- Email: [email protected]
Class I, or neutroclusion, treated with new edgewise mechanism
CLASS
I, OR NEUTROCLUSION, TREATED EDGEWISE MECHANISM S. L.
KREGARMAN,
D.D.S.,
NEW
WITH
NEW
N. Y.
YORK,
T
HE case presented, although not one of unusual appearance, is a very interesting one, and it was treated by the cust,omary routine of procedure. It was diagnosed a Class 1, or IIentr.oclnsion, case wit,h a mesial drifting of both right ai~(l left c.nspic\-to-lnolar sections of the maxillary arch. My justification for presentill, (y this case is that it is one of contentious classification. J~idgiilg by the models alone, a good maiiy men wonl(l classify t,he case as (‘lass II, Div. 2, and treat it as such. Study of the photographs, however, leads one to believe that the facial form is altogether harmonious and The flattening of the central that the body of the mandible is well developed. incisors is most likely due to a hgpertonicity of the lip musculature.
The routine of Class II treatment would indicate a forward movement of t,he maxillary incisors, to be followed by mesial movement and development of the mandible. Treatment in accordalice with such a plan would undoubtedly end in a toothy appearance or a protrusive upper lip. My plan, therefore, was based upon preservation of the esthetic relation, and I determined that the primary movement necessary should be a distal tipping of all maxillary posterior teeth and canines rather than a mesial movement of the mandibular posterior teeth. Fig. 1 shows the initial models taken November, 1932. History.-Female, aged thirteen years and eight months. Mother had been exceedingly nervous during pregnancy. The child was breast fed for three months, milk being meager and insufficient. She was bottle fed for one year. case
Orthodontists,
report presented at the Chicago, April. 1937.
Thirty-Fifth
Annual
55
Meeting
of
the
American
Society
of
56
S. L. Kregarman
First deciduous tooth erupted at seven months of age. First permanent tooth erupted at seven years of age. No severe illness was contracted other than children’s diseases. Tonsils were removed at six years. Height 5 feet and 5 inches. Weight 125 pounds. Mentally very normal. Study of the Fig. 2 shows photographs taken at beginning of treatment. profile photograph discloses that the body of the mandible is well formed and Study of the upper lip would caution in normal relation to skull anatomy. against any labial movement of the maxillary incisors other than necessary rotations and aligning of the arch. Diag?zosis.-Class I complicated by forward migration of buccal segments of maxillary arch. Corrective tooth movement was indicated. Maxillary arch : 1. Buccal movement of premolars and molars. 2. Distal movement of molars, premolars and canines. 3. Rotation of incisors. 4. General aligning to ideal arch form.
Fig.
2.
Mandibular arch : 1. Buccal movement of canines, premolars and molars. 2. Labial movement of incisors. 3. Rotation of canines and right central incisor. 4. Depression of incisors and leveling excessive dip in curve of Spee. Manipulation of mechanism to produce these movements in maxillary arch: 1.. Band all teeth except second molars and four incisors, using rectangular tubes on first molar bands and tie-brackets on others. 2. Obtain bracket engagement-using 0.022 x 0.028 inch gold platinum arch wire. 3. Place tip-back bends on buceal segments to carry teeth distally, attach intermaxillary hooks mesial to canines to use for Class II elastic force. 4. Tie in brackets, keeping anterior section away from incisors.
Class I Treated
With
57
New Edgewise Mechanism
5. When correct axial inclination of posterior teeth is obtai .ned, place bracket bands on four incisors. 6. Continue tip-back bends until correct mesiodistal rel .ation ship is obtained. 7. Gradually remove tip-back bends continuing wear of il ltermaxillary elastics, and align all teeth to idea1 arch 1iorm.
4 p
Ma lipulation of mechanism to produce these movements in the mand libular arc1 1. Band all teeth from first molar to first molar, with ret ztang ular tubes on molar bands and tie-brackets on others.
58
8. L. Kregarman 2. Use round 0.020 inch stainless steel, then round 0.022 inch used until bracket engagement is obtained without warping arch wire. 3. Replace with edgewise 0.022 x 0.028 inch gold platinum wire, shaped to ideal typal arch form. 4. Place slight tip-back bends in buccal segments to insure stationary anchorage. 5. Complete rotations and the force application until ideal form of arch is obtained.
Fig.
5.
P’ig.
6.
Home Treatment.-Orbicularis-oris muscle relaxing exercises to aid in lip tonicity. Fig. 3 illustrates the case in November, 1933, when maxillary incisor hands were placed. It will be noted that considerable buccal torque had been I show this to illustrate obtained in both right and left maxillary segments. that, in struggling with a new technique, we often do things we do not desire. Fig. 4 shows radiographs made at that time. None had been made at the beginning. Fig. 5 shows the case in April, 1935. Retention appliances were then constructed. Fig. 6 shows photographs at, this time. Treatment ended. Fig. 7 shows radiographs at this time.
Ret entiolz.--Mandibular arch, lingual bar from molar to molar an a premola .r bands with lingual hooks overlapping bar.
Ma xillaq- ar~il, lingual bar from molar to molar with finger at Lac sxtende Id at mesial to cuspid ; also labial round arch from molar to mLola interma ,xillary hooks in cuspid region for use of elastics at, night. Rel ;ainers were removed iu April, 1936. Fig :. 8 shows models of case in March, 1937, eleven months after re were re imoved.
firSt
nt .th
I, OR NEUTROCLUSION, TREATED EDGEWISE MECHANISM S. L.
