Jessica presented at 10 years of age with severe crowding, in the late mixed dentition.Both Jessica and her parents were very keen that her orthodontic problem should be dealt with soon and without extractions - she was therefore a case for arch development / non extraction treatment. The crowding was quite severe. Numerous deciduous teeth were still present and the permanent canines were coming through very crowded, in an out locked position. Note how the lower left canine is completely locked out of the dental arch, due to the severe crowding present.

Jessica is at an ideal developmental stage to commence non-extraction / arch development - several baby teeth are still present and the second molars are not yet through.The upper arch (second image below) was the least crowded but there was still not enough room to accommodate all the permanent teeth. The lower arch (third image below).

Treatment commenced with a lower lip bumper and an upper, removable appliance. The upper appliance was of the "Nudger" type and was designed to begin space creation by the distalisation (backward movement) of the first molars (third image below).

The lip bumper was assisted by intermaxillary elastics - these were worn at the same time as the headgear and produced very effective lower molar distalisation. Considerable space was created in both upper and lower arches.

After 13 months, the adult teeth had all erupted and the space was adequate. The case could then be finished with fixed appliances.

Four months with fixed braces produced excellent alignment.

The finished result after 17 months treatment.

The upper arch sequence

The lower arch sequence

The Orthodontists amongst us might like to see the before and after lateral skull radiographs, to ensure that there was no undesirable incisor proclination (first image).

In the second image below the before (black) and after (red) cephalometric tracings, superimposed on cranial base.

Again, demonstrating the lack of any unfavourable changes - a good result and a good profile!