PMC5030400_01
Initial composite.
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He had a symmetrical, mesofacial face and a retrognathic soft tissue profile (Figure 1).
Initial models.
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There was a history of trauma to his upper left central incisor with no pulpal damage and a fractured mesial incisal edge (Figures 2 and 3).
Initial full mouth radiographs.
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The maxillary arch was narrow and tapered with moderate crowding and the mandibular arch was narrow and ovoid with severe crowding having both permanent canines impacted and retained primary first molars with stainless steel crowns (Figures 3 and 4). There was a history of trauma to his upper left central incisor with no pulpal damage and a fractured mesial incisal edge (Figures 2 and 3).
Initial panoramic radiograph.
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The maxillary arch was narrow and tapered with moderate crowding and the mandibular arch was narrow and ovoid with severe crowding having both permanent canines impacted and retained primary first molars with stainless steel crowns (Figures 3 and 4).
Initial cephalometric radiograph.
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TMJs were normal. The cephalometric analysis showed a relatively well-positioned maxilla, retrusive mandible with an ANB angle of 7.3 , a high mandibular plane angle of 35.0 , convex skeletal and soft tissue profiles, an acute nasolabial angle, protrusive upper and lower lips, retroclined lower incisors, and cervical development of CVS 2 (Figure 5). The airway was widened in the two-dimensional view of the cephalometric radiograph when compared to his initial in Figure 5.
Initial hand-wrist radiograph.
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Significant growth was also anticipated in this patient during treatment as shown in his hand-wrist radiograph (Figure 6).
Progress photographs.
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He underwent his first stage of comprehensive orthodontic treatment nonextraction with fixed edgewise appliances and a Haas palatal expander and mandibular Arnold expander (Figures 7 and 8).
Progress photographs.
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He underwent his first stage of comprehensive orthodontic treatment nonextraction with fixed edgewise appliances and a Haas palatal expander and mandibular Arnold expander (Figures 7 and 8).
Stage 1: Orthodontic Treatment Final Composite.
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Hawley and fixed canine-to-canine mandibular retainer (Figures 9  -12).
Stage 1: Orthodontic Treatment Final Models.
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Hawley and fixed canine-to-canine mandibular retainer (Figures 9  -12).
Stage 1: Orthodontic Treatment Final Panoramic Radiograph.
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Hawley and fixed canine-to-canine mandibular retainer (Figures 9  -12).
Stage 1: Orthodontic Treatment Cephalometric Radiograph.
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Hawley and fixed canine-to-canine mandibular retainer (Figures 9  -12).
Stage 1: Orthodontic Treatment Superimposition.
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Stage 1 treatment superimposition (Figure 13) showed there was bite opening with extrusion of upper molars, the lower incisors were flared, and the upper and lower lips moved forward 4 mm. and 6 mm., respectively.
Stage 2: Orthodontic Treatment Initial Composite.
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It was agreed to extract his four third molars and both his lower first premolars and retract the lower anterior teeth so a maximum advancement of his mandible with a bilateral sagittal split osteotomy (BSSO) could be obtained (Figures 14 and 15).
Stage 2: Presurgical Composite.
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It was agreed to extract his four third molars and both his lower first premolars and retract the lower anterior teeth so a maximum advancement of his mandible with a bilateral sagittal split osteotomy (BSSO) could be obtained (Figures 14 and 15).