Orthotown June 2023 - 58
CONTINUING EDUCATION
* Monitor the patient periodically until she is
in late-mixed dentition.
* If she " grows well " and you think you can
preserve enough arch length to accommodate
the permanent teeth, insert space
maintainers in the late mixed dentition in
an effort to preserve the e-space and treat
the case non-extraction.
* If she doesn't " grow well " and crowding
becomes severe, extract four premolars.
Yet does preserving e-space or extracting
premolars address the actual etiology? In other
words, is the etiology of her crowding loss of arch
length and/or large teeth? As you look past the
teeth, you'll notice that she has narrow, V-shaped
arches, large buccal corridors, a high/vaulted
palate, a vertical growth pattern, insufficient
space for the tongue, " tired eyes " with allergic
shiners (indicative of atopy), erythematous gingival
margins in the maxillary anterior sextant
(or " chapped gums, " as I like to say), and adherent
plaque on the incisors-the latter two being
symptoms of mouth breathing/snoring.
A low-dose CBCT is an invaluable diagnostic
tool that allows us to obtain significantly
more information than traditional 2D imaging.
While it confirms that there is no obstruction
of the nasopharynx (Fig. 5), we detect moderate
turbinate hypertrophy in the nasal passageways
(Fig. 6) and significant restriction of the oropharyngeal
airway space (Fig. 7), providing us with
a better understanding of the etiology of the
presenting malocclusion.
Using this information, we can develop a treatment
approach that addresses the etiology:
* Refer patient to the allergist for evaluation of
turbinate hypertrophy and atopy.
* Place bite ramps and full braces with broad
archwires to develop the arches, normalize
arch width and create space for the tongue
and the permanent teeth (Fig. 8).
* Retain with Essix C+.
Figs. 9-13 show the results that were achieved
in just 14 months after only six adjustment visits
(eight total visits including bond and debond).
JUNE 2023 | 58 | ORTHOTOWN.COM
Notice the resolution of the crowding as well as
the redirection of teeth #6 and #11 away from the
roots of the permanent lateral incisors. Further,
notice the improvement in both the interincisal
angle and lip fullness relative to Rickett's
E-plane. Amazing changes were also achieved
in her facial aesthetics, tongue space, tired eyes,
and allergic shiners (Fig. 14). Which child do you
believe looks healthier?
FIG. 5
FIG. 6
FIG. 7
FIG. 8
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Orthotown June 2023
Table of Contents for the Digital Edition of Orthotown June 2023
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