Figure 12 Figure 13 Figure 15 Figure 11 persistent presence of tonsillar and adenoidal enlargement. At 14 weeks following the completion of activa-tion, the midline palatal suture was confirmed to be fully ossified on the anterior periapical radiograph (Fig. 22), demonstrating the remarkable osteogenic capacity of the pediatric facial skeleton at this age. Upon completion of expansion and reverse pull facegear therapy (Fig. 23), the upper and lower expansion appliances were removed and upper Touch All Teeth (TAT) appliances were placed to retain the achieved expan-sion (Fig. 24). Pre-and post-treatment smile views (Fig. 25) demonstrate notable development of the zygo-matic areas with marked improve-ment in nasal form and function, along with evident soft tissue adapta-tion to the broader dental arch. Fig. 26 illustrates the patient's facial profile at rest following RPE and reverse pull facegear therapy. Following seven months of treat-ment, the patient demonstrated patent nasal breathing and passive lip seal. The case continues to be moni-tored, with adenotonsillectomy and allergy intervention reserved as adjunctive measures should they prove necessary for maintenance of nasal airway patency and normal Figure 14 Figure 16 orthodontics.com Summer 2026 31
Journal of the American Orthodontic Society Summer 2026: Page 31
