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Authors: Dr. Upasak Mukherjee, Dr. Arjun Nayak, Dr. Krishna Nayak US
 

A 12 year old growing female patient reported to our department with the chief complaint of forwardly placed irregular upper front teeth. On Extra-oral Examination, patient was having a convex facial profile, leptoprosopic facial index with incompetent lips, recessive chin, shallow mentolabial sulcus with a vertical growth pattern. She had incompetent lips with a high smile line and a recessive chin.

Extra Oralphotographs

On Intra-oral examination, the molar relation was Angle’s Class II, Canine relation was Class II and an Incisor relationship of Class II Div I with an overjet 7mm and overbite of 4mm.

 
INTRA ORAL PHOTOGRAPHS
DIAGNOSIS

Growing female patient having Skeletal Class II malocclusion with a retrusive mandible, steep mandibular plane angle, recessive chin with incompetent lips and a high smile line.

TREATMENT OBJECTIVES
  1. Correction of Skeletal Class II Malocclusion
  2. To attain Class I molar and canine relationship
  3. Obtain ideal overjet and overbite
  4. To obtain proper lip competency and achieve a harmonious profile
TREATMENT PLAN
  • Removable appliance with Z spring to correct relation of 12
  • Growth Modulation appliance (ACTIVATOR) together and HEADGEAR
  • Non extraction with PEA 0.022MBT Prescription mechanotherapy
  • FIRST PHASE(GROWTH MODULATION)

    In order to improve the Skeletal Class II relationship in a vertically growing patient with a retrusive mandible and to restrain the growth of prognathic maxilla, an Activator with High pull Headgear was chosen as the treatment of choice.Activator moves the mandible in a forward and downward direction with posterior disocclusion and the headgear to restrict the maxillary growth.

    Removable appliance with Z spring was delivered to correct the lingually locked 12 for 3 months before starting with the Activator-Headgear combination therapy. The Activator was advised to be worn full day except eating to take the maximum benefit of all the functional forces applied to the dentition. The patient was advised to wear the headgear 14hours a day for best results. The appliance was delivered with force delivery of 300 gms which was gradually increased to 500gms over a period of next few months. The patient wore the activator for a period of 8 months. This resulted in a forward mandibular posture with improved upper to lower incisor relationship.

     
    REMOVABLE APPLIANCE WITH Z SPRING TOCORRECT LINGUALLY LOCKED LATERAL INCISOR;ACTIVATOR
    ACTIVATOR HEADGEAR COMBINATION IN PLACE
    POST GROWTH MODULATION PHASE

    Post growth modulation with sagittal correction achievedfrom Skeletal Class II to Class Iand also dental correction from Class II to Class I which is evident from the profile and intra oral photographs.

    INTRAORAL AND EXTRAORALPOST GROWTH MODULATION PHOTOGRAPHS
    SECOND PHASE

    Non Extraction treatment was undertaken with fixed mechano therapy using 0.022slot MBT bracket system.

    Midtreatment; Distalization Using Open Coil Spring
     
    Post Treatment Photos

    POST TREATMENT OUTCOME

    The post treatment photographs show proper alignment and intercuspation of the arches together with a harmonious soft tissue profile. The treatment results showed significant improvement in the patient’s stomatognathic system with best possible esthetics and function.

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