Case 11: Class II, division 1, deep bite, unilateral crossbite, treated
Phase I+II non-extraction. Female age 11 year 3 months
Start records
. Vertical
Frankfort to
mandibular plane
Palatal to
mandibular plane
. Wits
. Steiner
Start
Mean ± SD
24,5°
22° (18°- 28°)
27°
28° (24°- 33°)
+0,5 mm
-1 - +2 mm
SNA
75,5°
82° ± 3,5
SNB
72,5°
80° ± 3,5
ANB
3°
2°-4° ± 2,5
34,5°
33° ± 2,5
2,5 mm
14°
4 mm
22°
GoGnSN
+ 1/NA
- 1/NB
. Y-axis to SN
2 mm
4 mm
16°
25°
70°
67°
Summary ceph measurements:
- Class I vertical average, open growth pattern
- Retruded maxilla and mandible
- Upper and lower incisors are retroclined and retrusive
Diagnosis Summary
The molar asymmetry of near class I on the right side and 6mm class II on the left
was suspected to be a functional shift of the mandible caused by the unilateral
crossbite. Non-extraction would be confirmed at the start of phase II, with phase I
treatment aimed at correcting the posterior crossbite and functional shift.
Phase I treatment Summary
A “hyrax” rapid maxillary expansion appliance was expanded 9mm, then
retained with a transpalatal bar (TPA) in the short 6 month phase I.
Phase II treatment summary
1 year of full banded and bonded (straight wire) appliances were used. 4 months
of class II elastics were used in the mechanics phase, and then again for another 3
months during finishing.
15 Month Panoramic x-ray
Final Records
. Vertical
Frankfort to
mandibular plane
Palatal to
mandibular plane
. Wits
. Steiner
Start
Finish
24,5°
24°
22° (18°- 28°)
27°
28,5°
28° (24°- 33°)
+0,5 mm -0,5 mm
Mean ±SD
-1 - +2 mm
SNA
75,5°
73,5°
82° ± 3,5
SNB
72,5°
72°
80° ± 3,5
ANB
3°
1,5°
2°-4° ± 2,5
34,5°
35,5°
33° ± 2,5
2,5 mm
6 mm
4 mm
14°
23,5°
22°
GoGnSN
+ 1/NA
- 1/NB
. Y-axis to
SN
2 mm
5,5 mm
4 mm
16°
26°
25°
70°
71,5°
67°
Summary ceph measurements:
- Class I was maintained, slightly more open growth pattern
- Upper and lower incisors proclined and protruded
Final Remarks
The case was a routine case. The lower lateral incisors needed more labial root
torque.
Additional comments not a part of the exam
Doctor time: no assistant was employed at this practice
Phase I = 4 hours
 consultations, take records, process records, diagnosis = 3 hours
 Impressions and fabricate Hyrax expander, retain with TPA (3 visits
total) = 1 hour
Phase II = 7.5 hours
 no consultations, records, nor diagnosis
 initial band and bond (direct) = 1.5 hours
 3 visits @ 15 min = 0.75 hour
 6 visits @ 20 min = 2 hours
 2 visits @ 30 min (finishing) = 1 hour
 Deband, take final records, fabricate clear overlay retainers plus extra
upper Hawley retainer to retain crossbite = 2.25 hours
Total Doctor time = 11.5 hours
Estimated with 1 assistant = doctor 6.5 hours, assistant 5 hours