Case report

CASE WILLIAM

1. Title.-R.

S.

REPORT

D.D.S.,

SMITH,

SAN

FRANCISCO,

CALIF.

C., boy, white, aged 11 years.

2. Diagnosis.-All of the teeth in the upper jaw are anterior to normal positions in the skull, and the mandible is in distal occlusion to the teeth of the upper jaw. There is a degree of macrognathia of the upper jaw and a degree of micrognathia of the lower jaw.

3. History,.-The patient is large for his age and in good health with the upper teeth; his exception of frequent head colds. His mother had protruding father is wearing an upper denture and his lower teeth are irregular. No history of serious illness ; childhood diseases : measles and chicken pox. Gingival tissues in good condition. Good diet. Deciduous teeth lost at a normal age. Cavities to be filled. Parents’ teeth had many restorations. 4. Etiology.-Finger-sucking

and mouth breathing,

heredity.

5. Plan of Treatment.-Treatment

1. 2. 3. 4. 5.

To To To To To

objectives : open the bite. move all of the upper teeth to the distal and lingual. shorten the upper anterior teet,h. place the upper left first premolar in a more normal position. correct the irregularities in the lower anterior teeth.

Mechanics of treatment: Ribbon arch bracket bands were placed on all of the upper and lower anterior teeth. Tie bracket bands were placed on the four lower premolars, and the upper left first premolar was banded with a ribbon arch bracket band. Square precious metal arch wire, 0.022 inch, was used as a labial arch wire on the lower teeth. A large ribbon arch with nuts and threaded ends was used on the upper teeth. Previous to the placing of the arch wires the four permanent first molars were banded and 0.022 inch by 0.022 inch square buccal tubes were placed on the lower first molars. Curved sheaths were soldered on the upper molar bands with considerable angle to bring about the tipping of the first molars and the shortening of the upper anterior teeth. When the lower anterior rotations had been made, cleats were soldered on the lower labial arch wire at the cuspid bracket bands, and spurs were soldered on the lower labial arch wire at the mesial of the buccal tubes on the lower first molars, Lingual crown torque was placed in the anterior region of the lower wire. Hooks were soldered on the upper labial arch wire between the upper lateral incisors and the cuspids. Intermaxillary elastics were placed on the teeth, and the nuts were tightened at frequent intervals. A headcap was made for the patient, hooks were soldered dist,ally to the lower central incisors, and, with the use of large retraction hooks, the occipital anchorage appliance was used at night. flllment

This

of

case report the author’s

was submitted requirements

to for

the American certification. 996

Board

of

Orthodontics

in partial

ful-

CASE

Fig..

REPORT

1.

99’i

WILLIAM

S.

Fig.

SMITH

2

CASE

HEPOK’I’

!I!?9

1000

WILLIAM

S.

SMITH

6. Progress of Case.-The patient was seen at two-week twenty-three months. His cooperation was very good. 7. Secondary

plus orbicularis

Treatment

(Retention).-Retention

intervals

for

with a Kesling positioner

oris exercises.

8. Results Achieved.-The lower third of the face showed a definite vertical development. The upper anterior teeth and perhaps the anterior part of the maxilla have been placed lingually. The bite has been opened, the upper anterior teeth depressed. The irregularities of the upper and lower anterior teeth have been corrected. Orbicularis oris exercise has helped correct the mout.h breathing. and Conclusions.-The diagnosis, plan of treatment, objectives were correct. The final results were gratifying.

9. Observations

treatment

IO. Posttreatment

completion were taken. 450

SUTTER

STREET.

Pindings.-Roentgenograms

and

and pictures four years after