Case Do

An adult female patient, aged 19.11 years, with Class I dental bases (ANB 3°) and a slightly low-angle pattern (MM 23°). Upper incisors were retroclined at 97° to the maxillary plane, and lower incisors were retroclined at 84° to the mandibular plane.

Fig. 7.164

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The patient presented with a typical Class II division 2 malocclusion. The molar relationship was 1 mm Class II on the left and 5 mm Class II on the right side. There was an associated midline discrepancy of 3 mm.

The lower left second molar had been a source of chronic sepsis, and was considered to have a very poor prognosis. A decision was made to extract this tooth, together with the upper second molars and the lower right third molar.

The upper left second molar was extracted to balance the loss of the lower left second molar. The upper right second molar was extracted to assist treatment mechanics, to achieve a Class I relationship.

Fig. 7.164

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Fig. 7.170

D.O.Beginning 19.11 years 7/8/96

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Fig. 7.166

D.O.Beginning 19.11 years 7/8/96

SNA 83 ° SNB 80° ANB / 3 ° A-N FH 2 mm Po-N FH 1 mm WITS O mm GoGnSN , 29" FM ¿. 20 ° MM 23 " 1 to A-Po O mm 1 to A-Po -2 mm 1 to Max Plane' 97 • 1 to Mand Plane. 84 •

Fig. 7.176

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Fig. 7.179

At the start of treatment, all molars were banded and brackets were bonded on the remaining teeth. Additionally, ail upper acrylic removable bite plate was provided for full-time wear. The opening upper arch wire was .0175 mullistrand, with a bend in the upper left central incisor region to reduce force. 1'his was replaced I month later by a .016 HANTwire. During the first 2 months, a .016 HANT wire was used in the lower arch. The lower left first molar band was repositioned at the second adjustment visit.

Sequential views of the right side occlusion 2 months, 3 months, and 7 months into treatment. At 2 months, upper and lower rectangular HANT wires were placed, and the bite plate was discontinued. After 7 months, upper and lower rectangular steel wires were placed to complete correction of the overbite (p. 111).

Occlusal views of the case after 8 months of treatment. The patient was asked to wear full-time light Class II elastics to assist bite opening.

Fig. 7.173

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Reverse curves (p. 137) were added to the rectangular wires after they had been in place for 2 months. Addition torque was placed in the upper incisor region to assist bite opening.

Settling was commenced after 14 months of treatment, and .016 HANT wires were used for this. A Kobayashi tie was placed on the upper right canine, and the patient was asked to wear right side Class II elastics as necessary to maintain the buccal occlusion on that side and the midline correction.

A full upper .014 or .016 archwire is used when settling some Class II cases (p. 295). Such wires can be bent back behind molars to control the overjet.

The case after removal of fixed appliances and I month of further settling.

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Occlusal views of the case after band removal and 1 month of settling. It was agreed with the patient to monitor the development and eruption of the three remaining third molars.

Fig. 7.197

A subtle but pleasing improvement in the facial profile occurred as a result of upper and lower incisors being moved to more appropriate positions in the facial complex. During treatment the SNA angle increased from 83° to 84° (p. 170). SNB angle increased by 2° to 82° (p. 181).

Fig. 7.200

www.allislam.net Problem

Superimpositions confirm that most of the correction was obtained by dental change, although there was some mesial movement of pogonion during the treatment period.

Fig. 7.200

Fig. 7.203

SN at S

D.O. Begin

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Fig. 7.198

SNA 84 0 SNB 82 ° ANB /- 2' A-N FH 2 mm Po-N FH 2 mm WITS -3 mm GoGnSN 27 ° FM / 1 9 • MM 20 ° 1 to A-Po 5 mm 1 to A-Po 2 mm 1 to Max Plane 114 ° to Mand Plane 1 06 •

Fig. 7.199

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Palatal Plane & Palate Curvature

Mand. Symphasis & Mand. Plane

D.O.Begin

D.O.Final

Fig. 7.207

D.O. Begin

D.O. Final

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Fig. 7.209

Intraoral photographs after correction of the lower left third molar.

Intraoral photographs taken 19 months after completion of treatment show that the lower left third molar has erupted into a less than ideal position.

A lower lingual arch from first molar to first molar was placed, with a band on the lower left third molar. A section archwire was used together with a separating module to assist in uprighting the lower left third molar.

Fig. 7.209

Occlusal views of the case after completion of the orthodontic treatment. Upper third molars erupted into satisfactory position (p. 173).

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