Carlson C, Sung J, McComb RW Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary deficiency in an adult. Am J Orthod Dentofacial Orthop. 2016; 149:716-728 https://doi.org/10.1016/j.ajodo.2015.04.043
Si J, Hu X, Du Y Rapid maxillary expansion treatment increases midfacial depth in early mixed dentition. Front Pediatr. 2023; 10 https://doi.org/10.3389/fped.2022.1028968
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Angelieri F, Cevidanes LH, Franchi L Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2013; 144:759-769 https://doi.org/10.1016/j.ajodo.2013.04.022
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This case report describes the comprehensive orthodontic treatment of a 14-year-old female patient presenting with maxillary transverse deficiency, bilateral ectopic maxillary canines and a Class III malocclusion. The treatment protocol involved the use of rapid maxillary expansion (RME), piggyback mechanics, and ballista springs, tailored to address the unique challenges of this case. The successful integration of these methods facilitated effective space creation, guidance of one of the canines into correct position, as well as overall occlusal correction. The following report highlights the importance of multidisciplinary and individualized treatment planning required in the management of complex orthodontic cases.
CPD/Clinical Relevance:
It is important to adopt a multidisciplinary approach to diagnose and manage complex malocclusions involving maxillary transverse deficiencies and impacted canines to optimize functional and aesthetic outcomes.
Article
Maxillary transverse deficiency and impacted canines are commonly encountered challenges in orthodontic practice. While impacted canines can often be addressed with conventional orthodontic techniques, the complication of ankylosis frequently presents a considerable challenge. This report presents the case of a 14-year-old female patient with pronounced maxillary transverse deficiency and bilateral ectopic canines, one of which was later confirmed to be ankylosed. The treatment plan was designed to address these problems through a combination of various orthodontic techniques, surgical intervention and provision of restorative treatment.
Approximately 18% of children in the mixed dentition have transverse maxillary constriction.1 It commonly manifests with a reduced buccal overjet and the presence of unilateral or bilateral posterior crossbite, potentially leading to anteroposterior discrepancies and facial asymmetry as growth continues.2 Rapid maxillary expansion (RME) is a widely used technique for correcting maxillary transverse deficiencies. It involves the application of lateral forces to the maxillary suture, facilitating skeletal expansion. Various methods, such as the Hyrax expander, exist to achieve RME. Success depends on the patient's age, skeletal maturity, and the severity of the deficiency.3 While intervention in the mixed dentition and prepubertal years is more predictable for palatal suture opening,4 chronological age alone is unreliable for determining the developmental status of the suture during growth.5 For this reason, Angelieri et al proposed a classification of mid-palatal sutural fusion using CBCT to provide reliable parameters for clinical decisions between conventional and surgically assisted RME in adolescent and young adult patients.5
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