Alternative plan

In Phase I, additional functional appliances, such as the Activator, might be used instead of the Twin Block. Headgear therapy is another alternative, although it is not suggested in this case since it has a restraining effect on the maxilla, whereas repositioning the mandible would enhance the facial profile more. Twin Block was chosen over Activator because to increased patient acceptability. Extraction of upper premolars is a possibility, however it is not the best technique because it does not help Class II patients.

Treatment progress and results

The Phase I objectives were successfully attained, due in part to the appliance design and patient compliance. The overjet was reduced by extending the jaw and adjusting the incisor inclination. The canines and molars were overcorrected to Class III, and the space for the missing upper incisor was extended (by 3 mm) as a result; nonetheless, the overbite persisted (Figure 5). Dental hygiene was also maintained.

The second phase of treatment employed a pre-adjusted, edgewise fixed appliance (0.022 × 0.028 MBT) to raise and position teeth, achieve Class I molars and canines, and optimize room for the upper left central incisor. Phase II lasted twelve months. An acrylic tooth with a bonded bracket and extended acrylic phalanges served to retain the space while also improving the patient's look [Figure 6]. The treatment duration lasted 24 months, with 9 months of functional appliance usage, a 3-month transition period between functional and fixed appliances, and finally a 12-month fixed appliance therapy phase. The gap created for the removed central incisor is visible in the end-of-treatment images [Figure 7].

The gap increased from 5.5 mm at the beginning of the treatment to 8.5 mm all over the postfunctional period. This region was kept at the end of the fixed appliance procedure. A periapical (PA) radiograph taken at the end of treatment showed good root synchronization for both the upper right central and upper left lateral incisors, that is important for future implant placement. Expansion changed the maxillary transverse size whereas enhancing the intermolar and interpremolar widths [Table 2]. At the end of phase II, the patients' inability to keep up with wearing Class II elastic as well as keeping adequate oral hygiene resulted in the discontinuation of therapy and acceptance of the current occlusion to prevent further deterioration in oral hygiene.

Summary

Alternative Plan for Oral Health Treatment

• Alternative plans include using functional appliances like the Activator, headgear therapy, Twin Block, and extraction of upper premolars.
• The Twin Block was chosen due to greater patient acceptance.Extraction of upper premolars is not the optimal strategy as it doesn't benefit Class II patients.

Treatment Progress and Results

• Phase I objectives were met satisfactorily due to appliance design and patient compliance.
• Overjet was decreased by advancing the mandible and changing incisor inclination.
• Canines and molars were overcorrected to Class III, and space for missing upper incisor was expanded.
• Dental hygiene was maintained.

Treatment Time

• Total treatment time was 24 months, including 9 months of functional appliance use, a 3-month transition period between functional and fixed appliances, and a 12-month fixed appliance therapy phase.
• The gap made for the lost central incisor grew from 5.5 mm at the start of therapy to 8.5 mm during the postfunctional period.
• Expansion altered the maxillary transverse dimension and increased the intermolar and inter-premolar widths.
• The patients' failure to comply with wearing Class II elastic and maintaining acceptable oral hygiene led to the termination of therapy.