Patient’s initial records. The 21.1 year old female shows a severe Class III dental and skeletal pattern. She previously had lower bicuspids removed and shows moderate crowding in her upper and lower arches.

Cephalometric surgical treatment plan and facial prediction. Surgical treatment plan consisted of a maxillary advancement and mandibular set back.

Dental Pre-Surgical VTO. The VTO established extraction of the upper maxillary bicuspids was required for proper tooth fit.

Initial leveling and aligning stages of treatment. Upper .020 stainless steel wire was placed. Lacebacks to the upper canines and open coil spring in the area of the rotated upper right lateral incisor were placed. A .016 heat activated wire was placed in the lower arch.

Shows upper .020 steel wire with activation of the open coil spring and a button bonded to the facial surface of the upper right lateral. The button was tied distally, with elastic chain, for rotation. The lower second molars were banded and a .016 heat activated wire placed.

Upper .016 heat activated wire with the lateral incisor included in archwire. Lacebacks on the upper arch were continued. A lower .019 x .025 heat activated wire was placed.

Upper and lower .019 x .025 stainless steel posted wires were placed. Active tiebacks on the upper arch and lower passive wire tiebacks on lower arch are utilized for space closure.

Space closure in .019 x .025 wires was completed and maintained with passive wire tiebacks. Pre-surgical panorex was taken.

Pre-surgical records were completed. Cephalometric superimpositions show presurgical orthodontic movement achieved.

Opening of distal to lateral spaces for temporary bonding, increasing upper anterior tooth size, was completed.

Post-surgical intra-orals.

Final settling of case using an .018 round sectional wire and a lower .016 heat
activated wire. The extraction sites are figure eighted to maintain space closure.

Patient’s final records.

Final cephalogram and superimpositions. Superimpositions show achieved surgical maxillary advancement and slight mandibular setback, resulting in very aesthetic facial balance.