KREGARMAN,
D.D.S.,
NEW
WITH
NEW
N. Y.
YORK,
T
HE case presented, although not one of unusual appearance, is a very interesting one, and it was treated by the cust,omary routine of procedure. It was diagnosed a Class 1, or IIentr.oclnsion, case wit,h a mesial drifting of both right ai~(l left c.nspic\-to-lnolar sections of the maxillary arch. My justification for presentill, (y this case is that it is one of contentious classification. J~idgiilg by the models alone, a good maiiy men wonl(l classify t,he case as (‘lass II, Div. 2, and treat it as such. Study of the photographs, however, leads one to believe that the facial form is altogether harmonious and The flattening of the central that the body of the mandible is well developed. incisors is most likely due to a hgpertonicity of the lip musculature.
The routine of Class II treatment would indicate a forward movement of t,he maxillary incisors, to be followed by mesial movement and development of the mandible. Treatment in accordalice with such a plan would undoubtedly end in a toothy appearance or a protrusive upper lip. My plan, therefore, was based upon preservation of the esthetic relation, and I determined that the primary movement necessary should be a distal tipping of all maxillary posterior teeth and canines rather than a mesial movement of the mandibular posterior teeth. Fig. 1 shows the initial models taken November, 1932. History.-Female, aged thirteen years and eight months. Mother had been exceedingly nervous during pregnancy. The child was breast fed for three months, milk being meager and insufficient. She was bottle fed for one year. case
Orthodontists,
report presented at the Chicago, April. 1937.
Thirty-Fifth
Annual
55
Meeting
of
the
American
Society
of
56
S. L. Kregarman
First deciduous tooth erupted at seven months of age. First permanent tooth erupted at seven years of age. No severe illness was contracted other than children’s diseases. Tonsils were removed at six years. Height 5 feet and 5 inches. Weight 125 pounds. Mentally very normal. Study of the Fig. 2 shows photographs taken at beginning of treatment. profile photograph discloses that the body of the mandible is well formed and Study of the upper lip would caution in normal relation to skull anatomy. against any labial movement of the maxillary incisors other than necessary rotations and aligning of the arch. Diag?zosis.-Class I complicated by forward migration of buccal segments of maxillary arch. Corrective tooth movement was indicated. Maxillary arch : 1. Buccal movement of premolars and molars. 2. Distal movement of molars, premolars and canines. 3. Rotation of incisors. 4. General aligning to ideal arch form.
Fig.
2.
Mandibular arch : 1. Buccal movement of canines, premolars and molars. 2. Labial movement of incisors. 3. Rotation of canines and right central incisor. 4. Depression of incisors and leveling excessive dip in curve of Spee. Manipulation of mechanism to produce these movements in maxillary arch: 1.. Band all teeth except second molars and four incisors, using rectangular tubes on first molar bands and tie-brackets on others. 2. Obtain bracket engagement-using 0.022 x 0.028 inch gold platinum arch wire. 3. Place tip-back bends on buceal segments to carry teeth distally, attach intermaxillary hooks mesial to canines to use for Class II elastic force. 4. Tie in brackets, keeping anterior section away from incisors.
Class I Treated
With
57
New Edgewise Mechanism
5. When correct axial inclination of posterior teeth is obtai .ned, place bracket bands on four incisors. 6. Continue tip-back bends until correct mesiodistal rel .ation ship is obtained. 7. Gradually remove tip-back bends continuing wear of il ltermaxillary elastics, and align all teeth to idea1 arch 1iorm.
4 p
Ma lipulation of mechanism to produce these movements in the mand libular arc1 1. Band all teeth from first molar to first molar, with ret ztang ular tubes on molar bands and tie-brackets on others.
58
8. L. Kregarman 2. Use round 0.020 inch stainless steel, then round 0.022 inch used until bracket engagement is obtained without warping arch wire. 3. Replace with edgewise 0.022 x 0.028 inch gold platinum wire, shaped to ideal typal arch form. 4. Place slight tip-back bends in buccal segments to insure stationary anchorage. 5. Complete rotations and the force application until ideal form of arch is obtained.
Fig.
5.
P’ig.
6.
Home Treatment.-Orbicularis-oris muscle relaxing exercises to aid in lip tonicity. Fig. 3 illustrates the case in November, 1933, when maxillary incisor hands were placed. It will be noted that considerable buccal torque had been I show this to illustrate obtained in both right and left maxillary segments. that, in struggling with a new technique, we often do things we do not desire. Fig. 4 shows radiographs made at that time. None had been made at the beginning. Fig. 5 shows the case in April, 1935. Retention appliances were then constructed. Fig. 6 shows photographs at, this time. Treatment ended. Fig. 7 shows radiographs at this time.
Ret entiolz.--Mandibular arch, lingual bar from molar to molar an a premola .r bands with lingual hooks overlapping bar.
Ma xillaq- ar~il, lingual bar from molar to molar with finger at Lac sxtende Id at mesial to cuspid ; also labial round arch from molar to mLola interma ,xillary hooks in cuspid region for use of elastics at, night. Rel ;ainers were removed iu April, 1936. Fig :. 8 shows models of case in March, 1937, eleven months after re were re imoved.
firSt
nt .th