Should you pick a removable or fixed expander?
Read more about expanders here: https://www.straightsmilesolutions.com/blog/rpe-2/
Benefits of Expanders in Phase 1 EARLY MIXED DENTITION:
Develops the arches to the ideal width. Hypothetically speaking usually when the arches are developed in the early mixed dentition to the ideal width, the teeth tend to come in straight/straighter, there is less risk of impactions, there is less crowding, less risk for orthognathic surgery, less chance of premolar extractions. Of course we are just “paving the road” for the future. We can’t always predict the future. We can just make it more likely to turn out better. It also decreases the chance that they actually “need” braces. You can do this in combination of an EG appliance (eruptive guidance) for retention and you should have a super-nice outcome. Most likely you’ll only need a few express/white label aligners for Phase 2. Again, no promises! It just just more likely.
SCHWARTZ VS FIXED:
Some patients/parents come in with a strong preference for fixed or removable. You should go over the benefits and risks of each one and still make a clinical recommendation.
REMOVABLE (aka Schwartz)-
* Can be done in upper or upper/lower. Look at the arches. If there is lower crowding do upper and lower. If there is posterior crossbite, do 2 turns a week on top and 1 on the lower. If no crossbite and just v-shaped arches or crowding, do 2 turns top, 2 turns lower per week.
* Sometimes when you “untrap” the lower arch you can get some growth of the mandible and some natural expansion of the lower arch. A lower schwartz is just for arch expansion. There is no suture in the mandible so you aren’t growing jaws there.
* Schwartz is WAY better from the patient experience. Hygiene is better, discomfort is better, they can eat whatever they want, they can pick colors and bling it out. Schwartz is “fun”. Most patients are very compliant. Give them a case with a necklace or clip so they don’t lose it at school or at lunch.
* Build in a compliance contract/agreement with the price if they do lose them or the price to upgrade to fixed if they elect to.
* Schwartz expanders also can be customizable to add screws/pistons to jump anterior crossbites, distalize molars or facemask hooks to help to bring a maxilla forward.
* You can add acrylic to the front plate to open the COS (fix deep bites) or to the posterior teeth to intrude the molars (open bite)
* You can also embed a tongue/thumb crib for habits
* It is easier to turn because you can take it out of the mouth
* Often parents like the idea of fixed initially but from a patient experience, it is pretty miserable. They are bulky, hard to talk, hard to eat and uncomfortable. They are also smelly and trap a lot of food and plaque. More often than not, parents who elect fixed tend to regret it in hindsight. It is also hard for the parents to turn because they need to do it intra-orally.
* If you have a severe thumb habit, a fixed might be better because they will take out the removable appliance.