CASE STUDY them on the palatal area, between the second bicuspids and first molars. The Dr. Echeverri method to intrude the upper molars was followed, leaving an 018×025 stainless steel archwire in place in (buccal) braces of the upper arch. Power chain elastics attached to ligature wires inserted into each microimplant were activated with at least 10 ounces of force after inserting them into a transpalatal arch from upper second left to upper second right permanent molars with palatal hooks soldered to the bands. Palatal metal buttons were also bonded on the first and second bicuspids bilaterally to attach power chain elastics (with very little force) to them from the same ligature wires that were inserted into each microimplant. This set-up allowed the ante-rior open-bite to close very nicely and took approxi-mately 7 months to achieve complete closure (from month 13 to 20 of treatment). Once the bite was closed, the posterior occlusal rela-tionships landed in almost ideal relationships, with the midlines coinciding almost completely. The patient was asked to wear up and down elastics with a Class II vector on one side and a Class III vector on the other side to achieve full bilateral intercuspation, and this also helped to correct (or tweak) the midline quite nicely. In month 24, upper and lower impressions were taken for a fixed upper 2×2 and lower 3×3 retainers, keeping his braces in place until the retainers came back from the lab and we were ready to cement them on to the patient's teeth. On the next appointment (one week later), the fixed upper and lower retainers were bonded in place and, immediately after, another impression was taken of his upper arch, and the lab made an upper Essix removable retainer which he took home in the same appointment with instructions for daily use and care of it. The microimplants were removed from the palate in a later appointment. Though I would have liked to increase his overbite Fig. 4 rather than extrude the upper incisors to close his ante-rior open-bite to end up with a more esthetic smile (less gingival display). The first six months of treatment were spent going through the Straight Wire Series and allowing the NPE to also expand the posterior teeth and move them out of cross-bite. On the seventh month, a transpalatal bar was placed on the upper first molars and microimplants were inserted on the buccal shelves between the first and second molars, but the bone was not sturdy enough to support the pressure, so it was decided instead to place Fig. 5 Fig. 6 42 Summer 2015 JAOS
Journal of the American Orthodontic Society Summer 2015-Buyer's Guide: Page 42
