Fig. 2 Fig. 3 maxilla to th the b base of the skull ill t f th k ll and d a 3 degree prognatism of the mandible and an obvious reverse over jet. The treatment proceeded as follows. First, the surgeon performed surgery to expose the maxillary canines allowing us to place brackets on the crowns of the canines as well as a connected ligature wire. The end of the ligature was placed out of the gingiva and the surgical area was sutured. (Fig. 2) Roth brackets with a 0.18 slot were used for bracketing, and in addition rapid palatal expansion was placed and head gear usage was recommended to the patient. During the initial stage of treatment coil spring was used for creating enough space for canine eruption. An acrylic covering was included with the rapid palatal expansion in order to remove occlusal interference. At the beginning of the maxil-lary treatment, a segmental tech-nique was used and stainless steel wires were placed. After creating enough space, the teeth were erupted to some extent by using ligature wire, then they were connected to the arch wire with chain elastic. Whenever the brackets became debanded, the gingival tissue was removed and the impacted crown was bracketed again. (Fig. 3) By treating the mandibular tooth alignment the reverse overjet became worse. After the eruption of the canines and the elimination of the cross bite, the rapid palatal expan-sion device was removed and Fig. 4 Class lll elastics were worn to decrease the mandibular overjet.(Fig. 4) As a result of correcting the cross bite, the patient’s air way also improved. This led to better growth of the maxillary area and the resolv-ing of the infra orbital depression. The upper right lateral incisor torqued towards the labial due to having a talon cusp that created interference with the mandible, so Fig. 5 we reshaped the palatal area of the lateral tooth. The treatment time was 2 years and the brackets were debounded upon completion of the case but there was still some protrusion needed in the anterior mandibular teeth. To resolve this problem, after consulting with Dr. Chris Baker, we decided to make a removable appli-ance. The anterior lower teeth were striped and the removable appliance www.orthodontics.com www orthodontics com September/ September/October r October 2012 39
Journal of the American Orthodontic Society September-October 2012: Page 39
