Treatment arrangement and ground

The patient was first referred to the school of hygiene to treat the gum inflammation and improve his oral care. The treatment was planned in two main stages. In the first stage, the goal was to use growth to reduce the overjet, get the molars and canines into a normal Class I relationship, and create more room for the missing front tooth. This was done using a Twin Block appliance, which was worn full time (18 hours a day) for 9 months, and then only at night for 3 months. To record the bite, the patient was asked to bite while moving his lower jaw forward so that the front teeth touched edge to edge.

The appliance was redesigned by adding two C-clasps.
One was placed near the upper left side molar, and another was near the upper right central incisor. Each clasp was attached to a separate acrylic plate to help create space for the missing front tooth during expansion [Figure 4]. The appliance included 0.9 mm stainless steel Adam clasps on the first molars and premolars, and ball-ended clasps on the lower front teeth. Occlusal stops, which were 0.8 mm thick, were added to the upper and lower second molars to control how far they would erupt. A 10 mm expansion screw and C clasps between the upper central and lateral incisors were also added to the upper acrylic plate, which helped expand the space for the upper left central incisor.

In the second stage, upper and lower preadjusted Edgewise appliances with an MBT prescription were used.
These helped keep the canines and molars in the correct Class I position, maintain the overbite and overjet correction, fix any tooth rotations, align the teeth properly, and create the right space for the missing upper left central incisor. Retention was done using upper and lower Hawley retainers.

Summary

Gum inflammation treatment and improved oral care

• The patient was referred for gum inflammation treatment and improved oral care at the school of hygiene.
• Treatment involved two stages:
  • **Stage One:**
    
    • Aimed to reduce overjet, establish normal Class I relationships for molars and canines, and create space for a missing front tooth.
    • Utilized a Twin Block appliance worn 18 hours daily for 9 months, then at night for 3 months.
    • The appliance was redesigned with two C-clasps for expanded space during treatment.
    • Features included stainless steel Adam clasps on molars and premolars, ball-ended clasps on lower front teeth, occlusal stops on second molars, and an expansion screw.
    •  
  • **Stage Two:**

    • Used upper and lower preadjusted Edgewise appliances with an MBT prescription.

    • Ensured correct positioning of canines and molars, maintained bite corrections, aligned teeth, and created space for the upper left central incisor.

    • Retention involved upper and lower Hawley retainers.