Orthotown June 2022 - 38
Fig. 4a: Initial CBCT overlay to assess midlines.
Fig. 4b: CBCT overlay of planned dental midlines.
Fig. 5a: CBCT overlay of initial Spark Approver model.
Fig. 5b: CBCT overlay of planned Spark Approver model.
Case study
Diagnosis
A 27-year-old patient sought orthodontic treatment to
correct his anterior open bite (AOB) and spacing. He presented
with a dolichofacial convex Class II skeletal pattern. The
maxillary occlusal plane was tipped inferiorly in the posterior
region, resulting in a downward and backward rotation of
the mandible. A functional mandibular shift of 1 mm to the
right was noted secondary to a slightly constricted maxilla
and crossbite of the UR3 (Figs. 1-3, p. 37).
Additional findings:
* Class III tendency of the left molar and canine;
Class II relationship of the right canines.
* 1 mm overjet; -3 mm overbite.
* 90% incisal display on smiling.
* Reverse smile arc.
* Proclined and slightly intruded maxillary incisors;
proclined and intruded mandibular incisors.
* Maxillary midline 1.5 mm to the left of facial and
mandibular midline 2.5 mm right of facial.
* Mild maxillary spacing and moderate mandibular
spacing.
38 JUNE 2022 // orthotown.com
* Bolton discrepancy with 2.4 mm mandibular excess.
* Thin gingival biotype.
* TMJ: WNL.
* Tongue thrust habit.
Treatment plan and digital setup
Because of the anterior open bite and the patient's
desire for a comfortable and aesthetic treatment option, an
estimated 18-month treatment with Spark Clear Aligners
was planned. Our treatment goals were to close the AOB,
broaden the maxillary arch to eliminate the UR3 crossbite
and functional shift, obtain a Class I occlusion, close spacing,
obtain coincident midlines and improve the smile arc.
Using an iCat FLX, an arches/TMJ QuickScan+ CBCT
was taken, with an effective dose of 9 microsieverts and
dose area product of 79.6 milligrays per square centimeter.1
The data was uploaded into Spark Approver software and used
to coordinate maxillary and mandibular midlines with the
face (Figs. 4a and 4b), plan the desired final incisor vertical
and A-P positions (Figs. 5a and 5b), and assess planned tooth
positions within the alveolar bone.
Uprighting and relative extrusion of the anterior teeth
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Orthotown June 2022
Table of Contents for the Digital Edition of Orthotown June 2022
Orthotown June 2022 - Intro
Orthotown June 2022 - Cover1
Orthotown June 2022 - Cover2
Orthotown June 2022 - 1
Orthotown June 2022 - 2
Orthotown June 2022 - 3
Orthotown June 2022 - 4
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Orthotown June 2022 - Cover3
Orthotown June 2022 - Cover4
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