Orthotown September 2021 - 44

STA RT U P S H OWC A S E
S PE CI A L S E C T I O N
COM P L I A N C E- F R E E
O P T IO NS
InBrace's new category of behind-the-teeth treatment
enables automated tooth movement in all six degrees
of freedom-and is customizable - BY DR. JOHN PHAM
CASE STUDY
A 20-year-old patient presented with
the chief complaint of upper canine in
crossbite
and crowding. Although she
wanted straighter teeth, she would have
gone untreated rather than put in the work
of wearing plastic aligners or have a visible
appliance placed on the front of her teeth.
The patient had no signifi cant medical
or dental history, and no contraindications
to orthodontic treatment. Extraoral examination
revealed symmetric facial proportions
and a harmonious lower profi le with
well positioned upper and lower lips.
Intraoral examination (Fig. 1) revealed
a minor Class II relationship with normal
overbite, 2.5 mm of crowding in the mandibular
arch and 4 mm of crowding in the
maxillary arch. UL3 was in lingual crossbite
with LL3, causing a functional mandibular
shift to the left side. Upper midline
was coincident but not parallel to the facial
midline. Lower midline deviated to the left
by 2 mm. TMJ examination was noncontributory.
The cephalometric analysis indicated
a mild skeletal Class II with mesofacial
growth pattern.
Main problems to be addressed were:
1. Upper and lower crowding.
2.
UL3 lingually positioned in crossbite,
which was affecting smile aesthetics.
3. Dental Class II relationship.
4. Midline discrepancy.
5. Upper midline slanted to the right.
44 SEPTEMBER 2021 // orthotown.com
Patient records and intraoral scan
(Fig. 2a) were used to generate the InBrace
Smile Design (Fig. 2b). The InBrace appliance
was bonded using 3D-printed indirect
bonding trays. At the initial bonding
appointment (Fig. 3a), bite turbos were
bonded on the palatal cusps of the maxillary
second molars to avoid heavy bracket
interference in occlusion, and Smartwire 1
was engaged in all brackets except UR3,
which was signifi cantly rotated (Fig. 3b).
Once engaged, the Smartwire Intelligent
Programmed (IP) Loops in the interproximal
regions were then activated to move
teeth in all six degrees of freedom, including
opening space to more easily engage
UR3 and derotate UL3.
In two months, the alignment of the
upper teeth had improved signifi cantly,
and space had been created, which allowed
the UR3 bracket to be engaged and UL3
to be derotated more easily (Fig. 3c). At
fi ve months, alignment had been completed,
and the IP Loops had closed the space
that had opened to aid with derotation of
UL3 (Fig. 3d). Smartwire 2 was engaged,
and clear buttons were bonded to start
Class II box elastics (3/16 inch, 4.5 oz.)
on both sides. When Class I relationship
was achieved, Digital Enhancement
Smartwires were engaged for fi nal detailing
(Fig. 3e). After 14 months of active treatment,
the case was debonded (Fig. 3f).
For the lower arch (Fig. 4a),
Smartwire 1 was engaged in all brackets
at the initial bonding appointment
(Fig. 4b). Two months later, the alignment
had signifi cantly improved, allowing for
Smartwire 2 engagement (Fig. 4c). At fi ve
months, Smartwire 2A, which has a lower
anterior straight-wire section, was used to
fi nish the lower anterior alignment and to
increase rigidity to better support Class II
elastics (Fig. 4d). When Class I relationship
was achieved, Digital Enhancement
Smartwires were used for fi nal detailing
(Fig. 4e). A fi xed lower 3-3 retainer was
placed at debond.
This case was treated in 14 months
and seven appointments; Fig. 5 shows the
patient's fi nal records. Notably, this patient
Fig. 1
Fig.2a, 2b
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Orthotown September 2021

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