Skeletal treatment objectives included orthopedic expansion of the
maxilla in the transverse dimension. Dental treatment aimed to increase
intermolar width, upright the mandibular posterior segments
buccolingually, proclining the maxillary incisors, achieve a class I
canine relationship, and position the lower incisors optimally to
achieve ideal overjet and overbite.
Treatment was initiated using a miniscrew-assisted rapid palatal
expander to widen the upper arch by 4 mm (Figure 4). The patient
cooperated with maintaining oral hygiene, and the parents assisted with
turning the expander. After expansion, the molars were banded, and the
remaining teeth were bonded with 0.022” × 0.028” slot standard edgewise
bands and MBT prescription brackets. Initially, both arches were leveled
and aligned through thermo-activated NiTi wires: 0.012” NiTi, 0.016”
NiTi, and 0.017” × 0.025” Nitinol wires. Progress X-rays and
repositioning of bands and brackets were performed as needed to ensure
root parallelism. Arch coordination was then attained with upper and
lower 0.019” × 0.025” SS wires. These wires also leveled the Curve of
Spee, uprighted the posterior teeth buccolingually, intruded the lower
anterior teeth, and coordinated the arches. Residual spaces were closed
with power chains, and detailed bends were made. The patient was
debonded after finishing and detailing, and retainers were delivered.
The retainers provided were upper removable wrap-around Hawley and lower
fixed lingual retainers.