Multiloop Edgewise: Weaving Bite Harmony In Turner's Smile

This case report presents the orthodontic treatment of a Turner syndrome patient with posterior crossbite, Class II malocclusion, and moderate open bite, whose chief complaint was poor dental occlusion. Systemic medical history revealed a diagnosis of Turner syndrome. Previous studies indicate that such patients commonly exhibit Class II facial profiles with mandibular retrognathism, increased overjet, and occasional open bite. This patient also presented with a high palatal vault and narrow maxillary arch, contributing to posterior crossbite, potentially associated with chronic mouth-breathing habits. Treatment employed multiloop edgewise archwires (MEAW) without auxiliary anchorage. The protocol included (1) distal uprighting and intrusion of mesially inclined maxillary molars to address open bite and establish Class I molar relationships; (2) long Class II elastics to reduce overjet and achieve neutral occlusion; (3) archwire expansion combined with comprehensive arch alignment to resolve posterior crossbite; (4) differential anterior retraction for midline correction; and (5) orofacial myofunctional therapy improves muscle function for lasting results. The total treatment duration was 21 months. Post-treatment evaluation demonstrated neutral canine and molar relationships, aligned dental midlines, normalized anterior overbite/overjet, and an improved straight facial profile. Retention outcomes remained satisfactory at the 18-month follow-up. The case highlights that simplified appliance systems can successfully manage complex malocclusions in syndromic patients when combined with targeted functional guidance to ensure long-term stability.