Case Report Category #:	10
Patient's Name:
Date of Birth:	9/24/86
Age (years and months):	9 yr. 11 mo.

A. Pretreatment Records

Date of Records: 9/11/96

Diagnosis:

• Skeletal: Class II denture base relationship due to a flat occlusal plane.
• Dental: 5mm Class II, 11 mm overjet, proclined upper incisors, slight mandibular crowding, slight maxillary spacing.
• Facial: Large interlabial gap, insufficient lower lip protrusion, large incision stomion distance and gummy smile.

Treatment Plan: Extraction of 14 and 24, intrusion and retraction of incisors, retraction of maxillary 3-3, flaring lower incisors.

Treatment: Extraction of 14 and 24, intrusion and retraction of maxillary 2-2, retract maxillary anterior segment allowing the buccal segment to come slightly forward, align mandibular incisors.

• Initiated Treatment Date: 10/2/96
• Appliance Removal Date: 8/24/98
• Active Treatment Time Duration: 1 yr. 10 mo.

B. Posttreatment Records

Date of Records: 9/1/98
Retention: Maxillary Hawley and mandibular spring aligner.

• Retention Completed Date: Ongoing
• Retention Duration: Ongoing

History and Etiology: Short upper lip and lower lip interposition allowed the maxillary incisors to flare.

Diagnosis:

• Skeletal: Class II denture base relationship due to a flat occlusal plane.
• Dental: 5mm Class II, 11 mm overjet, proclined upper incisors, slight mandibular crowding, slight maxillary spacing.

Treatment Plan: Extraction of 14 and 24, intrusion and retraction of incisors with a 3-piece intrusion arch and high pull headgear at night, retraction of maxillary 3-3 with cervical pull headgear at night during the first phase of space closure, flaring and alignment of lower incisors.

Specific Objectives of Treatment (A-P, Transverse, Vertical)
Maxilla

• A-P: Maintain

Mandible

• A-P: Maintain
• Vertical: Maintain

Maxillary Dentition

• A-P: Retract maxillary incisors, slip buccal segments 2 mm.
• Vertical: Intrude incisors.
• Intermolar Width: Maintain in arch form.

Mandibular Dentition

• A-P: Flare incisors
• Vertical: Maintain
• Intermolar / Intercanine Width: Maintain

Facial Esthetics: Decrease interlabial gap, decrease lip protrusion, decrease incision stomion distance.

APPLIANCES .022 slot fixed appliances, 3-piece intrusion arch, high pull headgear, cervical pull headgear.

Treatment Progress: Extraction of 14 and 24, intrusion and retraction of maxillary 2-2 with high pull headgear at night, retract maxillary anterior segment while wearing cervical pull headgear, align mandibular incisors, allow maxillary buccal segments to come forward during space closure.

Results Achieved (A-P, Transverse, Vertical)
Maxilla

• A-P: A-point moved 1.8 mm posteriorly.

Mandible

• A-P: Maintained
• Vertical: Lower face height increased 2.1 mm with growth, mandibular plane angle increase 1.9 degrees.

Maxillary Dentition

• A-P: 6 mm incisor retraction, 3 mm buccal segment protraction.
• Vertical: 2 mm incisor intrusion.
• Intermolar Width: Decreased 5 mm, maintaining the arch form.

Mandibular Dentition

• A-P: Incisors moved 1.2 mm anteriorly.
• Vertical: 1.5 mm incisor and molar extrusion.
• Intermolar / Intercanine Width: intermolar width decreased 1.5 mm, intercanine width 1 mm.

Facial Esthetics: Interlabial gap decreased, upper lip protrusion stayed the same, lower lip came 3.7 mm forward, incision stomion decreased.

Retention: Maxillary Hawley and mandibular spring aligner, 24 hours a day for 1 month, followed by night time for 1 year, patient is wearing them 3 nights a week.

Final Evaluation of Treatment: Maxillary incisor intrusion and retraction facilitated moving the incisal edge along the occlusal plane, thereby also decreasing the incision stomion distance, while maintaining the overbite; maxillary incisor retraction decreased the interlabial gap.