CASE REPORT Fig. 5: The Rickets tracing and analysis is shown: molar Class I, skeletal Class I (A-Po), Class II (ANB), retrusive maxilla, protrusive mandible, and mesocephalic facial pattern. vertical growth component. Simi-larly, the y-axis and SL measure-ment confirmed the vertical growth factor shown in Figs. 4 and 5. Due to the patient’s age, future facial growth was expected. The patient’s soft tissue profile showed the upper lip behind the soft tissue line, with the lower lip slightly forward to the line. The analysis indicated a dolichocephalic Class II skeletal and dental classification Class I on ANB due to clockwise mandibular growth. The authors’ experience has been that when the cephalometric tracing has a positive ANB and neutral or negative Wits, the maxil-lary arch is underdeveloped. with lingualized molars and crowded canines and incisors. í Maxillary arch with transverse constriction and anterior incisor crowding. í Deviated mandibular midline. í Mouth breathing. The treatment objectives were to: í Improve facial and dental aesthetics. í Align and level teeth to achieve the above objectives. í Transverse expansion of maxillary arch. í Create space for maxillary canines and second molars. í Achieve Class I molar and canine relationship. í Correct mandibular midline. í Increase maxillary lip support. í Retain positive results over time. The treatment plan was as follows: í Straight wire technique to create space in both arches to align and level arches. If needed, use NPE as an arch expander. í Coilspring used as needed to expand spaces for individual teeth. í Use TADs if needed for vertical control. í Chain elastics to help move individual teeth as needed within the individual arch. í Inter-arch elastics as needed to achieve a Class I dental occlusion. í Maintain positive results by long-term retention using bonded maxillary and mandibu-lar fixed lingual and palatal retainers and Essix retainers. Diagnosis, Objectives, & Plan The resulting diagnosis was as follows: í Class I skeletal (A-PO), Class III Wits and Class II (ANB). í Class I dental. í Mandibular clockwise growth 20 Fall 2025 JAOS
Journal of the American Orthodontic Society Fall 2025: Page 20
