Pearls of the Pacific Figure 4. Initial and final photos of patient using low pulsatile force appliance with 95% compliance. Total treatment time was less than 18 months. is used. Our goal is to reduce stage 1 treatment by two to three months compared with the traditional wire sequence, which can take up to six to seven months before 0.0195 × 0.025-in SS wires are placed. This is done safely as low pulsatile force action changes bone physiology 46 with minimal patient discomfort after each arch placement. There are other pearls that reduce treatment time during stages 2 and 3. For additional information, contact Dr. Straty Righellis at straty.er@gmail.com. PCSO Bulletin Summer 2019