| Objective:The purpose of the case was to present the treatment approach of straight wire technology and MEAW(Multilloop Edgewise Arch Wire)technology with the Tweed-Merrifield directional force technique concept and wearing headgear of an adult patient with skeletal Class ?and deep bite.we discuss the clinical effect of it.Method:An adult female patient,26 years old,with a skeletal Class ? malocclusion with deep bite was selected from the Stomatology Department of A building of the second affiliated hospital of Dalian Medical University in June 2014.She had ever orthodontic treatment.Clinical examination:Permanent teeth dentition.The relationship of both molars was Class I,but she is skeletal Class ?,normal angle,profile was protrusion,gummy smile,lower right second premolar is missing,lower midline shifted to right,the distance of anterior overjet is about 6mm and deep bite(?).There was a deep Spee curve.Both lower molars were inclining to the mesial.Upper arch was?°crowding.Lower arch was I°crowding.According to the result of clinical examination,model analysis and cephalometric analysis of the patient,the plan of the case we choose was extracting upper first premolars and lower left second premolars(because the first premolar was carries,extract first),and alignment with bonding MBT brackets.She needed strong anchorage for canines retraction by increasing the number of the anchorage teeth,keeping the same distance for both side;to retract the anterior with “Two step space closing method”;anterior teeth intrusion with headgear;occlusion construction with MEAW and short Class ? elastic(3/16).Short Class ? elastic can prevent upper anterior teeth extrusion,inclining to lingual,and lower molars extrusion,inclining to the mesial,the plane of occlusion was counterclockwise rotation.When finishing treatment,the patient was removed the appliance.We prepare for the patient with Hawley retainer.Then we take finished cephalometric and panoramic,making model.Results:The treatment process lasted 21 months in total.Cephalometric analysis between pre-treament and post treatment:Soft tissue profile changed towards more esthetic,Z angle changed from 55.9° to 61.3°;anterior teeth over bite changed 5.2mm to3.2mm;over jet changed from 5mm to 2.6mm;the distance between edge of the lip and incisal margin changed from 5.2mm to 2.5mm;NLA angle increased 3.6°;and the patient was incompetent lips disappeared,when the patient closed mouth,she didn't have chin lip muscle tension.FMA decreased to 0.9°,which indicated that the mandibular have counterclockwise rotation.The angle of U1 to SN almost didn't change,which indicated that the teeth retracted bodily.The distance between upper or lower lip and E-line were0 mm and 2.1mm,the data was normal.As a adult skeletal Class ? patient,the profile made the greatest change.The curve of Spee leveled significantly.The canine relationship was normal.Conclusion:Camouflaged orthodontic treatment involved with straight-wire and MEAW appliance with the Tweed-Merrifield directional force technique concept;combined with headgear as extra oral anchorage and occlusion relationship adjustment by MEAW;we can make the best of the both worlds;we not only use anterior teeth retraction to change profile,but also obtain good occlusion relationship.we get harmony,stable and esthetic treatment effect. |
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