case_images: PMC5030400_01
case_images: Initial composite.
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case_images: fig1
case_images: He had a symmetrical, mesofacial face and a retrognathic soft tissue profile (Figure 1).
case_images: Initial models.
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case_images: fig2
case_images: There was a history of trauma to his upper left central incisor with no pulpal damage and a fractured mesial incisal edge (Figures 2 and 3).
case_images: Initial full mouth radiographs.
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case_images: fig3
case_images: The maxillary arch was narrow and tapered with moderate crowding and the mandibular arch was narrow and ovoid with severe crowding having both permanent canines impacted and retained primary first molars with stainless steel crowns (Figures 3 and 4). There was a history of trauma to his upper left central incisor with no pulpal damage and a fractured mesial incisal edge (Figures 2 and 3).
case_images: Initial panoramic radiograph.
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case_images: fig4
case_images: The maxillary arch was narrow and tapered with moderate crowding and the mandibular arch was narrow and ovoid with severe crowding having both permanent canines impacted and retained primary first molars with stainless steel crowns (Figures 3 and 4).
case_images: Initial cephalometric radiograph.
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case_images: fig5
case_images: TMJs were normal. The cephalometric analysis showed a relatively well-positioned maxilla, retrusive mandible with an ANB angle of 7.3 , a high mandibular plane angle of 35.0 , convex skeletal and soft tissue profiles, an acute nasolabial angle, protrusive upper and lower lips, retroclined lower incisors, and cervical development of CVS 2 (Figure 5). The airway was widened in the two-dimensional view of the cephalometric radiograph when compared to his initial in Figure 5.
case_images: Initial hand-wrist radiograph.
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case_images: fig6
case_images: Significant growth was also anticipated in this patient during treatment as shown in his hand-wrist radiograph (Figure 6).
case_images: Progress photographs.
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case_images: fig7
case_images: He underwent his first stage of comprehensive orthodontic treatment nonextraction with fixed edgewise appliances and a Haas palatal expander and mandibular Arnold expander (Figures 7 and 8).
case_images: Progress photographs.
case_images: CRID2016-5473580.008.jpg
case_images: PMC5030400_01_CRID2016-5473580.008.jpg
case_images: fig8
case_images: He underwent his first stage of comprehensive orthodontic treatment nonextraction with fixed edgewise appliances and a Haas palatal expander and mandibular Arnold expander (Figures 7 and 8).
case_images: Stage 1: Orthodontic Treatment Final Composite.
case_images: CRID2016-5473580.009.jpg
case_images: PMC5030400_01_CRID2016-5473580.009.jpg
case_images: fig9
case_images: Hawley and fixed canine-to-canine mandibular retainer (Figures 9  -12).
case_images: Stage 1: Orthodontic Treatment Final Models.
case_images: CRID2016-5473580.010.jpg
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case_images: fig10
case_images: Hawley and fixed canine-to-canine mandibular retainer (Figures 9  -12).
case_images: Stage 1: Orthodontic Treatment Final Panoramic Radiograph.
case_images: CRID2016-5473580.011.jpg
case_images: PMC5030400_01_CRID2016-5473580.011.jpg
case_images: fig11
case_images: Hawley and fixed canine-to-canine mandibular retainer (Figures 9  -12).
case_images: Stage 1: Orthodontic Treatment Cephalometric Radiograph.
case_images: CRID2016-5473580.012.jpg
case_images: PMC5030400_01_CRID2016-5473580.012.jpg
case_images: fig12
case_images: Hawley and fixed canine-to-canine mandibular retainer (Figures 9  -12).
case_images: Stage 1: Orthodontic Treatment Superimposition.
case_images: CRID2016-5473580.013.jpg
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case_images: fig13
case_images: Stage 1 treatment superimposition (Figure 13) showed there was bite opening with extrusion of upper molars, the lower incisors were flared, and the upper and lower lips moved forward 4 mm. and 6 mm., respectively.
case_images: Stage 2: Orthodontic Treatment Initial Composite.
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case_images: fig14
case_images: It was agreed to extract his four third molars and both his lower first premolars and retract the lower anterior teeth so a maximum advancement of his mandible with a bilateral sagittal split osteotomy (BSSO) could be obtained (Figures 14 and 15).
case_images: Stage 2: Presurgical Composite.
case_images: CRID2016-5473580.015.jpg
case_images: PMC5030400_01_CRID2016-5473580.015.jpg
case_images: fig15
case_images: It was agreed to extract his four third molars and both his lower first premolars and retract the lower anterior teeth so a maximum advancement of his mandible with a bilateral sagittal split osteotomy (BSSO) could be obtained (Figures 14 and 15).