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
- Bracket Placement for Smile Arch
- Variable Torque Bracket Selection
- 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 rubberbands – 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
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.