In this study, it was found that the maxillary arch
of patients with HVDRR was significantly smaller in length, depth, and width when compared with their healthy controls.
Hawkins (9) (1969) observed that Class II, Division 1 malocclusions with adenoid facies could be attributed to predominantly mouth breathing, which would produce muscular imbalance, resulting in the narrowing of the maxillary arch
, protrusion of the maxillary anterior teeth, shortening of the upper lip and lower lip in a hypotonic condition.
According to Santoro Ayuob et al21 study findings, larger values of mean anterior ratio require either removal of tooth structure in the mandibular arch (inter proximal reencountering) or the addition of tooth structure in the maxillary arch
to achieve an ideal overjet and overbite.
The patient presented with failing teeth and mobile fixed restorations in the maxillary arch
indicating clearance of remaining tooth structure (figure 1).
As related in other studies, (2,4,9,20) the maxillary arch
and the central maxillary incisors were the most affected arch and teeth.
Mandibular arch was seen partially edentulous was more than maxillary arch
Therefore such inter arch mechanics should be considered only when the desired forces cannot be applied from within the maxillary arch
Radiographic assessment is essential for the practitioner managing the child patient so that eruption deviations can be handled with extraction of the infra-erupted primary molar and space management procedures, such as a lingual holding arch in the mandibular arch and a Nance space maintainer in the maxillary arch
2 On comparison of the arch dimensions of Class I and Class III significant difference was found in maxillary arch
depth while the rest of the arch dimension showed no statistically significant differences as in Table 2.
Severe crowding was present in the maxillary arch
and upper midline was shifted to right side.
On intra oral examination, a completely edentulous class I maxillary arch
with V shaped palate, a partially edentulous Kennedy's Class II mod I mandibular arch (missing teeth 36,37,46,47 and 48), a favourable floor of the mouth and a normal tongue were noted.
036 mils stainless steel transpalatal arch cemented on first molar along with soldered extended arms for further retention of whole maxillary arch