CASE REPORT Fig. 6 Fig. 8 Fig. 10 Fig. 9 Fig. 7 CASE C ASE SUMMARY SUMMARY & ANALYSIS EPM was seen for Phase II orthodontic consultation. A clinical exam was performed and the need for records was explained and scheduled after the second consulta-tion visit. Orthodontic records were taken and analyzed. Patient’s diag-nosis was completed and treatment plan elaborated and prepared for presentation to patient. EPM was 13 years, 4 months old at the onset of treatment. For the first three months she was treated with very light arch wires in the arch wire sequence (AWS) achieving an initial alignment and leveling and minimizing molar extrusion (Elite Opti-MIM Mini-twin Bracket System and Epic Contour molar bands with lingual sheaths by Ortho Organizers ® ). Initial treatment employed .014 Nitinol archwire followed by .018 Nitinol archwire. During these three months the objectives were align-ment, leveling and creation of space for the teeth. Open coil spring was used in the area of maxillary canines to correct maxillary incisor retrocli-nation and create space for the canines. All molars present were incorporated into archwire sequence to allow for vertical and horizontal movement in the future (Fig. 6). After four months, two TADs of 8 mm length and 1.6 mm diameter DIAGNOSIS D IAGNOSIS í Class II, Division II skeletal clas-sification í Class II molar and canine dental classification í Retrusive maxillary incisor angu-lation í Excessive overbite í Maxillary canines in ectopic position í Mid arch constrictions for maxil-lary and mandibular arches í Strong vertical growth potential INITIAL I NITIAL TREATMENT TREAT A MENT PLAN í Level, align and rotate the upper and lower arches with archwire series í Create space for maxillary canines by protrusion of maxil-lary incisors, and distalization of posterior maxillary segments based on skeletal anchorage í Distalize maxillary molars into a Class I molar occlusion í Move ectopically placed maxil-lary canines into a Class I canine occlusion í Align, level, and expand lower arch based on straight archwire sequence í Achieve positive overbite and overjet relationship í Maintain positive result by long term retention with a combina-tion maxillary Hawley retainer and bonded lower lingual retainer í Long term retention and recall visits protocol Estimated Treatment Time 24-36 months TREATMENT OBJECTIVES í Improve facial and dental esthetics í Align and level teeth in their arches í Eliminate ectopic position of maxillary canines í Reduce excessive maxillary incisor retrusion and overjet í Achieve a Class I canine and molar dental occlusion í Retain positive results over time Fig. 12 Fig. 11 20 November/December 2012 JAOS
Journal of the American Orthodontic Society November-December 2012: Page 20
