Orthotown November 2020 - 46
CASE 2
Hugo, 23, presented with a Class III malocclusion (Figs. 5-7).
He had lower anterior crowding and a supernumerary #10
(Figs. 8-10). The palatal #10 was wider and closely resembled
the right lateral, so I chose to extract the labial left lateral
incisor. The anterior bite was edge to edge.
My plan was to treat Hugo with full fixed passive self-ligating
brackets, non-extraction (with the exception of the labial
supernumerary lateral) with no miniscrews and nonsurgically.
I placed upper and lower Pitts 21 fixed appliances, including
the upper left labial lateral so I could widen the periodontal
membrane, so that upon extraction of #10, I could leave the
labial plate intact. I inverted the upper and lower anteriors for
inclination control, and bracketed for smile-arc protection and
VID (Figs. 11 and 12).
I began with widened .014 nickel titanium. I placed bite
buttons on the upper first and second molars to disarticulate
(Figs. 13 and 14) and began with short Class III light elastics
through the bite from the lingual of upper second bicuspids
Fig. 5
Fig. 6
Fig. 8
Fig. 11
to the labial of lower canines (3/16, 2.5-ounce). The patient
also wore an anterior rainbow elastic from lower canines up
over upper centrals (5/16, 2.5-ounce) a minimum of 12 hours
per day. Of particular note, with full-time Class III elastics, the
upper anteriors never flared throughout treatment, showing
wonderful 3D control of the square wire in a square slot (Fig. 15).
At seven months (Fig. 15), I had the patient up the force on
the light Class III elastics to 3/16, 3.5-ounce full time. I never
go above 3.5-ounce elastics for short Class IIIs, and never go
above 2.5-ounce elastics for anterior elastics. It took a little
extra treatment time, because I waited too long to remove the
posterior bite turbos. He faithfully wore his elastics and did a
great job with oral hygiene. Having left the posterior turbos
on too long, I cut the upper wire behind the second bicuspid
in order to sock in the molars quickly.
Not only was his smile transformed, but he had a wonderful
aesthetic enhancement to his profile. His occlusal results are
also very nice (Figs. 16-20).
Fig. 7
Fig. 9
Fig. 12
Fig. 10
Fig. 13
Fig. 14
Fig. 15
Fig. 16
46
Fig. 17
Fig. 18
Fig. 19
Fig. 20
NOVEMBER 2020 // orthotown.com
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Orthotown November 2020
Table of Contents for the Digital Edition of Orthotown November 2020
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Orthotown November 2020 - Cover2
Orthotown November 2020 - 1
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