Case Report Category #:	6
Patient's Name:
Date of Birth:	7-23-84
Age (years and months):	9 years , 3 months

A. PRETREATMENT RECORDS

Date of Records: 10- 13-93

Diagnosis:

•	Skeletal: Class II
•	Dental: Class II, division 1, excessive overjet, deep overbite, slight crowding.
•	Facial: Convex, severe bimaxillary protrusion, obtuse nasolabial angle.

Treatment Plan:

• Extract Mx right and left deciduous cuspids.
• Let develop to allow for eruption of Mx right and left and Mn left cuspids. Recall in six months.
• Extract Mx and Mn first bicuspids.
• Band and bond Mx and Mn arches through first molars.
• Retract Mx and Mn cuspids with high-pull J-hook headgear.
• Band Mx and Mn second molars.
• Retract Mx and Mn incisors.
• Completion and detailing

Treatment:

• Band Mx and Mn first molars and md second bicuspids; bond Mx and Mn cuspid to cuspid.
• Level and rotate with .016, .018, 17x22.
• Retract Mx and Mn cuspids with high-pull headgear on .018, 17x22, 18x25.
• Band Mx second bicuspids and all four second molars.
• Retract Mx and Mn incisors with 19x25 closing arch and high-pull headgear to Mx incisors.
• Completion and detailing with Class II and anterior box elastics on 19x25.

• Initiated Treatment Date: 4-18-94
• Appliance Removal Date: 8-19-97
• Active Treatment Time Duration: 38 months

B. POSTTREATMENT RECORDS

Date of Records: 12-2-97
Retention: Mx removable and Mn fixed cuspid to cuspid retainers.

• Retention Completed Date: 8-23-00
• Retention Duration: 36 months

HISTORY AND ETIOLOGY:

Delane is a female and was nine years and three months of age when first examined. She was of average height and build; however, her dental age was ahead of her chronological age with all four first bicuspids in full eruption. There was no history of serious illnesses or injuries and she has experienced the usual childhood diseases. Caries incidence was not excessive and oral hygiene was good. Mild enamel hypoplasia was evident on the Mx and Mn anterior teeth. Genetic influence was the main cause of Delane's malocclusion as her mother has a severe bimaxillary protrusion with crowding.

DIAGNOSIS:

•	Skeletal: Class II
•	Dental: Class II, division 1

TREATMENT PLAN:

See above.

SPECIFIC OBJECTIVES OF TREATMENT:

Maxilla

•	A-P: Reduce A-P , reduce or maintain SNA.

Mandible

•	A-P: Encourage mandibular response with mechanics, increase SNB.
•	Vertical: Maintain vertical dimension.

Maxillary Dentition

•	A-P: Reduce anterior procumbency.
•	Vertical: Maintain vertical dimension.
•	Intermolar Width: Maintain intermolar width.

Mandibular Dentition

•	A-P: Reduce anterior procumbency.
•	Vertical: Maintain vertical dimension.
•	Intermolar / Intercanine Width: Maintain intermolar/intercanine width.

Facial Esthetics

•	Reduce lip fullness

APPLIANCES:

.022 Edgewise appliance, high-pull J-hook head gear.

TREATMENT PROGRESS:

The Mx and Mn first bicuspids were extracted. The teeth were banded and bonded through the first molars. Mx and Mn cuspids were retracted with J-hook headgear. Second molars were banded and the Mx and Mn incisors were retracted closing all spaces. The Mx anterior teeth were supported with a high pull J-hook headgear during retraction. Class II elastics, anterior box elastics and high pull J-hook headgear were employed for the Class II correction and final detailing.

RESULTS ACHIEVED:

Maxilla

•	A-P: Maintained, no change in SNA.

Mandible

•	A-P: Improved, SNB increased with good mandibular growth response.
•	Vertical: Closed slightly, good downward and forward growth.

Maxillary Dentition

•	A-P: Anterior teeth retracted bodily and intruded.
•	Vertical: Posterior dentition increased.
•	Intermolar Width: maintained.

Mandibular Dentition

•	A-P: Anterior teeth retracted and uprighted.
•	Vertical: Posterior dentition increased.
•	Intermolar / Intercanine Width: Intermolar width reduced, intercanine width maintained.

Facial Esthetics

•	Significant reduction in lip fullness and improvement of facial contours.

RETENTION:

Mx removable retainer and Mn fixed cuspid to cuspid.

FINAL EVALUATION OF TREATMENT:

All dental objectives were achieved which included the elimination of the procumbency of the Mx and Mn anterior teeth, an uprighting of the Mn incisors over basal bone, a bodily retraction of the Mx incisors, and an ideal overbite and overjet relationship. There was a solid Class I cuspid relationship with a good interdigitated posterior occlusion. Skeletal objectives were achieved through good mechanical control of the dentition and a strong mandibular growth response. Facial esthetic changes were excellent with a marked reduction in lip fullness and an improvement in facial balance and contours. The Mx second molars were left too far buccally, but have since settled into occlusion during retention. There was a slight space opening in the lower right buccal segment which has closed during retention.

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