Pacific Coast Society of Orthodontists Bulletin Fall 2016 - 36

Case Report 4. Extract maxillary primary lateral incisors and mandibular first premolars. 5. Protract maxillary molars with temporary anchorage devices (TADs) and facemask, while retracting the mandibular canines with maximum anchorage. 6. Bond mandibular 2-2 with same edgewise appliance. 7. Finish in Class I dental relationship. 8. Maxillary and mandibular Hawley retainers for retention. Treatment Progress A MARPE appliance was delivered and activated until 7 mm arch width gain (measured at the maxillary first molars) was successfully achieved. True skeletal expansion was indicated by a 1 mm midline diastema. Transient opening of the bite was noted due to the occlusal interference on the molar cusps. 0.022" Damon Q (Ormco) brackets were initially used for the leveling and aligning; 0.016" CuNiTi wires were used on the maxillary arch and 0.014"*0.025" CuNiTi wires on the mandibular arch. TADs were placed between the mandibular first and second molars to provide an intrusion force on the lower molars while applying a buccal crown torque. Curve of Spee was reduced to 1 mm as a result of the uprighting of the molars and the application of the intrusive forces. The open bite caused by the cuspal interference was resolved as the mandibular molars came into occlusion. Maxillary primary lateral incisors and mandibular first premolars were extracted. After removing the MARPE, maxillary 0.019"*0.025" stainless steel (SS) archwires were segmented distal to maxillary second premolars, so that maxillary first molars could be protracted using a facemask appliance and palatal TADs assisted by a transpalatal arch. 36 After space closure, continuous archwires were used, and the case was finished using 0.019"* 0.025" titanium molybdenum alloy (TMA) archwire on the maxillary and 0.019"*0.025" SS archwire on the mandibular arch. Interarch elastics were used to help the extrusion and settling of the teeth. The case was completed after 23 months of treatment. The plan for retention involved instructing the patient to perform the clenching exercise and lip closure while wearing a set of Hawley retainers. Upper and lower Hawley retainers will be used 24 hours a day for six months, and then during nighttime indefinitely thereafter. Results Acheived The skeletal transverse discrepancy was successfully corrected to provide a better skeletal foundation for the alignment. The mandibular molars are upright, which is shown as an increase of occlusal height in the superimposition, and the curve of Wilson is significantly reduced. The intrusive force on the mandibular molars was successful in minimizing the opening of the bite, and the extrusion of the maxillary central incisors provided an esthetic outcome. The patient's vertical facial proportions were maintained as planned. The maxillary molars were protracted sufficiently to prevent the collapse of the maxillary anterior teeth after the extraction of the primary maxillary lateral incisors. The end result shows a favorable overjet and overbite, even with the slight growth of the mandible. After enameloplasty of the maxillary canines, there was no significant Bolton discrepancy remaining, and an esthetic smile was achieved. PCSO Bulletin  Fall 2016

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2016