Case Al

The following case shows an example of a patient with a tapered arch form and prominent canine roots at the start of treatment.

This 15.5-year-old female patient was Class I skeletally, with a high-angle vertical pattern. From the frontal aspect, she had a narrow facial appearance, with some mandibular asymmetry to the left. Lower incisors were retroclined at 78" to the mandibular plane to the mandibular plane and at APo -1 mm. The facial profile was pleasing and harmonious.

Dentally, the patient was Class 1 in the buccal segments. The centric occlusion and centric relation were coincident, with no displacements at terminal closure. There was mild crowding of the upper and lower incisor regions, and notable prominence of the canine roots. Upper and lower midlines were coincident. There was a small amount of enamel damage to the incisal edge of the upper right central incisor.

The facial appearance was reflected in the arch form, which was narrow and tapered. There were extensive, but not deep, restorations in first and second molars. There was a lack of space for the third molars, with impactions on the left side, and a supplemental upper left third molar. It was decided to extract all the third molars. The mild crowding would be resolved by torqueing and uprighting of the buccal segments and slight proclination in the lower incisor region. The selected arch form would be tapered, which would maintain the basic form of the patient's dental arches.

Standard .022 metal brackets were placed. The upper and lower canine brackets were inverted, to maintain the canine roots in bone. All the teeth, including second molars, were banded or bracketed. The opening wires were .016 HANT to an ovoid arch form.

A.L. Beginning 15.5 years 9/20/95

A.L. Beginning 15.5 years 9/20/95

1 to A-Po -1 mm 1 to Max Plane/101 ° 1 to Mand Plane. 78 °

The .016 11ANT wires in the ovoid form were followed by .010/. 025 rectangular 11A NT wires, with the selected tapered > arch form. The .019/.025 rectangular HANT wires had the n effect of torqueing and uprighting (he buccal segments (Fig.

-n 4.40) as a result of the reduced torque specification of the

O appliance system in lower premolars and molars. This in turn provided additional space for anterior alignment. The earlier decision to invert the canine brackets allowed good control of the canine roots during the leveling and aligning stages.

The .019/.025 rectangular HANT wires were followed by .0I9/.025 rectangular stainless steel wires, with tapered arch form, and with soldered hooks. The patient wore light Class II elastics for a short period, to reduce a small overjet which had developed. The .019/.025 rectangular stainless steel wires were maintained during the middle and later part of the treatment. It was felt that the patient's arches had become a little loo ovoid during the alignment stage, and the .019/ 025 stainless steel wires were carefully maintained in the tapered form, to narrow the arches slightly. The occlusal views at the end of treatment show that this was achieved.

Late in the treatment, the referring dentist requested enamel reshaping of the incisal edge of the upper right central incisor. This was followed by repositioning of the incisor bracket, and then re-leveling and aligning using a .014 steel wire. In the lower arch, a .016 IIANT wire was used to commence settling of the case.

scanned by UST team

scanned by UST team

Selective up-and-down elastics were used with light wires during the settling stage. The light wires allowed settling of the arch form.

A pleasing dental result was achieved. The canine crown and root positions result from the bracket specifications used in this case. These were +7° torque and 8° tip in the upper, and +6° torque and 3° tip in the lower.

A lower bonded retainer and an upper removable retainer were used. The tapered arch form was suitable for this case because it relates to the patient's starting lower arch form and is appropriate for her narrow facial appearance. Early in the treatment the arch form became a little too ovoid, but the steel rectangular wires were successfully used to restore and maintain the tapered shape into the final result.

Facially, the patient was similar to the starting appearance, which was very satisfactory. Dentally, there was a change in angulation of the lower incisors, with 1mm of proclination towards APo, and this helped to resolve the lower anterior crowding.

mm mm mm

mm mm mm

SNA < 78 SNB / 75 AN8 -C 3 A-N FH -1 Po-N ; FH -2 WITS 0 GoGnSN 43 FM / 31 MM 38 1 to A-Po 3 1 to A-Po 0 1 to Max Plane/102 1 to Mand Plane< 85

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