Post on 06-Apr-2018
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SPONTANEOUS CORRECTION OFCLASS II MALOCCLUSIONAFTER RAPID PALATALEXPANSIONROBERTO M. A. LIMA FILHO, DDS, MSA; ANNACAROLINA LIMA, DDS, MSB;ANTONIO CARLOS DE
OLIVEIRA RUELLAS, DDS, PHDANGLE ORTHOD 2003;73:745-752.
ase
Report
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INTRODUCTION
Rapid palatal expansion Initially used to correct posterior
cross-bite
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The patient was treated in theearly mixed dentition with a Haas-
type rapid palatal expansionappliance as the only intervention.
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Widening the maxilla
a spontaneous forward positioningof the mandible during the
retention period in cases of Class IImalocclusion in mixed dentitionassociated with maxillary
constriction
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PALATAL
EXPANSION
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HAAS EXPANDER THE HAAS
APPLIANCE IS A BANDED APPLIANCEWITH A PALATAL EXPANSION SCREWHOUSED IN PALATAL ACRYLIC. IT ISDESIGNED FOR LATERAL EXPANSION
AND BECAUSE OF THE PALATAL
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RAPID PALATAL EXPANDER(RPE) A TYPE OF PALATALEXPANDER. THE RPE USUALLY HAS ASCREWWHICH THE PATIENT ORPARENT TURNS TO WIDEN THE
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BONDED RPE A PALATAL
EXPANDERW
HICH IN ADDITION TOTHE METAL FRAMEWORK, CONTAINSPLASTIC OVER THE BITINGSURFACES OF THE BACK TEETH.THIS TYPE OF EXPANDER IS USED TO
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THE CETLIN APPLIANCE
FUNCTION:
DISTAL MOVEMENT OFTHE LAST MOLARSUSING A HEADGEARDESCRIPTION : SIMPLE PLATE TO
MOVE THE LAST MOLARS DISTALLY
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FAN EXPANDEREXPANDS ANTERIOR WITH MINIMALPOSTERIOR INVOLVEMENT USING AFAN SHAPED 9 MMSCREW. EXCELLENT FOR USE IN
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HYRAX EXPANDER
THIS ALL METAL HYGIENICAPPLIANCE IS TYPICALLYFABRICATED WITH BANDS ON THEFIRST MOLARS AND LINGUAL BARSEXTENDING TO THE FIRST
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MOUTH
BREATHING
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CLASSIFICATION OF
MOUTHBREATHING
Anatomic
Obstructive
Habitual
Etiology of Moutheathing
Nasal insufficiency
Allergies , Chronicinfection
Airway obstruction
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TREATMENT CONSIDERATIONOF MOUTHBREATHING
Age of the childENT examination
Correction of any pathologycondition
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TREATMENT OF
MOUTHBREATHING Symptomatic treatment Elimination of cause Interception of the Habit
- Physical Exercise
- Lip Exercise- Oral screen Correction of the malocclusion
- Class I Oral shield appliance
-Class II
Monobloc activator- class III Chin cap
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TREATMENT
OPTIONOne-PhaseOne alternative would be to defer
the orthodontic treatment until thelate mixed or early permanentdentition stage of development
was established
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TREATMENT
OPTIONTwo-phaseBy widening the maxillary dental
arch and apical base through rapidpalatal expansionRemove the functional
interferences caused by maxillaryconstriction
Allowing the mandible move to amore comfortable anteriorposterior
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Two-phase
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GENERAL PLAN OF
TREATMENT
Because of the patientsyoung age, treatment was
accomplished in two phases.
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PHASE I
Expand the maxilla with a Haas-type cemented rapid palatal
expansion appliance.
Stabilized and left in place for 3months. A maxillary acrylic platewould then be laced
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PHASE II
leveling, aligning, and finishingdetails.
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TREATMENT
PROGRESSHaas-type palatalexpander
- 2 turn/dayScrew opened 21 mm ,Central incisor
separated 4 mm
Maxillaryacrylic plate
Observed
21day
3
Months
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RESULT AND
DISCUSSIONPalatal expansionThe contained jaw was able to
move forward.To eliminate the orthodontic
problemTo create a stable occlusion
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RESULT AND
DISCUSSIONAfter 1 year
: - transverse dimension correct
- mandible forward to normalposition.
- spontaneous correction of theclass II malocclusion
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Variables 7 y 8 y 11 y, 6 m
SNA 79.5 79.5 80.0
SNB 75.5 76.0 77.0
ANB 4.0 3.5 3.0
Convexity
8.0 6.5 5.0
SN-GoGn 3
8.0 3
8.53
8.5
CEPHALOMETRIC
MEASUREMENTS ()
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Facialasymmetry at 7
years
Facial symmetryat 15 years
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no facial painno crepitus or clickingno limitation in motion ofthe jaw.
NO ADVERSE
EFFECTS
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CONCLUSION
Mild class 2 relationships withtransverse problem
Rapid palatalexpansion
Wide maxillary apical base
anteroposterior correctionShort duration
,cost
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OBJECTIVE
minimize the problems inpermanent dentition
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THANK YOU FOR YOUR ATTENTION !!