Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 37

Case Report

Case Report

How would you treat this malocclusion?
Pretreatment
Case C.N. 13 years, 11 months
A video of this case can be found at https://
www.pcsortho.org/case-reports/
C.N. presents to our office with a chief
complaint of " her anterior spacing. " She
is unaware that she has retained primary
maxillary canines (C and H) and that her
maxillary canines (U3s) are palatally impacted. She is postmenarchal and has waited to
begin orthodontic treatment because she
still has primary teeth A and J present. She
wants treatment with Invisalign only and
does not want braces; she is distraught to
learn that she has two impacted canines.
Diagnosis and Etiology
Extraoral and Intraoral Findings
C.N. presents with a convex profile with
strong chin, obtuse nasolabial angle, retrognathic mandible, and decreased lower
anterior facial height. At rest, she has no
maxillary incisor display; upon smiling, she
displays 100% maxillary incisal show and
about 3-mm gingival display. There appears
to be a slight occlusal cant down to the left
and more gingival show upon smiling on the
left. She has a slight mandibular asymmetry
to the right. Both her maxillary and mandibular dental midline are coincident with each
other but slightly off to her facial midline.
She presents with a one-quarter cusp Class
II molar relationship on the right and Class
I on the left. Both primary maxillary canines
(C and H) are present and in Class II relationship with mandibular canines. Primary
second molars (A and J) are retained, and
maxillary second premolars are emerging
through the gingiva. The maxillary right
second molar is emerging, and the remaining second molars are in. She presents with
a deep overbite (80%), a moderate curve of
Spee, and 2-mm overjet. She presents with
moderate spacing in the maxillary arch and
adequate space in the mandible with mesially rotated premolars. Periodontally, she has

Spring 2021    PCSO Bulletin	

Figure 1. Initial facial and intraoral photographs (13 years, 11 months)

Figure 2. Initial dental models (13 years, 11 months). Bite turbos were bonded on the lingual
sides of the U1s when the initial intraoral scan was taken; bite registrations were removed
when the models were based

37


https://www.pcsortho.org/case-reports/ https://www.pcsortho.org/case-reports/

Pacific Coast Society of Orthodontists Bulletin Spring 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2021

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