“Doctor, you will see everything yourself!”
Two-stage orthodontic treatment of an open crossbite in a child
Course of treatment
After the examination of the oral cavity and the photo protocol, I revealed the following:
- sharp shrinking of the superior jaw;
- deficit of space for the eruption of permanent teeth;
- cross ratio of the superior and interior jaws in the posterior area on the right and left (from the first molar to the canine, the teeth of the interior jaw overlap the teeth of the superior jaw, but it should be vice versa);
- open bite in the anterior area and the severe deformity of the superior jaw.
The first question I asked was “sucks her thumb?” I got an affirmative response. I had no doubt. A persistent bad habit of thumb sucking leads to a serious deformation of the superior jaw and bite opening.
At the time of the first appointment, Vika was 7 years old. We talked to her, looked at the photos. I explained that if we did not get rid of this bad habit, our treatment would not be effective. I am extremely glad that Vikulya took heed of my words, and as early as the next appointment, her mother told me that the bad habit had gone.
Well, now back to the teeth. The formed serious skeletal pathology could not be corrected quickly and at ease. We came up with a multi-stage plan.
The first and the most important thing was to get rid of the bad habit of sucking a thumb!
First stage of treatment: Haas appliance
First, we work with a sharp deficit of the superior jaw. Since the interior jaw has completely blocked the superior jaw, it will not be able to grow and shape up physiologically in a child. Therefore, the 1st stage of the orthodontic treatment was the expansion and stimulation of the growth of the superior jaw using a fixed Haas appliance to correct the overlap in the lateral sections on the right and left, as well as to create a place for the eruption of permanent teeth.
The screw was activated once a day for 3 weeks. After that, the screw was stabilized. The stabilization phase took 6.5 months.
Second stage of treatment: Schwartz appliance
The second stage of the orthodontic treatment was a removable Schwarz plate with a screw and a valve for the tongue on the superior jaw. This appliance was used to reskill the work of the tongue and to place it between the teeth. Correction of an open bite in the anterior region is possible only with the correct position of the tongue in statics and dynamics. Further, the second appliance helped to maintain the already achieved result of the expansion of the superior jaw after the first stage.
The screw was activated once every 7 days. The appliance was on 24/7. Visits and my activation of the appliance took place once in 2 months for 10 months.
Treatment outcome
Vikulya gave serious consideration to the treatment and impeccably followed all the recommendations.
As a result, we got:
- expanding the maxilla and creating room for the eruption of permanent teeth;
- fixing the cross overlap in the posterior maxilla on the right and left;
- significant reduction of disocclusion in the anterior area;
- improving the position of the teeth in the interior jaw.
This is, of course, not the end of the work. We will continue to work on the position of the tongue, and for the permanent bite there will be a full orthodontic treatment using the braces.
Treatment outcome
