PMC4745967_01
Pretreatment intraoral photographs, radiographs, and cephalometric tracing.
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Class II division 1 malocclusion, overjet of 9.0 mm, and AOB of 4.0 mm. Constricted maxillary arch, slight diastema between the maxillary incisors and between the lower central incisors, and a slight midline deviation to the left were also present (Figure 1). The absence of second maxillary premolars was detected in the panoramic radiograph (Figure 1).
The expander before and after fixation. Thumb sucking position.
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Progress after 3 weeks of palatal expansion. The appliance work as "reminder" and serve to curb the habit.
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A fixed Haas-type appliance for RPE was planned and fixed in order to achieve palatal expansion and serve as a "reminder" to curb the habit and indirectly promote the closure of the anterior open bite (Figure 3).
Postexpansion intraoral photographs, radiographs, and cephalometric superimposition. Black, initial; blue, final.
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Orthodontic treatment was started with the fixation of the palatal device to the first molars and bonding on the palatal surfaces of the molars and deciduous canines (Figure 4).
Nine months after removal of the palatal expander and no thumb sucking habit.
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During the first weeks of use of a palatal expander and in the subsequent months in the retention phase, the patient stopped her habit and the spontaneous correction of AOB was observed (Figure 5).
18 months after removal of palatal expander appliance. Relapse of the anterior open bite due to relapse of the thumb sucking habit. Callus on the right thumb observed.
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However, some months after the removal of the Haas-type palatal expander, the relapse of the habit was observed (Figure 6).