Orthotown November 2023 - 59
insufficient space for the tongue. Therefore, full
upper and lower braces and asymmetrical bite
ramps were placed. Treatment duration was
14 months and consisted of eight total appointments
(bonding, five adjustments, progress
bonding to bond tooth #10, debond).
Fig. 11 demonstrates that we accomplished our
objectives of eliminating the posterior crossbite
and CR/CO shift, increasing arch perimeter,
aligning the incisors and increasing space for the
tongue. In addition, expanding the mandibular
arch allowed for the retroclination of the mandibular
incisors, creating a more ideal interincisal
angle and improving the attached gingiva
on the mandibular central incisors. You can also
notice ectopic tooth #6 in the posttreatment Panorex.
I can almost assure you that had we treated
this patient with RME alone, we would not have
had sufficient space for this tooth to erupt and it
would almost certainly have been impacted.
The before and after occlusal pictures (Fig. 12)
reveal significant expansion of the maxilla and
the mandibular arches and tremendous improvement
in arch form. You will notice that tooth #21
is erupting into the location of its expanded
predecessor, proving that this approach does not
simply tip primary teeth but instead uses the primary
teeth to achieve dentoalveolar expansion.
Mom reported that the patient stopped snoring
and mouth-breathing four to five months
into treatment, which makes sense because the
patient's tongue now has sufficient space to rest
more anteriorly in the oral cavity, decreasing the
obstruction of the oropharynx (Fig. 13). Volumetric
analysis reveals that the minimum area in the
oropharyngeal region increased more than 100%
from 45.4 mm2
to 97.6 mm2 (Fig. 14, p. 60).
Regarding whether we tipped the maxillary
teeth or achieved orthopedic expansion, you can
see that the molars remained upright despite
achieving 5.24 mm of expansion (Fig. 15, p. 60).
I can assure you that more tipping and alveolar
bending would have occurred had we used an
RPE, and we would have had to overexpand the
NOVEMBER 2023 | 59 | ORTHOTOWN.COM
Fig. 10
Fig. 11
Fig. 12: Before (left) and after (right).
Fig. 13
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Orthotown November 2023
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