Orthotown June 2022 - 16

townie treatment case
Fig. 10a
Fig. 10b
Fig. 11a
Fig. 11b
repositioned for a better smile arc, and interproximal reduction from
lower canine to canine was performed with energy chain under
the brackets to close the spaces with reduced friction. A control
panoramic and cephalometric X-ray (Figs. 8a and 8b, p. 15) were
taken at this stage before debonding.
On the 13th visit, 17 months into treatment, upper and lower
fixed appliances were debonded, and a lower 3-3 fixed wire retainer
(Ortho FlexTech, Reliance) was installed. Soft and hard tissue were
contoured, the embrasure touched up and gingiva on upper anterior
teeth trimmed. The patient was supplied with polycarbonate retainers
for both arches to wear at night (Figs. 9a-9h, p. 15).
Case discussion
The case was completed in 17 months with 13 visits. The use of
a reduced-slot passive self-ligating bracket system, with slow, light
wire expansion delivering forces around 25-30g, helped achieve
the transverse and antero-posterior correction of the malocclusion,
assisted by immediate light short Class III elastics and posterior
bite disarticulation.
Flipping upper and lower anterior brackets from lateral to lateral
to get opposite torque built in the prescription was an important
factor in controlling the axial inclination of the anterior teeth and
counteracting the side effects of using Class III elastics. It would
have been more efficient to bond upper anterior brackets more
gingivally from the start to achieve a better smile arc and incisor
display. Some upper and lower interproximal reduction was necessary
to harmonize contact points and coordinate the upper and lower
anterior teeth size.5
16 JUNE 2022 // orthotown.com
The application of buccal shelf TADs ensured a full mandibular
dentoalveolar distal retraction and helped optimize the antero-posterior
position of the maxillary anterior teeth, preventing them from
unwanted excessive labial movement, which would have caused
a compromise in the smile dynamics of the patient. Before/after
pairings are Figs. 10 and 11.
Conclusion
Camouflage treatment of adult Class III malocclusion has
always been considered to offer suboptimal results because the
unwanted side effects of the mechanics used successfully correct
the underlying dentoskeletal problem but miss the goals regarding
aesthetic outcomes. By using mandibular buccal shelf TADs and
taking advantage of the ability to flip the upper and lower anterior
brackets 180 degrees, control over placement of the maxillary
incisors for the most pleasing aesthetic result can now be achieved. n
References
1.
Park, Hyo-Sang. " Efficient Use of Microimplants in Orthodontics. " Dentos 2015: Vol. 2, Chapter
4: 206-210.
2. Buitrago, Diego Fernando López, and Saavedra, Claudia Marcela Corral. " Therapeutic Management
of a Pseudo Class III Malocclusion Case Report. " Rev Mex de Orto, 2015: 249.
3. Foster, Chad. " A Protocol for Inverting Upper Incisor Brackets. " Orthodontic Practice, Vol. 12,
Spring 2021: N1.
4.
Chang, Chris, Huang, Chi, and Roberts, Eugene W. " 3D Cortical Bone Anatomy of the Mandibular
Buccal Shelf: A CBCT Study to Define Sites for Extra-Alveolar Bone Screws To Treat Class III
Malocclusion. " IJOI 41, 2016.
5. Sarver, D. " Enameloplasty and Esthetic Finishing in Orthodontics: Identification and Treatment of
Microesthetic Features In Orthodontics, Part 1. " J Esth Rest Dent, Vol 23 Issue 5: 296-302.

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