Non-extraction And Upper Expansion Treatment Of Angle Class ? Malocclusion

Objectives:To study the non-extraction and maxilla expansion treatment of an class ? patient,discuss the clinical outcome of this approach.Methods:A 19 years old female patient presented in dentistry department of the Second Hospital of Dalian Medical University in March 2016.This patient is a permanent dentition patient,the patient had an anterior crossbite with a bilateral molar and canine class ? relationships.Severe crowding was observed in upper arch and the patient got a little crowding in the lower arch,0.2mm midline shift to the left was found in the lower arch.The two lateral incisors erupted palatally.The patient got few anterior teeth openbite,premolars and molars crossbite both side.Curve of spee was steep on the both side.Maxillary arch form was oval,a square to round arch form in the mandible.46 was a RCT tooth with big dentin defect.No obvious abnormity on the tongue nor facial soft tissue.No obvious abnormityon TMJ.Oral hygiene was good.Chin position is in the middle of the face with out any deviations.Laterally,the profile was concave.The maxilla was normal and mandibular protrusion was obvious.After cephalometric analysis and model analysis,a non-exaction treatment plan was decided for the patient by using Quad-helix with fixed appliance device first for expansion.Use the arch expansion gap to relieve congestion on dentition,the maxillar dentition rapid neat row on the flat,and the lifting of crossbite,extract 46 then correct the curve of spee and relieve lower arch congestion.Move 47,48 forward to regain the molar relationship.Use MEAW(multiloop edgewise archwire,MEAW)wire with anterior box or tri-angle elastic to upright the lower premolars and molars to correct the canine and molar relationship,establish a good relationship between the posterior and anterior teeth occlusion overbite.Use helical-bulbous loop to push the upper molars backward the n upright the upper anterior teeth.Results:Patient already undergoes 26 months of orthodontic treatment,until now:(1)patient's teeth aligned in good position,no deviation in upper and lower midlines,posterior crossbite was corrected,bilateral molars in a good relation,there is a 2mm space between 42 and 43,a labial inclination is observed in the upper a nterior teeth during this period,using the MEAW wire to control the occlusal plane and helical bulbous loop on the upper to push the molars backward,then upright the upper anterior teeth.(2)comparing the data measured before and after treatment: after maxillar expansion,the width between two canine increased from 25.10 mm to 35.25 mm.SNB reduced from 83.32 to 82.76,ANB reduced from-1.82 to-1.90,FMA reduced from 32.17 to 32.01,suggesting that there is a anticlockwise rotation of the mandible,indicating it is a better changed during the whole treatment,FMIA reduced,Z angle reduced from 85.43 to 77.71,patient lateral profile was improved,APDI reduced from 97.13 to 92.47,so skeletal class ? relations has improved,ODI increased,anterior open bite tendency under control,normal overbite relationship established,there is still a labial inclination observed in the upper anterior teeth during this period,using the MEAW wire to control the occlusal plane and helical bulbous loop on the upper to push the molars backward then upright the upper anterior teeth.Conclusion:For the mild skeletal Class ? patients with posterior crossbite malocclusion,select orthopedic orthodontic force with non-extraction treatment can get a good result,a patient does not need to extraction of any teeth,get a good and stable occlusion and appearance and camouflaging skeletal problem by using orthodontic treatment is the best treatment for the patient.