clinical orthodontics // message board
Vertical Control 1
A Townie wants to know how peers would treatment plan a case where a patient is concerned with the
development of her lateral open bite.
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orthothai
Member Since: 10/14/13
Post: 1 of 9
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How Do I Handle the Vertical
2 2013
in ThisJULY
Case?
Handle Vertical
Class II With Lower
Impacted Canine
Lower Impacted
Introduction
Here is a case that makes me think quite a lot. Not being in a position to refer the patient (I
am the only orthodontist in the country), I told the patient that it would be preferable to delay
treatment until she goes back to Europe since this is a multidisciplinary case needing a long-term
follow up.
Nevertheless I am curious of how you think the case should be managed. This patient did
an orthodontic treatment as a teenager with four bicuspid extractions (very flat profile). She
consulted me because she was concerned by the development over the years of a lateral open bite.
Lateral tongue thrust is present during deglutition.
The anterior mandibular alveolar bone is razor thin and you can almost see the root through
the gingiva. For resolving the crowding and allowing the eruption of the #5 and #6 (intruding
the posterior sector in this case is of course not possible) I need to distalize the posterior segment.
Extraction is out, stripping would not be sufficient and just leveling would lead to proclination
of the lower incisor and probably a major perio problem.
A lateral and anterior tongue crib would be necessary (and life contention with a removable
appliance having a crib-like effect). A treatment sequence that has been suggested was expansion
of the upper and tongue crib, leveling of the upper whole arch and of the lower posterior segment.
When the upper wire is 17x25 SS, use of Class III elastic such as a Carriere Distalizer for
distalizing the lower posterior segment (this, by the way, would work-I already used both
carrier distalizer and the variation with a segmental wire on the posterior sector successfully on
Class III patient).
Once the space is gained, use of a more conventional full arch mechanic.
Conclusion
Any thoughts on this case? n
MAY 21 2015
Continued on p. 12
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SEPTEMBER 2015 // orthotown.com
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