Children’s Orthodontic Treatment: Arch Expansion, Crowding, and Protruding Mouth Correction

Hello.

I would like to explain orthodontic treatment for children.

I have previously explained that, assuming there are no skeletal problems such as a prominent lower jaw or facial asymmetry, undergoing orthodontic treatment with Invisalign First during childhood makes it very unlikely that the child will need orthodontic treatment again as an adult.

This is because it can provide the benefits of a conventional pediatric arch-expansion appliance and the benefits of a 2×4 appliance for aligning the front teeth at the same time.

Today, I would like to introduce a case of arch expansion and correction of crowding and protruding teeth in a child.

22.08

This 9-year-old child visited us for pediatric orthodontic treatment.

22.08

The upper front teeth covered the lower teeth so deeply that they were not visible, indicating a deep overbite. Protrusion of the upper teeth was also visible.

The X-ray showed that eight primary teeth were still present, but since the warranty period was 18 months, most of the permanent teeth were expected to erupt by then.

We made the appliance with the goals of creating space for the permanent teeth to erupt through arch expansion, reducing the protrusion of the upper teeth, and aligning the front teeth.

After waiting a month and a half, the first appliance was fitted in September 2022. The image below shows the result after wearing the entire first set for nine months, through June 2023.

23.06

The deep overbite had been corrected, and the midline was well aligned.

23.06

The protrusion of the front teeth had been corrected, and the canines were in the process of erupting.

23.06

The teeth were considerably well aligned.

Several primary teeth had also fallen out, and the permanent teeth were continuing to erupt.

In this situation, rather than immediately making a new set of appliances, it is better to take a short break and wait several months for the permanent teeth that are currently erupting to come in fully.

Making the next appliance after that has several advantages, including ensuring a better fit.

We also advised removing the primary teeth at the appropriate time so that as many permanent teeth as possible could be guided to erupt within the 18-month warranty period.

After taking a five-month break while wearing the final appliance only during sleep, the canines and premolars had erupted to some extent, so we proceeded with a new set. Around the 17th month, just before the warranty period ended, we made one more set to finish aligning the slightly rotated canine as well. Treatment was finally completed in August 2024.

24.09

24.09

A total of two new sets were made. The total treatment period was two years, including a five-month break in the middle.

At the end of treatment, two primary teeth remained, and there was sufficient space, so the unerupted permanent successor teeth were also expected to erupt into proper positions.

2022.08~2024.09

2022.08~2024.09

The expanded dental arch achieved through arch expansion and the neatly aligned front teeth are noticeable.

2022.08~2024.09

The midline was precisely aligned, and the deep overbite had also been corrected.

2022.08~2024.09

2022.08~2024.09

2022.08~2024.09

Improvement in the protrusion of the front teeth

The patient was a child at the first visit and became an adolescent during orthodontic treatment.

The front-tooth angles and smile line are both good.

The root parallelism is also good.

When the protrusion of the front teeth is improved, the mouth can finally close comfortably.

With results like this, additional orthodontic treatment is generally not necessary in adulthood.

However, to maintain the results, the retainer must be worn while sleeping, and regular follow-up checks during the retention period must also be attended.

At our dental clinic, we treat pediatric patients with the goal of making this their first and last orthodontic treatment.

I hope this information was helpful to those considering orthodontic treatment for children.

Thank you for reading this long post.