case_images: PMC11018373_01
case_images: (a-c) Extraoral and (d-h) intraoral photography before orthodontic treatment.
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case_images: fig1
case_images: According to the extraoral inspection (Figure 1), she had an almost symmetrical face, increased lower face height, a straight profile with a slightly prominent chin, and acceptable contact between the lips in rest position.
case_images: Dental casts before orthodontic treatment.
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case_images: fig2
case_images: The analysis of dental casts reported that both the maxillary and mandibular arch had a 5 mm and 3 mm space discrepancy, respectively (Figure 2). For extrusion of the upper front teeth and correcting the mesially inclined canine, we applied on mesial and distal side the extrusion lever arms composed of beta-titanium (TMA) wire, 0.017 x 0.025 inch (force dosed 30 gr per side) (Figures 2(d)-2(f)).
case_images: Initial panoramic and lateral cephalometric radiography.
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case_images: fig3
case_images: The panoramic radiograph revealed that all third molars were fully developed, that cavity fillings were present on some teeth in both jaws, and no radiologically evident signs of pathological processes in the bone or periapical tissue (Figure 3).
case_images: (a) Placement of the transpalatal arch. (b) Added upper segmented fixed appliance. (c) Supporting mechanism connected with palatal mini-implant that enabled indirect skeletal anchorage. (d) Right profile. (e) En face and (f) left profile intraoral photography of upper and lower fixed appliance with beta-titanium cantilever.
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case_images: fig4
case_images: In the first phase of treatment, the bands were cemented on the first permanent molars, and the transpalatal arch was placed, which was activated for bilateral molar derotation (Figure 4(a)). After 3 months, the upper segmented fixed appliance was inserted, which included the upper premolars in addition to the first permanent molars (Figure 4(b)). The transpalatal arch was removed in the next stage, and one mini-implant was placed in anterior palatum with a supporting device attached to the first permanent molars to provide indirect skeletal anchorage (Figure 4(c)). Class III elastics (2 oz; size 5/16 inches) were immediately incorporated to achieve uprighting and distalization of the lower posterior teeth and extrusion and retroinclination of the lower incisors (Figures 4(d)-4(f)).
case_images: (a-c) Extraoral and (d-h) intraoral photography after orthodontic treatment.
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case_images: fig5
case_images: The buccal corridors, which were visible when the patient smiles, were significantly reduced after the correction of transverse occlusal relations, which improved the esthetics of the patient's smile (Figure 5).
case_images: Dental casts after finishing the orthodontic treatment.
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case_images: fig6
case_images: Panoramic and lateral cephalometric radiography after the orthodontic treatment.
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case_images: fig7