Orthotown July/August 2024 - 27
Fig. 10: Before treatment and at 14 months-Class I spacing and improved oral health.
Fig. 11: Pure distalization evident in panoramic view.
After eight months in treatment, both appliances
were ready to be removed (Figs. 6 and 7).
At this point, both arches were expanded and
the molars and second premolars were distalized,
creating an " extraction space " distal to the
first bicuspids.
After the appliances were removed, the first
bicuspids were bonded and a new segment wire
was placed from the first molar to the first bicuspid.
The first bicuspids were then distalized with
an elastic thread, while the molars and second
bicuspids served as anchorage.
Braces phase
Once the first bicuspids had fully distalized, twin
brackets were placed on the remaining dentition.
Progress photos taken after three months with
braces show the V-shaped arches beginning to
form a healthy ovoid shape, and the crowding
was replaced with mild spacing (Figs. 8-10).
After 14 months of treatment, only three of
those with braces, we transformed this Class III
canine, severely crowded, narrow arches situation
into a Class I spacing. The rest is basic
orthodontics. One surprising thing was that this
teenager's oral hygiene, with braces, was actually
better than when he started (although still far
from ideal).
A comparison of panoramic radiographs
before treatment (Fig. 11a) and while braces are
already on (Fig. 11b) shows the bodily distalization
of the molars and lack of blocking of the second
molars, as some suspect would be the case.
Final results
Occlusal views of both arches (Figs. 12 and 13,
p. 28) show the remarkable resolution of the
crowded arches by merely using two noncompliance
devices. The persistent oral hygiene and
other personal matters forced an early termination
of treatment without achieving ideal results.
However, aesthetic smile, healthy functional bite
and improved facial symmetry were achieved
(Fig. 14, p. 28). More importantly, resolution of
JULY/AUGUST 2024 | 27 | ORTHOTOWN.COM
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Orthotown July/August 2024
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