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Dr. Higgins Cases

 

1. Completed Xbow Two Phase Cases

2. Completed Xbow One Phase Only Cases

3. Extraction Cases

4. Non-extraction Cases (Deep Overbite,Without Xbow)

5. Surgery Cases

6. Adult Cases

7. Lower Incisor Alignment

 

All images are the property of Dr. Duncan W. Higgins and cannot be copied or reproduced

without the consent of Dr. Higgins.

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1. Completed Two Phase Cases

The following patients were treated by Dr. Duncan Higgins

 

 

 

Initial

1. Xbow (springs for 4 months) 2. RME (part of Xbow) 6 months 3. full braces 12 months. 22 months total

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Initial

1. RME X 6 2. Xbow with right spring only 3 months 3. Full braces 11 months

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After RME, Lower Lingual Arch

Upper RME X 6, Xbow (springs for 6 months)

10 months full braces

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1. Xbow (springs for 5 months) 2. RME 3. Full braces for 12 months

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1. Xbow (springs for 4 months) 2. RME 3. full braces for 13 months

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1. RME X 6 2. Xbow (left spring for 2 months, right spring for 5 months) 3. full braces for 11 months

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initial

1. 2X6 RME 2. Xbow (springs for 2 months)

14 months full braces

Upper lip preservation with a convex profile and obtuse naso-labial angle, non-extraction in a crowded Class II deep overbite patient

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Initial

1. Upper 2X6/RME (Max TAP) 2. Xbow 4 months 3. Full braces 9 months

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Before

1. Xbow: left spring 3 months, right spring 5 months___2. RME (compensatory upper jaw expansion)

3. replace springs for 3 months___After photos taken 2 months after Xbow removal.

After 14 months full braces.

 

5 years post deband

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Initial

5 months Xbow followed by 11 months braces

 

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Before

1. Xbow 4 months 2. Compensatory maxillary expansion 3. Replace springs 4 months 4. More maxillary expansion

Photos taken 6 months after spring removal. No braces have been used yet. Cephalometric radiographs below.

Initial___________________________________Post Xbow

8 months full braces after Xbow

2 years after deband

6 years post deband

 

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xbow

Before

xbow

6 months Xbow (9 months after Forsus spring removal)

xbow

11 months braces (2 years after Forsus spring removal. No headgear or Class II elastics were used)

4 years after deband, 6 years after Forsus spring removal

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Initial

 

4 months Xbow followed by compensatory maxillary expansion followed by 10 months full braces

2 years post deband

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Before

After 8 months Xbow, no expansion needed, after photos taken 1 month after springs removed, cephs below

12 months braces

4 years post deband

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The following patient had biilateral impacted maxillary canines complicated by an asymmetric Class II.

Before

After Xbow 3 months spring left, 5 months spring right, no braces to this point and no surgical exposure of canines

Above case before, note full cusp Class II bicuspid right, Class I bicuspid left, midlines off, primary maxillary canines

After 5 months Xbow followed by 12 months full braces

6 years post deband

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Initial

After upper incisor alignment, day of Xbow insertion

After 3 months of Xbow followed by compensatory maxillary expansion,

now will retain expansion and test Class II correction for 5 months before removing appliances.

Ready for phase 2 braces

8 months braces

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Initial, impinging overbite

1. Upper 2X6 and posterior bite openers, 2. 6 months Xbow followed by compensatory maxillary expansion,

now hold expansion and test Cl II correction for 5 months

 

12 months braces

3 years post deband

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Initial

Progress after Xbow, maxillary expansion, and upper canine alignment

Initial__________________________________Progress after 2X4 followed by 4 months Xbow

______________________________________followed by maxillary expansion

Progress after canine alignment______________Progress after 6 months braces

Initial_________________________________Progress after 6 months braces

 

10 months full braces

2 years post deband

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This high angle patient presented with a half cusp Class II bicuspid relationship and a bicuspid openbite on the right side.

 

.The Xbow RME was cemented as well as an upper 2X6 due to the lingually blocked lateral incisors.

Once the anteriors were aligned the Triple "L" Arch and springs were placed.

The springs were on for 3 months before compensatory maxillary expansion was started.

The expansion was retained for 5 months before the appliance was removed and an upper Essix retainer was delivered.

