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SPONTANEOUS CORRECTION OFCLASS II MALOCCLUSIONAFTER RAPID PALATALEXPANSIONROBERTO M. A. LIMA FILHO, DDS, MSA; ANNACAROLINA LIMA, DDS, MSB;ANTONIO CARLOS DE

OLIVEIRA RUELLAS, DDS, PHDANGLE ORTHOD 2003;73:745-752.

ase

Report


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INTRODUCTION

Rapid palatal expansion Initially used to correct posterior

cross-bite


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The patient was treated in theearly mixed dentition with a Haas-

type rapid palatal expansionappliance as the only intervention.


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Widening the maxilla

a spontaneous forward positioningof the mandible during the

retention period in cases of Class IImalocclusion in mixed dentitionassociated with maxillary

constriction


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PALATAL

EXPANSION


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HAAS EXPANDER THE HAAS

APPLIANCE IS A BANDED APPLIANCEWITH A PALATAL EXPANSION SCREWHOUSED IN PALATAL ACRYLIC. IT ISDESIGNED FOR LATERAL EXPANSION

AND BECAUSE OF THE PALATAL


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RAPID PALATAL EXPANDER(RPE) A TYPE OF PALATALEXPANDER. THE RPE USUALLY HAS ASCREWWHICH THE PATIENT ORPARENT TURNS TO WIDEN THE


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BONDED RPE A PALATAL

EXPANDERW

HICH IN ADDITION TOTHE METAL FRAMEWORK, CONTAINSPLASTIC OVER THE BITINGSURFACES OF THE BACK TEETH.THIS TYPE OF EXPANDER IS USED TO


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THE CETLIN APPLIANCE

FUNCTION:

DISTAL MOVEMENT OFTHE LAST MOLARSUSING A HEADGEARDESCRIPTION : SIMPLE PLATE TO

MOVE THE LAST MOLARS DISTALLY


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FAN EXPANDEREXPANDS ANTERIOR WITH MINIMALPOSTERIOR INVOLVEMENT USING AFAN SHAPED 9 MMSCREW. EXCELLENT FOR USE IN


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HYRAX EXPANDER

THIS ALL METAL HYGIENICAPPLIANCE IS TYPICALLYFABRICATED WITH BANDS ON THEFIRST MOLARS AND LINGUAL BARSEXTENDING TO THE FIRST


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MOUTH

BREATHING


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CLASSIFICATION OF

MOUTHBREATHING

Anatomic

Obstructive

Habitual

Etiology of Moutheathing

Nasal insufficiency

Allergies , Chronicinfection

Airway obstruction


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TREATMENT CONSIDERATIONOF MOUTHBREATHING

Age of the childENT examination

Correction of any pathologycondition


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TREATMENT OF

MOUTHBREATHING Symptomatic treatment Elimination of cause Interception of the Habit

- Physical Exercise

- Lip Exercise- Oral screen Correction of the malocclusion

- Class I Oral shield appliance

-Class II

Monobloc activator- class III Chin cap


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TREATMENT

OPTIONOne-PhaseOne alternative would be to defer

the orthodontic treatment until thelate mixed or early permanentdentition stage of development

was established


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TREATMENT

OPTIONTwo-phaseBy widening the maxillary dental

arch and apical base through rapidpalatal expansionRemove the functional

interferences caused by maxillaryconstriction

Allowing the mandible move to amore comfortable anteriorposterior


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Two-phase


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GENERAL PLAN OF

TREATMENT

Because of the patientsyoung age, treatment was

accomplished in two phases.


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PHASE I

Expand the maxilla with a Haas-type cemented rapid palatal

expansion appliance.

Stabilized and left in place for 3months. A maxillary acrylic platewould then be laced


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PHASE II

leveling, aligning, and finishingdetails.


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TREATMENT

PROGRESSHaas-type palatalexpander

- 2 turn/dayScrew opened 21 mm ,Central incisor

separated 4 mm

Maxillaryacrylic plate

Observed

21day

3

Months


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RESULT AND

DISCUSSIONPalatal expansionThe contained jaw was able to

move forward.To eliminate the orthodontic

problemTo create a stable occlusion


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RESULT AND

DISCUSSIONAfter 1 year

: - transverse dimension correct

- mandible forward to normalposition.

- spontaneous correction of theclass II malocclusion


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Variables 7 y 8 y 11 y, 6 m

SNA 79.5 79.5 80.0

SNB 75.5 76.0 77.0

ANB 4.0 3.5 3.0

Convexity

8.0 6.5 5.0

SN-GoGn 3

8.0 3

8.53

8.5

CEPHALOMETRIC

MEASUREMENTS ()


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Facialasymmetry at 7

years

Facial symmetryat 15 years


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no facial painno crepitus or clickingno limitation in motion ofthe jaw.

NO ADVERSE

EFFECTS


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CONCLUSION

Mild class 2 relationships withtransverse problem

Rapid palatalexpansion

Wide maxillary apical base

anteroposterior correctionShort duration

,cost


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OBJECTIVE

minimize the problems inpermanent dentition


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THANK YOU FOR YOUR ATTENTION !!

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