The 20 Principles of the Alexander Discipline, Volume 2. R.G. "Wick" Alexander
Finish with multiple elastics.
Evaluation
This case was treated in 1983, before superelastic archwires came into being. Yet both arches were treated with only three archwires, all stainless steel (SS). A mistake made in the case was not adequately opening the space in the maxillary left second premolar. However, records taken 20 years posttreatment showed no negative side effects with the cantilever partial denture.
Although I always give the patient the option to wear or remove, the patient continues to wear her bonded 3 × 3. Why? In this case, the incisor mandibular plane angle (IMPA) was considerably advanced, and the patient’s maturity at the beginning of treatment made me comfortable leaving the 3 × 3 in place.
Excellent oral hygiene throughout the years resulted in healthy periodontal hard and soft tissues.
Discussion
In deep bite malocclusions, always begin treatment in the maxillary arch to improve torque on anterior teeth. This will also create a normal maxillary arch form, so the bite plate will fit better. In this case, a bite plate was placed when the mandibular arch was bonded/banded 7 months later. Very little adjustment was needed on the bite plate, so it was comfortable for the patient to wear. Comparing intraoral lateral views of 12 and 18 months shows the leveling of the mandibular arch using reverse curve of Spee.
Case 1-1
Figs 1-2a to 1-2c Pretreatment facial views of a 39-year-old woman. (a) Soft tissue profile shows balance. (b) Frontal view shows balance. (c) Smile shows slight asymmetry.
Figs 1-2d to 1-2f Pretreatment intraoral views. (d) Class I molar relationship. (e) Overbite of 8 mm and overjet of 4 mm. (f) Mandibular left first molar in reverse articulation relationship.
Figs 1-2g and 1-2h Pretreatment occlusal views. Initial maxillary intermolar width: 31.1 mm; initial mandibular intercanine width: 24.4 mm. (g) Maxillary arch is crowded and narrow. (h) Mandibular discrepancy is 5 mm.
Fig 1-2i Pretreatment cephalometric tracing showing skeletal Class I low-angle pattern and upright maxillary and mandibular incisors.
Fig 1-2j Pretreatment panoramic radiograph shows missing four first premolars, maxillary left second molar, and four third molars.
Figs 1-2k and 1-2l Intraoral views 12 months into treatment. Note the curve of Spee in the mandibular arch. A maxillary coil spring is used to create and hold space for a partial denture.
Figs 1-2m and 1-2n Intraoral views 18 months into treatment. The mandibular arch is leveled, and there is less space on the left side for the maxillary second premolar partial denture than expected.
Figs 1-2o and 1-2p Intraoral views 22 months into treatment. The mandibular archwire is sectioned, and finishing elastics consisting of a W with a tail are used.
Figs 1-2q to 1-2s Final facial views, age 41 years. (q) Soft tissue profile shows nice balance. (r) Frontal view shows nice balance. (s) Smile has a nice line and arc. There are no dark buccal corridors.
Figs 1-2t to 1-2v Final occlusion. (t) Class I molar relationship. (u) Midline is coincident. (v) Partial denture in place for the maxillary left second premolar.
Figs 1-2w and 1-2x Final occlusal views. Final maxillary intermolar width: 32.1 mm; final mandibular intercanine width: 28.0 mm.
Fig 1-2y Final cephalometric tracing.
Fig 1-2z Final panoramic radiograph showing root positions and partial denture placement on the left side.
Figs 1-2aa to 1-2cc Facial views 20 years posttreatment.
Figs 1-2dd to 1-2ff Intraoral views 20 years posttreatment.
Figs 1-2gg and 1-2hh Occlusal views 20 years posttreatment. The patient being an adult at the beginning of treatment, the bonded 3 × 3 has remained in position.
Table 1-1 Archwire sequence
| Archwire | Duration (months) | |
|---|---|---|
| Maxillary | ||
| 0.0175 multistrand SS | 1 | |
| 0.016 SS | 8 | |
| 17 × 25 SS | 14 | |
| Active treatment time: | 23 months | |
| Mandibular | ||
| None | 6 | |
| 0.0175 multistrand SS | 3 | |
| 17 × 25 multistrand SS | 2 | |
| 17 × 25 SS | 12 | |
| Active treatment time: | 17 months | |
Table 1-2 Individualized forces
| Force | Duration (months) | |
|---|---|---|
| Coil (maxillary left | 21 | |
| second premolar) | ||
| Bite plate | 12 | |
| Elastics | ||
| Triangular | 3 | |
| Class II | 5 | |
| Buccal box | 1 | |
| Finishing | 1 | |
Case 1-2
Overview
This patient was first examined when my office had been open for only 12 days, at which time I had no education in treating mixed dentition malocclusions or any guidance in the use of cervical facebows.
Examination and diagnosis
A 7-year-old girl presented a