10 months braces

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Before

1. 4 upper incisor brackets followed by Xbow, springs for 3 months. 2. Full braces for 1 year

This case shows the importance of non-extraction treatment and not retracting the upper lip in a Class II patient with a convex profile.

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Initial

1. Xbow 4 months____ 2. RME____ 3. Replace left spring one month____ 4. 12 months braces

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Initial

Max TAP followed by Xbow for 4 months with compensatory maxillary expansion followed by 15 months full braces

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Initial

After 5 months Xbow followed by maxillary expansion followed by 12 months braces

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Initial

Xbow 4 months right spring, 5 months left spring, followed by compensatory maxillary expansion,

photos taken 7 months after spring removal

14 months full braces, day of deband

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Initial

Upper 2X6, 5 months Xbow followed by 10 months full braces

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Initial

5 months Xbow followed by compensatory maxillary expansion followed by 10 months full braces (no elastics worn)

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Initial

Upper 2X4 and 5 months Xbow followed by 12 months full braces

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Before

Xbow with springs for 4 months right and 5 months left followed by compensatory maxillary expansion,

followed by 10 months full braces.

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Initial

Xbow with springs for 4 months, followed by compensatory maxillary expansion, followed by 15 months full braces

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Initial

Xbow with springs for 3 months, followed by compensatory maxillary expansion, followed by 9 months full braces

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initial

Xbow overcorrection. Day of right spring removal. Left spring removed a month previously.

Left spring was on for 3 months. Right spring was on for 4 months.

Day of Xbow removal after one month settling. Note profile improvement.

After 10 months braces

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Initial

Xbow installation

After 5 months springs and settling

Xbow removed, waiting for complete eruption of all permanent teeth before indirect bonding

7 months braces

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initial

Xbow 6 months right spring, 8 months left spring, compensatory maxillary expansion, 12 months braces

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initial

1. Upper 2X4 2. Xbow 3 months 3. compensatory maxillary expansion 4. Full braces 11 months

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Initial

1. maxillary expansion 2. Xbow with springs for 5 months 3. compensatory maxillary expansion 4.13 months braces

 

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initial

 

1. Partial upper braces

2. Xbow for 5 months

3. Maxillary expansion

4. 15 months full braces

_

profile change in short lower facial height

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initial, requires Class II correction and space opening for build-ups of upper lateral incisors

Xbow 5 months right spring, 7 months left spring, compensatory maxillary expansion, full braces 9 months,

composite build-ups on lateral incisors, ready for permanent crowns

 

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Initial (missing lower second bicuspids)

1. Xbow 4 months, compensatory maxillary expansion. 2. 15 months full braces

(includes time waiting for lower third molars to erupt enough to bracket and extrude)

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Initial

1. 6 months Xbow, 2. 13 months full braces

Initial ________________________________Post Xbow____________________________Final

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Before

1. Upper 2X4

2. Xbow 4 months (mesial entry\shorty hook-up), day of spring removal and start of compensatory maxillary expansion

Note first bicuspid overcorrection from half cusp Class II to half cusp Cl III (as well as overjet correction) in 4 months.

 

6 months post springs, Waiting for full edgewise appliance, bite turbo, and Class II elastics to correct deep overbite.

After 7 months full braces

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This next patient is an example of upper anterior crowding where the molars are Class I

but the bicuspids are a half cusp Class II and the upper canines are blocked out and a full cusp Class II.

This required an upper 2X6 appliance to align the anteriors before the placement of the Triple "L" Arch and springs.

Initial

After upper alignment and Xbow correction to Class I bicuspid. Leave springs on to over-correct.

Day of spring removal after over-correction. Springs were on for 4 months.

RME and 2X6 with upper second molar mini tubes on bicuspid bands___.016X.025 SS anterior segment

(Use active retraction of upper incisors with a continuous archwire as little as possible to avoid root resorption.)

Day of appliance removal and placement of upper Essix retainer, bicuspid Class I, ready for indirect bonding of full braces.

7 months braces

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4 months Xbow plus maxillary expansion followed by 10 months braces

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1. Upper 2X4____ 2. 3 months Xbow____ 3. maxillary expansion____ 4. 14 months braces

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Before

After 8 months Xbow and 12 months full braces

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initial

1. Upper 2X4 with high torque brackets on central incisors

2. Xbow with springs for two and a half months

3. Compensatory maxillary expansion (RME part of Xbow)

4. Full braces for 6 months.

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Before

4.5 months Xbow followed by 14 months full braces.

