Damon - In the Clinic - Case Studies - Crowded Cases - Mark J

Age: 14 Years – 6 Months
Diagnosis: Class I Nonextraction Youth – Severe crowding, very flat profile

Background: Early in my career this patient would have been subjected to extractions without hesitation. Treatment decisions were based on headfilms and maintaining the original dental arch form. In following these cases long term, it became very apparent that there is a significant facial change with maturation. It is now well documented that there is tremendous nose and chin change into the late 20s and 30s. As these patients mature, many clinicians observed a tremendous dishing of facial profiles. When I started to challenge my thought process on treatment planning and its long-term facial impact, I asked the question, “Why are these patients so crowded?” Are the jaws smaller than normal or is there an imbalance of the orofacial musculature complex (see Bioadaptive response)? The treatment of this case illustrates very graphically what a significant role these muscle forces play in shaping arch form.

Orthodontists for many years have accepted the necessity of posterior arch change in early posterior crossbite cases (see Posterior expansion). This posterior arch change is usually fairly stable. Obviously the muscles have to adapt or these cases would never be stable. What is exciting about this new low-force technology used to treat this case is the positive impact it has on the alveolar bone and tissue. It appears that in most cases the patient is given a “second chance” to find a new balance of the orofacial muscular complex. Please observe the positive impact this low-force/low-friction treatment has had on this patient. The cuspids were engaged with the first archwire to encourage anterior movement of the incisors. It is very exciting when Face Driven Orthodontics and Treatment Planning can be accomplished in 14 months 2 weeks and 7 working appointments.