CASE STUDY Figs. 4 & 5: Gerety lateral cephalometric tracing indicated ANB Class III, Wits Class III, mandibular plane angle indicated neutral vertical growth expressed, maxillary incisor teeth were protrusive and buccal angulated and mandibular teeth were retrusive in position and angulation. On the left, Ricketts tracing confirmed previous findings. Figs. 7 & 8: Models for Bolton analysis and results. Arrows showed desired movements. Fig. 6: Study models showed anterior and posterior crossbite, Class III relationships and mismatched midlines. classification of -8 Wits. The mandibu-lar plane angle indicated range of neutral vertical growth in her past. Similarly, the Y-Axis and SL measure-ment indicated a neutral to vertical growth tendency (Figs. 4 & 5). Due to the patient’s age, her facial growth potential was not important. The patient’s soft tissue profile showed both upper and lower lips on the soft tissue line. The analysis indicated a neutral vertical Class II skeletal and dental classification. v Align and level teeth v Eliminate anterior and poste-rior crossbite v Eliminate mandibular diastemas and mandibular arch protrusion v Achieve a Class I molar and canine classification v Reduce mandibular lip push v Increase maxillary lip protrusion v Retain positive results over time v Change NPER for a custom built transpalatal bar with indentations and anterior palatal bar. Place a temporary anchorage device (TAD) in palatal premaxilla area and bond anterior bar to it. Use power chains from posterior bar to anterior bar to create maxil-lary protrusion to help correct anterior crossbite (Fig. 10). v Place TADs on buccal shelf on mandible at level of second molars to retrude mandibular dental arch (Figs. 11-13). v Maintain positive results by long term retention using bonded maxillary and mandibular fixed lingual and palatal retainers and clear removable retainers for sleep use. v Long-term retention and recall visit protocol. Treatment Time: 24-30 months Estimated time was extended due to multiple complex movements that needed to be staged at correct times to achieve the desired results without losing the appropriate anchorage. Diagnosis v Class III skeletal (A-PO & ANB) v Class III dental v Anterior and posterior dental crossbite v Maxillary constriction v Deviated midlines Treatment Plan v Level, align with archwire series, up to a 16 X 22 Stain-less Steel (SS) archwire. v Use a Nitanium Palatal Expander (NPE®) with lingual root torque to correct poste-rior crossbite and keep root torque and a straight curve of Wilson. Treatment Objectives v Improve facial and dental esthetics Case Summary & Analysis Patient had been previously seen at office three years ago. Her 10 Fall 2018 JAOS
Journal of the American Orthodontic Society Fall 2018: Page 10
