Achieving Optimal Lateral Arch Development

A family came into my office for an orthodontic consultation. Their son, a 7-year, 4-month-old male, had been socially traumatized by his peers. He had been called many names by his classmates who made fun of his protruding, flared out and gapped central incisors. Dentally, he had been treated by a pediatric dentist with multiple stainless steel crowns. His upper left D SSC had fallen off, but I detected no active caries so I left it alone. His lips were slightly hypertonic and I detected no airway issues. (Fig 1)

Skeletally, he was Mesocephalic with a GoGn of 30 degrees and Class I with an ANB of 3. (Fig 2) He had 90-degree rotated upper lateral incisors per his pano-lipse and a full complement of teeth. (Fig 3) He needed lateral arch development per his Sim analysis. To review: His lower centrals were average sized. I employed the Sim analysis to determine how much lateral arch development I wanted to achieve.