Orthotown October 2017 - 44
Fig. 6
Fig. 7
tonsils and adenoids had been removed, but
she still showed signs of OSA. She was a
referral from the ENT who had removed
her tonsils and wanted her to be evaluated
for orthodontic treatment (Fig. 6).
The treatment plan:
*
*
*
Bonded dual-arch expander.
Maxillary 2-2 fi xed appliances.
Retention with an invisible
palatal-coverage retainer.
* Growth and development observation.
After treatment (Fig. 7), the patient's
AHI score was greatly reduced to 0.1.
Subjectively, her parents let us know that
she slept better, performed better in school
We find that when we have
the correct understanding
of how we can truly help our
patients, and then ask the right
questions, we most benefit our
patients and the community.
44
OCTOBER 2017 // orthotown.com
and had an overall increase in energy levels.
We often hear such feedback from parents
in many of our expansion cases.
Our expansion methodology
Through our clinical experience, we
find that children who have restricted
airways often have audible, raspy breathing
that automatically triggers us into looking
into this further and discussing with the
parent, even if there has not been a formal
diagnosis of OSA.
We make some critical points in our
treatment-planning for maxillary expansion.
Often, patients with maxillary constriction
do not express posterior crossbites in their
occlusion; in these cases, we clinically note
a narrow maxillary arch form, often in
combination with a high arched palatal
vault. The mandibular arch will often
show lingually tipped posterior teeth that
compensate for the maxillary constriction.
In such cases-which are common in
our practice-our methodology is to do
substantial palatal expansion; we often
aim to incorporate up to 10-millimeter
measured maxillary expansion of a bonded
maxillary expander appliance (Fig. 8) to
see long-term benefits of both permanent
tooth eruption and possible reduction in
OSA symptoms. To compensate for the
resultant overexpansion of the maxillary
arch relative to the mandibular arch, we
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Table of Contents for the Digital Edition of Orthotown October 2017
Orthotown October 2017 - Intro
Orthotown October 2017 - Cover1
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Orthotown October 2017 - 1
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