Pacific Coast Society of Orthodontists Bulletin Spring 2020 - 41
Case Report
Case Report
How Would You Treat This Malocclusion?
Pretreatment
Case C.H., 16 years, 1 month
A 16-year-old male patient presents in good
health with a noncontributory medical history and excellent oral hygiene. His chief complaint is, "Get my teeth in line and straight.
I have a tooth inside my gums, and I want it
fixed." According to the patient's parents, he
was treated with a face mask to correct an
anterior crossbite seven years ago. For retention, he has worn an upper Hawley from the
end of treatment until the present time. His
dental history reveals that he clenches his
teeth, mostly at night. He presents with one
missing tooth on the maxillary left side and
an impacted premolar on maxillary right. He
notes that his height has changed in the past
year; he is now 5 feet 9 inches (180 cm). In
addition, his voice has changed, and he has
facial hair.
Extraoral and Intraoral Findings
The clinical examination shows a symmetric
face with a convex profile, competent lips,
acute nasolabial angle, normal labiomental
fold, and mildly weak soft-tissue chin. His lips
are protruded with respect to the E-line: the
upper lip by 2.6 mm and the lower lip by 6.4
mm. He exhibits about 50% to 60% maxillary
incisor display when smiling, with a flat smile
arc. On the right side, he presents mild Class
III molar and 1/4 cusp Class II canine relationships; on the left side, he presents mild Class I
molar and Class I canine relationships. He has
a normal overjet of 2 mm between #9 and
#24 and a 3-mm overjet between #8 and #25,
along with a reduced overbite of 1 mm. About
5% of the mandibular incisors are covered by
maxillary ones.
He also has severe maxillary spacing (9-10
mm), mainly because of the impacted UR5
and the missing UL5, and mild mandibular
crowding (about 2-3 mm). His maxillary midline
is coincident with his facial midline as well as
with his mandibular midline (Figures 1 and 2).
Spring 2020 PCSO Bulletin
Figure 1. Initial facial and intraoral photographs (C.H., male, 16 years, 1 month)
Figure 2. Initial digital dental models
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