Embracing a New Era

11 year old female, class II dental, late mixed dentition, moderate crowding.

  • Initial Records

    Initial intra-oral photographs showing moderate crowding, dental class II, late mixed dention with cuspids mesial to normal eruption pattern.  Our treatment: establish the lower arch to eliminate crowding by utilizing the lip bumper to preserve "E" space,  resolving crowding by lateral development rather than anterior incisor movement.

  • Initial Bracket Placement/Lower Lip Bumper

    Straight wire brackets placed on the upper arch with flexible archwire and first molar bands and lip bumper placed on the lower arch. Note bracket placement on primary cuspid to aid in upper arch development and alignment.

  • Seated maxillary transpalatal arch and new lip bumper

    Two month progress photos detail the level, align and rotating of the maxillary arch with archwire sequence.  Lower arch is developing with the aid of the lip bumper to maintain molar position allowing the anterior crowding to resolve by distal migration of the cuspids and erupting premolars.

  • Lip bumper activation

    The lip bumper is activated by "flattening" the omega and widening the molar area to advance the lip bumper forward and upright the first molars.  The transpalatal arch on the upper maintains the lateral position of the molars to be synchronized with the lower molar development.

  • Lower arch established

    Nine months of lip bumper therapy has allowed lateral development, preserved "E" space and resolved the crowding of the lower arch.  Lower arch has been established.

  • Bracketing with archwire sequence on the lower arch

    Straight wire brackets were placed on the lower teeth along with the intiation of the archwire sequence.

  • MDA Appliance Seated

    Once the lower arch is established, a .018 x .025 SS archwire is placed for anchorage.  The MDA appliance is seated and activated on the upper arch to obtain a Class I dental relationship.

  • Distalization continued

    The distalization is continued on the right side until the premolars are in the embrasures.

  • Distalization continued

    Note the postion of the premolars on the right side and continue the MDA appliance until the interdigitation of the posterior teeth is correct.

  • Distalization continued

    Note the improvement of the dental midline as the proper posterior occlusion is established.

  • Distalization complete
    1 month since previous treatment

    Once the premolars are in the correct AP relationship, the MDA is removed.

  • Maintaining Distalization and Archwire Sequence
    3 weeks since previous treatment

    After removing the MDA, the archwire sequence is continued and (2) class II 1/4" elastics are worn to maintain the distalization through the final level, align and rotate of the upper arch.

  • Chain elastic to address midline discrepancy
    3 weeks since previous treatment

    Once proper posterior occlusion is established, the dental midline can be addressed by using chain elastic to shift the maxillary teeth around the arch for ideal alignment.

  • Consolidating and final space closure
    3 weeks since previous treatment

    Once the proper midline is established, a consolidating chain is placed for final space closure and positioning of any over distalized teeth.

  • Bracket placement corrections

    For fine tuning and case finishing, bracket positions are changed to correct any "tipping" errors to improve anterior esthetics

  • Arch consolidation
    3 weeks since previous treatment

    A chain elastic is placed on the upper arch, molar to molar, for final consolidation following the rebracketing procedure.

  • Posted archwire with pletcher springs
    3 weeks since previous treatment

    The .018 x .025 SS posted archwire is placed in conjunction with pletcher springs for final space closure, anterior lingual root torque, posterior buccal root torque and bite opening.

  • Anterior finishing
    3 weeks since previous treatment

    Chain elastics are used in the anterior to complete any spacing issues.

  • Segmental archwires with finishing elastics

    Segmental archwires are placed, lateral to lateral on the upper and cuspid to cuspid on the lower.  Posterior finishing elastics to lock in the occlusion.

  • Post treatment
    3 weeks since previous treatment

    Photographs were taken post treatment, the day brackets were removed.  Total active treatment time: 30 months

  • 5 year follow up
    3 weeks since previous treatment

    Photographs taken 5 years post treatment.

  • 10 year follow up
    5 years since previous treatment

    Photographs taken 10 years post treatment.

  • 15 year follow up

    Photographs taken 15 years post treatment.