Damon - In the Clinic - Case Studies - Adult Class 2 Cases - Tammy B - 01

Age: 40 Years – 10 Months
Diagnosis: Class II, Division 2 Non-extraction Adult (correction with Class II elastics)

Background: This attractive 40-year-old patient is an example of what was mentioned in the Class II non-growing introduction. This patient has a beautiful upper lip-to-nose relationship with a strong chin button. The lower lip is slightly everted due to the position of the anterior dentition. What a challenge these cases used to be when using conventional mechanics. Early in my career I would have tried to distalize the molars or extract upper first bicuspids. Both of these treatment options would have had a significant impact on the profile with loss of upper lip support. With this lower force technology the overbite and torque can be corrected with the selection of high-torque maxillary anterior brackets and using a maxillary reverse curve Ni-Ti archwire with 20? of torque (see Reverse curve Ni-Ti archwire). This saves so much time and allows the clinician to start Class II elastics as soon as .019 x .025 SS wire is placed in the upper arch (see Final phase archwire). This stainless steel archwire is strongly recommended to maintain the vertical in the maxillary arch when pulling Class II elastics. It is so encouraging to correct a Class II molar and cuspid, eliminate crowding in both arches, and level the curve of Spee without severely dumping the lower incisors. In this case the lower incisors actually uprighted slightly with only minimal anterior bodily movement. Two very important tips are to always cut the lower archwire distal to the first molars prior to placing Class II elastics and instruct the patient to wear two elastics on each side when sleeping if they posture the mandible forward when wearing elastics. In some cases, the patient will position the jaw forward when sleeping and minimize the effect of elastic wear. It was very exciting to be able to exceed this patient’s expectations for orthodontics by finishing in 18 months with 11 total appointments. Obviously, outstanding patient cooperation is required!