PMC8311780_01
(A to C) Extraoral photographs; (D to H) Intraoral photographs showing AOB (E), SCB (F) in left side, maxillary transverse deficiency (G); upper and lower crowding (G and H)
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F1
On extraoral examination (Fig. 1), she was having a convex profile, asymmetric face slightly increased lower third, and mesofacial pattern. The upper midline was shifted 1.0 mm to the right and the lower midline was coincident with the facial midline, moderate to severe crowding on lower arch teeth (-5 mm) and upper arch (-3 mm) (Fig. 1).
Pretreatment panoramic and cephalometric radiography
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F2
Her radiological exam (Fig. 2) revealed that all permanent second premolars were with the crown completely formed (Nolla stage 5) and developing between primary molars.
(A and B) Haas expander with palatal vertical crib before expansion; (C to F) Fifteen days of activation there were SCP overcorrection, diastema aperture between upper incisors and increase of maxillary width; (G) Removable appliance with vertical palatal crib installed after expander removed; (H) Lingual arch
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F3
AOB (Fig. 3). Lingual arch was placed next to exfoliation of the lower second primary molars to harness the E-space (Fig. 3).
Patient after interceptive orthodontic treatment. (A to C) Extraoral photographs; (D to H) Intraoral photographs showing SCP and AOB correction and improvement of lower crowding
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F4
AOB closure and overcorrection. At the lower arch, there was the harness of the E-space and improvement of the crowding (Fig. 4).
Extraoral (A to C) and intraoral (D to H) photographs after corrective orthodontic treatment
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F5
By the end, the patient had good facial esthetics, stable, and adequate occlusion (Fig. 5).
PMC8311780_02
(A to C) Extraoral photographs; (D to H) Intraoral photographs showing SCB in right side (D); maxillary transverse deficiency (G); mild lower crowding (G and H)
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F6
On extraoral examination, the patient showed a symmetric face, convex profile, and mesofacial pattern (Fig. 6). Right SPC, midlines deviated, severe overbite, 4 mm overjet, diastemas between superior incisors, and mild lack of space on the lower arch (-3 mm) (Fig. 6).
Pretreatment panoramic and cephalometric radiography
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F7
His radiological exam revealed an advanced rhizolysis process in canines and primary first molars and ankylosis on the right lower second primary molar (Fig. 7).
(A) Haas expander before expansion; (B to E) After expansion (18 days); (F) Lingual arch. Note e-space maintained in right side
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F8
Lingual arch was placed to harness the E-space (Fig. 8).
Extraoral (A to C) and intraoral (D to H) photographs after interceptive orthodontic treatment
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F9
On permanent dentition (Fig. 9), it was placed an orthodontic corrective appliance to finalize the treatment.
Extraoral (A to C) and intraoral (D to H) photographs after corrective orthodontic treatment
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F10
At the end of the treatment, a harmonic smile, an appropriate occlusion, and good esthetics were achieved (Fig. 10).