records were taken and analyzed (Figs. 1-6). Patient’s diagnosis was completed, and the treatment plan was elaborated and prepared for presentation to both the parents and patient (Fig. 7). The patient was five years and one month old at the onset of active treatment. Treatment started with installation of NPE with active arms. The patient was seen one month later for an adjustment; the anterior cross bite was corrected by the NPE (Figs. 8, 9). Patient was seen some months later at which time anterior arm activation was suspended and the appliance was scheduled to be left in place for six months as a retention appliance (Figs. 10, 11). After four months, the NPE appli-ance was removed as the results that were set were achieved (Figs. 12-16). Fig. 18 Patient B: Case Summary & Analysis Preliminary orthodontic evalu-ation and cephalometric imaging were carried out together. Prelim-inary options given were no treatment or orthodontic therapy involving stimulation of maxil-lary bone growth and pressure on lingual aspect of maxillary teeth to create buccal protraction force. Once Parents heard all options, they choose to pursue orthodontic therapy. Patient was scheduled for collec-tion of orthodontic records includ-ing cephalometric images, impres-sions for stone models, and a subse-quent appointment to review the records with explanation of find-ings, diagnosis, and treatment options. Orthodontic records were taken and analyzed (Figs. 11-22). Patient’s diagnosis was completed, and treatment plan elaborated and prepared for presentation to parents and patient (Fig. 23). Patient was five years and three months old at the onset of active treatment. Patient had an NPE measured and installed. Bite blocks were bonded to second primary molars to open the bite and allow for easier “jump” of the anterior crossbite. Fig. 19 Fig. 20 Fig. 21 Composite bumps were bonded on the lingual-incisal third of teeth #D #E, #F, #G, (Fig. 26) to keep the active extended arms of the appli-ance in proper position. Patient returned two weeks later with appli-ance de-bonded (Fig. 24). Appliance was re-cemented and reactivated. After three weeks, there was a major correction but still in partial crossbite (Fig. 25). After six weeks, the anterior crossbite was corrected, and at eight weeks, the composite bite blocks are removed but the NPE was left in position to continue the transverse palatal expansion (Fig. 27). Three months after starting treatment, the appliance was removed, all composites used were removed and impressions were www.orthodontics.com Spring 2019 23
Journal of the American Orthodontic Society Spring 2019: Page 23
