CASE STUDY records were obtained, information and consent documents were reviewed and signed by Alex's parents and separators were placed between the interproximals of the first molars. The first molars were banded and premolars and anteriors were bracketed using .022 bracket slots (Modified Roth RX), and an upper and lower .016 Nitinol arch wire was placed. Since his 12-year-old molars were not fully erupted, they were not banded. The patient returned in the second month with six broken brackets. The upper brackets were repaired and lower brackets were left until the lower arch was more leveled. In month 4, the lower broken brackets were repaired and the patient was still in U/L .016niti wires. In month 6, the patient moved up to U/L .016 SS arch wires. The lower wire was expanded on the right side and the upper wire was constricted on the right. In month 7, we continued to coordi-nate the upper and lower arches by placing lower .018 SS wires to continue buccal expansion on the lower right side. The patient was instructed to wear buccal cross bite elastics between the right upper /lower first molars. In month 9, once the lower right first and second bicuspid were more leveled and aligned, lingual buttons were placed and the patient started wearing short buccal cross-bite elas-tics off the lingual button on the lower right bicuspids to the hook of the upper right bicuspid brackets. In month 10, the upper left central bracket was repositioned, and the broken upper right second bicuspid bracket was repaired. The patient was still wearing cross-bite elastics in U .016 SS wire and lower .018 SS wire and asked to wear midline elas-tics from the upper right canine to the lower left canine hooks. In month 11, a lower right central broken bracket was repaired and the upper .016 SS arch wire was constricted on the right. In month 12, upper .016x .016 SS arch wire was placed and on the lower Australian Fig. 6 Fig. 7 arch wire was used to expand the buccal segments and upright the lower bicuspids more. A wide lower 3-3 chain was placed to prevent lower incisors from flaring and to prevent spaces from opening up. In month 15, once the upper and lower arches were coordinated, the cross bite elastics were discontinued. In month 18, upper and lower 0.020 SS wires were used. A compen-sating curve was placed on the upper wire with a tieback to prevent flaring of the upper incisors in addi-tion a reverse curve was placed on the lower. By month 20 -22, the patient again had many more broken brackets which delayed his www.orthodontics.com Summer 2014 29
Journal of the American Orthodontic Society Summer 2014 / Buyer's Guide: Page 29
