Class I Non-Extraction

Pre-Treatment Photos
Pre-Treatment Records
Archwire Sequence
Treatment Progress - 12 Weeks
Treatment Progress - 18 Weeks
Treatment Progress - 37 Weeks
Treatment Progress - 43 Weeks
Post-Treatment Photos
Post-Treatment Records
Ceph Tracings - Initial vs Final
Post-Retention Photos

This case was treated by:
Dr. François Bérubé


Case Type:
Class I Non-Extraction

Problem List:
• Brachycephalic pattern
• Low Mandibular Plane Angle
• Short Lower Face
• Poor Upper and Lower Lip Support
• Clenching
• Parafunction
• Masticatory Muscle Pain
• Gingival Recession - tooth 12, 14, 43, 44, 45
• Upper and Lower incisor attrition
• Upper Right Impacted Canine
• Upper and Lower Crowding

Case Resumé:
A young lady, age 21 years. Growth is finished and she has relatively good posterior occlusion but has traumatic occlusion in the anterior section, due to her large overbite. The patient came to the office because of the discolouration and sensitivity of her upper right lateral incisor. She has a normal overjet of 2.5 mm, but a large overbite (6 mm). A Maryland bridge was masking her impacted canine, and the mesial wing bonded to the adjacent lateral is responsible for the discolouration of this tooth, and has resulted in traumatic occlusion of the lateral, resulting in gingival recession and sensitivity due to parafunction. On the panoramic X-ray, we can see a bony defect distal to the tooth 12 and the impacted upper right canine. We can also see 3 impacted wisdom teeth (18, 28, 48) and root dilaceration of tooth 15, 25, 35, 43, and 45. The curve of Spee is almost normal.

Treatment Plan

The patient was sent to the periodontist to evaluate the gingival tissue and recession prior to the start of treatment. The Periodontist decided to evaluate the recession as treatment progressed and re-evaluate the case once the Orthodontic treatment was completed.

Maxillary arch:

Remove the Maryland bridge, initiate dental alignment and create space in the arch for the impacted canine (13). Work up to a rectangular wire to prepare anchorage for orthodontic traction of the impacted canine. Next steps are to align the canine, coordinate arches, and finally, retention. At the end of treatment, re-evaluate the gingival tissue and the recession with the periodontist, and send the patient to the General Dentist to have cosmetic procedures to compensate for the incisal attrition of the upper incisors, if needed.

Mandibular arch:
Align the teeth, correct the curve of Spee, coordinate the arches using rectangular archwire, and if needed, incorporate anchorage using Class II elastics. Retention with a lingual bonded retainer, and re-evaluate the periodontics on the right side, particularly for tooth numbers 43, 44, and 45.