CLINICAL CASE REPORT Fig. 23-24: RPE is cemented and bonded in place. RME is bonded. Patient/parents start by activation twice a week allowing 3-4 days between them. Fig. 19: CBCT airway showing midrange airway flow. Fig. 20-22: CBCT images show the long A-P jaws with transverse constriction. These images help orient the diagnosis and treatment planning of the option of transverse expansion. Fig. 25: RPE with advanced activation combined with arch wire sequence. The AWS is used in the traditional manner taught in straight wire appliances making it very predictable with the mechanics. The first bicuspids have been liberated once the arch wires can do a better job helping the anterior arch development supported by the strong molar anchorage. elastic use, interproximal adjustment, or a combination as needed to achieve an acceptable result in a reasonable frame of time. Her active treatment time took 18 months followed by bonded retainers 2-2 on the maxilla and 3-3 on the mandible and Essix retainers for night time use. Figs. 8 and 10 show how her teeth and occlusion have contin-ued to improve as she has matured. Figs. 9 and 11 are post treatment airway CBCTs taken with a Prexion Pan/Ceph/CBCT machine that allows the visualization of patent airway. She had adequate airway and reported no more snoring since she was expanded and enjoyed better breathing. Her post treatment cephalometric image showed growth of the mandible and a balance of the maxillary and mandibular arch with a Class I skeletal and dental relationship at the end of treatment. Case 2 Medical and Dental History Our male patient had a diagnosis of autism spec-trum who with therapy and guidance had become highly functional. His pediatric dentist (co-author) wanted orthodontic therapy to help with severe Fig. 26: RME achieving maximum expansion and helping anchor the first molars. This gives excellent support to the AWS allowing use of secondary methods such as swing and rotation power chain loops for #22 and open coil activation for creation of space for #27. www.orthodontics.com Summer 2022 21
Journal of the American Orthodontic Society Summer 2022: Page 21
