Dr. Webster’s Case

Inital Exam

Chief Complaints

Raul doesn’t like how his smile isn’t level and would like a wider smile. He feels like all people see are his front two teeth when he smiles

Diagnosis

Anterior Open Bite
Tongue Thrust Keeping Bite Open
Flat (almost reverse) smile arch

Treatment Plan
  1. Bracket Placement for Smile Arch
  2. Variable Torque Bracket Selection
  3. Coach Raul to develop a normal swallowing pattern, keeping it from pushing on the anterior teeth. If necessary, we’ll use Tounge Tamers

Initial Setup

Positioned the brackets for a good smile arc.

Wires:
Upper-.014 CuTi (7-7)
Lower .013 CuTi (5-5 with composite stops)

We kept the wire off the LL7 because of the slight crossbite

Torque Selection

Upper
  • High Torque Upper 3’s
    • They look pretty dumped in.
  • Low Torque Upper 2-2
    • We want to overcome the flaring so we chose HT
  • Regular Torque Upper 4’s & 5’s
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 2.5

Wire Progression

Upper: .018 CuTi
Lower: .018 CuTi

Month 3.5

Wire Progression

Upper: .018 CuTi
Lower: 14×25 CuTi

Comments

Rebonded LL7 and UR7
New Arch Wires, Upper and Lower through the 7’s

Month 5

Wire Progression

Upper: 14×25 CuTi
Lower: 14×25 CuTi

Comments

Wire Tie L 3-3, Power Thread U 3-3,
Start Open Triangles w/Fox

Month 8

Wire Progression

Upper: 14×25 CuTi
Lower: 14×25 CuTi

Comments

We’ve moved on to 14×25 CuNi wires and are letting them work their magic.
Because these wires are rectangular, they will start to lightly express torque on the teeth.
We still are staying away from elastics while progressing through the wire sequence.

Month 10

Wire Progression

Upper: 18×25 CuTi
Lower: 14×25 CuTi

Comments

Placed new Upper and Lower ARch wires. And widened the arch wires.
Stepped down the upper 2-2
Slenderized lower anteriors

Month 13

Wire Progression

Upper: 19×25 TMA
Lower: 19×25 TMA

Comments

Added torque Upper 2-2
same rubberbandsĀ  – Rainbow NTO w/moose
Powerchain Lower 6×6

Month 14

Wire Progression

Upper: 19×25 TMA
Lower: 17×25 TMA

Comments

Repo’d upper 2-2
Slenderized between u1&2’s
Slenderized L1’s again
Power chain lower 6×6
Rainbow Elastics with moose

BeforeĀ  & 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.

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