Orthotown November 2023 - 58
CONTINUING EDUCATION
Fig. 6a: Right side before (left) and after (right).
The posttreatment CBCT slices (Figs. 6a and
Fig. 6b: Left side before (left) and after (right).
Fig. 7: Before (top), after (bottom).
6b) demonstrate the resolution of the crowding
and the transposition, as the eruption of teeth #6
and #11 normalized without having to remove
their primary predecessors. Fig. 7 shows the
pre- and posttreatment volumetric analyses and
demonstrates a significant change in patency of
the posterior airway, especially in the oropharynx
now that the tongue can assume a more normal
position in the oral cavity and is not being
forced posteriorly by the constricted arches.
In addition, the patient's mouth-breathing,
snoring and bruxing all resolved within six
months of the braces being placed. Dad was
more than impressed.
But is it stable? Fig. 8 shows the patient three
Fig. 8
years later, after retention with only a maxillary
and mandibular Essix C+. I let them know that
the occlusion and aesthetics were quite good and
we could perfect the alignment with approximately
six months of treatment, but they were
happy with the results and instead elected to
have final retainers fabricated.
Fig. 9
Case 2
This 9-year-old patient (Fig. 9) presented with
the chief complaint of crossbite. He had a narrow
maxilla with a right CR/CO shift of the mandible,
resulting in a unilateral posterior crossbite.
His mandibular arch was constricted, especially
in the middle and anterior thirds, resulting in
insufficient space for the tongue. He had moderate
maxillary and mild mandibular crowding,
proclined mandibular incisors with insufficient
attached gingiva on the mandibular central incisors,
and was a mouth breather who occasionally
snored. The pretreatment CBCT slice (Fig. 10)
shows the significant constriction of the oropharyngeal
airway.
The traditional approach would include the
placement of an RPE that is turned once or twice
a day to expand the maxilla. The new paradigm,
however, addresses the entire etiology, which
also includes the narrow mandibular arch and
NOVEMBER 2023 | 58 | ORTHOTOWN.COM
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Orthotown November 2023
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