Orthotown November 2023 - 57
Fig. 1
the amazing results that can be achieved
when full-fixed appliances are used to expand
the arches of preadolescent patients in the
early-mixed dentition.
Case 1
This 7.10-year-old patient (Fig. 1) presented with
the chief complaint of crowding. She has narrow,
V-shaped arches, moderate crowding in both
arches, retroclined incisors, insufficient space
for the tongue and a vertical growth pattern
with a steep MPA. The teeth are normal in
size. She had her adenoids removed but is still
a chronic mouth breather, snorer and bruxer.
Dad is a physician and is concerned because
he thought the removal of the lymphoid tissue
would solve his daughter's breathing problems.
A developing transposition of the permanent
maxillary canines and first premolars was also
noted (Fig. 2).
Full braces were placed on all erupted maxillary
and mandibular teeth along with bite
ramps on the maxillary E's to disocclude the
arches. Our treatment objectives were to expand
the maxilla and the mandibular arch, improve
the interincisal angle and create space for the
permanent teeth and the tongue. Treatment
lasted 16 months and included nine total visits
(bonding, six adjustments, one progress visit
to bond the laterals, and debond) and the final
Phase I records (Fig. 3) show that all objectives
were achieved.
The before and after occlusal pictures (Fig. 4)
demonstrate significant improvement in arch
width, form and perimeter, as well as increased
space for the tongue. Fig. 5 shows a 7.71 mm
increase in arch width across the primary maxillary
first molars and tremendous orthopedic
expansion and remodeling of the palatal bone.
This, along with the fact that the permanent
maxillary first premolars are erupting much
wider than they had been before expansion,
further substantiates the orthopedic change
that occurs with SME and, more specifically,
archwire expansion.
Fig. 2
Fig. 3
Fig. 4: Before (left), after (right).
Fig. 5: Before (left), after (right).
Initial: 27.99 mm
Final: 35.70 mm
Delta: +7.71 mm
NOVEMBER 2023 | 57 | ORTHOTOWN.COM
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Orthotown November 2023
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