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Assessment of Crowded Dentition Accompanied by Deep Bite and Overbite

Age:22

Gender:Male

Chief complaint:Malocclusion

Use product:PT ZERO self-ligating brackets

Treatment cycle:18 months

Issues:

Oral hygiene condition is acceptable.
The upper dental arch is ovoid, and the lower dental arch is squarish.
Crowding of 4mm in both upper and lower jaws.
Anterior teeth with Class II deep bite and Class III deep coverage.
Molar relationship: Distal relation on both left and right sides; left side posterior teeth in normal occlusion.
Spee's Curve: 4.5mm.

The height of both ascending rami is basically consistent, and the morphology of both condyles is basically consistent.
Impaction of teeth 18, 28, 48.
Supernumerary tooth located buccally at the root tip area of teeth 35, 36.

Diagnosis:

Cranial Coordinates: Straight facial profile.
Jawbone Coordinates: Skeletal Class I, average angle.
Dental Coordinates: Anterior teeth in both upper and lower jaws are labially inclined.
Anterior teeth with deep bite and deep coverage.

Treatment Approach and Plan:

Extraction of the supernumerary tooth in the left lower posterior area and bilateral upper wisdom teeth.
Elevate the occlusion, use anchorage screws and cross-arch traction to resolve the posterior teeth lockbite (left lower anchorage screw to correct the lingual tilt of the lower posterior teeth).
Align teeth and level the Spee’s Curve.
Use bilateral maxillary anchorage screws to push the molars backward, improving the molar relationship.

Treatment Progress

30, Jun. 2022

30, Nov. 2022

23, Oct. 2023

Summary:

For patients with a straight facial profile and minimal crowding, avoid designing an extraction orthodontic treatment whenever possible, as it is beneficial in maintaining the facial profile.
Ectopic teeth in the root apex area might affect tooth movement during orthodontic treatment; consider extraction before treatment.
Choosing the correct indications, combining self-ligating brackets with low-friction system and anchorage screws, pushing the molars backward to improve Class II molar and canine relationships, can achieve good treatment results while maintaining facial aesthetics.
Make rational use of anchorage screws, correcting lockbite without disrupting the three-dimensional vertical relationship.