Removable Sagittal appliances are frequently prescribed for patients requiring development of the premaxilla and/or distal movement of posterior segments. Many of these patients exhibit buccally displaced cuspids, usually due to a lack of arch length. Most Doctors suggest adjusting the gears one-quarter turn each four days. The patient is instructed to wear the appliance twenty-four hours a day, including at meal time. Wearing during meals is often recommended to take advantage of the forces of mastication on the occlusal bite planes usually included in these appliances. Although models can frequently be marked or occluded to determine the patient’s dental occlusion, a bite registration is recommended for appliance construction. This avoids the necessity of most in-office occlusal adjustments to the appliance.

The Sagittal to advance the premaxilla includes four clasps, two Sagittal gears, occlusal acrylic bite plane, cuspid retractors and/or labial bow. With the models articulated to the Doctor’s construction bite, the lower posterior cusps are deeply imbedded into the acrylic occlusal coverage of the upper appliance. The posteriors are thus anchored and provide the stability necessary for the appliance forces to be directed toward premaxilliary development.