Fig 2. Lateral Xray showing a concave profile
Fig 3 & 4. End of the mixed dentition stage: most of the permanent teeth have erupted, save the left upper canine, the left lateral incisor and the second bicuspids and second permanent molars)
There is stil a crossbite and the profile is concave (retruded upper jaw).
The profile cannot be corrected and improved by orthodontic means only: a surgical intervention (Lefort I osteotomy) will need to be planned and performed. It will be performed at the end of the pubertal growth period and the teeth will have to be prepared for this intervention with the help of a full fixed appliance (braces).
Fig 5 & 6 Extra-oral appearance before surgery
Fig 7 Presurgical orthodontic preparation
Fig 8 Lateral Xray showing the pre-surgical facial appearance (concavity of the profile)
Fig 9 Lateral Xray showing the post-surgical appearance, after advancement osteotomy of the upper jaw and push-back of the mandible. Please note the screws and plates that serve as rigid fixation, The teeth are now in good relationship, esthetically as well as functionally.
Fitg 10-11-12 Final result
Georges Herzog, consultant orthodontist of the CLP teams of the CHUV (Lausanne) and HUG (Geneva), contact: firstname.lastname@example.org