CCO Case File: Class II Right Sub-Division/Male 19 yrs.

Author: Dr. Luis Nunez

Initial facial photos
Initial facial photos

 

Initial X rays and cephalometric studies
Initial X rays and cephalometric studies

 

Initial intraoral photographs
Initial intraoral photographs

 

Case Summary:
Chief complaint is upper anterior crowding.

Diagnosis:
Adult patient 19 years old, Dolicho Facial Biotype. Skeletal class II with a convex profile. Molar and cuspid class II on the right side and class I on the left. Augmented overjet and a virtual high overbite because of upper anterior crowding and upright position. Triangular shape of the upper arch. Horizontal position of lower right third molar and the upper right one has not been formed.

Treatment Plan:
Stage I:
Bond upper appliance to correct crowding, level, align, and make some room for the lower brackets. Bond lower brackets and progress in the archwire sequence as soon as possible.

Stage II: Distalize upper molars and then retrude anteriors to correct class II, specially on the right side. Level upper and lower arch curvatures to help correct molar relationships. Class II Elastics to counteract the niti coils mesial force.

Stage III: Intraoral elastics to set the occlusion.

Appliance:
In-Ovation C CCO, 12° in the upper centrals, -6° in the lower anteriors.

Archwire Sequence:
UPPER:
Stage I: .014”Sentalloy, .018” Sentalloy .020”x .020” Bioforce,
Stage II: .019”x .025” Neo Sentalloy and .019”x .025” stainless steel
Stage III: .019”X .025” braided

LOWER:
Stage I: .014” Sentalloy, 020”x ,020” Bioforce,
Stage II: .019”x .025” Neo Sentalloy and .019”x .025” stainless steel
Stage III: .019”X .025” braided

Auxiliaries:
Stage II:
Sentalloy coils to distalize upper molars and bicuspids. Class II 3/16” medium and 1/8” heavy intermaxillary elastics to avoid upper incisor´s protrusion and help correct class II.

Male Adult 1AStage I: In-Ovation C brackets with .014” Sentalloy upper medium archwire. The intention here is to create the necessary space to bond the lower brackets. According to cuspids and bicuspids mesial inclination, an opening of the overjet and overbite is expected.

Male Adult 1BStage I: 4 weeks after, we moved into a .018” upper Sentalloy. Lower brackets were bonded and a .014” medium Sentalloy was placed. It was necessary to raise the occlusion with blue compomer at the first molars to avoid contact between upper incisors and lower anterior brackets. At the same time this builds up unblock the occlusion and ease corrections.

Male Adult 2AStage II: Upper 0.019”x 0.025” SS archwire and a lower 0.019”x 0.025” Neo Sentalloy to finish levelling the lower occlusal plane. To correct the class II, open Sentalloy coils were placed mesially to the upper first molars and 3/16” medium elastics were also indicated to avoid anterior protrusion. Once molars are moved distally, the coils must be moved mesially to the bicuspids, one at the time to meet the molars. Finally the anteriors have to be distalized with crimpable hooks in the archwire and closed coils with eyelets from the Second molars.

Male Adult 2B
Final intraoral photos after 18 months of treatment.

 

Facial photos after treatment
Facial photos after treatment

 

Smile pre and post treatment photos
Smile pre and post treatment photos

 

 

Final pre and post treatment photos
Final pre and post treatment photos

 

If you liked this article you may enjoy reading  Pseudo Class III Malocclusion.

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