Orthodontic Digest

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Evolve Brackets Case Study: Correction of a Class II Division II Malocclusion on a Mild Skeletal II Base

Orthodontist John Good showcases a recent successful orthodontic case using Evolve stainless steel brackets.

I recently made the change to working in solely private practices, and now enjoy being able to provide the highest standard of orthodontic care. My working week spreads over four practices in Suffolk; Island House Dental Care in Woodbridge, Abbey Dental Practice in Bury St Edmunds, Parkview Dental Centre and J Smallridge Dentalcare in Ipswich. As an orthodontic specialist with a broad dental background, I work closely with referring dentists for a multidisciplinary approach to ensure patients are well-informed, comfortable and ultimately satisfied with their results.

Offering a "Gold Standard" of care

Being able to offer a gold standard of care in private dental practices, with no compromising in certain areas, is very rewarding. I have a particular interest in aesthetic orthodontics; providing clear braces and aesthetic brackets in addition to stainless steel brackets.

Case study

A 14-year-old patient presented with a class II division II malocclusion on a mild skeletal II base (Figures 1 to 5), complicated by:

  • Mild crowding in the maxillary and mandibular arches.
  • Increased overbite.
  • 1/2 unit class II molar relationship bilaterally.
  • Centreline discrepancy.

The patient was concerned about his dental appearance thus wished to proceed with orthodontic intervention.

Pre-treatment mandibular occlusal view.Pre-treatment maxillary occlusal view.Pre-treatment left buccal view.Pre-treatment right buccal view.Pre-treatment anterior view.Post-treatment mandibular occlusal view.Post-treatment maxillary occlusal view.Post-treatment left buccal view.Post-treatment right buccal view.Post-treatment anterior view.

Fixed appliances – both metal and aesthetic solutions – were discussed, however the patient had no aesthetic concerns. In addition, with regard to orthodontic alignment with an aligner system, the patient and his mother were concerned about compliance. We also highlighted the additional challenge of the vertical movement of the UR3 with an aligner system. The patient opted to be treated over a duration of 12 months with Evolve stainless steel brackets on a nonextraction basis.

Wire sequence

  1. 0.014 nickel titanium upper and lower.
  2. 0.018 nickel titanium upper and lower.
  3. 0.018 stainless steel upper with nickel titanium push coil to create space for UR3 and aid centreline correction.
  4. Upper 3s included with an 0.014 nickel titanium piggyback wire with 0.018 stainless steel base wire.
  5. 0.019 x 0.025 nickel titanium upper and lower.
  6. 0.019 x 0.025 stainless steel upper and lower. We introduced a reverse curve of Spee into the lower arch wire to aid overbite reduction. Class II and box elastics were use in the finishing stages with a further anterior cross elastic to complete centreline correction.

Treatment reflection

On reflection, if I were to repeat the treatment, I would consider a bracket variation on the UR3 to reduce the buccal eminence to match the left side. As the tooth was buccally displaced at the start of treatment, adding palatal root torque through a local bracket variation could have addressed this early in treatment. In addition, better interdigitation of the UL3 could have been achieved with a combination of continuation of class II elastics (which would also have addressed the very mild centreline discrepancy) and alteration of the tip of the UL3 and LL3 with finishing bends in a light stainless steel archwire (ie, 0.018). However, the patient was happy with the result and keen to proceed with removal of the fixed appliance.

Final result

The final outcome is a well-interdigitated class I incisor relationship and we have corrected the occlusion both in terms of alignment and sagittal relationship. Treatment efficiency was good due to good patient engagement, very few appliance breakages and compliance with elastics. As the patient opted not to have bonded retainers, we provided upper and lower vacuum formed retainers for retention.

About John Good

JOHN GOOD BDS (DUND) MFDS RCSED PGDIP DCLINDENT(QMUL) MORTH RCSED

John qualified from the University of Dundee in 2012 and then worked in Edinburgh and Glasgow, across the dental specialties and in oral and maxillofacial surgery. He gained specialist training in orthodontics in the Royal London Hospital and Ipswich Hospital. During this time, he was awarded the Membership in Orthodontics from the prestigious Royal College of Surgeons of Edinburgh and completed a doctorate in clinical dentistry at Queen Mary University London, for which he was awarded the Jim Moss prize for his independent research on smile aesthetics.

About DB Orthodontics

It is our company mission to become a global leader in orthodontic and laboratory supplies. With over 45 years of experience in orthodontics, we recognise the importance of quality, service and innovation. Working to ISO13485 standards we strive for perfection in all that we do, from unique product design to the excellent service provided by our dedicated customer service and sales teams. We are continually developing our product range, designing innovative products through consultation with leading orthodontists from the world, to ensure that our products meet the high standards expected by today’s practitioners.

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