Pacific Coast Society of Orthodontists Bulletin Winter 2023 - 50

Case Report
palatal to the buccal TADs, essentially " bootstrapping "
the posterior teeth up. To minimize
the chance that she would break the elastomeric
chain during function, I cut channels
into the acrylic buccal-palatally into which the
elastomeric chains could run, avoiding direct
occlusion with the mandibular teeth (Figure 8).
Two months after treatment began, the patient
had her third molars removed. At that visit, two
mandibular TADs (Ace Ortho Bone Screw, 1.8
mm × 10 mm) were placed. The plan was to use
them as needed for mandibular arch distalization
as the mandible rotated counterclockwise
with the posterior intrusion. Ultimately, the
mandibular TADs were never used (Figure 8).
Figure 10. Posttreatment extraoral and intraoral photos (age 14 years and nine months)
The iatrogenic open bite was closed in 3.5
months. We continued posterior intrusion, and
six weeks later, we rebracketed the anterior maxillary
teeth more incisal and ran a continuous
archwire. The intention was to create intrusive
forces on the anterior maxillary teeth as the NiTi
wire leveled the arch. Figure 9 demonstrates the
VME changes after seven months of intrusion.
Various TADs failed during the course of treatment;
some were replaced, and others were
just removed. Once the upper arch was leveled
and the posterior teeth had been intruded to a
satisfactory level, the Triad was removed. Elastics
were used to manage some mild canting that
had developed as a result of more intrusion
on the right side than the left, some midline
discrepancy, and tight buccal overjet on the
left molars. The braces were removed after 21
months of orthodontic treatment in my office.
A mandibular fixed retainer was placed, and an
upper removable appliance was delivered.
Figure 11. Posttreatment dental models
Figure 12. Posttreatment panoramic image
sectioned distal of the maxillary cuspids. Triad®
acrylic (Dentsply Prosthetics, York, Pennsylvania)
was placed over the occlusal surfaces of
the maxillary molars and bicuspids to create
a " bridge. " To reinforce the bridge of acrylic, a
0.016 " × 0.022 " sectional stainless steel archwire
was embedded into the acrylic on both sides.
Note that the iatrogenic open bite was created
with the posterior Triad bite blocks. The TADs
were activated with elastomeric chains from the
Treatment Results
In assessing the final photos, models, and radiographs,
an ideal Class I occlusion with ideal overjet
and overbite was maintained. The gummy
smile was reduced to the patient's satisfaction;
her profile straightened, the lower face height
decreased, and the lip incompetence and mentalis
strain decreased (Figures 10 and 11).
The posttreatment panoramic image shows reasonable
root parallelism except for the mandib50
PCSO
Bulletin Winter 2023
Pacific Coast Society of Orthodontists Bulletin Winter 2023

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2023
