Clinica de Ortodoncia Dr. Arthur Nouel

7 1/2 year-old patient with a Cl II div 1 malocclusion , anterior open bite and lack of space for the upper lateral incisors, as well as premature loss of the primary lower left canine.
There is a finger or thumb habit and anterior tongue thrust. Congenitally missing 3^rd molars.

Some cephalometric values

          SNA:                   82
          SNB:                   73
          ANB:                    9
          < Facial:               80
          FH-Mandibular:   35
          SN-Mandibular:   42
          Goníaco:             138
          Interbasal:            32
          Eje Y:                  87
          1/ a Max.              61
          1\ a Mand.            98
          Wits:                       5

Diagnosis:
Angle Cl II div. 1. div, due to mandibular hypoplasia, with skeletal growth pattern that tends to an open bite.
Treatment objectives: Suppress the habits, distalize the maxillary first molars, expand and align the dental arches, and perform no extractions to avoid negative changes in the patient profile.
Treatment sequence:
1.-Fixed habit breaking appliance to avoid thumb sucking (22/9/95)
2.-Cementation of brackets on 2-1/\1-2, bands on 6/\6 and face bow with high-pull headgear (30/01/97)
3.-Placement of a pendulum type appliance to distalize first molars (16/11/00)
4.-Placement of a Nance button to maintain results of the Pendulum appliance (14/03/01)
5.-Placement of a palatal expander and lower retainer with a screw (21/6/01)
6.-Placement of an upper plate with springs to distalize 6/ (21/6/02) and \6 (12/12/02)
7.-Placement of .018 Alexander type fixed appliances (7/4/03)
8.-Removal of appliances and placement of transparent or invisible retainers (15/9/04)

Photographs of progress achieved
(19/11/99)Due to lack of cooperation when using the facebow, the Cl II persists and only the crossbiteand overbite have been modified. A Pendulum appliance, which is independent of patient compliance, is utilized to distalize the first molars.

(14/3/01)Results and secondary effects obtained with the Pendulum appliance. After removing this appliance, a Nance button is cemented in place to maintain the results.

21/06/01)A lower plate with a screw is placed to expand the dental arch and then a Palatal expander is placed to expand the maxillary arch and thus obtain the necessary space for the canines.