Xbow Cases

The following patients were treated by Dr. Duncan Higgins

Initial

After 8 months Xbow and beginning of compensatory maxillary expansion, upper first bicuspids over-corrected one half cusp

After maxillary expansion, bonding of brackets on upper anteriors, and 7 weeks of .012 niti archwire segment, day of placement of .018 niti archwire segment

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The following high angle patient presented with a half cusp Class II bicuspid relationship and a bicuspid openbite on the right side. The Xbow RME was cemented as well as an upper 2X6 due to the lingually blocked lateral incisors. Once the anteriors were aligned the Triple "L" Arch and springs were placed. The springs were on for 3 months before compensatory maxillary expansion was started. The expansion was retained for 5 months before the appliance was removed and an upper Essix retainer was delivered.

Before

After. There is still a half cusp of over-correction in the buccal segments. If this is still present when full braces are placed, Class III elastics will be used as well as IPR of the lower incisors to keep the lower incisors upright.

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Impinging overbite

1. Upper 2X6 and posterior bite openers, 2. 6 months Xbow followed by compensatory maxillary expansion, now hold expansion and test Cl II correction for 5 months

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Initial (missing lower second bicuspids)

1. Xbow 4 months, compensatory maxillary expansion. 2. 15 months full braces (includes time waiting for lower third molars to erupt enough to bracket and extrude)

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Initial

1. 6 months Xbow, 2. 13 months full braces

Initial

Post Xbow

Final

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This next patient is another example of upper anterior crowding where the molars are Class I but the bicuspids are a half cusp Class II and the upper canines are blocked out and a full cusp Class II. This required an upper 2X6 appliance to align the anteriors before the placement of the Triple "L" Arch and springs.

Initial

After upper alignment and Xbow correction to Class I bicuspid. Leave springs on to over-correct.

Day of spring removal after over-correction. Springs were on for 4 months.

Day of appliance removal and placement of upper Essix retainer, bicuspid Class I, ready for indirect bonding of full braces.

RME and 2X6 with upper second molar mini tubes on bicuspid bands___.016X.025 SS anterior segment

(Use active retraction of upper incisors with a continuous archwire as little as possible to avoid root resorption.)

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Before

1. Upper 2X4

2. Xbow 4 months (mesial entry\shorty hook-up), day of spring removal and start of compensatory maxillary expansion

Note first bicuspid overcorrection from half cusp Class II to half cusp Cl III (as well as overjet correction) in 4 months.

6 months post springs, Waiting for full edgewise appliance, bite turbo, and Class II elastics to correct deep overbite.

After 7 months full braces

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Before

1. Xbow: left spring 3 months, right spring 5 months___2. RME (compensatory upper jaw expansion)

3. replace springs for 3 months___After photos taken 2 months after Xbow removal.

After 14 months full braces.

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Before

1. Xbow 4 months 2. Compensatory maxillary expansion 3. Replace springs 4 months 4. More maxillary expansion

Photos taken 6 months after spring removal. No braces have been used yet. Cephalometric radiographs below.

8 months full braces after Xbow

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xbow

Before

xbow

6 months Xbow (9 months after Forsus spring removal)

xbow

11 months braces (2 years after Forsus spring removal. No headgear or Class II elastics were used)

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4 months Xbow plus maxillary expansion followed by 10 months braces

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1. Upper 2X4____ 2. 3 months Xbow____ 3. maxillary expansion____ 4. 14 months braces

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Before

After 8 months Xbow and 12 months full braces

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Before

After 8 months Xbow, no expansion needed, after photos taken 1 month after springs removed, cephs below

Patient is now in full braces to close spaces and finalize occlusion.

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initial

1. Upper 2X4 with high torque brackets on central incisors

2. Xbow with springs for two and a half months

3. Compensatory maxillary expansion (RME part of Xbow)

4. Full braces for 6 months.

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initial

Xbow overcorrection. Day of right spring removal. Left spring removed a month previously. Left spring was on for 3 months. Right spring was on for 4 months.

Day of Xbow removal after one month settling. Note profile improvement.

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Before

1. 4 upper incisor brackets followed by Xbow, springs for 3 months. 2. Full braces for 1 year

This case shows the importance of non-extraction treatment and not retracting the upper lip in a Class II patient with a convex profile.

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Before

After Xbow 3 months spring left, 5 months spring right, no braces to this point and no surgical exposure of canines

Above case before, note full cusp Class II bicuspid right, Class I bicuspid left, midlines off, primary maxillary canines

After 5 months Xbow followed by 12 months full braces

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profile change after 7 months Xbow, after photo taken 2 months after spring removal

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Before

Xbow

Xbow 6 months. After photos taken 14 months after spring removal. No braces have been used.

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Before

1. Upper 2X4 (4 incisor brackets) 2. Xbow 4 months 3. RME (compensatory upper jaw expansion)

After photos taken 7 months after Forsus spring removal. Full braces were not used.

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xbow

Before

xbow

1. Upper 2X4 (four incisor brackets) 2. Xbow 4 months (11 months after Forsus spring removal, full braces have not been used)

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xbow

Before

xbow

1. Upper 2X4 (4 incisor brackets) 2. Xbow 4 months

(7 months after Forsus spring removal. Full braces have not been used)

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Before

4.5 months Xbow followed by 14 months full braces.

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Before

1. Upper 2X4 (4 upper incisor brackets) 2. Xbow 5 months 3. RME (upper jaw expansion)

12 months full braces

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Before

Xbow 3 months

12 months full braces

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Before

6 months Xbow followed by 10 months full braces

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Before

Xbow 4 months (6 months after Forsus spring removal)

11 months full braces

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The following two phase Xbow patient was treated by Dr. Anthony Mair. Dr. Mair is well known for his lectures on non-surgical Class III treatment, treatment planning around the position of the root apices, and his Doppelganger theory. This is an example of a mature patient where Dr. Mair chose to extract upper second molars where third molars were developing. Dr. Mair compares the erupted second molar to "an elephant in the elevator" where the first molar cannot be distalized enough in a non-grower where there is a lack of headgear effect. By using molar substitution he feels there is less strain on lower anchorage and less lower incisor proclination. The following patient was in treatment a total of 23 months, including phase one Xbow with springs for 6 months. The total number of appointments was 13.

The following patient was treated by Dr. Bob Miller. Dr. Miller is known for the Flip-Lock Herbst Appliance and for developing the pushrod used in the Forsus spring. He lectures across the US and Canada on Xbow, bonding, TADs, and lasers. This patient presented with early loss of the upper left primary second molar and impaction of the second bicuspid wearing a Nance space maintainer. Dr. Miller designed a modified Xbow with a three band RME to open space for the second bicuspid and correct the Class II.