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Interceptive orthodontics – treatment of transverse (width) problems in children

Interceptive orthodontics – treatment of transverse (width) problems in children

Interceptive orthodontic treatment for children

Many parents come to our clinic to ask about interceptive orthodontic treatment (early orthodontics) for their children, with the idea that the treatment will last a few years; this is not true and quite unnecessary. It has been demonstrated that in many cases early treatments provide no advantages in the long term. However, there are certain cases where early orthodontics is highly recommended:

1. Cases of crossbite with functional deviation of the mandible – this occurs when there is a premature contact and closing the mouth causes deviation of the lower jaw (usually lasts 4-12 months)

2. Severe crowding – can generate gum problems and impede the eruption of permanent teeth (usually lasts 6-12 months)

3. Class III malocclusions with a small upper jaw – correction of class III malocclusions must be performed early (at the latest 8-9 years old for girls and 9-10 years old for boys, which is when the best skeletal effect is achieved) (usually lasts 12-18 months)

4. In class II malocclusions, when the overjet is greater than 7 mm – the treatment is aimed at reducing the overjet and not at correcting the class II, this is to avoid potential traumas – the class II malocclusion is treated at peak growth as in cases with a Herbst appliance (usually lasts 4-6 months).

Transverse or width problems in the dental arches

As documented above, when we provide treatments of this kind they do not usually last more than a year or a year and a half. The most common problems in children and adolescents are transverse problems, i.e. problems with the mouth width. The width problem tends to appear in the mouth in a variety of different ways, the most common are:

1. Premature loss of milk teeth

 Ortodoncia friedlander Barcelona disyuntor expansion perdida prematura niños

Premature loss of lower canines due to a lack of space (green line)

2. Dental crowding

Ortodoncia friedlander Barcelona placa expansion niños mordida cruzada corregida

Solution for dental crowding and a lack of space – in six months using a lower expander

3. Crossbite on one or both sides of the mouth

Ortodoncia friedlander Barcelona disyuntor expansion perdida prematura niños

Unilateral crossbite

Mandibular expansion

The problem has to be correctly diagnosed and the treatment must be aimed at solving the root cause of the problem. In other words, if there is crowding because of a narrow palate, before correcting the crowding the palate must be widened.

In the mandible (the lower dental arch) the expansion goes no further than the straightening of the molars at the rear of the mouth. I tend to use two main appliances for mandibular expansion:

1. Removable expander, ‘easy in easy out’. This expander is very comfortable, and is taken out to eat or to brush your teeth. The major drawback is that the patient can lose it or fail to use it correctly..

Ortodoncia Friedlander Barcelona placa de expansión inferior niños

Removable lower expander. Very comfortable to wear.

2. Fixed expander appliance that is cemented to the molars. With this appliance there is no possibility of it getting lost at school, and no patient collaboration is required.

Ortodoncia Friedlander Barcelona arco lingual de expansión inferior niños

Our lingual arch design with an expansion screw.

Both appliances are for slow expansion and work very well. In the majority of cases the problem is solved after six months of expansion. Sometimes, depending on the case, we use appliances such as the 2×4 or the lip-bumper.

Maxillary or palatal expansion

There are two possible ways to expand the upper jaw and give extra width to the dental arch:

1. Slow expansion – only moving the teeth.Slow maxillary expansion appliances never achieve the same effect as apalatal expander, even if they are used for 2 or 3 years. I do not tend to use this type of appliance for these and other reasons. Slow (or dentoalveolar) expansion is only used when there is dental compression, something that is not often seen.

2. Rapid (or orthopedic) expansion – really moving the bones. The appliance that achieves this type of expansion is a fixed appliance called a palatal expander, and it manages to provide the expansion in a very short timeframe.

ortodoncia frieldander barcelona disyuntor palatino mordida cruzada hyrax haas macnamara

Various palatal expander designs, from left to right: Hyrax expander, Haas expander and MacNamara expander.

What is our method?

In our clínic we almost always use a Hyrax palatal expander, because it is more hygienic and comfortable for the patient. Recently we have been using an even simpler ‘minimalist’ design of expander to increase comfort and improve hygiene during the treatment.

Ortodoncia Friedlander Barcelona disyuntor expansión niños

The minimalist, ‘single arm’ design of our palatal expander – very comfortable and very hygienic.

The treatment usually starts on the lower jaw, as this is a slower expansion. After a few months, when the lower jaw is almost fully expanded, the expansion on the upper jaw begins, as this widening of the upper maxilla with the palatal expander usually takes only 4-6 weeks. The most important sign of a good expansion is the opening of a space between the two upper central incisors, which is caused by the opening of the palatal suture. This can be checked with an occlusal x-ray. This space will close up on its own before long, and does not cause any problems.

ortodoncia frieldander barcelona disyuntor palatino mordida cruzada minimalista

Close-up of the ‘single arm’ design palatal expander that we use. Photos before and after the expansion.

This way, expansion treatments with just a palatal expander do not last longer than  6 months. If we have to expand both the lower and the upper jaw, the treatment tends to last no longer than 12 months.

At the end of the treatment the expansion achieved is maintained with a palatal bar for a few extra months. The palatal bar is an appliance that is very comfortable and hygienic.

Barra palatina colocada como mantenedor después de un tratamiento con disyuntor.

Palatal bar to maintain the expansion after treatment with a palatal expander.

For further information please contact us by telephone (+34) 93 832 72 81.



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