Case #
(was this your first case or ??)
Case type: class __ dental and skeletal
with protrusion and excess anterior
overjet
Age __ Male/Female
Transition to IP @ 6 months
Your Name, practice location,
POS OC#17
Initial Records
__ year old Chinese Male presented with the chief complaint of _________.
Start Panoramic x-ray
Start Cephalometric x-ray: (to do this page, print the dentalcad
tracing, then scan into adobe photoshop, label, then “insertimage-from file” in MS Word, resize the photo)
Start Model Measuring (to do this, print model measuring from
dentalcad, then scan, name, “insert-image” from file in Microsoft
word, resize photo)
Treatment Decision
A discussion of your treatment decision, what else you considered, and reasoning…..
For example: Non-Extraction was the initial diagnosis, which would have NOT solved
the chief complaint of this patient, who was complaining of protrusion (with straight
teeth). The patient had already gone through non-extraction orthodontics previously. I
consider this retreatment diagnosis as a missed diagnosis.
In the past, a change in diagnosis to bicuspid extraction would have been made.
Instead, the upper incisor brackets were changed to Labial root torque brackets, and
21x25N was engaged and retied for the next 6 months to test the ability to do more cases
non-extraction.
IP Appliance  Design
Say something about incisor torque, cuspid torque, molar buccal
tubes, archwires, rotations, positioning that you used for this case
(and maybe what you did not use). For example: Single patient standard
Roth IP Appliance was used for this case. At 6 months, a change to Labial root torque
brackets was made to reduce the upper incisor proclination and associated “overjet” felt
by the patient. There was also a change to mesial rotation brackets on 14M and 25M.
Other rotation brackets could have been used, but were not diagnosed using the “manual”
method (no software and no model measuring).
Ovoid non-extraction #1 (expanded) archwires were applied for the first 6 months. At
6 months, the lower archwire was changed to Ovoid non-extraction #2, the archform to
maintain the original shape and size. In the upper arch, 21x25N is not available in the IP
Shapes and sizes, so this was ovoid non-extraction #1 for the entire treatment. Changes in
the incisor torque would be due to the bracket-archwire interface.
There is no difference in the anterior expansion 3-3 between these archwires. The
upper posterior constriction did not cause a posterior crossbite. This is the overlay of the
upper non-extraction #1 and #2 archwires.
Selection of rotations with model measuring
More rotation brackets would have been selected had model measuring been available
at the time of treatment. This would have led to less under-corrections on the final result.
Rotations by this method are: 35M, 33D,41D,43D,44M in the lower arch, and
15M,14M,13D,11M,21D,22M,24M, 25M in the upper arch.
Results
Alignment and wire progression to rectangular wires consumed the first 14 months
due to the severe upper left second bicuspid (25) rotation. This was followed by some
lower arch finishing (only step bends to compensate for height bracket error). There were
NO finishing bends made in the upper arch. Several rotations were not fully corrected
due to a) combination labial root torque and rotation brackets were not available at the
time of treatment and b) 21x25N is too stiff an archwire to deflect fully into the bracket
slots. A better archwire would have been 18x25N heat activated. The case was
debanded at 20 months.
13 months photos
[Not required, but if you have progress photos or models or xrays that are significant to the case understanding, please include]
The reason for extraction, the protruded upper incisor with the feeling of excess overjet
was now corrected after 6 months of 21x25N and labial root torque brackets.
13 Months Cephalometric x-ray
Skeletal overlay: start vs. 13 months
[Skeletal, dental overlays are completed on your “finished” case
and possibly different stages of treatment. Comments on what these
show is added. Scan, same, insert-image-from file, resize.]
The mandible rotated down and back, avoiding the protrusive interference resulting
from detorquing and extrusion of the upper incisor. This also increased the class II dental
seen on the lateral views.
Dental Overlays: start vs. 13 months
(6 months of 21x25N in Labial root torque brackets)
There was NOT a loss of molar anchorage due to the added labial root torque applied
to the upper incisors. The increase in class II dental was due to mandibular rotation, an
avoidance response to the incisive protrusive interference.
After the root contacted the labial cortical plate, the crown had to move palatal as a
result of the torquing applied through the archwire and bracket. 10 degrees of change in
the upper incisor inclination is NOT seen with the previous straight wire appliances.
Comparison of Labial Cortex close-up: start vs. 13mo
Final Records
Comparison of the study models: Final vs. start
The archforms were maintained. The severe upper bicuspid rotations were not fully
corrected.
Final Panoramic x-ray
Final Cephalometric x-ray
Skeletal overlay: 13 months vs. final
Some counterclockwise rotation of the mandible took place in the last year of
treatment, a recovery of the clockwise rotation seen in the first year.
Dental overlays: 13 months vs. final
Upper incisor labial root torque was complete after 6 months of rectangular nickeltitanium wires, with no further detorquing noted in the last year.
Skeletal overlay: Start vs. final
The mandibular rotation seen in the first year did not fully recover in the second year.
Dental overlays: start vs. final
There was a change of 11 degrees of labial root torque as a result of the full size
nickel-titanium archwire engaged into the Labial root torque bracket. There is an
additional 10 degrees of labial root torque (+2 degrees) in the La bracket relative to the
standard Roth (+12 degrees) on the central incisor prescription.
The crown of the tooth moved lingual after the root could no longer move forward as
a result of contacting the labial cortical plate.