iDentistry The Journal Volume 14 No.1 | Page 17

The Journal ANB angle A to N perpendicular B to N perependicular FMA U1-SN U1-NA L1-NB L1-MP Inter- incisal angle Nasolabial angle Pretreatment -2° -6mm 7mm 28° 111° 32° 5mm 84° 132° 99° Post-treatment -1° -5mm 2mm 26° 115° 30° 3mm 90° 112° 98° Treatment Progress Treatment Results Initially posterior crossbite was treated using quad helix. Mandibular right second pre molar was extracted to correct canine relation and to decrowd, 45, 43 was bonded to close extraction space followed by bonding of maxillary arch using pre adjusted edgewise appliance (0.022 prescription). Initial alignment and levelling using 0.014” Niti The relationship of the right posterior teeth was improved after 4 months of leveling and expansion of the maxillary arch. 0.017x0.025 Niti followed by 0.019x0.025 Niti was given for alignment followed by 0.019x0.025 Stainless steel wire followed by 0.021x0.025 Stainless steel wire for better torque expression and to add rigidity and maintain the arch forms. After 10 months pre surgical orthodontics surgical crimpable hooks were placed on the archwires in preparation for the planned differential bilateral sagittal split osteotomy (BSSO) of the mandible(fig 4). Post surgically after six weeks of intermaxillary fixation with a splint, orthodontic treatment was resumed. Final arch coordination and minimal occlusal equilibration were accomplished during the next 6 months Finishing and detailing was done and the case was debonded. Fixed lingual bonded retainers were placed in the maxillary as well as mandibu lar arches. The mandibular skeletal asymmetry and prognathism was corrected, the patient’s facial asymmetry was much improved. The unilateral posterior crossbite was eliminated, and the dental midline was coincident and the minor crowding of the maxillary arch and mandibular arch was resolved. 16 Normal functional occlusion was established with normal anterior overbite and overjet. Mandibular arch form and intercanine width had been maintained. The panoramic radiographs show well-aligned parallel roots of the teeth, and there are no signs of root resorption(fig 7) The patient returned for reevaluation at 1 year after debonding. His occlusion was well maintained. The occlusal relationships of the premolars and molars were improved by settling. The facial photographs showed a harmonious, acceptable, and symmetrical appearance. Vol. 14 No. 1 Jan-Apr 2018