“Having multiple phases rolled into one worked well for this patient because she was very responsible at Fig. 10: Final 4 years after start of treatment. maintaining great oral hygiene, and wearing elastics when she was instructed.” the patient initially elected to go for the first option of phase one to treat the immediate need. In month one and after case presentation and acquiring informed consent for treatment, separating elastics were placed, and impressions were made to fabricate a maxillary NiTi palatal expander with hooks for RPFM. We bracketed the incisors only, placed 0.16 Bio-Kinetic UAW to level, align, and rotate the teeth with a slight tip down on the max wire to close the bite. We placed the maxillary appliance and delivered the RPFM with instructions of wear at least 14 hours a day. (Fig. 5) 4 -5 months after the start of treatment I placed brack-ets on the lingual surface of the mandibular incisors to deter the tongue from its continued thrusting habit (Fig. 6); Patient was wearing her RPFM like a champion. 8 months after the start of treatment her cross bite was corrected, and the patient was in a class I molar relationship, with the proper over bite and over jet, she had now completed Phase I (Fig. 7). I discussed the continuation of treatment with her Mom, expressing my fear of losing what we had already accomplished if they did not decided to roll into Phase II treatment until the case was finished. Fig. 11: 12 months post Tx. Fig. 12: 15 months post Tx. Fig. 13 40 May/June May/ y / J une 2013 JAO JAOS S
Journal of the American Orthodontic Society May-June 2013: Page 40
