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