|Fig.5||Fig.6 Right Mirror View||Fig.7 Left Mirror View|
Sixteen-year-old (Fig.1,2,3) has severe crowding (Fig.4), with block out of #10 (Fig.5). He requests ortho and agrees extraction of 4 of the first bicuspids. Prior to banding, bracketing and extraction in the same visit, open bite was noticed in the anterior and left posterior regions (Fig.5,6,7; possible surgery was discussed. The open bite appears to get worse as ortho progresses (Fig.8 (2 months after treatment) and Fig.9,10 (4 months). While gaining space for #10 (Fig.8-10) and moving the upper midline to the right (Fig.2), what can we do to alleviate the open bite? Placing mini-implants to intrude 6s, and 7s, particularly upper or those in the anterior to extrude #11 for example?He looks good clinically, i.e., does not have a long skinny face. I would align the teeth completely and even initiate space closure. Only then, perhaps consider TADs in the upper molar area for intrusion/bite closure as needed.
Xin Wei, DDS, PhD, MS 1st edition 01/05/2013, last revision 01/17/2013