Management of anterior and posterior crossbites with lingual appliances and miniscrew-assisted rapid palatal expansion: A case report.

RATIONALE

Current literature describes only 2 cases combining miniscrew-assisted rapid palatal expansion (MARPE) with lingual appliances. These cases require 2 impressions, 1 before and 1 after palatal expansion, to ensure accurate lingual appliance placement, potentially increasing treatment time and cost. This case report aimed to demonstrate a modified workflow of combining MARPE and lingual appliances in managing an adult patient with anteroposterior and transversal discrepancies, requiring only a single digital impression for both fabrication and positioning.

PATIENT CONCERNS

A 29-year-old female presented with anterior and posterior crossbites, a class III skeletal relationship, and maxillary constriction. The patient desired a nonsurgical and esthetic treatment approach.

DIAGNOSES

The patient was diagnosed with a class III malocclusion with anterior and posterior crossbite on a skeletal hypodivergent class III relationship and upper posterior constriction.

INTERVENTIONS

Treatment included MARPE for skeletal expansion, digitally planned lingual appliances for tooth alignment, and lower arch distalization for class III correction. A modified appliance sequence was utilized for optimal expansion retention and lingual bracket transfer accuracy.

OUTCOMES

The treatment successfully corrected the crossbites, improved dental and facial esthetics, and achieved partial skeletal correction.

LESSONS

The combination of MARPE and lingual appliances offers a viable treatment alternative that prioritizes both esthetics and effective skeletal expansion for nonsurgical and esthetic management of adult class III malocclusion with maxillary constriction. The modified workflow, employing a single digital impression, may offer several advantages, including reduced treatment duration and associated costs, prolonged postexpansion retention, and minimized aesthetic impact of midline diastema.