Growth modification with nasomaxillary protraction and hybrid Hyrax appliance
On 3D X-ray imaging and 2D (lateral cephalogram) we can see lack of upper jaw growth in all three directions: vertical, transverse and antero-posterior. Lower jaw also has its problems: we cannot be sure, but it looks like lower jaw can start excessive growth in puberty, while upper is almost finishing its growth before puberty. So we now see the actual upper jaw dimension, and possibly bigger lower.
We cannot manage the amount of lower jaw growth.
We can stimulate upper jaw growth in all 3 dimensions.
We use a miniscrew-bourne appliance for upper expansion (hybrid Hyrax).
How it was manufactured:
1. Intraoral scanning and upper jaw CBCT were superimposed in 3D by dental lab technician for guided miniscrew insertion.
2. The miniscrews are inserted under local anesthesia with help of a surgical guide.
3. Inserted miniscrews are scanned intraorally with scanbodies (so scanner could recognize them), and this scan is sent again to dental lab for appliance 3D design and printing (this appliance is designed in fully digital way and 3D printed with laser).
4. Then the new appliance is fixed intraorally with fixing screws and partially bonded on upper molars.
Now we can use it in 2 ways: upper jaw expansion by central screw activation (3 times a week, done by Alice’s parents) and upper jaw protraction with Face mask and elastics (extraoral appliance). So the upper jaw growth will be stimulated in 3 dimensions: it becomes wider with expansion screw, and it is pulled forward and downwards with protraction Face mask.
This is only 1st stage of treatment, when we use the rest of upper jaw growth potential to prepare for fixed appliance treatment (bracket system).
Reverse articulation, 3 class malocclusion.