Damon or Palate Expander and Facemask

[mamalaura]

My 10 year old son has seen two dentists with radically different proposals. The first used a traditional system and wants to start right away with a palate expander and facemask, and then do braces in a couple years. The other dentist uses the Damon system and wants to leave him alone for a year or so and then use the braces without a facemask or palate expander. For obvious reasons my son wants to go with the Damon, but I wonder if it will be as effective. Any thoughts?

[Sunny]

Hi and welcome to this forum Mamalaura.

My recommendation would be to consult further, to find out if other ortho's agree with one or other of these plans.

At 10 years of age, your son's palate is soft and will expand with ease. An expander is necessary to expand the palate, as archwires alone can't do that. The Damon system, is a brand name, so please don't get to caught up with the advertising that some marketing companies employ. The archwires used with brackets can (and usually do) reshape the arch so that the teeth can move more easily into their correct place, but archwires do not expand the palate on their own.

I have no understanding of why one ortho has recommended the use of a facemask, as in the practice where I work, they haven't been used for quite a few years, although I do understand that in some countries they are still in use. Please consult further and I hope you find an ortho you and your son trust and his treatment can begin when the time is right.

Take care!

[mariahfromchicago]

I agree with Sunny! Please get more consults, one may be totally wrong, and well that may mean more money spent on orthodontic treatment..

The "Damon" System (which is self ligating, so no colours) says on their website that in most cases extractions, headgear, and expanders are not needed.

Well headgear sounds like no fun, but if it works better than Damons, I don't know.

Most kids his age love choosing coloured ligatures to put on the braces and well hopefully your kid is okay with that.

Both SL and Non-SL have given people many great results!

Good luck!

[mamalaura]

I've decided to get two more consults - one with a damon orthodontist and one with a non-damon guy. The two I got originally were so polar opposite that I agree more info is necessary. Thanks for the input!

Laura

[Sunny]

That's a great way to go Laura.

Please don't be swayed by the brand of bracket, as brackets don't move teeth. It takes a skilled orthodontist using archwires and possibly other 'bits and pieces' like elastics etc, that move teeth. The damon brand seems to have a huge advertising budget ... and most orthodontist's wonder why they find it necessary to spend so much when there brackets are good, but no better than most others on the market.

Good luck!

[Zoso]

Must really agree. It's all about the skill of the orthodontist - Damon brand brackets do not enable the doctor to do anything he would not be able to do using a competing brand of orthodontic brackets.

Since one of the doctors is suggesting a facemask and expansion, I would assume that your son is showing a Class III pattern - commonly referred to as an underbite. This can result from a small, or set back maxilla (the upper jaw), from the mandible (lower jaw) being too large, or too far forward, from the maxilla and mandible being too small vertically, or from some combination of these issues. Most of the rest of what I will say will assume this to be the case.

I wonder though if perhaps the very different suggested treatment approaches might perhaps suggest a fundamental difference of opinion as to the diagnosis. I wonder if one doctor believes this to be a true skeletal Class III case, and whether the other perhaps feels that it is a pseudo Class III - in this case the front teeth will be in crossbite (the lower front teeth in front of the upper front teeth) but without a skeletal discrepancy being present - the lower jaw is being shifted forward when the mouth closes. In pseudo Class III if the lower jaw is "guided" into what is referred to as centric relation, then either a normal relationship between the front teeth, or an edge-to-edge bite can be seeen - this is one way of distinguishing between a true Class III and a pseudo Class III, although there's a lot more to it than that, and full X-rays and a cephalometric analysis of these would be required. True Class III cases are most commonly inherited.

Now, the most common treatment for a skeletal Class III case in the growing patient is to use protraction headgear, with or without prior palatal expansion - exactly what one of these doctors is recommending. At 10 years of age, your son is already at the upper end of the age range that is normally considered most optimal for this type of approach. But studies with older children have shown that though early treatment may be more effective, this type of therapy can still be effective in older children (10 - 13 years).

Other approaches might include using Class III Twin Blocks (reverse twin blocks) or a Frankel appliance. But what treatment will work the best really can depend on the precise details of the individual case. I am sure that someone who works in an orthodontic practice should be able to share other ideas too.

By the way, unlike when using palatal expanders, all that brackets and archwires alone can achieve is purely dental expansion. (That is the teeth can be moved further towards the outer edge of the bone that bears them, but there is no true expansion of the palate.)

The best advice I can give you is to proceed with your plan to seek more opinions. But before you do so, do some more research yourself, so that you can ask lots of questions as to why the doctors favour any particular approach. Make sure that you understand what they feel to be your son's diagnosis, and also the pros and cons they see to any particular treatment plan. Don't be afraid to say ask one doc why he is recommending an approach that is very different than that suggested by another. You owe it to yourself and your son to be a well-informed consumer, so that you can be confident in the treatment that you choose.