Case Report Category #:	5
Patient's Name:
Date of Birth:	01-13-82
Age (years and months):	11 years. 6 months.

A. Pretreatment Records

Date of Records: 07-12-93

Diagnosis:

•	Skeletal: Class II, malocclusion, ANB=5º, 45.5º Mandibular plane angle, FMA=39º
•	Dental: Class II division 1 malocclusion subdivision right. 100% deep closed bite, palatal impingement of mandibular incisors, flared maxillary incisors, maxillary diastema, 3mm midline discrepancy.
•	Facial: Convex facial profile
•	Habits: none

Treatment Plan:

• Dental Prophylaxis
• Extract maxillary first bicuspids, mandibular second bicuspids
• Band/bond maxillary and mandibular arches High pull Kloehn headgear
• Level maxillary and mandibular (stopped arches) open bite
• Retract # 21, then 22 mandibular, #6, 11 maxillary arch
• Shift mandibular midline coil spring
• Close space Class II/ClassIII elastics
• Detail
• Retain
• Re evaluation of third molars

Treatment:

• Extract maxillary first bicuspids / mandibular second bicuspids
• Extract maxillary first bicuspids, mandibular second bicuspids
• Band/bond maxillary and mandibular arches High pull Kloehn headgear
• Level maxillary and mandibular (stopped arches) open bite
• Retract # 21, then 22 mandibular, #6, 11 maxillary arch
• Shift mandibular midline coil spring
• Close space Class II/ClassIII elastics
• Detail
• Retain maxillary / mandibular Hawley retainers
• Re evaluation of third molars.

• Initiated Treatment Date: 09-14-93
• Appliance Removal Date: 06-21-96
• Active Treatment Time Duration: 33 months

B. Posttreatment Records

Date of Records: 3-27-97
Retention:

• Maxillary Wrap around Hawley retainer with tongue spurs
• Mandibular Hawley

• Retention Completed Date: 08-11-98 mandibular third molars erupting
• Retention Duration: 26 months

History and Etiology:

Medical: Good overall health
Dental: Dental health non-remarkable other than short roots in the maxillary anterior teeth.
Etiology: Heredity factors.
Chief Complaint: Overbite and deep bite, palatal impingement of mandibular incisors, diastema

Diagnosis:

•	Skeletal: Class II, malocclusion, ANB=5, 45.5º Mandibular plane angle, FMA=39º
•	Dental: Class II division1 malocclusion subdivision right. 100% deep closed bite, palatal impingement of mandibular incisors, flared maxillary incisors, maxillary diastema, and 3mm-midline discrepancy.

Treatment Plan:

The parents and the patient were counseled regarding severity of the anterior-posterior discrepancy, of the malocclusion and need for absolute cooperation, to achieve correction.

1. Dental Prophylaxis
2. Extract maxillary first bicuspids, mandibular second bicuspids
3. Band/bond maxillary and mandibular arches High pull Kloehn headgear
4. Level maxillary and mandibular (stopped arches) open bite
5. Retract # 21, then 22 mandibular, #6, 11 maxillary arch
6. Shift mandibular midline coil spring
7. Close space Class II/Class III elastics
8. Detail
9. Retain
10. Re evaluation of third molars

Specific Objectives of Treatment

Maxilla

•	A-P: Maintain A point, or retract slightly
•	Vertical: Minimize vertical changes

Mandible

•	A-P: Facilitate counter clockwise rotation of the mandible

Maxillary Dentition

•	A-P: Maintain maxillary molar position
•	Vertical: Resist vertical growth changes
•	Intermolar Width: Maintain

Mandibular Dentition

•	A-P: Shift asymmetric mandibular molars, achieve Class I, retract mandibular incisors
•	Vertical: Resist extrusion due to orthodontic mechanics
•	Intermolar / Intercanine Width: Maintain

Facial Esthetics:

•	Achieve facial balance, lip competence

APPLIANCES

.022 Edgewise 0-0 appliance

Treatment Progress:

1. Maxillary first bicuspids, mandibular second bicuspids were extracted.
2. The maxillary and mandibular arches were banded/bonded. A high pull Kloehn was delivered 12-14 hr./day wear requested
3. Maxillary and mandibular arches were leveled. .175 wildcat, .016, .018, .020, .021 steel stopped wires.
4. Mandibular second molars were banded and leveled.
5. The left first bicuspid was retracted through the extraction space.
6. Maxillary cuspids were retracted with power chain. As was the mandibular left cuspids. Class III elastic was worn to the cuspid during retraction.
7. The mandibular midline was shifted with coil springs.
8. The maxillary incisors were torqued on a .019X.025 the wire had an accentuated curve of spee.
9. With the mandibular midline on the mandibular arch was re-leveled with a .019X.025
10. The maxillary, and mandibular spaces were closed using closing loops .019X.025 and Class II elastics and up and down elastics.
11. Ideal .019X.025 wires were made and coordinated. Up and down elastics in the cuspids were used for the last month
12. Deband
13. Maxillary wrap around Hawley with springs to the upper second molars and mandibular Hawley were delivered
14. Retain re-evaluate third molars

Results Achieved

Maxilla

•	A-P: The maxillary position was well controlled A point retracted

Mandible

•	A-P: Forward growth of the mandible was taken advantage of
•	Vertical: The clockwise movement of the mandible was minimized

Maxillary Dentition

•	A-P: Incisors were retracted.
•	Vertical: Extrusion of the maxillary molar was resisted
•	Intermolar Width: Well controlled-maintained

Mandibular Dentition

•	A-P: Mesial movement of the first molars, retraction (uprighting) of the mandibular centrals
•	Vertical: Uprighting of the centrals results in relative extrusion. The molars extruded opening the bite.
•	Intermolar / Intercanine Width: Maintained

Facial Esthetics:

•	Facial profile improved
•	Increased lip competence
•	Convexity maintained

Retention:

Maxillary wrap around Hawley with springs to the upper second molars and mandibular Hawley were delivered. The patient was instructed to wear the retainers all the time for six months and at Retainers were discontinued and third molars were re evaluated.

Final Evaluation of Treatment:

Overjet was reduced and the Class II was corrected. The midline was corrected. Ideal function was achieved. The vertical nature of growth was resisted. Facial balance was maintained. I was lucky to follow this patient through retention. As evidenced by the retention cephalometric x-rays and photos, the patient continued to grow vertically through retention. The third molars erupted into good occlusion. Very nice case with good stability.

Go Back | Case Home | Go Forward