Background: Tooth size-arch length discrepancy (TSALD) is a consequence of disharmony between the size of the teeth and the space available to accommodate them in the dental arches, they are manifested in the form of either crowding or spacing. Crowding is the deviation in tooth position such as rotation, overlapping, tooth emergence inside or outside the dental arch and impaction due to the lack of space. Crowding may occur due to different reasons, for example, growth, maturation, aging of dentition, mesial drift, soft tissue pressures, and tooth morphology. The correction of severe mandibular crowding could be carried out by extraction, distalization, surgical and non-surgical expansion of the mandible.
Aim: The aim of this case report is to describe a novel method of non-surgical mandibular expansion.
Case report: This case report demonstrates a non-surgical dentoalveolar expansion by the use of a translingual force mandibular expander appliance (‘TORKO’ Leone rapid micro expander screw) for the correction of severe mandibular crowding with posterior bilateral scissor bite in an adolescent patient with reduced inter canine and premolar width. This is a case report first of its kind which demonstrates a severe crowding case treated by an expansion device and outlines the challenges faced in achieving well stable results.
Conclusion: The overall active orthodontic treatment lasted for 16 months, an expansion of 6 mm of inter-canine width is achieved. The one year follow up showed a stable mandibular arch following the treatment using TORKO appliance.
Clinical significance: In this case report we have discussed the concept of increasing mandibular inter-canine width in an adolescent patient presenting severe lower anterior crowding and the factors affecting its stability.
Ngan P, Alkire RG, Fields H Jr. Management of space problems in the primary and mixed dentitions. J Am Dent Assoc 1999 Sep;130:1330-1339.
Shah AA, Eleock C, Brook AH. Incisor crown shape and crowding. Am J Orthod 2003 May;123:562-567.
Van der Linden FP. Theoretical and practical aspects of crowding in the human dentition. J Am Dent Assoc 1974 Jul; 89(1):139-153.
Baume LJ. Physiological tooth migration and its significance for the development of occlusion-I. The biogenetic course of the deciduous teeth. J Dent Res 1950 Apr;29(4):440-447.
Dale JG. Guidance of occlusion: serial extraction in Orthodontics. In: Current principles and techniques. Editors, Graber TM, Swain BF, Publisher: St Louis: Mosby, 1985, pp. 259-366.
Hadelman CS. Non-surgical rapid maxillary expansion in adults: a clinical evaluation. Angle orthod 1997 Aug;67(4): 291-305.
Wallis C, McNamara C, Cunningham SJ, Sherriff M, Sandy JR, Ireland AJ. How good are we at estimating crowding and how does it affect our treatment decisions? Eur J Orthod 2014 Aug;36(I):65-70.
Conley R, Legan H. Mandibular Symphyseal Distraction Osteogenesis: Diagnosis and Treatment Planning Considerations. Angle Orthod 2003 Feb;73(1):3-11.
McNamara JA Jr, Brudon WL. Orthodontics and dentofacial orthopedics. Ann Arbor: Needham Press; 2001.
Kravitz ND. Treatment with the mandibular Arnold expander. J Clin Orthod. 2014 Nov;48(11):689-696.
Clark WJ. Transforce lingual appliances for arch development. J Clin Orthod 2005 Mar;39(3):137-142.
Moyers RE, Van Der Linden PGM, Riolo ML. Standards of human occlusal development. In: Craniofacial growth series, Manogram 5. Ann Arbor, Michigan, Center for Human Growth and De-velopment, University of Michigan.
Nance HN. The limitations of orthodontic treatment; mixed dentition diagnosis and treatment. Am J Orthod 1947 Apr;33:177-223.
Herberger RJ. Stability of mandibular intercuspid width after long periods of retention. Angle Orthod 1981 Jan;51: 78-83.
Myser SA, Campbell, PM, Boley J, Buschang PH. Long-term stability: Post-retention changes of the mandibular anterior teeth. Am J Orthod 2013 Sep;144(3):420-429.
Housley JA, Nanda RS, Currier GF, McCune DE. Stability of transverse expansion in the mandibular arch. Am J Orthod 2013 Sep;124(3):288-293.
Betts NJ, Vanarsdall RL, Barber HD, Higgins-Barber K, Fonseca RJ. Diagnosis and treatment of transverse maxillary deficiency. Int J Adult Orthodon Orthognath Surg 1995 Mar;10:75-96.
Harris FE. A longitudinal study of arch size and form in untreated adults. Am J Orthod Dentofacial Orthop 1997 Apr;111:419-427.
Marshall S, Dawson D, Southard KA, Lee AN, Casko JS, Southard TE. Transverse molar movements during growth. Am J Orthod Dentofacial Orthop 2003 Dec;124:615-624.
Glynn G, Sinclair PM, Alexander RG. Nonextraction orthodontic therapy: post-treatment dental and skeletal stability. Am J Orthod Dentofacial Orthop 1987 Oct;92:321-328.
Pune ky PJ, Sadowsky C, Begole EA. Tooth morphology and lower incisor alignment many years after orthodontic therapy. Am J Orthod 1984 Oct;86:299-305.