PMC4349126_01
Extra-oral and Intraoral pretreatment photographs. Parents authorized the publication of these pictures.
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The nasolabial angle was increased and the poor development of the zygomatic region suggested a maxillary deficiency (Figure 1). The terminal plan of primary second molars exhibited a mesial-step, with the left side presented canines in a crossbite relationship (Figure 1).
Intraoral photograph before (A, B, C, D and E) and after expansion (F and G)
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The next day, the activations were performed with 2/4 turns in the morning and 2/4 in the evening (Figure 2).
Photographs of the construction and adaptation of Turley s face mask. Parents authorized the publication of these pictures.
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During the activation phase, the patient's face was molded so that a modified Facemask was made (Figure 3).
Removable appliance with grid palate
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However, since the patient presented lingual interposition in the anterior region, a new acrylic appliance with a palatine grid was made (Figure 4).
Orthodontic fixed appliance
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Leveling and alignment were performed and the open coil springs were used to create space (Figure 5).
Modified Hawley retainer
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The treatment was completed in 2 years, and a modified Hawley retainer was inserted (Figure 6) for lingual crown torque of the upper canine's crowns.
Intraoral posttreatment photographs
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The mandibular incisors were slightly modified and the maxillary incisors that had been markedly tipped to the lingual side and retruded, now were tipping to the buccal side and protruded (Figure 7 and Figure 10).
Extra-oral and Intraoral long-term posttreatment photographs. Parents authorized the publication of these pictures.
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The 15-year follow-up intraoral photographs show the stability of the treatment with the canines and molars in occlusion (Figure 8).
Photographs and lateral radiographs. Parents authorized the publication of these pictures.
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On the other hand, the maxilla (Co-A) responded positively to the rapid maxillary expansion, associated to maxillary protraction (Figure 9 and Figure 10). The H line-nose variable decreased from 5 mm to 2 mm and the nasolabial angle went from 107  to 100  (Figure 9 and Figure 10).