Gnathological Treatment

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CASE LJ

An adult female patient, aged 23.1 years at start of treatment. The skeletal pattern was slightly Class II (ANB 5°) and low angle (MM 20°)

Fig. 7.38

The buccal occlusion was Class II bilaterally, with a deep bite and upper incisor crowding and rotations. All permanent teeth were present, including unerupted third molars. The possibility of a combined orthodontic/orthognathic surgical approach was discussed with the patient, but she wished to avoid surgery. Accordingly, a decision was made to extract all the third molars and the upper first premolars, and treat the case to a Class ii buccal occlusion.

All the teeth were banded or bracketed except the lower incisors. Lower incisor separation and enamel reduction were carried out.

Fig. 7.41
Fig. 7.44

L.J.Beginning 23.1 years 6/21/96

Fig. 7.39

L.J.Beginning 23.1 years 6/21/96

SNA

82

SNB

77

ANB

5

A-N

FH

3

mm

Po-N

FH

0

mm

WITS

3

mm

GoGnSN 30• FM 20 • MM /20 ° 1 to A-Po 6 mm 1 to A-Po 0 mm 1 to Max Plane,111 ° 1 to Mand Plane/ S8 °

After 5 months of treatment, lower first molar bands were repositioned. Upper and lower rectangular HANT wires are in place, and lacebacks have been discontinued.

After 2 months of treatment, upper and lower rectangular .017/.025 HANT wires are in place, with upper lacebacks to the canines. A lower right laceback is in place to assist with midline correction.

After 8 months of treatment, normal upper steel rectangular wires were placed, with passive tiebacks in the upper arch. Passive tiebacks (Figs 7.59 and 7.61) are normally placed for between four and six weeks. Active tiebacks (Figs 7.58, 7.62, 7.64) may then be used to achieve space closure and overjet reduction.

scanned by UST team

scanned by UST team

Normal settling procedures were followed, and the case is seen here after 20 months of treatment.

The case after one month of settling.

One year into treatment, and upper space closure with torque control is being achieved with active tiebacks and a steel

> rectangular wire.

33 rn

> After 15 months of treatment, upper space closure was almost

^ complete.

The case after appliance removal.

The facial profile shows pleasing balance and harmony. Predictably, there was little cephalometric change during the treatment period. The active treatment time was 21 months.

L.J.Final 25.0 years 5/26/96

L.J.Final 25.0 years 5/26/96

SNA ' 81 ° SNB '76 • ANB Í". 4 • A-N FH 1 mm Po-N FH -4 mm WITS 3 mm GoGnSN '31 ° FM / 21 ° MM 220 1 to A-Po 3 mm 1 to A-Po 0 mm 1 to Max Plane 102 • 1 to Mand Plane 99°

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