Orthotown June 2018 - 34

Case #2
The subject (Fig. 14) presented with excess overjet, severely
proclined upper and lower incisors (Fig. 15), lip incompetence, a
significant curve of Spee with crowding and stepped-up lower 3-3
(Fig. 16), and a reversed smile line.
Treatment objectives were to intrude and retract the upper and
lower incisors to establish optimal overjet, overbite and lip competence.
Upper and lower first premolars were extracted to resolve the
crowding and protrusion. The lower 6s and 7s were banded, and the
rest of the teeth bonded with .022 MBT brackets (Victory Series,
3M Unitek). Maxillary arch alignment was initiated with .014,
.018 and 19x25 Niti.
A 17x25 TMA T-loop arch wire, differentially gabled (β > α),
was used to intrude and retract the upper 3-3, while separate
canine retraction with segmented arch mechanics (17x25 TMA
retraction springs) was initiated in the lower arch to unravel the
lower crowding (Fig. 17).
Once there was adequate space, the lower incisors were leveled
with a one-piece intrusion arch, cinched distal to the 6s and ligated
between the 1s and 2s to provide a line of action closer to the center
of resistance of the anterior segment (Fig. 18).6
Ten months into treatment, the lower arch had been leveled and
the maxillary incisor proclination substantially reduced (Fig. 19).
However, the side effects of the mechanics were evident, with the
lingually tipped upper 3-3 and the distally tipped and rotated
lower 3s. Both phenomena were related to inadequate moment:
force ratio during retraction. At this stage, the arches were ready
for root correction, followed by correction of the AP relationship
with sliding mechanics.
At month 15, both upper and lower arches were in 19x25 SS with
good transverse and vertical control of the occlusal plane. Class II
elastics were applied from the lower 7s to the upper arch wire hook
to protract the lower molars into Class I. First- and second-order
bends were applied in the steel wires to fine-tune tooth and root
position. The final result at month 23 shows good intercuspation
and optimal incisal display (Fig. 21). Both upper and lower incisors
were intruded and uprighted during retraction and a slight opening
of the mandibular plane was also evident (Fig. 22). Lip competence
and facial balance were also significantly improved.

34

JUNE 2018 // orthotown.com

Fig. 14

Fig. 15

Fig. 17

Fig. 18

Fig. 19

Fig. 16



http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown June 2018

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