case 18.3 (1-5) pre-treatment images of a woman with class ii malocclusion with crowding of upper...

Case 18.3 (1-5) Pre-treatment images of a woman with Class II malocclusion with crowding of upper and lower incisors, increased overjet and overbite, midline discrepancy and absence of upper right first molar and lower left first molar. (6-9) The patient was treated with a progressive slenderizing technique carried out in the upper left hemiarch to correct the crowding, overjet and midline discrepancy. Ceramic brackets were bonded in the upper arch and bands with a Nance palatal arch were bonded in the upper right second molar and upper left second molar. (10) A brass wire separator was inserted between the upper left first molar and the second bicuspid. (11) Once the space was created, the slenderizing was done on the distal surface of the second bicuspid. (12) This obtained space between second bicuspid and first molar. (13) An elastic chain from the second bicuspid to the first molar was used to move the second bicuspid distally. (14) At the next appointment, the slenderizing was made on the distal surface of the first bicuspid and the mesial surface of the second bicuspid. (15) Proxoshape files were used to contour the margins of the stripped area. (16) The obtained space can be observed in this picture. (17) Then, an elastic chain from the first bicuspid to the first molar was used to move the first bicuspid distally. (18) At the next appointment, the slenderizing was made on the mesial surface of the first bicuspid and the distal surface of the cuspid. (19) The same procedure was used for the incisors. (20-24) Once the crowding and midline discrepancy was corrected, the treatment continued with the regular archwire sequence. (25-29) The final result: the patient needs a reconstruction of the upper right second molar and an implant for the lower left first molar.

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