Treatment Plan for Bimaxillary Crowding

A 29-year-old Chinese lady (healthcare worker) requests orthodontic treatment (Fig.1-8).  She is not interested in replacing the maxillary 2nd molars (Fig.6,8).  Clinical and radiologic examination reveals mild chronic periodontitis.  What are treatment options?

Model surgery may reveal a proper treatment option (Fig.9-23). 

First is to establish baselines (Fig.9-11). 

After extraction of LL8 and L4s (Fig.9-11 x), the lower anterior teeth are distalized (Fig.12-14); L7s are intruded (Fig.12 arrow).  Since there is a space between L3 and L5 (Fig.13 *), the posterior teeth may be mesialized (Fig.13 arrow).

The upper arch are moved distally (Le Fort I, Fig.15-17) to correct exaggerated anterior overjet (Fig.12 double arrows).  En bloc movement produces anterior midline discrepancy (Fig.16 black lines), one-sided posterior overjet (Fig.16 double arrows) and open bite on the other side (Fig.17 *).

It appears that upper segmental osteotomy is needed to improve occlusion (Fig.18-20).

Fine tune (orthodontics) is required to improve cosmetics (Fig.21-23). 

Discussion with Dr. Ness.

The journey starts hereProgress Report, Zygomatic.

Return to Professionals Implant & Ortho 2

Xin Wei, DDS, PhD, MS 1st edition 02/22/2015, last revision 05/03/2017