case_images: PMC10860898_01
case_images: Pre-treatment extraoral and intra-oral photographs. (A) Incompetent lips. (B) Inconsonant smile arch. (C) Facial profile: right lateral view showing the NLA line tangent to the base of the nose and a line tangent to the upper lip (red arrow); E-line is drawn from Pn (point of the nose) to pog (soft tissue pogonion) (black arrow). (D) Increased overjet. (E) Frontal view showing diastema. (F) Left lateral view showing increased overjet. (G, H) Occlusal view showing crowding in the upper and lower arches.. NLA, nasolabial angle
case_images: cureus-0016-00000052213-i01.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i01.jpg
case_images: FIG1
case_images: Her smile appeared fairly symmetrical, but she had a non-consonant smile arc and excessive display of maxillary gingiva when smiling (Figure 1).
case_images: Pretreatment dental cast
case_images: cureus-0016-00000052213-i02.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i02.jpg
case_images: FIG2
case_images: The final diagnosis was skeletal class II division I malocclusion with transverse maxillary deficiency (Figures 2-4).
case_images: Pretreatment lateral cephalometric and panoramic radiographs
case_images: cureus-0016-00000052213-i03.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i03.jpg
case_images: FIG3
case_images: The final diagnosis was skeletal class II division I malocclusion with transverse maxillary deficiency (Figures 2-4).
case_images: Lateral cephalometric radiographs showing the mandibular angle, pogonion line, and lower facial height. (A) Lower facial height: The ratio of the distances G-Sn and Sn-Me; in normal cases, it should be approximately 1:1. (B) Frankfort-mandibular plane angle (FMA) is formed by the intersection of the Frankfort horizontal plane (FH plane) and the mandibular plane (1). Pogonion line is a line to measure the position of the anterior teeth (2).. G-Sn, glabella to subnasale; Sn-Me, subnasale to menton
case_images: cureus-0016-00000052213-i04.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i04.jpg
case_images: FIG4
case_images: The final diagnosis was skeletal class II division I malocclusion with transverse maxillary deficiency (Figures 2-4).
case_images: Treatment progress. (A) Picture showing insertion of the high-pull headgear. (B) Image after the end of expansion. (C) Occlusal photograph showing the hyrax expander.
case_images: cureus-0016-00000052213-i05.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i05.jpg
case_images: FIG5
case_images: Trevisi) brackets (3 M Gemini MBT 0:022'' x 0:028'' slot size) were placed on the lower and upper teeth with 0.014 NiTi archwire. The headgear was still used at night for anchorage (Figures 5, 6).
case_images: After one year and two months of wearing headgear. Represent lateral view (A, B). Lower occlusal view shows the lower segmented arch with 0.014 NiTi (C) and the upper segmented arch with 0.018 NiTi (D).. NiTi, nickel-titanium
case_images: cureus-0016-00000052213-i06.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i06.jpg
case_images: FIG6
case_images: Trevisi) brackets (3 M Gemini MBT 0:022'' x 0:028'' slot size) were placed on the lower and upper teeth with 0.014 NiTi archwire. The headgear was still used at night for anchorage (Figures 5, 6).
case_images: Intra-oral view after creating space in the lower teeth. (A) Upper occlusal 0.019 x 0.025 SS archwire with powerchain from 3-3 (upper right canine to upper left canine). (B, C) After create space for the lateral start bring it to the arch (bond button lingually to the lower right lateral and powerchain from lower first central to canine and pass through the button of lateral on 0.018 SS arch wire.. SS, stainless steel.
case_images: cureus-0016-00000052213-i07.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i07.jpg
case_images: FIG7
case_images: During this phase, a power chain was used from the maxillary right canine to the left canine in an attempt to close the diastema (Figure 7).
case_images: Final phase of the treatment . A, B) Adding Kobayashi ligature to upper right and left lateral view for elastic holding zigzag elastic with class II component right and left (5/16 in diameter, 2.5 oz). (C, D) Both the upper and lower arches had 0.019 x 0.025 SS with steel colligation from 6-6 (from the upper right first molar to the upper left first molar).
case_images: cureus-0016-00000052213-i08.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i08.jpg
case_images: FIG8
case_images: Specifically, zigzag elastics with class II components on both the right and left sides (5/16 in diameter, 2.5 oz) (Figure 8) were used to correct the anteroposterior relationship of the dentition and to improve interdigitation, resulting in a more stable occlusal correction.
case_images: Post-treatment extra-oral and intra-oral photographs. (A) Lips position improved and became competent. (B) Consonant smile arch. (C) Improved facial profile and NLA. (D) Right lateral view showing the achieved minimum overjet. (E) Frontal view showing improved midline shift and close diastema. (F) Left lateral view showing the achieved minimum overjet. (G, H) Occlusal view results in resolved crowding in the upper and lower arches.. NLA, nasolabial angle
case_images: cureus-0016-00000052213-i09.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i09.jpg
case_images: FIG9
case_images: The post-treatment facial photographs showed a significant change in the upper lip posture in relation to the E-line, indicating that it has become competent (Figure 9). The upper and lower dental midlines coincided with the facial midline (Figure 9).
case_images: Final panoramic view
case_images: cureus-0016-00000052213-i10.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i10.jpg
case_images: FIG10
case_images: Initial and final lateral cephalometric radiographs
case_images: cureus-0016-00000052213-i11.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i11.jpg
case_images: FIG11
case_images: During the three-year retention follow-up, the patient's occlusion and facial esthetics were stable (Figures 11, 12).
case_images: Superimposition of the maxilla and mandible . The black line indicates pre-treatment, and the red line indicates post-treatment. 1, molar; 2, incisor; 3, pogonion; 4, gonion
case_images: cureus-0016-00000052213-i12.jpg
case_images: PMC10860898_01_cureus-0016-00000052213-i12.jpg
case_images: FIG12
case_images: During the three-year retention follow-up, the patient's occlusion and facial esthetics were stable (Figures 11, 12).