Page 28 - DP Vol 20 No 4 HR

ORTHODONTIC SECTION

Table 6: Summary of
cephalometric analysis

Fig 3a: Pre-surgical, full face smiling Fig 3b: Pre-surgical, side view

Fig 4a: Pre-surgical, upper arch Fig 4b: Pre-surgical, lower arch Fig 4c: Pre-surgical, intraoral view
• Achieve alignment
• Maintain the anterior open bite (AOB)
• Decompensate
• Coordinate the arches
• Maintain centerlines—lower coincident with
the chin and upper off to the left
• Eliminate occlusal interferences

Fig 4d: Pre-surgical, right hand view Fig 4e: Pre-surgical, left hand view BRACKET PRESCRIPTION AND
VARIATION
• Correct the overbite and overjet • Orthodontic camouflage with limited We placed upper ceramic and lower metal pre-
• Eliminate posterior crossbites objectives adjusted Edgewise fixed appliances with MBT
• Correct the upper centerline • Orthodontics combined with orthognathic prescription brackets, using a 0.022” x 0.028” slot
• Correct the anterior open bite jaw surgery and restorative care for size and a -6° prescription on the LL2 to LR2 to
• Restore or close the space for the missing comprehensive treatment (either opening prevent over-proclination of the lower incisors.
UL2 the space for the replacement of the UL2 or To reduce the canine eminence, as it was
• Retain the results closing the UL2 space and camouflaging the camouflaged to replace the UL2, the preferred
The treatment plan comprised several UL3 and UL4 restoratively) option is to invert an Andrew’s bracket, which
stages, including: The patient chose the last option, opting would change the torque from 7° labial root
1. Stabilization and prevention, which to close the space for the UL2, as this would torque to 7° palatal root torque.
involved a thorough check-up, bitewing comprehensively address all concerns and However, for this case, we decided it would be
X-rays, and two oral hygiene sessions treat her malocclusion and dentofacial more beneficial to use an MBT bracket with 7°
2. Stopping thumb sucking disproportions. palatal torque, which is available in three torque
3. Growth monitoring and observation for values (Figures 3 and 4).
three and a half years PRE-SURGICAL ORTHODONTIC
4. Orthodontics PHASE: 11 MONTHS SURGICAL PHASE
For the orthodontic stage, the options The aim of this phase was to: Under general anesthesia, a Le Fort I maxillary
were: • Relieve crowding in the lower arch osteotomy was performed to advance the maxilla,
• No treatment • Close space in the upper arch impact it posteriorly, and rotate it to correct the

28 Dental Practice I July-August 2024 I Vol 20 No 4