ROHIT SACHDEVA: The Shullman Smile Seminar Series (June 3, 2010) Patient 3-EF- (1/25/10-8/31/10)Debonded!

Dr. Howard Shullman demonstrates treatment of patient with Class I malocclusion in real time with SureSmile technology.

isit 1: Initial Records (1/10/10)

a. Took initial photos

b. Took CBCT Scan

Treatment Simulations

a. Initial model vs plan

b. Plan bracket placement

Visit 2: Bonded braces upper and lower - All Teeth – 7—7 (1/25/10)

a. GAC Innovation-C brackets U/ 5—5

b. GAC Innovation-R brackets L/ 3—3

c. Placed composite buildup on lower 1^st molars to open bite and allow correction of crossbite of UR3.

Visit 3: Emergency Visit (2/13/10)

– hooks on U/L 7’s removed due to tissue irritation

Visit 4: Progress Photos (2/23/10)

Visit 5: Progress Photos (3/15/10)

a. Placed 018 NiTi Upper and Lower back to 7’s

b. Placed stops mesial to upper and lower 6’s.

c. Placed button on the lingual of the UR3, patient will wear 3/16 4oz crossbite elastic

d. IPR lower 3—3 and distal to UR3.

Visit 6: Progress Photos (4/1/10)

a. Power Chain U2-2

b. Cont x-bite elastic on the right side only, photos

Visit 7: Progress Photos (4/19/10)

a. Inserted new UAW (20 x 20 Bioforce)

b. Power Chain U2-2

C. Cont x-bite elastics on the right side only, progress photos

Visit 8: Progress Photos (5/10/10)

a. Insert U 17x25 N, PC U2-2, bonded buttons lingual UR3-4

b. Changed elastics to x-bite/box: lingual UR3-4, buccal LR3-4

C. Added stops mesial of U/L 6's

Fig. Wire1

Fig. Final wire (17x25)

Fig. Upper Torque

Fig. Final Archwire (19x25)

Fig. Torque wire (without expansion)

Fig. RCOS (Expansion)- 19x25

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Visit 9: SureSmile wire Insertion (6/3/10)

a. Inserted U/L SureSmile wires U/ 17x25 Copper NiTi with 6.0 expansion and 3 mm curve of spee, L/ 17x25 Copper NiTi with 6.0 expansion and 4 mm curve of spee.

b. IPR mesial/distal LR2-LL3 , PC L6-6,

c. Removed lingual buttons, discont. x-bite elastics, changed to Class II box (Rt side: U3-4 - L45, Lt side: U3-4 - L56)

Visit 10: Progress (7/12/10)

a. Insert U/L aw's - 19 x 25 CuNiti-Niti (3mm RCOS & 6mm expansion)

b. PC U6-6

c. Changed elastics to short Class II on both sides (U3-L4, U4-L5), 3/16 H elastics

d. Removed bite turbos from L6's

e. Progress Photos

Visit 11: Progress (7/27/10)

a. Insert U/L Final 19x25 Copper-Niti aw's (without RCOS or expansion)

b. IPR mesial/distal UL2, distal of LR3, LR2, LL3, & LL2

c. PC U/L 6-6

d. Bonded bite turbos mesial/buccal of L6's (open bite approx 1mm)

e. Changed elastics to Class II on both sides (U3-L6)

f. Enameloplasty LR3

g. Progress Photos

Visit 12: Progress (8/17/10)

She still looks slightly class II ish on the left and for sure not interdigitated. She has a slight space, light contact, distal to UR2 and also distal to UL1, so powerchained her on the upper to close last remaining space. Her lower anteriors are not in contact with the lingual of the upper centrals, about .5mm space between, so should have enough overjet to close remaining upper space. I continued her on class II elastics for 2-3 weeks and hope to place sectional wires with zig-zag elastics for a few days prior to debonding.

Visit 13: Progress (8/31/10)

Sect UAW 2-2 and Sect LAW L3-3, laced U/L 6-6, removed occlusal bite turbos, changed elastic wear to short Class II (U3-L4, U4-L5, U5-L6) on both sides, 3/16M elastics, progress photos. Patient will be debonded in one week.

Visit 14: Progress (9/7/10)

Debonded U/L arches, removed composite, prophylaxis. Bonded fixed retainer lingual L3-3. U/L imps for essix retainers & final study models. Final photos and pano.