Case Lb

A female patient, 11.5 years old, with near average MM angle of 29°, slight Class Ml skeletal bases (ANB 1°) and a deep bile. Lower incisors were retroclined and crowded.

All permanent teeth were developing, and there was a possible supernumerary tooth in (he upper right third molar region. T he patient was informed that surgical uncovering of the upper canine crowns might be needed during treatment.

It was planned to treat the case without extractions. Mid-sized brackets were placed with a .014 sectional steel upper wire, and a .016 lower round I IANT wire to commence tooth movements. The patient was asked to wear a sleeping combination headgear. An upper acrylic removable bite plate was supplied for full-time wear.

Fig. 5.49

L.B. Beginning 11.5 years 5/10/96

SNA / 78 • SNB / 77 • ANBZ 1 0 A-N _ FH -2 mm Po-N FH -6 mm WITS -5 mm GoGnSN 37 ° FM / 27 " MM / 29 ° 1 to A-Po 5 mm 1 to A-Po -1 mm 1 to Max Plane/110 ° 1 to Mand Plane - 76 °

L.B. Beginning 11.5 years 5/10/96

ui After 3 months of treatment, a .016 lower steel round wire is in place, with coil springs to recreate space for lower canines,

> and procline and align lower incisors. Brackets adjacent to the n springs are lied to prevent rotations.

O 73

A sequence of slides of the right side of the treatment after 10 O months, 18 months, and 21 months, showing creation of

O upper canine space and then bonding of a button after

X uncovering. During treatment, lower right central and both m upper first premolar brackets were repositioned.

Normal .019/.025 rectangular steel wires in place after 22 months of treatment. The patient was asked to wear light Class II elastics at this stage. Some lower arch enamel reduction was carried out.

The recommended settling protocol was followed with a sectional upper .014 wire and a .016 11 ANT lower wire.

The case after appliance removal.

The patient was referred for a surgical opinion concerning the third molars and the supernumerary tooth.

Growth was mainly vertical during the treatment period. Upper incisors were at ideal positions, with lower incisors slightly overcorrected.

SNA 77 ° SN8 76° ANB/ 1° A N FH -3 mm Po-N FH -9 mm WITS -4 mm GoGnSN 39 • FM / 29 ♦ MM 32 • 1 to A-Po 9 mm 1 to A-Po 6 mm 1 to Max Plane 114° 1 to Mand Plane 88 °

Mand. Symphasis & Mand. Plane


Palatal Plane & Palate Curvature


L.B.Final ui


cd cd


A male patient, aged 13.6 years at (he start of treatment, with MM angle 31 ° and Class I dental bases.

Dentally, there was anterior and posterior crowding, with large third molars developing. Arch form was assessed as ovoid. It was felt that extraction of four premolars would be required in order to achieve a satisfactory and stable result in this case. A decision was made to extract the first premolars; although the second premolars were slightly small, they were consistently so and therefore good upper and lower tooth fit could be anticipated at the end of treatment.

The treatment was managed as a maximum anchorage case, and standard metal brackets were used for optimal control. Lacebacks and bendbacks were used in all four quadrants, with a lower lingual arch and an upper palatal bar to restrict molar movement during tooth alignment. Upper archwire was .016 HANT. Lower archwire was .015 multiStrand, with offset bends for the buccally placed lower canines. The upper left canine bracket was lassoed with a module.

Fig. 5.74
Fig. 5.77
Fig. 5.80

J.N. Beginning 13.6 years 8/21/96

J.N. Beginning 13.6 years 8/21/96

SNA 79 ° SNB / 76 ° ANB/ 3• A-N FH -2 mm Po-N FH -4 mm WITS 0 mm GoGnSN 36° FM / 27 ♦ MM / 31 • 1 to A-Po 6 mm 1 to A-Po 1.5 mm 1 to Max Plane 107 ° 1 to Mand Plane/ 92 °

scanned by UST team

tn Occlusal views at the start of treatment show the lower lingual arch and upper palatal bar, with lacebacks in place to control

> and then retract the canines.

Sequential views of the right side of the case 2 months, 4 months, and 6 months into treatment. In the upper arch, the O initial .016 11ANT wire was followed by a rectangular WANT

O wire and then a .019/.025 rectangular steel wire. In the lower x arch, a rectangular IIANT wire was placed after 4 months, and m continued in use at 6 months. The lower right canine was m retracted with lacebacks, and the upper canine simultaneously

=; moved distally (p. 101). This provided a small amount of

O additional anchorage during tooth leveling and aligning.

¡7) After 9 months of treatment, upper and lower steel rectangular wires are in place and space closure is continuing.

Occlusal view at 9 months. Full upper space closure will not be possible until more palatal root torque of the upper incisors has been achieved (p. 284). During tooth leveling and aligning, it is convenient to have a checklist which includes lacebacks, anchorage support, archwire size and engagement, bendbacks, and protection. 'Protection' refers to protection of (he appliance and archwires in the early stages of treatment, as well as protection of the patient's soft tissues from sharp aspects of the appliance, such as distal ends of the archwire which have not been properly turned in.




Anchorage support

Archwire size and engagement




Fig. 5.101

Fig. 5.104

After 1 year of treatment, lower second molars were banded after suitable separation and upper first molars were rebanded. Rectangular upper and lower HANT wires were placed with lacebacks to prevent extraction spaces reopening during re-leveling and aligning.

Occlusal views 12 months into treatment show the need to correct the position of the lower left second molar. Rectangular IIANT wires are very effective in achieving tooth movements of this type in this region. They give good control and do not distort in response to masticatory forces.

Fig. 5.101

Fig. 5.104

After 19 months of treatment, settling was commenced using .014 round wires in both arches and up-and-down elastics. The patient was checked at 2-weekIy intervals for approximately 6 weeks.

The case after 16 months of treatment. Normal upper and lower rectangular steel wires are in place and upper incisor torque is improving. Upper anterior teeth were tied with .010 wire ligatures to obtain full expression of the bracket system (p. 20).

Fig. 5.106

Fig. 5.103

Fig. 5.100

Fig. 5.102

Fig. 5.105

Fig. 5.100

Fig. 5.103

Fig. 5.106

Fig. 5.109

Fig. 5.113

Fig. 5.110

Fig. 5.116

The case after removal of appliances. Active treatment time was 22 months and conventional retainers were used, with

> the lower bonded retainer extended onto the lower second n premolars to prevent lower extraction spaces reopening.

The panoral radiograph confirms that there is adequate space q for the developing third molars, and that the upper canine

O root positions are favorable, relative to the second premolar

X roots, owing to the 8° of lip in the canine brackets.

During the treatment period, considerable Class 111 growth occurred, with a final ANB angle of 1 The facial profile shows pleasing balance and harmony.

Fig. 5.116

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