ortho the international C.E. magazine of orthodontics

16 I I C.E. article_ Bent Wire System space. Soft-tissue analysis showed a mouth-open posture and hyperactive peri-oral musculature. It was considered the myofunctional habits were a contributing factor to the malocclusion and, thus, a suitable case for the BWS and Trainer combination prior to fixed appliances once the permanent denti- tion was fully erupted. The plan of treatment involved a first phase with a BWS for the upper arch combined with an I-2n Trainer — “n” for no core or cage for increased flex- ibility and use with the BWS. The i-2n Trainer was used one hour daily plus overnight while sleeping. Monthly adjustment to the activating loops of the BWSweremadeinincrementsof1-2mmpermonth. This treatment was continued for four months, afterwhichtimetheupperBWSwasremovedandi-2 Trainerwasusedtomaintaintheexpansionachieved by the BWS. The i-2 Trainer also encouraged the tongue to as- sist in maintaining the maxillary expansion without retainers. At this stage, the lower arch form and dental alignment was assessed and showed con- siderable improvement. It was noted the space for the lower left permanent canine had increased — an effectthoughttobeproducedbythecombinationof maxillaryarchexpansionandcorrectionofmyofunc- tional habits. The midlines were also self-correcting. Space for the lower canines was ultimately achieved withoutalowerBWS.Thecaseisfurtherimprovedby continued use of the i-2 Trainer and the Myobrace Regular™toexploittheeruptionstagepriortotreat- ment finalization with fixed appliances as required. The observation of the effects and benefits of the BWS Orthodontic System are evident from this case, and the concepts are not new to orthodontics. Maxillary expansion tends to also improve the lower archlengthandassiststheorthodontistinachieving non-extraction outcomes with more stable results because of simultaneous correction of tongue posi- tion and retraining of the peri-oral musculature. The second phase of treatment did not require the BWS on the lower arch because arch development during the treatment period sufficiently opened the space for the lower permanent canine. The lower anterior dentition did not require the use of fixed appliances (Fig. 7a–7d). Thus, this case was treated during a 2-year period, required minimal chair side time, and a difficult extraction case was converted to a simple, non-extraction case. _Case No. 2 This 12-year-old female patient consulted be- cause of very underdeveloped maxillary arch form ortho2_2012 Fig. 7c Fig. 7d Fig. 7a Fig. 7b