CLINICAL CASE REPORT “Due to the patient’s age, future mandibular growth was very important to consider and try to manage. Patient’s soft tissue profile showed lower lip beyond the soft tissue line but the upper lip was behind it. The analysis indicated a brachycephalic Class III skeletal and Class I dental classification with an anterior crossbite.” b Mandibular incisors in ante-rior crossbite and diastemas between canines and incisors. Treatment Objectives b Improve facial and dental esthetics b Eliminate anterior crossbite b Align and level teeth to eliminate anterior crossbite b Transverse expansion of maxillary arch b Forward and downward growth of the maxilla b Achieve and maintain Class I molar & canine classification b Increase maxillary lip support b Eliminate Class III interarch relationship b Retain positive results over time Fig.8: Diagnosis and treatment plan template recording all information collected from clinical examination, cephalometric tracings and values, model examination, TMJ, airway. It allowed the diagnosing and treating doctor's elaboration of treatment plan including appliances and a flow chart of treatment. primary molars and bonded on lingual aspect of primary canines, with buccal arms with hooks b Reverse Pull Face Mask connecting to buccal arms of RPE creating anterior and downward growth of maxilla. b Bands on primary mandibular second molars, brackets on incisors to close mandibular incisor diastemas and help eliminate anterior crossbite. b Once maxillary expansion is complete, hold with RPE while fabricating a fixed maxillary retainer with buccal arms to continue using the RPFA to maintain the Class I jaw relationship. Estimated Treatment Time 12 months of active treatment, and several years of active retention during the active growing phase. Estimated time was generous due to the long growth period to achieve final jaw relationship stability. Treatment Plan b Transverse expansion of maxillary arch using custom-made rapid palatal expander (RPE) with bands on second Case Summary & Analysis Patient was a patient of record, under care of the office pediatric www.orthodontics.com Spring 2021 25
Journal of the American Orthodontic Society Spring 2021: Page 25
