Fig. 15 Class II correction and bite opening. “alex’s TReaTmenT lasTed 26 monThs wiTh exPansion and sTRaighT wiRe seRies. his denTal aRChes deVeloPed VeRy well, and alex was one of The fiRsT PaTienTs ThaT Really BRoughT The issue of Tongue Tie To my aTTenTion and sPaRked and inTeResT To leaRn moRe To Be aBle To helP PaTienTs who suffeR fRom ankyloglossia whiCh affeCTs faR moRe Than The Tongue.” procedure was performed again. From this point following the second frenectomy, Alex did his exercises faithfully. (Figure 10a -10b) What was remarkable were the changes that occurred to his posture immediately after the second release and in the weeks following the second release. His head posture uprighted dramatically and his mouth breathing transitioned to nasal breathing in combination with his maxillary and mandibular expan-sion. (Figs. 11a–11e) The first photograph is the preoperative profile (Fig. 11a), the second photo is after the first lingual frenectomy and physical therapy (Fig. 11b), the third photo is after relapse of the lingual frenum (Fig. 11c), the fourth photo is immediately after the second release procedure (Figure 11d), and the fifth photo is two weeks after the second frenectomy procedure with Alex performing his tongue stretch-ing exercises, (Fig. 11e). After the lower arch was expanded, a lower Wilson lingual arch was placed. (Figs. 10– 11). I prefer the lower Wilson appliance due to its simple removal with a dental scaler without removing the cemented bands. It is also very help-ful for increasing or decreasing the arch width based on treatment progress and needs for the patient. His Hyrax was removed and the Fig. 16 Deband. an upper .016TN wire to be placed with OCS to prepare room for the U3’s. (Figs. 8 -9) Alex had begun his physical ther-apy for shoulder and posture restora-tion at this point in treatment. There was a significant uprighting of the cervical and head posture after the initial frenectomy in combination with his physical therapy. With time, however and lack of proper myofunctional therapy, Alex’s lingual frenum redeveloped as scar tissue formed and his forward head posture began to relapse. At his next visit, the frenectomy was revised and the 40 Summer 2020 JAOS
Journal of the American Orthodontic Society Summer 2020: Page 40
