Pacific Coast Society of Orthodontists Bulletin Fall 2019 - 44

Case Report

How would you treat this malocclusion?
Pretreatment
Case A.C., 15 years, 5 months

Diagnosis and Etiology
A 15-year-old female patient presents to the office
with the chief complaint that "my dentist told me
that I have space between my bottom teeth and
an asymmetric bite."
She is not taking any medications and has no
known drug allergies or acknowledged habits.
Her oral hygiene is excellent, and she is highly
motivated for orthodontic treatment. She does
not have any obstructive sleep apnea nor temporomandibular joint symptoms, but she and her
mother have noticed dental crossbite after having
been advised of it by her general dentist.
Facial examination shows that the patient has
competent lips and her chin deviates slightly to
the left. The distance from the left philtrum to the
labial commissure is relatively short compared
with the same distance on her right side. She
presents a straight profile with acute nasolabial
angle and strong chin projection. Her lips are

protrusive with respect to the E-line: upper lip -1.0
mm versus lower lip -1.7 mm. Her smile arc is flat
and asymmetrical with much less tooth display
on her maxillary left teeth; gingival displays are
about adequate on her maxillary right teeth from
the maxillary right central incisor to the premolars (Figure 1).
She exhibits occlusal canting with her maxillary
right side downward and left side upward, anterior crossbite (maxillary left canine), and unilateral
posterior crossbite (UPC) on the left side (from
the maxillary second premolar to the first molar).
The patient's maxillary dental midline is coincident with her facial midline, but her mandibular
dental midline is deviated to the left by 3.7 mm.
She has Class I molar and canine relationships on
the right side and end-on Class II on the left side.
She also has a slightly constricted and asymmetrical maxillary arch, mild maxillary crowding (2
mm), and 1 mm of mandibular spacing between
the central incisors. The gingival margin of her

Figure	1. Initial
facial and intraoral
photos (A.C., 15
years, 5 months)

44	

PCSO	Bulletin	 	 Fall	2019



Pacific Coast Society of Orthodontists Bulletin Fall 2019

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2019

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