How long does the 6 1/2 Oz or 3/8 " elastic band retain its orthopedic force of at least 400 grams per side when it is used in Reverse Pull head gear? Is it necessary to wear more than 2 elastics in some cases?
You need to check the force levels in all cases each time the patient comes to you for followup & then decide on changing the elastics. There can not a single rule for every patient. Force levels vary with many factors like location of the hook in maxillary splint, Quality of latex used in the elastic, handling of the elastic by the patient etc.
If you assess the cranial rhythm of a patient undergoing reverse pull headgear, a 6 oz. elastic used on both sides will shut down the patient's cranial movement to nearly eliminate any sutural freedom at all. Without sutural movement between the skull bones, maxillary advancement is almost not possible. Working with osteopaths has demonstrated to me that forward traction forces on the headgear are tolerated by the cranium when the elastic force is 3 oz. per side or less. This force tolerance varies from patient to patient and you need an osteopathic technique to tell you what force is appropriate. I use a 2 and a half ounce elastic per side and find that this is suitable for most patients to achieve excellent results. The rule is, "don't shut down the cranial movement" because the cranial rhythm is what is required for cranial change. The results are far greater the using heavy elastic force which actually prohibits movement in the cranial structures rather than induce movement as we think it should.
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