Orthotown April 2018 - 28

message board
tom525
Member Since: 06/18/08
Post: 2 of 8

Looks like an asymmetric, hyperdivergent transverse deficiency case. I'd be very careful with
expansion and I don't like it that the 7s are unerupted in the maxilla. I'd warn the family about
the possibility of needing surgery. ■

1/23/2018

HJS

So L&A until 19x25 steel and coordinate both arches after that extraction? ■

Member Since: 01/07/06
Post: 3 of 8

Dr-T
Member Since: 05/19/09
Post: 4 of 8

1/23/2018

I see a high-angle Class III skeletal open bite in his future. He does need expansion of the
maxilla, but that might worsen the open bite. The other concern is that nonsurgical palatal
expansion at the age of 16 is unpredictable and sometimes not possible. You might have to concede
to cosmetic alignment for now, with the plan (or at least document) for orthognathic surgery
after growth completion. ■

1/23/2018

NickTi
Member Since: 12/04/10
Posts: 5 and 6 of 8

Also see Class III vertical, with Mx retrusion and trans insuff. I'm not seeing the asymmetry
clinically to the degree the ceph suggests. (Also looks like some IP caries in anterior.)
To my eye he needs CCW rotation of the Md occlusal plane to compensate. What about
expansion, Exo LR7, posterior segmental with Cl3 el to tip Md occlusal plane and close buccal
segments, then pick up Md 2-2 (bonded gingival), close space LL with TAD as required. Root
has a ways to go.
Disclaimer: Relative newbie.
And I don't see the need for a continuous steel arch wire in Md. ■

1/23/2018

HJS

What about upper 7s? ■

Member Since: 01/07/06
Post: 7 of 8

kaskas
Member Since: 12/08/13
Post: 8 of 8

1/24/2018

I would expand now with the warning that it might not get the results you want due to his
age. Also, see if he's willing to wear a face-mask headgear to bed. Yes, discuss the possibility of
needing surgery. I agree with NickTi about the LR7. I would bond the lower arch during the
expansion and use Class III elastics while the expander is still in.
As for the upper 7s, wait at least until after the expansion. If they haven't gotten any closer
to erupting by then and you need the space on the upper arch, then maybe extract at that point
and distalize the 6s a little. But, there is a good chance that after expansion, you'll be able to
rotate the upper 6s (mesial buccal cusp to the buccal) and procline and extrude the incisors to get
enough space to not extract. In that case, I'd just have the upper 7s exposed and hope they erupt.
Hoping seems kind of passive, I realize, but sometimes the upper 7s just need a little time and
an unencumbered pathway. I have had luck with debonding and then sending for exposures of
upper 7s and waiting and watching during retention. It's much easier on the patient than keeping
them in braces for who knows how long with mechanics in the back of their mouth, especially
on the patient who just wanted to straighten the front teeth.
If they don't erupt, however, and the gingiva doesn't grow over them again, then they'll
probably need extracting eventually due to hygiene difficulties. ■
1/29/2018

How would you proceed?
Search: "Expand Then Extract"
It looks like this Townie has a long way to go in treating his
patient. To view this conversation online, and share your
suggestions, go to orthotown.com and search "expand then
extract"-this message board will be the top result.

APRIL 2018 // orthotown.com

http://www.orthotown.com http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown April 2018