Orthotown November 2017 - 20

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tom525
Member Since: 06/18/08
Post: 10 of 41

Anybody care about the maxillary right canine? How about a little expansion and open space
for the tooth and see if it erupts? ■
3/3/2016

WKC
Member Since: 05/19/11
Post: 11 of 41

zxzxzx: My thought was that expanding the maxilla now non-surgically may make the surgery
later somewhat less complicated. I'm not at all certain how much difference it would make if
the surgically-assisted maxillary expansion could be avoided, but that was the thought process.
flybywire and davidharnick: The comments about informed consent are well taken. I discussed
with mom about potential complications and the possibility of surgery. However, I think I would
do well to sit down once more and present surgery as almost certainly being needed eventually.
tom25: I had planned to extract the URC after expansion. I saw getting the UR3 in is one
of the factors in support of treating now.
flybywire: "An occlusal splint may be a better way to check for a CR/CO discrepancy before
changing her occlusion permanently with an RPE." This seems like a very reasonable approach.
However, I'm not sure just what benefit I would get from learning if there was a CR-CO discrepancy
in this case. I think it's safe to say that the difference in the height of the condylar processes is
pretty well set at this point. I'm not sure if I'll ever know if the crossbite caused the mandible to
grow asymmetrically over time or if the mandibular asymmetry caused the crossbite. Again, it
does seem reasonable and may be the way to start.
I brought the records to a friend of mine in my town today who suggested starting now. His
rationale was, "What would you do if this was your daughter?" I think what he was saying was
that he didn't see leaving her as she is until growth is complete as a good option.
I would like to sincerely thank all of you for your insightful comments. It's a tremendous
benefit to be able to get the perspective from many different practicing orthodontists and I'm
extremely grateful! ■
3/3/2016

donticsortho
Member Since: 06/25/12
Post: 12 of 41

Do you guys do expanders early to prevent possible canting and asymmetric growth in your
younger patients? There was an AAO lecture on this a while back and it really got me thinking. ■
3/3/2016

Fenrisúlfr
Member Since: 02/25/09
Post: 13 of 41

12 years old is probably too old, however, there is some data to illuminate the chicken vs. egg
argument. The x-bite can lead to asymmetry. ■
3/3/2016

WKC
Member Since: 05/19/11
Post: 14 of 41

I just saw her for the first time last month. I do routinely correct posterior crossbites as early
as feasible. ■
3/3/2016

splint123
Member Since: 03/03/06
Post: 16 of 41

Just curious if those who completely discount functional appliances to modify growth don't
see that cross bites can provide, at times, a demonstrable functional effect on the mandible?
I too would expand and begin readying the patient for surgery. This will allow UR3 to
be brought in as well as aid in the traverse correction. Also, it will give you options to attempt
non-surgical correction with TADs and elastics to level the cant through compensation. It should
at least be presented as a possible option. ■
3/4/2016

flybywire
Member Since: 06/28/04
Post: 17 of 41

I do too. My reasons are many:
1. It's easier with a tooth-borne RPE (or quad helix) in the early mixed dentition vs. later with

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