Sapreet’s Case

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 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

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 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

Torque Selection

Upper
  • High Torque Upper 3’s
    • They look pretty dumped in.
  • Regular Torque upper 2-2
Lower
  • Regular torque Lower 2-2
  • LL3 Low Torque
  • LR3 High Torque

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.

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.

Torque Selection

Upper
  • High Torque Upper 3’s
    • They look pretty dumped in.
  • Regular Torque upper 2-2
Lower
  • Regular torque Lower 2-2
  • LL3 Low Torque
  • LR3 High Torque

Treatment Progression

Month 2

Wire Progression

Upper: .018 CuNi
Lower: .016 CuNi

Comments

We also placed stops to keep the wire from moving too much.

Month 4

Wire Progression

Upper:.018 CuNi
Lower: .018 CuNi

Bracket Repo

Came in with broken brackets on Upper Right 2 and Upper right 6. We rebonded.
We also bonded Upper Left 3 with a high torque bracket

Month 6

Wire Progression

Upper: 14×25 CuNi
Lower: 14×25 CuNi

Bracket Repo:

UL3 (same torque)

Comments

Wire tie on the Lower

Month 12

Wire Progression

Upper: 14×25 CuNi
Lower: 14×25 CuNi

Comments

Wire Tie Upper 3-3
Wire Tie Lower 3-3

Month 16 – Phase I Debond

Wire Progression

Upper: 19×25 PT
Lower: 19×25 PT

Bracket Repo:

was in 19X25 PT For 2 Months before debond

Phase II

Wire Progression

Upper: .014 CuNi
Lower: .014 CuNi

Bonded 6-6 No LL5 or UL3

Brackets

Bonded in the Damon Q

Month 2

Wires

Upper: .018 CuTi
Lower: .016 CuTi

Brackets

Bonded L5’s and UL6

Month 4

Wire Progression

Upper: .014 CuNi
Lower: .018 CuNi

Brackets

Came in with UR2 and UR6 brackets off- Rebonded

Bonded UL3 with ah High Torque Bracket

Month 6

Wire Progression

Upper: .014 CuNiTi
Lower: 14×25 CuNiTi

Brackets

Repo’d UL3

Auxiliaries

Wire Tied the lower

Month 8

Wire Progression

Upper: 14×25 CuTi
Lower: 14×25 CuTi

Auxiliaries

Removed wire tie

Month 10

Wire Progression

Upper: .018 CuNi
Lower: .018 CuNi

Brackets

Repo’d Upper 3’s and UR1

Month 12

Wire Progression

Upper: 14×25 CuTi
Lower: 14×25 CuTi

Auxiliaries

Wire Tie U/L3-3

Month 15

Wire Progression

Upper: .014 CuNi
Lower: .018 CuNi

Brackets

Bonded U/L 7’s

Progress

Hightlights

Nothing Major happened for these 5 months. We kept everything tight with wire ties and went from the .014 CuTi/.018 CuTi into the 14×25 CuTi

Month 20

Wire Progression

Upper: 19×25 TMA
Lower: 17×25 TMA

Brackets

Repo’d upper 4’5 and 5’s and LR2

Elastics

cl 2 RS box LS w/ moose

Month 21

Wire Progression

Upper: 19×25 TMA
Lower: 17×25 TMA

Brackets

UR1 UR 5 and L 2’s

Steel tie LL2 where wire wouldn’t go in

Month 24

Auxiliaries

Power Chain Upper 6-6

Comments

Slenderized between the U1’s

Continued Elastics

Month 24.5 – Debond

Comments

We are happy with the progress she has made but we have some contouring to do for that Next Level Finish

Finish

Comments

BeforeĀ  & After

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