CASE REPORT Fig. 9 Fig. 8 b Start archwire sequence on lower arch. b Place D2 appliance bilaterally on maxillary arch and place LLHA on mandibular arch for anchorage b Correct Class II with elastics b Remove D2 appliance and place rest of upper brackets and molar bands b Finish archwire sequence b Maxillary and mandibular bonded fixed retainers 3 – 3 b Estimated treatment time: 18 months. Schuamburg, Illinois). Four weeks later, first molar bands with lingual sheath were placed with a 0.016 Ni Ti wire on the lower arch and a sectional from #7 to #10 was placed on the upper arch. During this appointment, a fixed/removable lower lingual arch was also placed. We also placed bilateral D2 appli-ances from maxillary canines to maxillary first molars. The patient was instructed on the wear of Force 2 Class II elastics (Carriere Motion elastics. 3/16” 8 oz. Henry Schein, Carlsbad, CA). (Fig 13 A, B and 14). She was told to wear the elastics all the time, except when she was eating. The objectives of the elastics, as well as proper care of appliances were also discussed with patient and her mother. In addition, we started with an archwire sequence focused on the lower arch. At five months of treatment, it was observed that the Class II molar relationship had improved. During her regular ortho checks every four weeks, it was obvious Fig. 10 Case Summary KD’s treatment began in June 2020. On the initial appointment, 0.022 slot brackets were placed on upper incisors only, as well as on the entire lower arch including premolars, canines and incisors. This is the typical protocol we use in our practice for Class II correc-tion using the D2 appliance. The first wire used was a 0,014 Ni Ti wire (upper sectional). 3 mm incisal stops were also placed on lingual of teeth #8 and #9 on the first appointment, in order to prevent brackets from being knocked off by the occlusion, due to the presence of deep bite. To place the incisal stops, we use Minimolds (Ortho Arch, that K D was compliant with elas-tic wear involving her D2 appli-ance. The left and right side were in a good Class I molar relation-ship when she bit down. The crowding present on the lower arch was starting to improve due to the archwire sequence we had followed. The position of tooth #6 had also improved due to D2 elastic wear. She was instructed to wear the elastics at nighttime only to “hold the bite” the way it was. She was reappointed the next month to remove the D2 appliances. At six months of treatment, all teeth were bracketed, and upper first and second molar bands were placed and the lower lingual hold-ing arch was removed. We contin-ued with regular archwire 28 Summer 2022 JAOS
Journal of the American Orthodontic Society Summer 2022: Page 28
