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In the past month, I saw the mother of a young girl who had an upper fixed rapid maxillary expander for her bilateral crossbite. Fortunately, the girl was 9 years old and the RME worked as predicted. Her mother had a bilateral posterior crossbite with a really narrow maxilla and I knew if she was to have correction for this, she would need a maxillary surgically assisted expansion.
There is a RCT that shows that 3rd molars have a small but not clinically significant effect on lower incisor crowding once the braces are removed. But what about patients who had an anterior open bite or an anterior open bite tendency before treatment? All of us learn through observations of our patients and when they are on retainers- how does growth and not wearing retainers affect anterior open bites.
It seems this question is something that pops up many times over and asked by many patients. A recent systematic review of all the studies looked at the highest quality of evidence ie: RCT’s and prospective observational cohort studies and found that extractions of 4 premolar teeth in borderline cases do not worsen facial profiles, and to the contrary, where the lips are protrusive to start, provide an improvement in this appearance, as judged by laypersons. What makes this study relevant is that the authors were dentists and not orthodontists, eliminating possibility of author bias.
It is generally advisable to manage patients with underbites early. This is because the maxilla articulates with many facial bones and the circummaxillary sutures become more ossified with age. Compliance with wear of a removable facemask at night when they are sleeping is generally better (see below). We also generally tend to overcorrect at this young age, in view of possible further mandibular growth later. The 2 patients below show the marked improvement seen in the upper cheek fullness and upper lip profile immediately after early Class 3 treatment.
Lingual arches are a type of passive space maintainer. It comprises of an orthodontic band and usually an 0.036ss wire soldered to the bands on the lingual aspects.
Below is an case study that is representative of what can happen spontaneously with a lingual arch. Note the spontaneous improvement in the lower arch crowding
Below is a series of 3 sequential x-rays of the same patient. Note the ectopic unerupted 35 that is erupting distally on the initial OPG Jan 2015. It eventually erupts and contacts the mesial aspect of the 36 root (Nov 2015), then stops moving(compared with July 2016).
We referred him to an oral surgeon recently for an orthodontic exposure of 35, whom only had the last two x-rays, without the first panorex x-ray, and concluded that 35 was ankylosed. In our experience it is rare to see a tooth whose root is still developing be ankylosed.
Invisalign was first introduced into Australia about 15 years ago. Since then a lot has changed. Over the past few years, there have been new entrants into the market too. So what has changed?
Have parents ever asked you what is the cause of isolated enamel discoloration or hypoplasia on their child's upper incisors? This paper would explain why localized incisor enamel discoloration is linked to early trauma, particularly at a very early age 0-2 yrs, with more severe trauma associated with crown and root malformations.
I would like to thank pediatric dentist Dr Diane Tay who has kindly volunteered her time to summarize this systematic review which provides insights into this. Read her review and access the full journal article below.
I wanted to share the story of this patient- I think he was about 9 years old when he saw me. The main problem was the impaction of tooth 35. Prior to this, he had seen an oral surgeon who concluded the risks of damaging the tooth 35 developing tooth bud from extracting the 75 was too high and it was best waiting. His dentist had then advised he see an orthodontist.
We all know the effect of impacted canines can have on adjacent teeth ie: ectopic resorption, asides from adding to the duration of orthodontic treatment, by 6 or 12 months longer. Patients also need to undergo a surgical exposure of the teeth, not to mention the increased anxiety about pain & discomfort in the young teenage patient from this procedure. So I would like to share with you 3 cases of early treatment where the impacted canine improved in position. This is not to say all of my early treatment cases did not require a surgical exposure as a few minority very impacted cases, still needed this. But the point I would like to share with you is an earlier review maximises the options available to these young patients. And often the initial interventions are relatively simple. And yes, we still do offer an obligation free initial orthodontic consultation, so there is no out-of-pocket costs for your young patients.
23 was almost horizontally impacted. She was 9 years old. We extracted the 53 & 63 and made her an upper removable expander which she wore well. The spontaneous improvement in the 23 position was obvious.
After 12 months