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By J. Sandy

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Posterior buccal capping can also be used to disengage the bite and prevent concomitant expansion of the lower arch. Once the cross bite is corrected the buccal capping can be removed and the appliance used as a retainer to allow the buccal occlusion to settle in. Occasionally two appliances will be needed if a considerable amount of expansion is needed. qxd 04/12/2003 14:31 Page 12 PRACTICE 12 Fig. 5a Narrowness of the upper arch can produce a traumatic bite Fig. 5b To avoid painful cuspal contact the patient may move the mandible to one side producing a mandibular deviation and a cross bite Fig.

Carious teeth should be restored and the periodontal condition and oral hygiene should be excellent before treatment starts. BRITISH DENTAL JOURNAL VOLUME 195 NO. 12 DECEMBER 20 2003 Fig. qxd 13/11/2003 11:03 Page 684 PRACTICE Fig. 2 The importance of keeping extraction patterns symmetrical is demonstrated. The lower arch crowding has been dealt with by removal of two lower premolars. The loss of the corresponding upper premolars means the molar relationship at the end of treatment should be Class I Providing the lower incisors are well aligned, achieving this will generally produce sufficient space to align the upper incisors.

If extractions are undertaken in the lower arch these should generally be matched by extractions in the upper. If no extractions are carried out in the lower arch the space for upper arch alignment may come from either distal movement of the upper buccal segments or extraction of upper premolars. The choice depends on the space requirements and the buccal occlusion. As the degree of crowding and overjet increase, then the space requirements will also increase and it is more likely that extractions as opposed to distal movement will be indicated.

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