Orthotown November 2017 - 22

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TADs or surgery (cost, ease, complexity).
2. There might be some spontaneous decompensation or leveling of the lower molars in a
growing patient (if they are lingually oriented).
3. Skeletal asymmetry might be averted.
4. Parents and patients are more cooperative (my opinion).
5. Treatment can be kept brief (expand and get out).
6. Once the transverse is fi xed, it's usually fi xed for good (if you have to expand again, then
I'd argue it wasn't fi xed the first time!)
7. Airway opening.
8. Business reasons (controversial but reasons nonetheless.)
a. GPs and pedos expect and sometimes demand it (keep referrers happy.)
b. Parents expect and sometimes demand it (keep parents happy.)
c. Competitive forces.
d. Insurance coverage/dynamics.
9. CR/CO discrepancies may be unveiled. ■
3/4/2016

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

I've always said to parents something like, "Correcting posterior crossbites early is one of
the few things orthodontists generally agree upon." The rationale as I've understood it, was to
prevent changes in growth that would require surgical correction later. Looking at the article
posted by Fenrisúlfr, this case seems that it may be an excellent example of the benefits of early
correction of posterior crossbites.
Random thought: I appreciate the "why?" question. Your students are fortunate to have you
for a professor. ■
3/4/2016

Fenrisúlfr
Member Since: 02/25/09
Post: 21 of 41

That is also generally my concern with a unilateral x-bite with a shift in the mixed dentition.
If the x-bite is bilateral and with no shift, I'll evaluate on a case-by-case basis for intervention.
Since the buccal segments are not erupted yet, there is still a chance that another round of
expansion may be required in Phase II. ■
3/4/2016

flybywire
Member Since: 06/28/04
Post: 22 of 41

I agree with you both, in general. In this particular case, if surgery is inevitable, why not wait
to correct the transverse as part of the surgical set-up as Dr. Ruff alluded to previously? What
benefit is correcting the transverse now? Will this create new problems? ■
3/4/2016

WKC
Member Since: 05/19/11
Post: 23 of 41

At the time that she would be ready for surgery (when growth is complete), wouldn't the
maxillary suture likely be fused and therefore require splitting the maxilla as part of the surgery?
I am admittedly not very familiar with the details of the surgical procedures. I just thought that
impacting the maxilla as one piece may be less complicated than splitting it surgically.
However, if the surgery would carry the same degree of risk/complexity either way (split now
with RPE or split later with surgery), the benefit of expanding now may not be worth the risks
of creating new problems. ■
3/4/2016

Fenrisúlfr
Member Since: 02/25/09
Post: 24 of 41

A couple of reasons: a slide may not always be discernible especially a long standing one.
Discluding and decompensating the arches, followed by expansion can often reveal some of these
hidden positional asymmetries.

NOVEMBER 2017 // orthotown.com

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