Pacific Coast Society of Orthodontists Bulletin Winter 2022 - 49

Case Report
to help aid in mandibular arch leveling. Initially
the treatment progressed well, and the
patient reported good compliance with the
headgear for the first two months. Unfortunately,
after this initial period the patient did
not wear the headgear as prescribed and lost
the acrylic bite plate.
Space closure was performed with a 0.019″
× 0.025″ titanium molybdenum archwire
with elastic chain maxillary 6-6. After nine
months of treatment, the right molar relationship
was corrected to end on Class II. At
this stage, we reconsidered the approach
of using FORSUS unilaterally, and instead
we used functional bite blocks for the mild
mandibular forward reposition. The bite
blocks (Fuji IX Glass Ionomer Cement, GC,
Tokyo, Japan) were placed on the maxillary
U4s to help posture the mandible forward
and achieve a Class I molar relationship. We
changed the archwires to 0.019″ × 0.025″
stainless steel. These bite blocks were maintained
for eight months (Figure 6).
A progress panoramic radiograph was taken
at nine months into treatment when all
spaces were closed, and some brackets were
repositioned. After 13 months, the left-side
molar relationship was Class I and the right
side was a 2-mm Class II. Unfortunately, at
this stage we had a six-month COVID-19-induced
clinic closure. On reopening, we commenced
detailing in 0.019″ × 0.025″ titanium
molybdenum archwires with detailing bends
and used some Class II elastics (3/16, 6 oz) to
correct the mild Class II molar relationship
on the right side. This detailing stage lasted
six months. All of the archwires used in this
treatment were from American Orthodontics.
Prior to debonding, we used the esthetic
checklist that includes 14 diagnostic parameters,
recommended by Magne et al.,1
to
examine the patient's smile arc and micro-esthetics
and then used Coachman's Digital
Smile Design concept2
to examine the ideal
Figure 6. Progress intraoral photographs showing after seven months of treatment (A-D)
and eight months of treatment (E-G): patient was in the (A) central relation and (B) forward
postured position, and (C) functional bite turbos were bonded on U4s but not on (D) the
mandibular arch. When comparing (C) and (F), note that the space between UR3 and UR4
appeared one month after having these turbos cemented
Figure 7. (A) Microesthetic evaluation after debonding, (B) gingival contour designs for the
laser gingivectomy, (C) maxillary anterior intraoral view, (D) smiling profile view, and (E)
front intraoral views at edge to edge and (F) in central occlusion views
tooth size and gingival architecture and plan
gingivectomy using Mac-based Keynote. After
careful examination and planning, gingivectomy
on the maxillary anterior six teeth was
performed, and more than 2 mm of keratinized
tissue width was maintained (Figure 7).
A retention scheme of a maxillary Hawley
with an anterior acrylic bite plate and mandibular
Hawley with occlusal rests on the
mandibular 6s were prescribed and delivered
to be worn at night. Vacuum-formed
Essix retainers were also fabricated for dayWinter
2022 PCSO Bulletin
49

Pacific Coast Society of Orthodontists Bulletin Winter 2022

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2022