Page 45 - DP Vol 22 No 1

incisors. Mild crowding was noted in the
mandibular anterior region, accompanied
by lingual inclination of teeth 42 and 43.
The maxillary midline was deviated to
the left. Functional assessment revealed
speech difficulty affecting the /s/ and /z/
phonetic sounds. Panoramic radiography
(Figure 3) confirmed the presence of all
permanent teeth except the third molars,
which were congenitally absent. Alveolar
Fig 2d: Intraoral maxillary occlusal view Fig 2e: Intraoral mandibular occlusal view bone levels were within normal limits.
Lateral cephalometric analysis (Figure
4) indicated a Class III skeletal pattern.
Digital intraoral scans were subsequently
obtained to support diagnosis and
treatment planning.

Fig 3: Pre-treatment panoramic radiograph Fig 4: Pre-treatment lateral cephalometric
analysis
non-visible system, the patient and his
parents elected to proceed with the Brava
appliance.

The treatment protocol followed:
The patient was treated exclusively using
the Brava Lingual Orthodontic system.
Customized biomechanical arms were
digitally designed to achieve individualized
tooth movements. The Brava appliances
Figs 5a-b: The Brava appliances placed in both the maxillary and mandibular arches were then placed in both maxillary and
mandibular arches (Figures 5a and 5b).
Treatment objectives eliminating anterior crowding, and achieving The biomechanical arms were engineered
The primary treatment objective was to satisfactory alignment of both arches. to correct the anterior crossbite through
establish a harmonious jaw relationship non Based on the patient’s concern about controlled labial movement of 11, while
surgically, achieve a bilateral skeletal and appliance visibility and his inability to visit mild mandibular crowding was addressed
dental Class I occlusion, and obtain ideal the practice for monthly check-ups, various via light, continuous forces for coordinated
overjet and overbite with correction of the orthodontic options were discussed. After alignment of 42 and 43. Regular follow-up
maxillary midline deviation. Additional reviewing the available alternatives and appointments were scheduled in accordance
goals included improving the facial profile, considering his preference for an esthetic, with the Brava treatment protocol.

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Dental Practice I January-February 2026 I Vol 22 No 1 45