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* Treatment Plan
Due to the thin lips and the obtuse naso-labial angle in profile , a nonextraction option for teeth alignment was chosen ; extraction of teeth will significantly increase the risk of incisor over-retraction , and further reduction of lip support . Orthopedic palatal expansion was ruled out due to the patient ’ s prior experience and general reluctance . The option for self-ligating orthodontic braces ( Damon variety ; . 022 slot , Roth Rx ) was chosen . It was decided that interproximal reduction may be required if dental arch expansion with the orthodontic appliances was inadequate .
The off-centered maxillary dental midline will be corrected by strategic orthodontic alignment & space management .
To reduce the risks of anterior bite opening during orthodontic alignment , early introduction of inter-arch elastics was planned . In addition , treatment efficiency and accuracy was greatly enhanced using digital , 3D treatment planning and robotically-designed orthodontic wires via SureSmile Technology ( Orametrix , Inc ., Richardson , TX ).
Orthodontic Patient with Crowded Dentition and Steep Mandibular Plane Angle Treated With The Aid of 3D Digital Technology and Robotically Bent Custom Arch Wires
by Deji V . Fashemo , DDS , MPH
Healthy adolescent female patient ( age 13 years , 9 months old at presentation ) with a budding modeling career came in for orthodontic consultation regarding her crowded teeth ; she desired straight teeth for a more pleasing smile . She is interested in a treatment plan that keeps her in braces for the shortest possible time so she may resume her modeling engagements . This patient was previously treated with limited Phase I maxillary orthopedic and orthodontic appliances at another office .
On facial examination , the patient was noted to have mild to moderate dolichocephalic head type . Her facial soft tissue profile was straight , and the naso-labial angle obtuse ; the lips were competent at rest and displayed no muscle strain .
Intra-orally , the patient had present all permanent teeth up to the 2 nd molars . The buccally-displaced ( and blocked out ) maxillary right canine was very striking ; the left canine was crowded too , but to a lesser extent . In addition , the lower anterior teeth showed moderate crowding and overlap . Molar Classification was Angle Class I on both left and right sides ; overjet and overbite were minimal . The maxillary dental midline was deviated to the patient ’ s right side by approximately 3mm . Oral hygiene was excellent .
On radiographic examination , the panoramic X-ray showed all bone and teeth structures within normal limits . The un-erupted 3 rd molars were present in all four quadrants . Cephalometric evaluation corroborated the straight skeletal profile , a steep mandibular plane angle , and the reduced upper and lower lip prominence .
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