Orthotown November 2023 - 17
Fig. 2
Fig. 4
Fig. 5
Fig. 3
Fig. 6
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The advantage of this option was
the predictability of the outcome.
The patient's parents ultimately
chose Option 1, because of an overall
concern about having permanent
teeth removed. The treatment objectives
for this patient were:
* Correct the bite discrepancy.
* Dental camouflage, given skeletal
relationship.
* Guide the impacted teeth into the
correct position in the mouth.
* Straighten and align teeth.
* Avoid jaw surgery.
Progress through treatment
A decision was made with the
patient's parents to attempt expansion
and removal of primary teeth.
A Hyrex expander was fabricated and
cemented; as instructed, the patient
completed 21 turns.
At the next appointment, dental
tipping was seen and a posteroanterior
(PA) ceph was taken (Fig. 2)
to confirm there was no evidence of
sutural expansion. At that time, the
expander was removed.
Extraction of all first premolars (#5,
#12, #21 and #28) was decided, along
with exposure of #11 with gold chain
and bracket bonding. The upper arch
was bonded, except #10-the goal was
to allow #10 to float freely, because
#11 was extruded and distalized in
hopes of limiting potential damage
to #10.
Sixteen weeks later, the lower arch
was bonded, and there was continued
distalization and extrusion of #11
(Fig. 3). The bracket was bonded to #10
one month later. Vertical elastics were
NOVEMBER 2023 |
17 | ORTHOTOWN.COM
initiated on left canines and second
premolars to level arches.
In January 2020, a progress Panorex
(Fig. 4) was taken to check #10's root
structure. At this point, COVID-19
medical professional protocol was put
in place and treatment was delayed for
six months.
Orthodontic treatment resumed in
July 2020, including a standardizing
archwire sequence and alignment
(Fig. 5).
In September 2021, a progress
Panorex (Fig. 6) revealed that while
there was mild root resorption on #10,
it is our belief that if we had bonded
during extrusion of #11, there was a
strong possibility the tooth may have
been lost. Because of the decision to
delay bonding, the long-term prognosis
of #10 at this point was excellent.
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Orthotown November 2023
Table of Contents for the Digital Edition of Orthotown November 2023
Orthotown November 2023 - Cover1
Orthotown November 2023 - Cover2
Orthotown November 2023 - 1
Orthotown November 2023 - 2
Orthotown November 2023 - 3
Orthotown November 2023 - 4
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Orthotown November 2023 - 7
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Orthotown November 2023 - Cover3
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