expansions and Constrictions” of
the maxilla is as follows.
This is a protocol for loosening the maxilla through alternate weekly rapid
expansions and constrictions of maxilla. It takes 7-9 weeks to loosen the maxilla.
You should be able to see the mobile or loosening maxilla while holding patient’s
head with one hand and rocking his/her maxilla up and down with another hand.
Also ask patient’s feel of his/her mobile maxilla.
Alt-RAMEC is as follows:
4 turns a day for one week (expansion)
4 turns a day backward for one week (constriction)
Repeat this for 6 more weeks. Ask mom to turn twice in the morning and twice
in the evening.
Always keep the expander opened. An expanded maxilla allows a greater amount
of maxillary protraction than a constricted maxilla. The expanded space between
central incisors could be saved for relieving anterior crowding or for compensating
dental effects, such as the proclined maxillary incisors due to the protraction.
3. Start protraction right after Alt-RAMEC & continue
for approximately 6 to 7 months.
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Soldered Double-Hinged Expander
Billing code is 4020 – $129.00 |
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Bonded Double-Hinge Expander w/posterior coverage
Billing code is 4030 – $169.00 |
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Notes
about Class III Hooks
1. The original design from Taiwan included two protraction springs
bent by the clinician and placed chairside.
2. The USA version utilizes soldered or embedded class III hooks
for a facemask attachment for protraction.
For this reason, the fees listed here are excluding the Class III
hooks and should be added accordingly. |
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Parts of the Double –Hinged Screw |
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