PMC5101373_01
Extraoral and intraoral initial photos.
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There was prevalence of horizontal growth (Figure 1). There are half cusp (1/2) class II malocclusion on the right side and 3/4 cusp class II on the left side and overjet of 2 mm and overbite of 5 mm (Figure 1).
Initial panoramic radiography and teleradiography.
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After assessing the panoramic radiography and teleradiography (Figure 2), the patient was diagnosed with maxillary retrusion, thus causing natural compensatory proclination of upper incisors.
Bonding of upper and lower fixed appliances after one month from the start of distalization with pendulum.
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After installation, an alginate molding was made and forwarded to the production of the pendulum's anchorage unit, where it would be bonded with photoresin (Figure 3).
Start of tooth 22 alignment. JS spring used for space opening. Buccal torque of first upper molars.
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A bracket was not bonded to tooth 22 for lack of space in the dental arch (Figure 4). I, with accentuated buccal torque (Figure 4) and decreasing upper and lower crowding. In this step, the pendulum was removed along with the anchorage unit.
Class I upper molars and closing of remaining spaces with chain elastics.
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In the tenth month of treatment, the remaining spaces were closed with chain elastics and with the installation of a 0.019'' x 0.025'' steel wire in the upper arch, improving the torque in the first upper molars (Figure 5); a 0.018'' steel wire was installed in the lower arch. Folds (offset) were applied in the area of teeth 33 and 43, seeking the proper lateral movement (Figure 5).
Removal of fixed appliance and bonding of 3 x 3 retainer on the lower arch 11 months after treatment started.
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Orthodontic therapy lasted 12 months (Figures 6 and 7).
Final panoramic radiography and teleradiography.
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Orthodontic therapy lasted 12 months (Figures 6 and 7).
Rebonding of fixed appliance to correct relapse.
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In the first posttreatment control, one month after the removal of the fixed appliance, the upper anterior teeth were rebonded for the repositioning of tooth 22, which presented lingual relapse (Figure 8) due to the lack of patient cooperation in using the upper removable retainer.
After 3 months, the fixed appliance was removed again and an upper fixed retainer was produced from tooth 21 to tooth 23.
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Releveling lasted 3 months, and after removal a fixed retainer was installed on teeth 21, 22, and 23 (Figure 9).