Management of Transverse Constriction Malocclusions in Adolescents

Orthodontic treatment of pediatric and adolescent patients can be challenging due to developmental and genetic issues such as altered arch development variations and eruption patterns. These conditions can present situations where the tooth and skeletal arch relationships required for an acceptable and esthetically pleasing occlusion are altered, creating challenging dental and orthodontic issues. An additional factor entering diagnosis and treatment planning is the need to consider airway needs and proper tongue space and the need for anatomical modifications, if observed. The American Lung Association has a saying we must listen to, “if you can’t breathe, nothing else matters.”

For the authors, recognition of possible impediments of airway flow is paramount in the evaluation of a patient. Previously, only posterior unilateral or bilateral crossbite would be considered for expansion of the maxillary arch. This would eliminate crossbites, and indirectly help develop the midface of a patient including palatal and nasal structures, directly improving airway. Treatment usually consisted of using
a palatal expander such as W-arch, quad helix, NPE, or RPE with the expectation for the mandible to catch up in its lateral growth, once it was liberated from the constrictions of the maxillary arch. The tongue musculature was supposed to create adequate lateral forces thus expanding the mandibular arch.

The authors have come to realize that this approach is slow, inefficient and unpredictable. The challenge became finding a system for controlled lateral expansion integrated with the straight wire orthodontics, for patients, who could benefit from it. Some of the benefits of this type of treatment could include reduction or need of extractions, elimination of crowding, development of the maxilla and mandible to better match the anatomy of the tongue, improvement of airway and improvement of patient’s esthetics and their self-esteem.

The authors will present two adolescent patients who did not have anterior or posterior crossbites, but were diagnosed as having transverse constriction of the maxilla and mandible, dental crowding and self-esteem issues caused by their dental esthetics. (Figs. 1 & 15)

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Juan Echeverri

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