Skeletal treatment objectives included orthopedic expansion of the maxilla in the transverse dimension. Dental treatment aimed to increase intermolar width, upright the mandibular posterior segments buccolingually, proclining the maxillary incisors, achieve a class I canine relationship, and position the lower incisors optimally to achieve ideal overjet and overbite.
Treatment was initiated using a miniscrew-assisted rapid palatal expander to widen the upper arch by 4 mm (Figure 4). The patient cooperated with maintaining oral hygiene, and the parents assisted with turning the expander. After expansion, the molars were banded, and the remaining teeth were bonded with 0.022” × 0.028” slot standard edgewise bands and MBT prescription brackets. Initially, both arches were leveled and aligned through thermo-activated NiTi wires: 0.012” NiTi, 0.016” NiTi, and 0.017” × 0.025” Nitinol wires. Progress X-rays and repositioning of bands and brackets were performed as needed to ensure root parallelism. Arch coordination was then attained with upper and lower 0.019” × 0.025” SS wires. These wires also leveled the Curve of Spee, uprighted the posterior teeth buccolingually, intruded the lower anterior teeth, and coordinated the arches. Residual spaces were closed with power chains, and detailed bends were made. The patient was debonded after finishing and detailing, and retainers were delivered. The retainers provided were upper removable wrap-around Hawley and lower fixed lingual retainers.