Pacific Coast Society of Orthodontists Bulletin Fall 2017 - 35

Case Report

How would you treat this malocclusion?
Post-Treatment
Case B.Q. 16 years, 9 months

Treatment Plan
The patient's mother decided against the surgical treatment option. This left us with treatment
plan #2, closing the open bite non-surgically.

Retention includes a bonded L3-3 retainer as well
as upper and lower Essix retainers to assist with
vertical control of posterior teeth and to maintain the overbite.

The patient had a severe anterior open bite with
a high mandibular plane angle. A large part of his
open bite was due to proclination of his maxillary
anterior teeth. Therefore, the non-surgical plan
with extractions of all first premolars and good
vertical control of posterior teeth was chosen. To
prepare the anchorage in the maxillary arch, a
Nance appliance was delivered. After space closure, it was changed to the low-hanging TPA
because of its ability to provide vertical control of
maxillary posterior teeth. We started the vertical
elastics early in order to aid with tipping back
and extruding the incisors and closing the open
bite. Additionally, the patient has a good growth
potential (CVMS II), which should support the
achievement of the treatment goals. Lastly, we
worked with the patient and his family to eliminate his habitual open mouth posture. Overall,
protraction of the molars from space closure and
vertical control with low-hanging TPA along with
the favorable growth can contribute to the correction of open bite via counterclockwise rotation
of the mandible.

Treatment Progress
We started by bonding the brackets to confirm
that the patient was able to handle fixed appliances before referring him to an oral surgeon
for extraction of all first premolars. Extractions
were ordered soon after placement of the fixed
appliances.
Spaces were closed en masse by retraction with
C-chains, allowing for controlled tipping of the
maxillary and mandibular incisors. From early on,
anterior vertical elastics were used in order to
assist with closing the open bite via controlled
tipping and extrusion of maxillary and mandibular anterior teeth.
Fixed appliances were debonded in two stages
and a bonded lower 3-3 retainer was delivered at
the debond visit.

Progress composite 1

Fall 2017  PCSO Bulletin

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Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2017

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