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Before

1. Upper 2X4 (4 upper incisor brackets) 2. Xbow 5 months 3. RME (upper jaw expansion)

12 months full braces

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Before

Xbow 3 months

12 months full braces

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Before

6 months Xbow followed by 10 months full braces

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Before

Xbow 4 months (6 months after Forsus spring removal)

11 months full braces

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Initial

1. Upper 2X4, Xbow, 5 months springs, maxillary expansion, replace left spring 2 months, 2. 19 months braces

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Initial

4 months Xbow followed by maxillary expansion followed by 19 months full braces

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initial

After Xbow with springs for 3 months followed by maxillary expansion and then right spring replaced for 2 additional months

12 months full braces

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initial

 

Xbow with springs for 5 months followed by maxillary expansion then 15 moths full braces

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initial 19 years

Xbow with springs for 7 months followed by 8 months full braces

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Initial (1999)

Post Xbow

Pre Phase 2 full braces

Final (2006)

10 years post deband

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Here's a difficult case that took a bit longer in full braces

Initial

5 years post RME

1. Xbow with springs 5 months 2. RME (part of Xbow)

17 months full braces

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Initial

1. RME X 6 __________2. Xbow 5 months_____________3. 15 months full braces

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Initial

1. Xbow 4 months___________2. Compensatory maxillary expansion____________3. 17 months full braces

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Initial

1. RME X 4 2. Xbow with springs for 7 months 3. Full braces for 14 months

Opening the bite and proclining upper and lower incisors enhanced the lips

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2. Completed One Phase Only Cases

1. RME X 6 2. Xbow (springs for 3 months)

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After upper partial braces and Xbow with springs for 3 months followed by maxillary expansion

Dr. McDonald removed third molars and exposed the impacted central incisor and right canine

Waiting for the upper second molars to erupt before determining the need for full braces

 

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modified Triple "L" Arch to open space for impacted second bicuspid

after over-correction and spring removal (springs for 4 months)

1. RME 2. Xbow (springs for 4 months, after settling)

final after full braces

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initial

2 years after maxillary expansion

partial upper braces and Xbow with springs for 3 months followed by maxillary expansion,

Full braces have not been used

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Initial

Upper 2X6, 4 months Xbow, ready for maxillary expansion

11 months after spring removal, full braces have not been used

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Initial, posterior crossbite and anterior crowding

4 years after maxillary expansion

Xbow with springs removed after 3 months, followed by compensatory maxillary expansion, no braces used, photos taken 2 years after Xbow removal

Initial_________________________________4 years after maxillary expansion_____________2 years after Xbow, no braces used

 

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initial

1. RME 2. Xbow 3 months 3. RME

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Before

Xbow

Xbow 6 months. After photos taken 14 months after spring removal. No braces have been used.

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Before

1. Upper 2X4 (4 incisor brackets) 2. Xbow 4 months 3. RME (compensatory upper jaw expansion)

After photos taken 7 months after Forsus spring removal. Full braces were not used.

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xbow

Before

xbow

1. Upper 2X4 (four incisor brackets) 2. Xbow 4 months (11 months after Forsus spring removal,

Full braces have not been used)

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xbow

Before

xbow

1. Upper 2X4 (4 incisor brackets) 2. Xbow 4 months

(7 months after Forsus spring removal. Full braces have not been used)

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Initial (first bicuspid relationship 1mm Class II right, 4mm Class II left)

Treated by Xbow only without any braces. Springs were placed on both sides for 4 months followed by compensatory maxillary expansion.

The left spring was replaced for 3 more months and then removed to allow rebound. The appliance was debanded one month later.

The teeth were allowed to settle for an additional 2 months.

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Initial

1.Xbow 4 months followed by compensatory maxillary expansion, 2. Replace right spring for 4 more months,

Photos taken after 2 months settling.

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Extraction Cases

 

Initial

15 months braces

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Initial

11 months braces and four bicuspid extraction

 

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Initial

15 months four bicuspid extraction

.

