CASE REPORT • Avoid extractions per parent’s request • Retain positive results over time Treatment Plan • Transverse expansion of the maxillary arch using a custom-made rapid palatal expander (RPE) with banded molars and bonded on to the lingual aspect of the first bicuspids. • Class II D2 Motion distalizer used on mandibular arch as a Class III dental distalizer. • Use interarch Class III elastics to protract the maxillary arch and distalize the mandibular bicuspids and molars. • Create space for mandibular canines, then bring them into the arch using straight wire orthodontics • Once maxillary expansion is complete and the arch is in a strong rectangular archwire, remove RPE, and continue with brackets and archwires using elastics as needed. Fig. 6 Custom made orthodontic form with a compilation of all data, diagnosis, and orthodontic treatment plan. • Use sectional elastics as needed to achieve interarch coordination • Maintain positive results by long term retention using bonded maxillary and mandibular fixed lingual and palatal retainers and Essix retainers • Long term retention and recall visit protocol • If needed due to lack of compliance with elastic use, consider extraction of the first mandibular bicuspids or dental distalization of the mandibular teeth using skele-tal anchorage such as TADs cation camouflaged as a Class I based on ANB due to the clockwise mandibular growth. Treatment Objectives • Improve facial and dental esthetics • Align and level teeth to achieve above objective • Transverse expansion of maxillary arch • Distalize mandibular bicuspids and molars • Create space for mandibular canines • Achieve Class I molar and canine relationship • Correct mandibular midline • Achieve a Class I molar & canine classification • Increase maxillary lip support • Camouflage Class III interarch relationship Diagnosis • Class III skeletal (A-PO), Wits and Class I (ANB) • Class III dental • Class III mandibular clockwise growth and canines in ectopic position • Maxillary arch with transverse constriction and anterior incisor crowding • Deviated mandibular midline • Mesial impaction #1, horizon-tal impaction #16 • Absence of #17, #32 Estimated Treatment Time Estimated treatment time was generous, 24-26 months, due to multiple complex movements that 16 Summer 2020 JAOS
Journal of the American Orthodontic Society Summer 2020: Page 16
