The 20 Principles of the Alexander Discipline, Volume 3. R.G. "Wick" Alexander

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СКАЧАТЬ three-piece maxillary segmental Le Fort I osteotomy and mandibular advancement. All four first premolars were extracted to create adequate space for correction of the arch length discrepancy.

      Note: In my experience, “driftodontics” is not usually successful in adult patients, so in this case, during routine maxillary canine retraction with power chains, mandibular sectional archwires were used to retract the mandibular canines.

      Evaluation

      Interestingly, as the canines were being retracted, the open bite was spontaneously closing! Figures 1-7k to 1-7dd show the occlusion and arches at various points in the treatment.

      As the treatment progressed, both the patient and I began to wonder whether surgery would be necessary. We soon changed the treatment plan to exclude surgery and used typical open bite mechanics (eg, reverse curve of Spee, etc). The final treatment results are shown in Figs 1-7ee to 1-7nn.

      Discussion

      In retrospect, had we planned to treat the patient nonsurgically from the start, I would have extracted the mandibular left second premolar instead of the first premolar. This would have improved the final left molar relationship.

      Long-term stability

      Long-term observation (7 years posttreatment) shows that his results are completely stable (Figs 1-7oo to 1-7ww). I wonder if surgery could have improved the final or long-term result.

Table 1-4

Archwire sequence

Archwire	Duration (months)
Maxillary
0.016 nitinol	3
0.016 SS	6
17 × 25 TMA closing loop	7
17 × 25 TMA	3
17 × 25 SS	6
Active treatment time:	25 months
Mandibular
None	3
17 × 25 TMA sectional closing loop	6
0.016 nitinol	3
0.016 SS	1
16 × 22 SS	3
17 × 25 SS	9
Active treatment time:	22 months

Table 1-5

Individualized forces

Force	Duration (months)
Chains on maxillary canines	6
Elastics
Class II	7
Anterior box	1
Finishing (W with a tail)	1

Table 1-6

Measurements

	Initial (mm)	Final (mm)
Maxillary intermolar width (6 × 6)	32.2	33.4
Mandibular intercanine width (3 × 3)	26.0	28.4

       Case 1-2

Figs 1-7a to 1-7c Pretreatment facial views.

      Figs 1-7d to 1-7f Pretreatment intraoral views.

      Figs 1-7g and 1-7h Pretreatment occlusal views.

      Fig 1-7i Pretreatment cephalometric tracing.

Fig 1-7j Pretreatment panoramic radiograph.

Figs 1-7k to 1-7m Intraoral views 6 months into treatment: maxillary 0.016 SS archwire and mandibular 17 × 25 SS archwire.

      Figs 1-7n and 1-7o Occlusal views 6 months into treatment.

      Figs 1-7p to 1-7r Intraoral views 11 months into treatment: maxillary 17 × 25 TMA closing loop archwire and mandibular 0.016 SS archwire with chain.

      Figs 1-7s and 1-7t Occlusal views 11 months into treatment.

      Figs 1-7u to 1-7w Intraoral views 15 months into treatment: mandibular 16 × 22 SS archwire.

      Figs 1-7x and 1-7y Occlusal views 15 months into treatment.

      Figs 1-7z to 1-7bb Intraoral views 21 months into treatment: СКАЧАТЬ