Pacific Coast Society of Orthodontists Bulletin Fall 2019 - 48

Case Report

obtained, and bracket reposition
was performed after both arches
were leveled with 0.019 × 0.025-in
NiTi for four weeks. After bracket
repositioning, 0.018-in NiTi wires
were placed followed by 0.017
× 0.025-in NiTi. When the 0.019
× 0.025-in stainless steel wires
were placed, the patient started
wearing Class II elastics (left side)
and triangle elastics from U3 to
L34 (right side) for 20 to 22 hours
per day. She was also instructed
to use a cross elastic UR2 to LL2 for
12 to 14 hours a day to help correct
the midline. The size of the elastics
was 3/16-in 6 oz. About 0.1 to 0.2
mm of interproximal reduction
was accomplished L4-4 to resolve
the Bolton discrepancy. A power
chain U/L was placed to close all
spaces (Figure 6). Detailing was
performed with 0.017 × 0.025in titanium molybdenum alloy.
Detailed wire bending and seating
elastics were used for the finishing stage. No TSADs were used,
as the patient was eager to finish
treatment prior to her summer vacation and the start of her senior
year. Dental canting was reduced
once the crossbite was eliminated, but an occlusal cant was still
evident on the mandibular arch.
The active orthodontic treatment
was completed in 21 months.
Upon completion of treatment, a
mandibular 3-3 fixed retainer was
bonded (Figure 7). A maxillary Hawley retainer was recommended;
however, the patient preferred not
to have this for esthetic reasons. As
a result, additional to the mandibular fixed retainer, upper and
lower Essix were delivered. She was

48	

Figure	6. Treatment
progress after the modified palatal expander
was removed

Figure	7. Final facial and
intraoral photos (A.C., 17
years, 1 month)

instructed to wear the Essix for 22 hours per day for
the first six months, at night for the next two years,
and then four nights a week for life. She knew that
the Essix retainers would need to be replaced regularly as needed during the retention.

Treatment Results
The patient's chief complaint was addressed.
Acceptable esthetic and functional results were
achieved. Her smile line and smile arc were
improved. Her anterior vertical dimension was

PCSO	Bulletin	 	 Fall	2019



Pacific Coast Society of Orthodontists Bulletin Fall 2019

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