Orthotown November 2017 - 15

Band upper 6's bond upper 43-24
Coil for upper 3 prn
Procline and align upper anteriors ... four months
Bond unerupted teeth ASAP.
Band/bond lower arch, level align, intrude lower anteriors with reverse curve ... 5-6 months
Forsus springs on heaviest rectangular wires engageable ... 4-6 months.
Remove springs after true Class I and begin anterior vertical V elastic 32 ... 2 months
Detail anterior coupling ... 2 months
Done. Unless relapse from muscle pull requires additional Class II elastic wear or additional
time in Forsus or surgery as last resort for ideal correction.
This has worked for me in very many similar cases. ■

jkglenos
Member Since: 04/10/03
Post: 4 of 16

8/30/2017

I would personally use a Herbst appliance. Crowns on the U6s and L4s. I find that very
effective in these deep bite, Div 2 cases in patients in the growth spurt. High torque brackets
U2-2, get into a 21x25Ni in the upper ASAP while the Herbst is on. *No brackets on the lower
teeth with the Herbst*
The Class II and overjet look worse on the ceph than on the photos? ■

dhmjdds
Member Since: 11/16/04
Post: 5 of 16

8/31/2017

I would not consider surgery or extractions at this point. Growing patient. I would band 6's
bond upper incisors and lower everything. Use some good (Aussie) archwires, 016/018 and place
some strong tip back bends mesial to the upper molars. Watch the bite open and the Class II
start to get better. Add some light CL2 elastics prn. No HG, bite plate, or other contraptions.
Once you get Class I then pick up upper cuspids and bi's. If you haven't read Mulligan's book,
you should. It is a very good introduction into lightwire mechanics. ■

emac
Member Since: 11/21/11
Post: 6 of 16

8/31/2017

I think you did the right thing by mentioning surgery. I would not extract U4s as that is
counterproductive to any future surgery that may be planned. As for the other opinions offered
here, they are all fine and do not call for the extraction of teeth. You do not want to extract upper
teeth now and take surgery off the table in the future.
My opinion: It's a surgery case with a tripod BSSO to decrease chin prominence. You can align
the teeth now but to think that you can predictably get enough growth to correct this skeletal issue
is somewhat wishful thinking. Just my thoughts and opinion. Have a nice long weekend everyone. ■

justinudm
Member Since: 09/29/14
Post: 7 of 16

9/1/2017

I would not mention surgery as an option at this age. You may be right, but you will not get
the chance to treat. I would offer a treatment including orthopedic advancement with a Herbst
or like appliance and tell them that we expect partial correction of the overbite/overjet. If pinned
down, I would say 50 percent but always go for more in your treatment.
Most people will accept compromise instead of surgery until after you have achieved some
improvement. Please no extractions. You have a low MP angle which is good for orthopedic
advancement and upper expansion and upper anterior fl aring. If you don't use a Herbst or
similar appliance, take a course. You can't practice good orthodontics on what you learned
in school. ■

Pickron
Member Since: 10/18/09
Post: 8 of 16

9/4/2017

Fenrisúlfr

I think the data on functional appliances growing mandibles is pretty clear ... ■
9/4/2017

Member Since: 02/25/09
Post: 9 of 16

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