Crowding

Before Treatment Photos

I first saw this girl at age 8. She had a digit sucking habit until age 7. She presented with an anterior open bite, narrow upper and lower arch forms, and anterior crowding. Note how her lower front teeth look longer because they were getting pushed forward off the center of the supporting bone. The gum tissue in these areas is very thin and she was at high risk of gum recession and eventual loss of these teeth. She also had a Class II dental problem (upper teeth stick out relative to lower teeth).

The goals of the intial stage of treatment were to regain space, and start to address the Class II problem. I first used upper and lower transverse appliances (removable expanders) to develop her arch forms and gain space. During this initial stage of treatment I referred her to a periodontist, who did a soft tissue graft where the gum tissue was too thin. I later put braces on her upper first molars so that she could wear a headgear along with a removable appliance to start to move her upper molars back (to address the Class II problem). This initial stage was about 16 months. The next set of photos were taken at the end of the 16 months, just prior to putting her braces on.

The goals for this second phase of treatment were to complete the Class II correction and alignment. She had full upper and lower braces, and initially had an additional appliance to help move her upper molars back. She also wore elastics to help make the correction. Below are the pictures taken the day I removed her braces (the stains are from inadequately removing plaque - this is something her general dentist can address).

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