Case Report 4

     In another patient with a Class I deep overbite malocclusion, a thirty-year-old man (Fig. 4A, B), the upper incisors were extruded markedly and inclined lingually.  The cephalometric analysis showed an ODI of 80 degrees, indicating that the skeletal pattern was not as bad as the occlusion had shown.  Although the APDI showed a low angulation (71°), this was due to an abnormally forward-positioned Point A (Fig. 4C).  In Fact, the skeletal pattern was close to a Class I.  The panoramic film showed that the third molars had not erupted, and the upper right third molar was impacted (Fig. 4D).  The extraction of third molars was recommended, but the patient declined to have them removed. 

     Initially, a reverse-looped MEAW was inserted on the upper incisors to intrude them and to toque the roots palatally (Fig. 4E,F).  Six weeks later, the upper incisors were leveled considerably.  An upper bite plate then was placed and the lower brackets were bonded (Fig. 4G,H).  Ten months after the initiation of treatment, the arches were aligned, and the upper reverse MEAW and a lower conventional MEAW were inserted (Fig. 4I,J).  The reverse MEAW is designed with the loops facing distally with each tooth stepped down 2-3mm for the upper from the canine to the second molar.

     After seventeen months of active treatment, the occlusion was restored to a good relationship (Fig. 4K,L).  Due to poor oral hygiene, a hypertrophic gingival was observed, but the tissue swelling subsided a few weeks after the appliance removal.  Cephalometrically, the superimposition showed that there were no noticeable changes in the skeletal pattern; the upper central incisor roots were torqued palatally 25° and intruded by 3mm, while the lower incisors were inclined labially 10° and intruded 2mm (Fig. 4M,N)  (Fig. 4O,P)