CCO Case File: Class II Non-Extraction Male 12.4 yrs.

Author: Dr. Antonino Secchi

 

 

Case summary:
12:4 yo Male with a Class II division 1 malocclusion. He is low angle with a good mandibular body as well as ramus height. Excessive proclination of upper incisors with a deep curve of Spee. Skeletal
transverse dimension is normal (Mx-Mx 62mm, Ag-Ag 76mm).

Tx Strategy by Stages:
Stage I: leveling and aligning, correct all rotations and tip of incisors. Start leveling curve of Spee.
Stage II: Coordinate upper and lower arches, leveling curve of Spee with a 0.019” x 0.019” SS with reverse curve of Spee added manually. Use Sentalloy compressed coils and Class II elastics to help with Class II correction.
Stage III: Achieve optimal intercuspation of the buccal segment using vertical triangular elastics.

Appliance:
In-Ovation ‘R’ CCO System

Wire Sequence:
Stage I: 0.014” Sentalloy AccuForm Medium.
0.020” x 0.020” Bioforce AccuForm Medium.
Stage II: 0.019” x 0.019” SS AccuForm Medium.
Stage III: 0.019” x 0.019” Braided AccuForm Medium.

Auxiliaries:
Sentalloy compressed Coils
Elastics 3/16” 6oz (Thailand).

Stage I. In-Ovation ‘R’ CCO System with upper and lower 0.014” Sentalloy AccuForm Medium wires. Upper premolars were skipped in order to facilitate the placement of the compressed Sentalloy coil.

Stage I. Upper and lower 0.020” x 0.020” Bioforce AccuForm Medium wires.

Stage II. Upper and lower 0.019” x 0.025” ss. AccuForm Medium wires. Wires must be coordinated before placement. Compressed Sentalloy coils were added between upper canines and first molars. Class II elastics 3/16”, 6oz (Thailand). Reverse curve of Spee added manually to lower wire.

Stage II. Upper and lower 0.019” x 0.025” ss. AccuForm Medium wires. Notice how the lower archwire is now much more leveled. Right side in Class I, Left side almost in Class I at the molars, still end on at the canines. However, there is space distal of upper canine to move the anterior teeth back to a Class I and correct the midlines.

Stage II. Upper and lower 0.019” x 0.025” ss. AccuForm Medium wires. Upper and lower occlusal planes leveled and paralleled. Sentalloy coils were removed. Elastics short Class II 3/16” 6oz. (upper 3, lower 5).

Stage II. Upper and lower 0.019” x 0.025” ss. AccuForm Medium wires. Spaces are consolidated. Power chain upper 3 to 3. Good Class I on both sides. Start vertical triangular elastics 3/16” 6oz. (upper 3, lower 3 and 4).

Stage III. These pictures were taken just before we changed the upper archwire. 0.019” x 0.025” Braided AccuForm Medium wire was used only in the upper arch. Vertical triangular elastics 3/16” 6oz were used until braces were removed.

Intraoral final photos. 24 months of active Tx.

It is important to clarify that the active tx could have been several months shorter. Patient “disappear” for 7 months (family reasons) toward the end of tx.

 

 

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