Case 14: Class II division 1, Mandibular advancement surgery, periodontal disease, missing first bicuspids. Female age 33

Multidisciplinary case requirement was satisfied with this case

Start records

Start Mean ± SD

. Vertical Frankfort to mandibular plane 26° 22° (18°- 28°)

Palatal to mandibular plane 28,5° 28° (24°- 33°)

. Wits 9 mm -1 - +2 mm

. Steiner SNA 86° 82° ± 3,5

SNB 78° 80° ± 3,5

ANB 8° 2°-4° ± 2,5

GoGnSN 37° 33° ± 2,5+ 1/NA 5,5 mm 4 mm

26° 22°- 1/NB 7,5 mm 4 mm

27° 25°. Y-axis to SN 69° 67°

Summary ceph measurements- Large class II average- Proclined upper incisors

Diagnosis Summary: The missing teeth were possibly due to previous ortho attempt with removable appliances. The periodontal limitation was one issue in favor of the surgical approach to reduce treatment time and the amount of tooth movement. Skeletal resistance, predicted by ANB +8 was significant and would be a problem with orthodontic tooth movement approaches. Facial esthetics were effected by the malocclusion and could be improved by surgery. Maxillary surgery was considered but was not needed. The patient was under treatment with a periodontist for 1 year after the initial records were taken, and had consultations with a maxillofacial surgeon before the start of orthodontics. This case fulfilled the requirement of 1 multidisciplinary case, which impacted cuspids did not qualify.

Treatment Summary Minimum anchorage was used to close the upper spaces, with efforts to keep the upper midline centered. The upper molars were asymmetric at the start, with the upper left molar being in a more mesial position than the upper right. Pre-surgical orthodontics took 20 months, with visits to the periodontist every 3 months during this time. The surgery was completed in June 2002, and was followed by 4 months of post-surgery orthodontic finishing. Pre-surgery records

Final Records

Start Progress Finish Mean ± SD

. VerticalFrankfort to mandibular plane

26° 26,5° 31,5° 22° (18°- 28°)

Palatal to mandibular plane

28,5° 28° 32,5° 28° (24°- 33°)

. Wits 9 mm 4,5 0,5 -1 - +2 mm

. Steiner SNA 86° 86° 86° 82° ± 3,5

SNB 78° 78,5° 80,5° 80° ± 3,5

ANB 8° 7,5° 5,5° 2° ± 2,5

GoGnSN 37° 36° 41° 33° ± 2,5

+ 1/NA 5,5 mm 1,5 4,5 4 mm

26° 10° 22° 22°

- 1/NB 7,5 mm 4,5 9 4 mm

27° 21° 30° 25°

. Y-axis to SN 69° 69° 69° 67°

Summary ceph measurements

- Skeletal Class II changed into a class I.- Vertical average measurement changed into a skeletal open - Upper incisors are positioned in an ideal inclination and A-P

position - Lower incisors are proclined and protrusive.

Final Remarks: There was a problem with the periodontal involved teeth tipping more than would be expected while closing spaces. There was some space at the end between teeth 14-13. Otherwise, the case was not so difficult with surgery to correct the class II and deep bite.

Additional comments not a part of the examination

Doctor time: no assistant was employed at this practice

Consultations, take records, process records, diagnosis = 3.3 hours. * one extra 20 minute consultation after the surgeon consult, otherwise same

Initial band and bond (direct) = 1.5 hoursPre-surgery ortho: 3 visits @ 15 minutes = 0.75 hour16 visits @ 20 minutes = 5.3 hoursPost-surgery ortho:1 visit @ 20 minutes = 0.3 hour3 visits @ 30 minutes = 1.5 hoursDeband, final records, fabricate and deliver retainers = 2 hours

Total Doctor Time = 14.65 hoursEstimated with 1 assistant = doctor 8.5 hours, assistant 6 hour