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Room of Truth—–Is Long-term Stability a Possibility? by Dr. R. G. Wick Alexander

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Overview

Although a conscientious practitioner can learn much from every case treated, certain patients can stand out and be unusually educated when they display unique conditions and then respond to treatment in manners not expected. Such a patient is presented here, a 16-year-old female with an extremely high angle, Class III skeletal pattern. Dentally, she was Class III molar relationship, right posterior crossbite, anterior open bite of four millimeters. She had a mandibular arch length discrepancy of five millimeters.


Examination and Diagnosis

The patient had an extremely vertical skeletal pattern (SN–MP of 49 degrees), a transversely constricted maxilla, a dental open bite (four millimeters) and a tongue thrust. Skeletal surgery (three piece maxilla) was discussed but we agreed to attempt treating the patient non-surgically and non-extraction.

Treatment Plan

Initially, a fixed palatal expander was used. The patient was instructed to turn the appliance every other day because of potential discomfort. She was also asked to squeeze her teeth together as often as possible. Rather than wear a facemask, she would wear Class III vectored “box” elastics.

Long-term Stability

Open bite malocclusions are difficult enough to maintain stability, but when adding Class III non-growing skeletal patterns, the challenge is even greater. Sixteen years post treatment, the patient continues with her “tongue exercises” and sleeps with a wrap-around retainer with a small hole in the anterior part of the acrylic where she places her tongue.1

Interestingly, the occlusion improved with time! Why? My assumption is that the final occlusion is in stable position with the oral and intra-oral muscular tissues functioning normally.

1. At her request, she continues to wear the bonded 3x3. This is common in most adult patients.

R.G. “Wick” Alexander is recognized internationally for his innovation in orthodontic procedures. He is well known for his work in designing the Alexander Discipline, a bracket system and orthodontic technique, which is used by orthodontists around the world. He has lectured internationally on the discipline as well as published 3 books, with another scheduled for 2005. He has many research papers and articles in professional journals. In addition to his traveling and teaching, he lives in Arlington with his wife, Janna. They have three children and twelve grandchildren. His sons Chuck and J. Moody continue the orthodontic legacy, along with his brother C. Moody and nephew, Cliff Alexander.
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