CASE STUDY Fig. 6 Instructions were given for proper oral hygiene. The patient returned on 10/23/19 and an .016 reverse NiTi Mx wire was placed to open the bite and give clearance to bracket the lower arch. At the next visit, the patient was placed in a .020 SS maxillary wire and a .016 SS mandibular wires with loops, and 2.5 oz Class III elastics to be worn full time were also placed. In January 2020, maxillary and mandibular arch wires continued with a .014 NiTi piggyback wire and Class III elastics. (Fig. 7) Stage II began and we worked to achieve an ideal midline by using elastics. In March 2021, we moved to a .020SS Maxillary wire and a .020 mandibu-lar wire with a relaxed long power chain on the maxillary and a non-relaxed long power chain on the mandibular arch. (Fig. 8) Once Stage II objectives were finished, we moved to Stage III. On 10/20/21, the mandibular arch brackets were removed and a fixed permanent retainer was placed on the lingual surface of the anterior teeth. An .022 wire continued on the maxillary arch with a short power chain. (Fig. 9) On 12/10/2021, the upper arch brackets were removed a little over 25.5 months since treatment was started. An upper Essix retainer was deliv-ered. (Fig. 10). We started with NiTi and “pillows” to open the bite. As treat-ment progressed, the maxillary anterior teeth level and aligned and jumped the lower bite. We then closed lower spaces with power chain and began Class III elastic wear. In general, I was very satisfied with the result. Upper right 4 is not completely in occlusion but we are watching for it to settle into place. The final panoramic (Fig. 11) and Ceph (Fig. 12) were taken. Fig. 7 Fig. 8 Fig. 9 Final Takeaways A dissatisfaction with one’s dental appearance is a strong predic-tor for low self-esteem. The self-esteem of a person can be under-stood as the capability to accept the worthiness of oneself. It is recog-nized as important in playing a criti-22 Winter 2023 JAOS
Journal of the American Orthodontic Society Winter 2023: Page 22
