ORTHO BITES Fig. 4 Fig. 7 Fig. 10 “The treatment plan was a phase approach, correcting the cross bite; correcting Fig. 5 Fig. 11 the Class II dental occlusion; and maintain a Class I occlusion, hopefully avoiding a Phase II treatment.” Fig. 12 Fig. 8 Fig. 6 Fig. 9 Nitanium Palatal Expander (NPE – Ortho Organizers) to address the cross bite as well as rotate the upper first molars; and placed composite pads to open the bite to prevent bracket failure as well as to allow the cross bite to be corrected more easily.(Fig 4) A nice feature of the pre-fabri-cated Nitinol utility wire is that, because the wire adapts to the bracket slot, the force created brings the anteriors into align-ment, simply displacing the primary canines laterally. By July 2007, the rotations were corrected in the upper first molars, the cross bite was corrected, and the anteri-ors were relatively aligned. (Fig 5) In September, with anteriors aligned, I removed the NPE, and replaced the .018 Nitinol with .016 x .016 Stainless Steel utility arch wires. (Fig 6) I advanced the four anteriors slightly in this arch wire. In November 2007, I fabricated a lower .018 x .025 Stainless Steel util-ity arch wire and placed a Multi Distalizing Arch Appliance (MDA – Ortho Organizers) in the upper arch. (Fig 7) I stressed to the patient and parents how very important wearing the Class II elastics were as we had very little anterior anchorage and were relying on the lower arch as our the primary anchor unit. The patient was very compli-ant and by January 2008, I had achieved a Class I molar. (Fig 8) I left the MDA in another month. (Fig 9) In March 2008, I removed all appliances, brackets, bands and cement; took final Phase I records; and placed a Fixed Removable Lingual Arch (FRLA – Ortho Organizers) for Phase I retention. I was pleased with the overall result. Her GoGn remained relatively constant (33 degrees); her ANB decreased from 5.5 to 3.5 degrees; and her WITS decreased from 6.3 to 2 mm. (Fig 9-12) Her interincisal angle did decrease from 127 to 114 www.orthodontics.com November/December 2011 11
Journal of the American Orthodontic Society November-December 2011: Page 11
