Expand your mind
By Dr. Derek Bock
Having a symbiotic relationship with a pediatric dentist has many benefits; both in business and patient care. Most orthodontists have been classically trained, where we kick the can down the road for comprehensive treatment and avoid 2-Phase treatment like the plague!! This is due in part to limited research on the benefits of early treatment modalities, and partly due to the antiquated mindset and clinical dogma that is so pervasive amongst those who teach us. I’d like to present a case that should challenge your established mindset on early treatment, and hopefully, peak enough interest for you to explore this space in our profession where the most potential life impact exists!
Summary and Diagnosis:
- 6y6m Caucasian male on initial presentation
- 8y1m when we initiated treatment
- Diagnosed Sleep Apnea via two sleep studies
- Tonsil and adenoid removal at five yrs of age
- Still apnic per the 2nd sleep study
- Class II Skeletal Relationship
- Mandibular retrognathic with strong pogonion camouflage
Maxillary constriction with high palatal vault
- Maxillary intermolar distance 31.3 mm
- Obligate mouth breather
- Low posterior tongue posture
- Significant maxillary expansion for:
- Airway demand
- To help create arch-length
- To allow full mandibular curve of Wilson decompensation
- Arch development to aid in future maxillary and mandibular dentition eruption
- Idealize incisor torque during arch development to reduce Phase II needs/complexity
The patient was 6-years old when he initially presented to the office for an orthodontic consult. He was placed in our observation system to wait for the development of maxillary and mandibular incisors. Treatment was initiated with a Haas RPE that contained a 12mm screw. Initial turning instructions were 1x/day for 4wks. There was a 12-week consolidation phase, during which the normal force of occlusion began to flatten the curve of Wilson. Turns were restarted at this point for 1x/day for 3wks to max out the screw. The patient was reappointed for expander removal and full extended bonding with open coil PSL mechanics. Standard torque maxillary and low torque mandibular Damon Q PSL brackets were utilized. The patient had a normal arch wire sequence for my practice; .014CuNiti, .018CuNiti, 14x25Cuniti, 18x25CuNiti. Final arch wires were 19x25ss in the maxillary arch and 17x25ss in the mandibular arch. Prescribed retention was removable maxillary and mandibular Hawley retainers with 2-2 labial bows and adams clasps on the 6’s.
Compare the serial records and measurements and look at the positive impact that we achieved for this young man in a relatively short amount of time with minimal clinical effort. There’s an entire segment of the patient population that could benefit from relatively straight forward Phase I treatment with skeletal expansion and arch development. This treatment shouldn’t be taboo just because it’s not well documented in poor study design. For more Radical Phase I treatment modalities, come over to my group; www.facebook.com/groups/PragmaticOrthodontics. We can explore this case in detail, along with all the other cases that are posted on a daily basis.