Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 55

Case Report
(Figure 11). The cephalometric evaluation
indicated a reduction of the skeletal Class
II relationship (ANB angle from 8.5° to 7.2°),
a slight counterclockwise rotation of the
mandible (SN-MP angle from 43.2° to 41.5°),
and improved maxillary and mandibular
incisor inclinations (U1-SN angle from 118° to
103.8°, L1-MP from 100° to 96.5°) (Figure 12
and Table 2). The superimposition further
confirmed the cephalometric findings, and
the anterior open bite was closed by a combination of maxillary molar intrusion and
maxillary incisor extrusion. The facial profile
improved significantly by presenting better
chin support and less protrusive lips. The
ABO cast-radiograph evaluation score was
18 (Figure 13).

Figure 11. Posttreatment panoramic radiograph and lateral cephalogram

The total treatment took 41 months, partially
due to the severity of the malocclusion; however, 13-month use of Class II elastics was one
of the concerns. Once we noticed that the
Class I occlusion relapsed to Class II occlusion,
it would have been better to reinstall the Forsus immediately instead of hoping the Class II
elastics would reverse the process.
Editor's Comments
This patient presented with significant anterior open bite along with severe discrepancies in all three dimensions, both skeletally
and dentally, and with minimal growth
during her orthodontic camouflage treatment. The authors were able to treat this
case with great final results.
The availability of temporary skeletal
anchorage devices (TSADs) has dramatically widened the envelope for orthodontic
treatment and has made it possible to treat
some traditionally surgical cases orthodontically. While acknowledging the power of the
TSADs, it is suggested that clinicians with
limited experience should approach these
cases cautiously, because TSADs do fail
sometimes. Moreover, the more complicated
the case, the longer the treatment will likely
be, and patient burnout often limits the
ultimate outcome.

Summer 2020    PCSO Bulletin	

Figure 12. Superimposition: black, pretreatment (14 years, 7 months); red, posttreatment (17
years, 4 months)

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Pacific Coast Society of Orthodontists Bulletin Summer 2020

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