Brooke’s Case Study

Video Coming Soon

Inital Exam

Chief Complaints

Doesn’t like spaces in the upper arch and lower alignment

Diagnosis

Class I R/l, Midline Centered, 2mm U-space, 2-3mm L-Crowding, Narrow Arches, U3’s Grown Flat, Gummy Smile

Treatment Options

Comprehensive treatment with U-Clear, L- Stainless Steel Brackets. Decided not to start with TAD’s. (Later on changed her mind)

Torque Selection

Upper

Upper 2-2 Regular Torque
Upper 3’s High Torque

Lower

Lower 2-2 Regular Torque
Lower 3’s High Torque

Month 1

Wire Progression

Upper: .014 Cu NiTi (Round)
Lower: .014 Cu NiTi (Round)

Comments

Month 2

Wire Progression

Upper: .018 Cu NiTi (Round)
Lower: .018 Cu NiTi (Round)

Comments

Month 3

Wire Progression

Upper: .018 Cu NiTi (Round)
Lower: .018 Cu NiTi (Round)

Auxilliaries

C-Chains: Add C-Chain at U L/R 6-6 (Closed, Under)

Month 4

Wire Progression

Upper: 14×25 Cu NiTi (Rectangular)
Lower: 14×25 Cu NiTi (Rectangular)

Auxiliaries

C-Chains: Remove C-Chain at 14-3 (Closed, Under)

Steel Ties: Add Steel Tie at U/L 3-3 (Braided)

Month 5

Wire Progression

Upper: 18×25 CuNiTi (Rectangular)
Lower: 18×25 CuNiTi (Rectangular)

Auxiliaries

C-Chains: Replace C-Chain at U/L 6-6 (Closed, Under)

Steel Ties: Remove Steel Tie at U 3-3 (Braided)

Month 8

Wire Progression

Upper: 14×25 Cu NiTi (Rectangular)
Lower: 14×25 Cu NiTi (Rectangular)

Auxiliaries

C-Chains: Remove C-Chain at 14-3 (Closed, Under)

Steel Ties: Add Steel Tie at U/L 3-3 (Braided)

Bracket Repositioning:

Brackets: Reposition Regular Torque Metal Bracket at LR 2; Update High Torque Clear Bracket at U R/L 2’s

Comments

Built up U 3’s, reshaped L3’s

Month 9

Wire Progression

Upper: 19×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)

Comments

Month 10

Wire Progression

Upper: 18×25 Cu NiTi (Rectangular)
Lower: 16×25 SS (Rectangular)

Brackets: Reposition High Torque Clear Bracket at UL 2-3; Rebond High Torque Clear Bracket at UL 3

Comments

Month 10

Wire Progression

Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)

C-Chains: Add C-Chain at L L/R 6-6 (Closed, Under)

Steel Ties: Remove Steel Tie at L L/R 3-3 (Braided)

Auxiliaries

C-Chains: Add C-Chain at L L/R 6-6 (Closed, Under)

Steel Ties: Remove Steel Tie at L L/R 3-3 (Braided)

Comments

Slenderized U/L 2-2

Month 10

Wire Progression

Upper: 16×25 SS (Rectangular)

Lower: 16×25 SS (Rectangular)

Wire Hooks: Add Wire Hook at UL2-UL3,UR3-UR2

C-Chains: Remove C-Chain at LL6-LR6,UL6-UR6 (Closed, Under)

Steel Ties: Add Steel Tie at LL3-LR3,UR3-UL3 (Figureeight, Under)

Retraction Springs: Add Retraction Spring at AWHook(L L 2-3)-TAD,AWHook(U L 4-5)-TAD (Short)

Bite Turbos: Add Bite Turbo at LL7,LR7

TADs: Add TAD at UR3-UR2,UL2-UL3 (Buccal)

Comments

We started in .014 CuNi for 6 weeks and placed coil springs on the upper & lower 3’s back to the 6’s, activating them by 1/2 bracket’s length
Used a light-medium titanium coil spring. only advancing the coil spring by 1/2 a bracket every 6 weeks.
.018 for 6 weeks
14×25 rectangular wires for 6 weeks

Month 11

Wire Progression

Comments

Month 14

Comments

Month 16

Wire Progression

Comments

Month 20

Wire Progression

Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)

Auxiliaries

Wire Hooks: Remove Wire Hook at UR3-UR2, UL2-UL3; Add Wire Hook at UR4-UR3, UL3-UL4, LL4-LL3, LL3-LL2, LR2-LR3, LR3-LR4

Elastic Bands: Add Moose at AWHook(UL3-UL4)-AWHook(LL2-LL3)-AWHook(LL3-LL4), AWHook(LR3-LR4)-AWHook(LR3-LR2)-AWHook(UR4-UR3) (Fulltime)

C-Chains: Add C-Chain at UR6-UL6 (Closed)

Steel Ties: Remove Steel Tie at UR3-UL3 (Figure Eight)

Retraction Springs: Remove Retraction Spring at AWHook(UR3-UR2)-TAD(UR3-UR2), AWHook(UL2-UL3)-TAD(UL2-UL3) (Short)

Comments

Placed sling U3-3

Month 21

Wire Progression

Upper: 16×25 SS (Rectangular)

Lower: 16×25 SS (Rectangular)

Auxiliaries

Bends:Add Bend at UR3 (Upper, BuccalStep)

Bracket Hooks: Add Bracket Hook at UR3,UL3,LL4,LR4

Elastic Bands: Remove All Elastic Band; Add 6-4-3 (Moose) (Fulltime, Both)

C-Chain: Changed C-Chain at UR6-UR6-UL6 (Closed)

TADs: Remove TAD at UR3-UR2,UL2-UL3 (Buccal)

Month 22

Wire Progression

Upper: 16×25 SS (Rectangular)

Lower: 16×25 SS (Rectangular)

Auxiliaries

Wire Hooks: Add Wire Hook at UR3-UR2,UL2-UL3

C-Chains: Remove C-Chain at UR6-UR6-UL6 (Closed); Add C-Chain at UR3-UL3 (Closed, Under)

Tie-Backs: Add Tie-Back at UR6-AWHook(UR3-UR2),AWHook(UL2-UL3)-UL6,AWHook(LL3-LL2)-LL6,LR6-AWHook(LR2-LR3) (Long)

IPRs: Add IPR at UR2-UR1,UR1-UL1,UL1-UL2 (Both, 0.1mm)

Month 23

Wire Progression

Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)

Auxiliaries

Bends: Add Bend at UR2-UL2 (Upper, ExtrusionStep); Add Bend at LL4,LR4 (Lower, IntrusionStep); Add Bend at UR2 (Upper, BuccalStep); Add Bend at UL2 (Upper, MesialIn)

C-Chains: Remove C-Chain at UR3-UL3 (Closed, Under); Add C-Chain at UR7-UL7 (Open, Under)

Tie-Backs: Remove Tie-Back at UR6-AWHook(UR3-UR2), AWHook(UL2-UL3)-UL6 (Long)