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04.12.2023

Growth modification with nasomaxillary protraction and hybrid Hyrax appliance

Patient Alice
Date August 2023
Time
Price
Alice (10 years old) first visited our clinic with her mother Daria at the end of August 2023. They were referred to our clinic in Dubai from the Saint-Petersburg branch of Polar Bear clinic. They were pretty much concerned about Alice’s bite...
Alice (10 years old) first visited our clinic with her mother Daria at the end of August 2023. They were referred to our clinic in Dubai from the Saint-Petersburg branch of Polar Bear clinic. They were pretty much concerned about Alice’s bite as it was obviously not healthy and reflected even in face appearance.
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Diagnostics

Photoprotocol

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.

Bad news

We cannot manage the amount of lower jaw growth.

Good news

We can stimulate upper jaw growth in all 3 dimensions. 

Treatment

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.

3D plan
Surgical guide

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).

Scanbodies

4. Then the new appliance is fixed intraorally with fixing screws and partially bonded on upper molars.

Fixed appliance

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.

Sideview

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).

Diagnosis

Reverse articulation, 3 class malocclusion.

Doctors who treated

Dr. Ekaterina Kuzheleva
specialist orthodontist;
languages: English, Russian
Dr. Aleksandr Siniakov
specialist Oral Surgery, implantologist, periodontist;
languages: English, Russian
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