Case 17: Class II division 1, Phase I+II, non-extraction with headgear,
Female age 12
Start records
. Vertical
Frankfort to
mandibular plane
Palatal to
mandibular plane
. Wits
Start
Mean ± SD
18,5°
22° (18°- 28°)
19°
28° (24°- 33°)
6 mm
. Steiner
-1 - +2 mm
SNA
83°
82° ± 3,5
SNB
75°
80° ± 3,5
ANB
8°
2°-4° ± 2,5
GoGnSN
29°
33° ± 2,5
2,5 mm
16°
4,5 mm
4 mm
22°
4 mm
24°
25°
65°
67°
+ 1/NA
- 1/NB
. Y-axis to SN
Summary ceph measurements:
- Class II closed
- Upper incisors retroclined
Diagnosis summary
Skeletal and dental class II led to phase I with cervical headgear, 24 oz per side, as
eruption of the 5s was still pending. The upper right third molar (18) was small and
the other missing, eliminating a molar extraction treatment decision. A lower
lingual arch (LLA 6-6) was used with some slicing of the Es to gain space in the
lower arch. The preliminary diagnosis was for non-extraction.
Treatment Summary
Phase I: Excellent headgear wear for 2 years and 3 months changed ANB +8 to
ANB +2. It took 3 years for the second bicuspids to erupt, which was a surprise. An
ASHH activator and surgery were considered as possible treatments.
+1 year in Phase I
Overlay: start vs. 1 year
Mandibular positioning when considering the surgery option
Phase II treatment Summary
The lower arch was aligned and eventually 21x25ss archwire was engaged. In the
upper arch, 19x25ss T loops were used to retract the upper incisors after retraction
of the upper 4s and 3s with nickel-titanium closed coils.
Final Records
. Vertical
Frankfort to
mandibular plane
Palatal to
mandibular plane
. Wits
. Steiner
Start
Progress finish
Mean ± SD
18,5°
20°
21°
22° (18°- 28°)
19°
21°
18°
28° (24°- 33°)
6 mm
4 mm
2,5 mm
-1 - +2 mm
SNA
83°
81°
80°
82° ± 3,5
SNB
75°
75°
75,5°
80° ± 3,5
ANB
8°
6°
4,5°
2°-4° ± 2,5
GoGnSN
29°
31°
30°
33° ± 2,5
+ 1/NA
- 1/NB
. Y-axis toSN
2,5 mm
3,5 mm 3 mm
4 mm
16°
22,5°
23,5°
22°
4,5 mm
6 mm
5,5 mm
4 mm
24°
29°
27°
25°
65°
67°
66°
67°
Summary ceph measurements:
- Skeletal class II changed into a class I
- AP position and inclination upper incisors improved
- Lower incisors finished slightly protrusive and proclined
Overlay: start (black), 1 year (blue), final (red)
Overlay: start (black) vs. final (red)
Final Remarks:
This was a 3 year case due to delayed eruption of the second bicuspids. The upper
8s formed later, following the initial evaluation.
Additional comments not a part of the exam
Doctor Time: no assistant was employed in this practice
Consultations (2), initial records, process records, diagnosis = 3 hours
Initial band and bond = 1.5 hours
12 visits @ 15 minutes = 3 hours
16 visits @ 20 minutes = 5.3 hours
4 visits @ 30 minutes = 2 hours
Deband, final records, fabricate and deliver retainers = 2 hours
Total Doctor time = 16.8 hours
Estimated with 1 assistant = doctor 9 hours, assistant 7.8 hours