was likely exacerbating his open bite. But we felt the etiology of his open bite may also have been genetic since he had a poor maxillary and mandibular jaw alignment and problems with the eruption of his teeth. His dentition is healthy, there is only one filling and his periodon-tal condition has been good. He has an over jet of 4 mm and an over bite of (-3mm). The molars and canines are Class I to a slight Class III. He had no history of thumb sucking or an accident that may have contributed to his open anterior bite. The average person swallows 2,000–4,000 times per day and exerts as much as six pounds of pressure with each swallow. Braces will correct GG’s bite but once they are removed, the tongue is strong enough to cause the teeth to return to their original opened position. For this reason, it is important to correct the tongue thrust before orthodontic treat-ment begins and we will make that part of our treatment. Fig. 2 Radiographic Analysis GG’s panoramic X-ray showed that he still had all four of his third molars developing and there were no missing teeth present. (Fig. 1) The condyles appear normal and the bone density and root development all appear with in normal range. The cephalometric X-ray showed that GG was dentally protrusive with an anterior/ posterior skeletal Class III and a CCW vertical growth pattern. (Fig. 2) All other soft tissue and facial analysis showed GG was within the normal range for someone of Hispanic descent. A Class III skeletal maloc-clusion is present with a 3 mm simple open bite from canine to canine. His Overjet is 4mm. Fig. 3 ᕢ Treatment will begin with a passive start involving the use of nickel titanium wires at the initial banding in order to begin leveling and aligning of teeth. ᕣ TP .016 stainless steel wires with Class III elastics will be placed to help close the bite. ᕤ Once the tongue thrust habit is controlled, the appliance will be removed. ᕥ In order to settle the bite, steps will be placed in the wires. ᕦ Retention will involve the use of an upper Trutain retainer and a lower bonded wire from canine to canine. ᕧ Retention checks will be scheduled every 3 months, or as needed ,to check that bite opening does not recur during growth. Treatment Plan ᕡ A habit appliance will be placed on the maxilla to work to resolve the present tongue thrust. www.orthodontics.com Winter 2023 25
Journal of the American Orthodontic Society Winter 2023: Page 25
