present. Teeth 6, 11,13 were unerupted and impacted and tooth #12 was impacted and buccally displaced. Intra oral periapical radio-graphs revealed permanent teeth all with roots within normal limits and no other periapical pathology associ-ated with the primary teeth. No root resorption was present on the panoramic x-ray. (Fig. 2) She had a high-vaulted A-shaped palate and retroclined lower incisors. The Cephalometric x-ray (Fig. 3) was traced using the Jack-son Basic Analysis. (Fig. 4) Lucia has a Class I skeletal pattern with an ANB of 4.1. The mandibular plane angle is 30.4 indicating a neutral growth pattern. The overall orthodontic diagnosis was a dental and skeletal Class I malocclusion with an anterior open bite and posterior cross bite with multiple maxillary tooth impactions. TMJ analysis revealed an asymp-tomatic TMJ with no pain upon opening or closing and a normal range of opening 52mm with no deviation upon opening or closing and no joint pain or noise. Fig. 3 TREATMENT OBJECTIVES ᕡ To level and align all teeth to a balanced and fully intercus-pated molar, premolar and canine occlusion with a proper overjet and overbite. ᕢ Close anterior open bite and correct posterior cross bite. ᕣ Erupt impacted teeth into alignment. Fig. 4 Fig. 5 TREATMENT PLAN ᕡ Straight-wire brackets on upper and lower arch (.022 slot Roth). ᕢ Banded Hyrax for palatal expansion will be kept on during the eruption of the impacted canines and the upper impacted premolars. ᕣ Archwire sequence: .014 niti. .018 niti, 16x22 braided ss, 16x22 niti ..020 ss, 16x22ss, 19x25 beta titanium ᕤ Canine and premolar surgical exposure and bond with gold chain ᕥ Piggy back wire for extru-sion of impacted teeth (Fig. 5) ᕦ Finish to a Class I with closure of the anterior open bite and correct posterior cross bite ᕧ Hawley retainer with clear acrylic on the facial and permanent retention upper 2x2 and lower 3x3. A special consideration was made for flap design during surgical expo-www.orthodontics.com Winter 2023 17
Journal of the American Orthodontic Society Winter 2023: Page 17
