Post on 27-Jan-2021
CS: Mild Class II division 2
QST Fixed AppliancesTreatment time 5 months
History
CS was a 38 year old male (orthodontic technician) whose main complaint was “my upper laterals stick out!” He expressed he
would like to have his upper teeth straightened relatively quickly
Extra-oral examination
Class I skeletal baseAverage Frankfort-Mandibular Planes AngleAverage vertical proportionsAverage nasolabial angleCompetent lipsNo asymmetry
Intra-oral examination
Previously extracted 34, 44
Class II division 2 incisors, class I molars, class II canines
Increased overjet and overbite
Lower arch crowding 1mm, upper arch crowding 2mm
Buccal occlusion well interdigitated
Summary
CS complained “my upper laterals stick out!” He presented with a class II division 2 incisor
relationship on a skeletal I base, with increased overjet and overbite, mild upper and lower arch
crowding and previously extracted lower first premolars. He had retroclined upper central incisors and proclined upper lateral incisors. He preferred to
have the upper arch only treated
Treatment Options
1. Comprehensive orthodontic treatment. Extraction of 14 and 24, followed by fixed appliances to correct the overjet, overbite and buccal segment relationship to class I. Estimated treatment time 18-24 months and prohibitively long for CS
2. QST upper fixed only. Accept a residual overjet, as the central incisors would procline with upper arch alignment only. Estimated treatment time 5-7 months
Treatment Plan
• Upper QST fixed appliance to relieve crowding, align the anterior arch and improve anterior aesthetics
• Accept an increased overjet and class II buccal segments. IPR to limit any overjet increase and facilitate alignment
• Indefinite retention with fixed and removable retainers
Mid Treatment (2nd adjustment) in 0.016” niti
• Metal archwire used
• Upper wire cinched 90⁰ behind molar tubes to limit
upper incisor proclination
Post-orthodontics
Before
After
Summary
Well aligned upper incisors at normal angulation
Residual increased overjet
Improved upper incisor levels
Treatment duration 5 months