Video
Inital Exam
Chief Complaints
- Benson can’t close his lips.
- He has a hard time chewing his food.
- He doesn’t like to smile because he is embarrassed of his teeth.
- Judging by looks, it seems like Benson might have developmental problems. This is not the case. He is a very sharp kid who is smart and articulate.
Diagnosis
- Mandibular Asymmetry
- Bi-lateral Crossbite
- Severe Class III
- Tongue Thrust Issues
- Anterior Open Bite
Treatment Options
- 2 jaw surgery- The issue here is we would have to wait until Benson is done growing before getting the surgery done. This didn’t resonate because of how long he would go without any treatment, especially with the brutal bullying culture we have in schools these days.
- We could do an RPE and Facemask, but that seemed like an outdated option due to the technology we now have with PSL.
- Thanks to Chris Chang’s example, I learned we could also place Buccal Shelf TADs and retract the lower arch while rotating the occlusal plane. This option would impact Benson’s life the fastest, so that’s what we chose to do!
Treatment Plan
- Variable Torque Bracket Selection
- Use Tongue Tamers to influence a normal swallowing pattern, keeping it from pushing on the teeth.
- Once we place SS wires, have the 8’s extracted and place two Buccal Shelf TADs to retract the lower arch
Initial Setup
- I’ve placed tongue tamers Upper and Lower 2-2.
- Initial wires are .014 CuNi
- Notice I placed a stop in between the upper 1s to keep the wire from traveling too far and poking the patient.
- I’ve clipped the lower wire distal to the 5s and placed a little composite to keep the wire from sliding out of the slot. (It would have also been fine to place a stop in between the lower 1s like we did on the upper.
- I chose to hold off on any type of elastics and just let the wires do the work.
Inital Bonding
Torque Selection
Upper
- High Torque Upper 3’s
- They look pretty dumped in.
- Low Torque upper 2-2
- Because we are using class III mechanics, we want to avoid causing the upper teeth to flare forward
Lower
As we retract the lower arch, the lower anteriors are going to want to dump in lingually.
- Lower 2-2- Low Torque bracket reversed
- This will keep the roots upright and the crowns upright and not just dump the crowns back or stick the roots out through the bone.
- Lower 3s-High Torque
Month 2
Wires
Upper: .018 CuNi
Lower:Â .018 CuNi
Auxiliries
C-Chain upper 5-5
Month 3.5
Wire Progression
Upper: 14×25 CuNi
Lower: 14×25 CuNi
Auxiliries
Remove c-chains
Add Steel ties (braided) Upper and Lower 3-3
Month 6.5
Wire Progression
Upper: 19×25 SS
Lower: 16×25 SS
Bracket Repo:
Reposition Regular Torque Metal Bracket at LR2
Update High Torque Clear Bracket at UR/UL2
Comments
At this visit we built up the upper 3’s and reshaped the lower 3’s
Month 7.5
Wire Progression
Upper: 19×25 SS
Lower: 16×25 SS
Month 8.5
Wire Progression
Upper: 19×25 SS
Lower: 16×25 SS
Bracket Repo:
Rebond High torque Clear at UL3
Repositioned UL2 & UL3
Auxiliaries
C-Chain L6-6
Comments
Slenderized U/L 2-2
Month 12
TAD’s
Add TAD at UR3-UR2,UL2-UL3 (Buccal)
Add Retraction Spring at AWHook(LL2-3)-TAD,AWHook(UL4-5)-TAD (Short)
Wire Progression
Upper: 19×25 SS
Lower: 16×25 SS
Add Wire Hook at UL2-UL3,UR3-UR2
Auxiliaries
Remove C-chains L6-6
Add Steel Tie L3-3 and U 3-3 (Figureeight, under)
Add Bite Turbo at LL7 and LR7
Before & After
Case Summary
This was a tough case! I am still amazed at how we were able to impact Benson’s life through orthodontic treatment. As you look at the comparison photos, he looks like a completely different person. He no longer looks like he has developmental problems and finally has learned how to smile!
This is truly why we do what we do. We are here to change peoples’ lives and impact them for the better! Be sure to watch the video walkthrough for this case. I am able to go more in depth about the story behind Benson’s case. It’s worth the watch.