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initial

12 months total treatment time with four bicuspid extraction and full braces

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Initial

15 months braces and four bicuspid extraction

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initial

15 months braces with four bicuspid extraction

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Initial

10 months braces

Vertical incisor/gingival change

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CBCT revealed the impacted incisor did not have a root so Dr. McDonald removed

it and exposed the canine which was moved into the central position to eventually

be restored to match the adjacent central. The maxillary right first bicuspid was

removed to treat the Class II on that side.

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Initial, missing lower second bicuspids, retained primary second molars, decision to extract and close spaces

18 months braces

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Initial, missing upper lateral incisors, retained right primary canine, decision to extract and close spaces

13 months braces

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Initial

16 months braces

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Initial

16 months braces, note profile improvement with extractions

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Initial

15 months braces (extractions included impacted lower canine)

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Initial, missing upper lateral incisors

17 months braces

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Initial

Extract impacted upper canines and lower left second bicuspid, 20 months braces

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Initial

Removed impacted upper left lateral incisor, 16 months braces

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Initial, missing upper lateral incisors and two lower incisors

19 months braces

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Non -extraction cases

Initial

16 months

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15 months full braces

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Initial

18 months full braces

 

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Initial

18 months full braces including surgical exposure of the maxillary left canine, 9 months after deband

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10 years old________________16 years old_________________5 months alignment

10 years old______________16 years old______________5 months alignment

10 years old

16 years old

14 months braces, normal incisor proclination for a short lower facial height patient

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The following case shows alignment of an ectopically erupted upper left first bicuspid. There were no open coil springs used.

Day of indirect bonding and placement of .012 niti________________________________________Final

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Surgery Cases

Thanks to Dr. Bill McDonald, Oral and Maxillofacial Surgeon

Class II

Class III

Two Jaw Advancement

 

Initial ____________________________15 months total treatment time

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Initial

16 months

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2 years braces and lower jaw advancement surgery, two lower bicuspids extracted to allow retraction (decompensation) of lower incisors and lip

 

Initial

17 months braces and mandibular advancement surgery

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Full braces and mandibular advancement surgery

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Full braces and lower jaw advancement surgery, two lower bicuspids were extracted and the lower incisors were retracted (decompensated)

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Initial

18 months, two lower incisors extracted and mandibular advancement surgery

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Initial

After 14 months including two jaw advancement surgery

 

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12 months braces with maxillary and mandibular advancement surgery to restore profile

after bicuspid extraction and braces for dental retraction as a teen

Superimposition of before and after ceph tracings

 

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Initial

24 months braces and lower jaw surgery

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Initial twin sister

23 months braces and lower jaw surgery

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Initial

18 months, including lower extractions and space closure to upright lower incisors, lower jaw advancement surgery

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initial

20 months total treatment time including space closure of upper lateral incisor

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Above patient's twin brother

Initial

20 months

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Initial

15 months braces and two jaw surgery

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Initial

13 months braces including lower jaw surgery

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Adult Cases

12 months full braces

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Initial

15 months braces, extract four second bicuspids and four third molars

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initial

13 months full braces

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9 months braces

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Initial, missing two upper lateral incisors and two lower central incisors, three retained baby teeth

19 months braces

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Initial

7 months braces

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Initial

14 months braces

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Initial

12 months braces

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Initial

12 months braces

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Initial

18 months braces including interproximal reduction to reshape incisors

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The following is an example of adult expansion with some severe rotations.

Initial

Total treatment time: 24 months

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Initial

Final, 14 months full braces, Class II elastics, interproximal reduction of incisors

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The following is an example of rapid alignment followed by interproximal reduction of the upper and lower incisors.

Total treatment time was 11 months.

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The following case is an example of rapid upper incisor alignment and interproximal reduction.

Initial

6 months total treatment time

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retained primary canine, Class II canine, midline discrepancy

_

20 months full braces

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Initial

After 7 months braces

 

Initial__________________________________After 7 months braces and interproximal reduction of incisors

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Lower Incisor Alignment

 

6 months total treatment time with lower incisor extraction

7 months total treatment time with interproximal reduction of lower incisors

8 months total treatment time with interproximal reduction of lower incisors

Unilateral buccal crossbite requiring lower arch uprighting

 

 

 

 

 

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