"I am only going to give you 15 months...." - Jacqueline Hazari

[TypeR]

NO INVISALIGN, NO TIME... CAN WE FIX IT???
Limitations
•   3rd ever F/F fixed appliance case!
•   Severe time constraints for wedding – subsequently re-scheduled for November 2008, allowing approximately 16 months from start of treatment
•   Thin lower cuspid tissue
•   Periodontal status prior and any associated bone loss
•   Right & left TMD

May Not Be Able To Correct
•   Malocclusion fully due to severe time constraints
•   Class II without patient cooperation
•   Or retrieve 13

The periodontal condition was rigorously managed prior to starting orthodontic treatment.  Given the severe time constraints, it was not possible to further delay treatment for 3 months (when a post-periodontal treatment review would normally be conducted).



Treatment Plan:  Extraction of 14, 24 & 32, F/F (braces)
Anchorage:  TPA
Mechanics:  2 step retraction, upper T-loops


5 Months Before The Day of the Wedding... CAN IT BE DONE???
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Day of Deband
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(Lateral Ceph. will be available upon request)


Critical Evaluation

•   Minor bracketing error 21
•   Minor gap opening between 31 & 33 (corrected with modified lower Essix retainer)
•   Gingival Aesthetics:  insufficient 11 gingival height and/or increased height of upper laterals; perhaps insufficient visible clinical crown (gingivectomy?) 13/11/21/23.
•   Minor detorquing of upper LHS
•   Further finishing to improve occlusion:  tightness of occlusion; canine guidance or group function; anterior coupling; adjustment of working & non-working side interferences.

I believe this is called:  Wedded Bliss...

[DMcGann]

Wow!  Now that is impressive.  How did you decide on the treatment decision of upper 4s/one lower incisor extraction?  Was that just a guess or did you have dental vto to help you make that unusual decision?  the cuspid that was in the palate has good torque on the finish...what bracket torque/archwire did you use in the upper arch?  What bracket torque on the upper incisors.  I know you are still working on the records but if you have some overlays we would all be interested, especially if you got what you predicted on the dental vto.  Thanks for sharing.

[TypeR]

Hi Dr. McGann,

Sincere apologies for taking soooooo long to reply.

I have been to HK and back, SoCal and back including a visit to HQ and have not had a chance to reply, and unfortunately have not had the opportunity to get a post-op lateral ceph. either (which is forthcoming hopefully because she is due to have a review soon - 1 year since deband).

In answer to your questions (btw, diagnosis & reasoning completed by myself and confirmed with Dr. Nicassio who concurred):
1.  No VTO was used.  My biggest constrain was time.  There was too much lower crowding - so to fix this issue, extraction of a lower 1 is the simplest way to remedy this.  I was aware there may be some deep bite problems (with 3 lower incisor finish) or I may not get the necessary guidance or anterior coupling that I would like for the best occlusion.
2.  There was also significant upper crowding, as evidence by the palatally-displaced canine.  I wanted the upper 3s in their correct position.  So, the simplest fix was to extract the UR4.  I also want to extract symmetrically so I extracted the UL4.
3.  The cuspid was aligned initially with some sort of GAC bracket so that I wouldn't waste $$$ when I needed to change bracket later on.  Eventually, I used the Li bracket torque for the upper 3-3 EXCEPT for the UR3, for which I used La.  I used small tapered for the upper and small ovoid for the lower

I hope this helps and again, sorry for the late response.

Would you still the ceph. overlay?


Regards,
Richard

[DMcGann]

thanks for the added information.  More than for me, I think others viewing your case would like to know as much as possible....so they can do the same on one of their cases.  again, nice work. don