Video
- Initial Exam
- Initial Setup
- Visit 1
- Visit 2
- Visit 3
- Visit 4
- Visit 5
- Visit 6
- Visit 7
- Visit 8
- Visit 9
- Visit 10
- Visit 11
- Visit 12
- Final
Inital Exam
Chief Complaints
- “I have lost my upper face.”
- Upper lip has collapsed due to 4 bi extraction 25 years ago
- Lack of upper lip support makes nose appear to be larger
Diagnosis
- Lack of upper lip support due to 4 bi extraction from prior orthodontic treatment (25 years ago)
- Collapsed posterior arches
- Root resorption & bone loss from prior treatment
Treatment Options
- Surgical option- 2 jaw surgery to restore upper/mid face support
- Open extracted bicuspid space and place implants
- Open extracted bicuspid space and use TADs to close molars forward, protecting the upper lip. (Mindy chose this option.)
Torque Selection
Upper
- Upper 3’s High Torque
- Upper 2-2 Low Torque
- Upper 4-6 Regular Torque
Lower
- Lower 2-2 Low Torque
- Lower 3-5 Regular Torque
Month 1
Wire Progression
Upper: .014 Cu NiTi (Round)
Lower: .014 Cu NiTi (Round)
Auxiliary
Brackets: Update Regular Torque Metal Bracket at LL3, LL4, LL5, LR5, LR3, LR4; Add Clear 2 LT 7-7
Bite Turbos: Add Bite Turbo at LR7, LL7
Comments
Bonded TT’s U/L 3-3
Month 3
Wire Progression
Upper: 14×25 Cu NiTi (Rectangular)
Lower: 14×25 Cu NiTi (Rectangular)
Auxiliary
Bracket Hooks: Add Bracket Hook at UL3, UR3, LL3, LR4, LR5, LL4
Elastic Bands: Add Parrot at UR3-LR4-LR5, UL3-LL3-LL4 (Fulltime)
Comments
Month 6
Wire Progression
Upper: 18×25 Cu NiTi (Rectangular)
Lower: 16×25 Cu NiTi (Rectangular)
Auxiliary
Wire Hooks: Add Wire Hook at UR1-UL1
Elastic Bands: Remove Parrot at UR3-LR4-LR5, UL3-LL3-LL4
Steel Ties: Add Steel Tie at UL3-UR3 (Figureeight, Under); Add Steel Tie at LR3-LL3 (Figureeight, Over)
Comments
Dr.Frost said he would love the 8’s to come out sooner then later – Talked to mom about that and she said we already refured her to Dr.Boyse and she will get her in this summer.
Month 8
Wire Progression
Upper: 14×25 Cu NiTi (Rectangular)
Lower: 16×25 Cu NiTi (Rectangular)
Auxiliary
Brackets: Reposition Low Torque Clear Bracket at UR2; Reposition MolarTube Bracket at UR6; Reposition Regular Torque Metal Bracket at UR5, UL5, LL3; Reposition Low Torque Metal Bracket at LR2
Comments
Month 9
Wire Progression
Upper: 18×25 Cu NiTi (Rectangular)
Lower: 16×25 Cu NiTi (Rectangular)
Auxiliary
Comments
Month 10
Wire Progression
Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)
Auxiliary
Elastic Bands: Remove Moose at LR4-AWHook(UR1-UL1)-LL3-AWHook(UR1-UL1) (Fulltime)
Comments
Month 12
Wire Progression
Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)
Auxiliary
Bracket Hooks: Add Bracket Hook at UR4, UR1, UL1, UL4, LL5, LR3
Elastic Bands: Add Moose at UR4-LR4-LR5, UL4-LL5-LL4 (Fulltime); Add Triangle (Moose) (Fulltime, Both)
Comments
Month 13
Wire Progression
Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)
Auxiliary
Bends: Add Bend at UR3-UR2 (Upper, ExtrusionStep); Add Bend at UL2 (Upper, IntrusionStep)
Bite Turbos: Remove Bite Turbo at LL7, LR7
Comments
Month 14
Wire Progression
Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)
Auxiliary
Bends: Add Bend at UR4, UL1, UL4 (Upper, ExtrusionStep); Add Bend at UL2 (Upper, MesialIn)
Comments
Month 15
Wire Progression
Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)
Auxiliary
Comments
Didnt adj. PT past due on payments. Cont elastics.
Month 18
Wire Progression
Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)
Auxiliary
Update SnapLink Bracket at UR6
Comments
Month 21
Wire Progression
Upper: 16×25 SS (Rectangular)
Lower: 16×25 SS (Rectangular)
Auxiliary
Bends: Add Bend at UR2 (Upper, BuccalStep); Add Bend at UL2 (Upper, DistalCrownTip); Add Bend at UL2 (Upper, MesialCrownTip); Remove Mesial Crown Tip Bend [UL2]
Comments
Plan:N/V: ck debond, Take L perm imp. remind Dr Frost Debond is Non-Doc
NN/V: Non-Doc Debond
NNN/V: smooth and polish, Deliver clears (pt leaves Aug 24th 2018 for NAU)
Case Summary
Notice the increase in arch width and the beautiful smile arc. With the increase in arch width, notice that you don’t see as much gum tissue in the posterior!
The day I took her braces off, I handed her a mirror and invited her to look at her new smile. With tears in her eyes, she told me that she “got her smile back”. This is truly why we do what we do. We are here to change peoples’ lives and impact them for the better!