Orthotown June 2020 - 20
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tom525
These are the occlusals. Haven't figured out yet how to black out the eyes on facial shots. ■
Member Since: 06/18/08
Post: 3 of 23
4/17/2015
Drorthosocal
Member Since: 08/21/09
Post: 4 of 23
First off, I don't like to use an expander (Quad, Hyrax, Haas, etc.) in the absence of a posterior
x-bite. Extra treatment (great for the large corporations to get something else to bill out for), in
my opinion. And to take a lateral step for a second, this is the main reason that I get more starts
than the guys down the street. Parents and patients just don't like expansion-they just don't! I
love it when I get shoppers saying, "Why are you not recommending an expander?" When they
ask, I know I got the case.
Now, to answer your question, the anterior crossbite needs to be corrected. Non-extraction,
I would do a 2x8 (like a 2x4 but brackets on the 6s and U/L D-D), open-coils to create space,
add small build-ups, and get the resolution.
What I commonly do is paint the worst-case scenario when it comes to the health of the
lateral roots and the presence of the permanent canines. I will let them know that we need to
watch this situation very carefully and if we notice any damage, we need to extract the Cs as
needed to help guide the teeth.
If the upper 2s look damaged already, I would do the same treatment plan except extract the
Cs, mesialize the roots of the U2s with my bracket placement, and paint the worst case again. ■
4/17/2015
tom525
Member Since: 06/18/08
Post: 5 of 23
Here are the photos extraorally. ■
4/17/2015
Fenrisúlfr
Member Since: 02/25/09
Post: 6 of 23
Any family history of Class III? A posterior x-bite is a surrogate (and not always reliable)
measure of a constricted maxilla, and dental compensations can mask a skeletal discrepancy.
In this case, I'd consider extraction of the upper Cs and a Hyrax if there is a transverse skeletal
discrepancy. I'd also start off with a 2x2 (bypassing the laterals) to advance the central incisors
out of anterior x-bite.
Attempting to bond and align the maxillary laterals should probably be delayed until the
maxillary canine position improves-the concerns IMO would be twofold.
Potential for root contact between the 2s and the crown of the 3s due to the DRT in the
brackets as well as the roots of the 2s tipping palatally during correction of the x-bite.
A CBCT would definitely be warranted to evaluate these issues prior to attempting x-bite
correction on the upper 2s. ■
4/17/2015
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Orthotown June 2020
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