Pacific Coast Society of Orthodontists Bulletin Fall 2016 - 35
Case Report
How would you treat this malocclusion?
Post-Treatment
Case E.B. 16 years, 8 months
Treatment Plan
Due to the skeletal discrepancy involving the
anterior crossbite, open bite, and constricted
maxillary and mandibular arches, as well as
patient's high angle pattern, any significant
amount of additional growth would make a surgical approach necessary. Therefore, the surgical
option involving SARPE and counterclockwise
rotation of the mandible was discussed. Growth
would need to be completed before the surgical
treatment.
The patient was found to be above stage 10 on
the skeletal maturity index of the hand-wrist
film, and CVMS stage IV indicated that the
patient was past the pubertal growth spurt.
Based on these findings, it was expected that
no significant growth was remaining, but a nonsurgical approach could be used. A MARPE
could be used for the transverse correction of
the maxilla, and the case could be treated with
extractions of the maxillary lateral incisors and
mandibular first premolars. The mesialization
of the maxillary first molars could be achieved
using additional palatal microimplants; to assist
in this, the patient would wear a facemask.
Because the mandibular retrognathism is mainly
due to the high-angle pattern, the prevention of
bite opening would be an important success
factor and would be controlled by the intrusive
force on the mandibular first molars by
mandibular microimplants.
Therefore, the treatment planned for is as follows:
1. Six millimeter of maxillary skeletal expansion.
2. Bond maxillary 5-5 and mandibular 3-7 with
0.022"*0.028" slot edgewise appliance.
3. Upright mandibular molars with an intruding
force.
Progress composite
Fall 2016 PCSO Bulletin
35
Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2016
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Pacific Coast Society of Orthodontists Bulletin Fall 2016 - 2
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Pacific Coast Society of Orthodontists Bulletin Fall 2016 - 35
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Pacific Coast Society of Orthodontists Bulletin Fall 2016 - 53
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