CASO 2: Class II Iskeletal, super Class I of angle with previous intersecting and biting
A 50-year-old patient goes to his office in July 2008 to solve his denture and his earlier cross-bite. Demand linguistic orthodontics. He earlier began a treatment of vestibular orthodontics that had to be withdrawn by his Orthodontist A few months after his initiation, as we referred to his patient, "his discomfort was unbearable."
Although given the background we are initially reluctant to treat her with linguistic orthodontics, The patient insists. We decided to maintain posterior occlusion and place bracketing only up to the presmolar seconds in an attempt to make the device more comfortable during the adaptation period.
Skeletal class 3 with maxillary origin. Mesofacial. Higher incisors to vestibulossit.Super class I molar and canine.
Previous cross-mold at 43 42 level. Medium lines focused with each other and with the filtrum. Retiring and over-biting diminished. A light earlier shortcut at the upper arcade, moderate at the lower arch. Retirement at 43 42.
Unirregularly worn incision bordes. No cross-sectional changes. No joint sympomatology. We found no important asymmetries at an extra-oral examination. Straight profile.
Social smile with complete exposure of crowns. We Intuate that at best smile will show 1 -2mm of gums.
In orthopantomography we note the absence of third molars.
Treatment plan
Objectives: To align and level both pits and solve earlier cross-bite. Keep occlusion back, improve overbiting and highlight.
Aparatology: Orthodontics Lingual Incognito ™ up to the second purmalars.
Design: Ribbonwise VH bracket Series, autobound clip at lower arcade.
Ark sequence
Upper arch
• .014 "Nitinol ™ SE
• .016 "x .022" Nitinol ™ SE
• .018 "x .025" Nitinol ™ SE
• .016 "x .022" steel
• .0182 "x .025" Beta III titanium
lower arch
• .014 "Nitinol ™ SE
• .016 "x .022" Nitinol ™ SE
• .016 "x .022" steel
• .0182 "x .025" Beta III Titanium
Treatment
Both pits have been cemeterized the same day. .014 "Nitinol ™ SE's upper and lower arches were placed. At the bottom was inserted into the autobound clip. A lower stripping was performed. The bite was lifted by means of comic pounding plans to facilitate correction of the cross-bite. (Fig.2)
Two months later .016 "x .022" Nitinol ™ SE was placed at the upper arcade. After another month, it was uploaded to .018 "x .025" Nitinol ™ SE at the upper arcade and .016 "x .022" Nitinol ™ SE at the lower arcade. During this period the 25's bracket took off twice, one of them was lost and TOP-Service had to be requested a new one. A lasso was used at 33 to help correct rotation, and powers at 41 and 43 to improve tip and torque respectively. (Fig. 3).
A month later, the upper steel was put up. The lower steel was put up three months later.
A lasso will be put back at 33 to improve rotation. To prevent the chainette from going down to the gingival margin, a small composite button will be put. I would have
It was best to have corrected this rotation with niti's arcs. The patient is instructed to wear midline gums (3 / 16 and 3.5 ounces) to focus the lower midline to the right (Fig. 4).
We did not get enough patient collaboration in using elastics. Two months later, the lower midline remained leaked to the left. We decided to accept the deviation and we went up .0182 "x .025" Beta III titanium top and bottom. (Fig. 5).
We have been trying to convince the patient to help us increase the overbite using elastics in a triangle, and we have built up vestibular buttons into upper and first and lower canines and premolars.
We had to remove them 1 week after we put them before the patient's refusal to carry anything that would be visible (Fig. 6).
After 14 months of treatment, we achieved the objectives of maintaining class I canine and molar, solving the cooling and earlier cross-bite, we decided to withdraw the device.
A fixed and indefinite retention was proposed at both pits but only accepted it at the lower arcade and so an upper essix was chosen as a retention device (Fig. 7).
Conclusions
We would have liked to have been more overbiting but to do so, patient collaboration would have been necessary with intermaxillary elastics. Only two bracketers have been taken off during treatment. The loss of 25's bracket and little collaboration with the use of elastics unnecessarily prolonged treatment. Despite being an especially sensitive patient, his attitude with respect to his device was extremely positive from the start.
At present I would avoid .018 "x .025" Nitinol ™ SE superior and steels, using the final protocolary arc .0182 "x .0182" Beta III titanium (as tip problems were not foreseeable in the side sectors and was not scheduled to expand) and would place more emphasis before starting treatment on importance
of intermaxillary elastics at the final stage of treatment.
Acknowledgments
Al Dr. Wiechmannan extraordinary person, who has given me time and time again an opportunity to learn from a great master.
