Orthotown March 24 - 42
CASE STUDY
Hyrax-Halterman
Appliance
BY DR. CHRIS TEETERS
E
ctopic correction of first molar position is
often complicated by a narrow maxillary
arch. In cases like this, a few approaches are
available to correct the ectopic position:
* Using a segmental archwire from the primary
second molar to the first permanent
molar to distalize the molar, followed by the
use of a traditional Hyrax expander. Challenges
with this approach include the limitations
of bonding a tube to the ectopic molar
because of its position, and the crossbite can
also interfere with the distal movement of
the first molars.
* Extracting the primary second molar and
using a Pendex appliance to distalize the
first molar. However, this often is only
achievable after the leeway space is lost once
the first molar has erupted more.
Neither option can achieve expansion and
ectopic molar correction at the same time. Often,
the primary second molar can be extracted to
allow for eruption of the permanent first molar,
but by the time the first molar erupts, there is significant
loss of space that is difficult to regain.
This case demonstrates a novel approach to
correcting both a posterior bilateral crossbite
and bilateral ectopic first molars at the same
time. We treated the patient with a HyraxHalterman
appliance.
MARCH 2024 | 42 | ORTHOTOWN.COM
Diagnosis and treatment plan
An 8-year-old patient (Fig. 1) presented with
a referral from her pediatric dentist because
of concerns about her ectopic first molars and
crossbite. A clinical examination revealed an
obtuse nasolabial angle, a long lower facial
height, near edge-to-edge overbite and overjet,
insufficient incisal display on smiling, and severe
maxillary and mandibular crowding.
The patient's lower midline was deviated to
the right, and she had a Class III tendency of
growth given her retroclined lower incisors and
mesial-step relationship of the primary second
molars. Radiographic evidence (Fig. 2) suggested
resorption of the distobuccal roots of the
primary second molars with concomitant mesial
drift of the first molars bilaterally.
Fig. 1
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