Pacific Coast Society of Orthodontists Bulletin Fall 2019 - 47

Case Report

How would you treat this malocclusion?
Posttreatment
Case A.C., 17 years, 1 month

Treatment Objectives and Treatment Plan
The treatment objectives were to expand the
maxillary arch, coordinate arches, eliminate the
posterior and anterior crossbite, retrocline the
maxillary anterior teeth, establish Class I molar
and canine relationships, eliminate dental canting, and level the curve of Spee. For facial esthetics, the objectives were to retract the lips relative
to the E-plane and to improve her smile. We
expected normal development and an increase
in facial height, an increase in smile arc, and an
increase in incisal display on the left side.

expander with a memory palatal split screw
(Memory Anatomic-Expander type "S," Forestadent, Pforzheim, Germany).

Treatment options along with the advantages
and disadvantages were discussed with the
patient and her parents. The first option was
accepted, but they requested that the most
minimally invasive treatment be used to correct
her occlusion. We decided to postpone the use
of TSADs until after the maxillary arch had been
expanded.

The patient was treated with slow palatal expansion (one turn every three days). The palatal
expander was activated seven turns at every
visit, and she was seen every three weeks until
there had been a total of 28 turns. After expansion of the maxillary arch, the mandibular arch
was bonded. The soldered guard was removed a
month after the completion of expansion. The expander was removed after a six-month retention
phase.

Treatment Progress
Treatment was started by bonding the maxillary arch with metal 0.022-in slot preadjusted
edgewise appliances with an MBT prescription
along with the placement of a modified palatal

The design of a Hyrax palatal expander was
modified by soldering an extension frame on the
right side (noncrossbite side) with the purpose of
preventing or reducing the amount of expansion
on that side. It extended from the right maxillary
canine to the right maxillary molar posteriorly
and to the mandibular dentition vertically (Figure
5A-D).

The initial wires placed were 0.016-in nickel-titanium (NiTi), followed by 0.016 x 0.022-in NiTi
to level and align. A panoramic radiograph was

Figure	5. Modified palatal
expander (memory palatal
split screw) with extension
frame soldered to the palatal expander

Fall	2019	 	 PCSO	Bulletin	

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Pacific Coast Society of Orthodontists Bulletin Fall 2019

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