Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 49
Case Report
How would you treat this malocclusion?
Posttreatment
Case K.G. 13 years, 11 months
Treatment Objectives
Our objectives included maintaining the patient's
skeletal relationships, profile pattern, lip
support, facial symmetry, and incisal display
on smiling. Dentally, we wanted to address
the supernumerary tooth present lingual to
the maxillary right lateral incisor as well as the
missing mandibular right first molar. We wanted
to establish Class I molar and canine relationships
on the right side while maintaining
the Class I posterior occlusion on the left side,
coincide the maxillary and mandibular midlines
with the facial midline, and maintain the
angulation and position of the maxillary and
mandibular incisors. Our goals also included
achieving ideal overbite and overjet, leveling
the mandibular curve of Spee, aligning all of
the dentition, and monitoring attached tissue
levels throughout treatment.
Treatment Alternatives
Two treatment plans were presented for the
patient, either opening space to replace the
mandibular right first molar or closing the
space and substituting the mandibular right
second molar for the mandibular right first
molar. Class II correction was to be achieved
with Class II elastics. It was discussed with
the patient and family that if the space was
closed, restoration would not be needed to
replace the missing tooth and that the mandibular
right third molar may come into the
space to serve as the second molar. However,
depending on the eruption of the mandibular
right third molar, additional treatment may
be necessary to achieve ideal position and
function.
Treatment Plan
The family chose to close the mandibular
right first molar space. In addition, the patient
played the trumpet. His mother expressed
concern about adapting to playing his instrument
with braces and asked if clear aligners
would be an option. After a discussion about
the importance of compliance with the alignFigure
5. Progress shown in extraoral and intraoral photos following the initial set of aligners
ers and the possibility of needing segmental
appliances to upright the mandibular right
second molar and close the space, it was
decided to proceed with clear aligner therapy
with Invisalign. One advantage of using aligners
is that Class II elastics could be used from
the beginning of treatment. The importance
of compliance with elastics and aligners was
discussed with the patient and family as well
as the most likely need for interproximal reduction
(IPR) during treatment. Maintenance
of regular prophylaxis appointments and
excellent oral hygiene were also emphasized.
Treatment Progress
The initial ClinCheck included 30 aligners with
optimized attachments and cutouts for buttons
for Class II elastics. The patient was given
six sets of initial aligners and was asked to
change them every two weeks in addition to
wearing Class II elastics (4.5 oz, ΒΌ " ) bilaterally
full-time. After completion of the initial sets of
aligners, there was significant improvement
of the alignment, posterior occlusion, and
position of the mandibular right second molar.
Progress records were taken, and a new scan
was submitted for refinement (Figure 5).
At this time, additional Class II correction was
needed on the right side, and the mandibular
right second molar needed more mesial root
tip and mesialization. The mandibular curve
of Spee still needed leveling, and we continued
to further align the dentition (especially
the maxillary right canine). In the refinement
ClinCheck, more intrusion of the mandibular
incisors was added, while extruding the
mandibular premolars (similar to the shape
of a reverse curve archwire), and sequential
distalization of the maxillary right posterior
dentition was initiated to help correct this side
to Class I while continuing full-time elastics
Spring 2023 PCSO Bulletin
49
Pacific Coast Society of Orthodontists Bulletin Spring 2023
Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2023
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 1
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 2
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 3
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 4
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 5
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 6
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 7
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 8
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 9
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 10
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 11
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 12
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 13
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 14
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 15
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 16
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 17
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 18
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 19
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 20
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 21
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 22
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 23
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Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 25
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 26
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 27
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 28
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Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 36
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 37
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 38
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 39
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 40
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 41
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 42
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 43
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 44
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 45
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 46
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 47
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 48
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 49
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 50
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 51
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 52
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 53
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 54
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 55
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 56
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 57
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 58
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 59
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 60
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 61
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 62
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 63
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 64
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