PMC4856937_01
Pretreatment extraoral photographs.
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A 14-year-old female was diagnosed with Class II subdivision malocclusion on the right side and a maxillary-to-facial midline discrepancy of 2 mm (Figures 1 and 2).
Pretreatment intraoral photographs and study casts (occlusal view).
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A 14-year-old female was diagnosed with Class II subdivision malocclusion on the right side and a maxillary-to-facial midline discrepancy of 2 mm (Figures 1 and 2).
Pretreatment radiographs.
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With the exception of 48, no tooth agenesis was confirmed by the orthopantomogram (Figure 3).
(a-d) Class II correction on the right side using TPA anchorage and horizontal elastics. In this phase, premolars were not bonded to facilitate sliding mechanics. (e-f) After achieving Class I premolar relationship, the remaining teeth were bonded. (g) Space closure with elastic power chain. (g, h) Torque correction by means of a customized two-spur torque auxiliary of 0.014-inch regular wire and uprighting springs on the maxillary canine brackets.
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Second molar anchorage was reinforced by anchor bends on a customized 0.016-inch premium plus pull-straightened Australian archwire (Wilcock, Whittlesea, Australia) mesial of the molar tube to counteract unwanted mesial movement of 16 into the extraction space (Figure 4(a)). High hat lock pins (TP Orthodontics, Westville, IN, USA) were placed on maxillary canines and partially bent mesially to receive light 8 mm horizontal elastics (5/16 inches) on the Class II buccal segment extending to the buccal hook on the maxillary second molar band (Figures 4(a)-4(c)). The initially malpositioned 12 was engaged to the archwire until adequate space had been created by canine distalization (Figures 4(b) and 4(c)). For the same reason, uprighting springs (TP, La Porte, Indiana, USA) were fixed in the vertical slots of the canine brackets (Figures 4(g) and 4(h)).
Posttreatment extraoral photographs.
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Anterior tooth retraction did not compromise the soft tissue profile (Figures 5 and 8).
Posttreatment intraoral photographs and study casts (occlusal view).
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Class I occlusion, tooth alignment, and midline correction were maintained for 4 years after appliance removal (Figures 6 and 9).
Posttreatment radiographs.
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Eruption of 18 was accelerated reaching occlusal contact with the antagonist, while the contralateral molar remained unerupted (Figures 7 and 10).
Four-year follow-up extraoral photographs.
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Anterior tooth retraction did not compromise the soft tissue profile (Figures 5 and 8).
Four-year follow-up intraoral photographs.
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Class I occlusion, tooth alignment, and midline correction were maintained for 4 years after appliance removal (Figures 6 and 9).
Four-year follow-up radiographs.
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Eruption of 18 was accelerated reaching occlusal contact with the antagonist, while the contralateral molar remained unerupted (Figures 7 and 10).