As part of our Consultant Spotlight this week, learn how our POS Consultant and Instructor, Dr. Shockley Wier, treats 9 year old Steve in Saint Paris, Ohio.
My patient, Steve
Start Summary:
Steve came to the office and didn’t like that his top front teeth were behind his bottom front teeth. His parents wanted him to have a nice smile.
- 9 years old
- Anterior and Posterior Crossbite
- Treated with Rapid Palatal Expander and Upper advancing Arch
- 14 month until Phase 2
Phase 2:
- 11.5 years old
- Treatment: Non Extraction with Cl III Elastics
- 30 months
Evaluation & Diagnosis
Upon evaluation of the case, I noticed anterior and posterior crossbite, coupled with Cl III in a growing patient. The upper 2s were severely blocked out and there was moderate upper and lower crowding. The patient was skeletal average with dental deep bite. The upper and lower incisors were retroclined.
As this was a growing Cl III patient, we needed to pay specific attention to growth, trying to ensure that the patient didn’t ‘grow out from under it’ in retention. Also, as there were skeletal issues, we wanted to correct these as early as possible to help establish an environment more conducive to normal development.
Treatment Plan
After comparing different treatment options and VTO projections, I suggested a nonextraction plan. I discussed the importance of early intervention with the family, and they agreed with the need to start treatment. I did advise that if mandibular growth was excessive, then surgery would be required for correction. I also explained that early intervention might reduce the potential for surgery in the future.
Virtual treatment objective of the treatment decision
The treatment was designed to correct the anterior and posterior crossbite, with a controlled advancement of the upper incisors. Labial root torque brackets were used to prevent excessive proclination of the upper incisors during advancement. The appliance was designed specifically for Steve in order to achieve optimal esthetics. Medium Ovoid wires were used to maintain the shape of the dental arches once upper expansion was complete. Custom IP brackets were used through the case.
The case was started with Rapid Palatal Expansion, followed by the placement of a transpalatal bar. Alignment was achieved with 014NT, followed by 18x25HA. Open coil was packed in order to achieve positive overjet. Once the rotations were corrected and the arches were leveled, 19x25ss upper and lower were placed with a KH in the lower arch. Elastics were worn until all upper spaces were closed and the case was Cl I. A final wrist X ray was taken to ensure that the patient has passed his pubertal growth spurt.
Case Outcome
Overall, Steve’s treatment progressed very well. Anterior and posterior crossbite were corrected. A little better brushing to reduce the gingival hypertrophy will yield a beautiful result.
Prior to ortho, the other kids used to tease Steve about his smile. Today, it’s one of his most handsome features. A happy patient and a happy doctor!!!
