Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 54

Case Report
the L6-6 to close the extraction space. Three
months later, the upper wire was upgraded
to 0.019 × 0.025-in SS. After six months of
treatment, the upper microimplant failed
again and was not replaced. At this point, two
buccal microimplants were placed interradicularly between the maxillary second premolar
and first molar bilaterally, and retraction of
the maxillary anterior teeth was started by
connecting power chains from the maxillary
canines to the buccal microimplants (Figures
5 and 6).
Eleven months into treatment, space closure
was completed, but the occlusion was still
Class II. Considering the vertical control, we
decided to place the Forsus Fatigue Resistant
Device bilaterally between the U6s and L3s
(Figure 7). The Forsus device was removed after
one month because of an edge-to-edge bite.
Immediately after removal, Class II (U3s-L7s)
elastics (Ormco Kangaroo, 3/16-in, 4.5 oz) were
used to maintain the Class I molar relationship. Unfortunately, the molar relationship
relapsed to Class II within three months. Class
II elastics with different force levels were used
(U3s-L7s) for another 13 months to resolve the
Class II occlusion. In the meantime, the first-,
second-, and third-order bends were applied
on a 0.019 × 0.025-in SS wire for finishing and
detailing (Figure 8). However, Class I occlusion was not achieved with the application
of Class II elastics, so the Forsus device was
reinstalled and activated for four months until
the bite was edge-to-edge. During the last
three months of treatment, a total of 0.2 mm
interproximal reduction was performed between the U1s to minimize the black triangles,
along with three months of Class II elastics to
maintain the Class I occlusion before debonding. Clear retainers were delivered to retain
treatment results.
Treatment Results
Posttreatment photographs and digital study
casts demonstrate the achievement of Class
I molar and canine relationships, dental
midlines coinciding with the facial midline,
and improved overbite and overjet (Figures 9
and 10). Evaluation of the panoramic radiograph showed correct root parallelism,
except for the maxillary second premolars,
due to compromised bracket placement

54	

Figure 8. Class II elastics were used to maintain the corrected molar and canine relationships for 13 months after the initially installed Forsus device, but this Class I occlusion was
relapsed back to Class II

Figure 9. Posttreatment facial and intraoral photographs (17 years, 4 months)

Figure 10. Posttreatment digital study casts

PCSO Bulletin    Summer 2020



Pacific Coast Society of Orthodontists Bulletin Summer 2020

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