Fig. 21 Fig. 19 Fig. 20 to the surgery but was left with moderately narrow dimensions of the upper and lower dental arches and a unilateral anterior tongue thrust and corresponding open bite in the left canine and lateral incisor region. She also had a mild loss of cervical lordosis as a result of the UAO and forward head posture resulting in cervico-genic headaches. Her upper and lower dental arches were expanded slowly with the TransForce 2 Transverse appliances to normative dimensions and treatment was completed with a straight wire series. (Fig.18) Pre-and post-cephalometric analysis with the Cara-pezza analysis showed a small decrease in SNB (82.9 to 82.2 ), a corresponding increase in ANB (-0.2 to +0.7 ) and a decrease in the Wits from -5.6mm to -1.0mm due to clockwise rotation of the mandible while increasing the skeletal vertical dimension as illustrated by an increase in the Y-axis and mandibular plane angle. The Sassouni+B analysis showed a 1-2mm vertical improvement of the skeletal deep bite tendency. Upper incisor position was improved with slight incisor advancement and an increase in upper incisor torque. The upper incisor edge ended on the facial arc of Sassouni, which is favorable for a female. The upper incisor torque is high, but this was expected due to the posteriorly positioned maxilla and skeletal Class III tendency. The palatal plane was also noted to be “tipped up” anteriorly pre-op, a common finding in patients with a history of upper airway obstruction or finger sucking. The palatal plane leveled out significantly through-out treatment. Finally, the ceph at the final records showed a lingual tonsil enlargement that could still pose a risk for UAO. However, in the absence of snor-ing and symptoms of OSA, it is appropriate to moni-tor as it should be regressing in size as the years go by. (Figs. 19-20) Brianna was an ideal patient for the use of the Trans-Force 2 Transverse appliances in both the upper and lower dental arches. Their use allowed uncrowding of Brianna’s dentition without dumping the upper and lower anterior teeth as might have occurred with the use of straight wire appliances alone. She ended with excellent facial proportions and a beautiful smile! (Fig. 21) References 1. http://ohlendorfappliancelab.com/wp-content/ uploads/2016/08/schwarz-model-analysis-technical-bulletin.pdf 2. Yupares Nimkarn, Peter G. Miles, Maria T. O'Reilly, and Robert J. Weyant (1995) The validity of maxillary expansion indices. The Angle Orthodontist: October 1995, Vol. 65, No. 5, pp. 321-326. 3. Tiziano Baccetti, Lorenzo Franchi, James A. McNamara Jr. The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics. Semin Orthod 11:119-129 © 2005 Elsevier Inc. 4. www.henryscheinortho.com/424-57LG-RevA-TransForce2-Transverse-Arch-Development-Planner.pdf 14 Fall 2017 JAOS
Journal of the American Orthodontic Society Fall 2017: Page 14
