The 20 Principles of the Alexander Discipline, Volume 2. R.G. "Wick" Alexander

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      Figs 1-2gg and 1-2hh Occlusal views 20 years posttreatment. The patient being an adult at the beginning of treatment, the bonded 3 × 3 has remained in position.

      Table 1-1 Archwire sequence

      Table 1-2 Individualized forces

      Case 1-2

      Overview

      This patient was first examined when my office had been open for only 12 days, at which time I had no education in treating mixed dentition malocclusions or any guidance in the use of cervical facebows.

       Examination and diagnosis

      A 7-year-old girl presented a mixed dentition with a Class II, Division 1 malocclusion. Her overbite was 4 mm, she had an overjet of 7 mm, and there was a mandibular arch-length discrepancy of 4 mm in the mixed dentition. The treatment objectives included the correction of the overjet and Class II molar relationship without the removal of permanent teeth.

       Treatment plan

      The treatment plan called for banding the maxillary permanent teeth (2 × 4) with a tied-back archwire and having the patient wear a cervical facebow 12 to 14 hours a day. If I were treating this patient today, I would divide this treatment into two phases, but at the time, I continued treatment until the permanent teeth could be banded and properly positioned.

      Evaluation

      Total treatment time was 39 months. The patient was retained with a maxillary wrap-around retainer and mandibular 3 × 3 for 3 years.

       Discussion

      Postretention records were taken 40 years after starting her treatment (36 years posttreatment and 33 years postretention). Final results demonstrate a very stable dentition in keeping with the goals we hope to attain in all of our cases.

      This patient will always be remembered as my first mixed dentition and cervical facebow case. Without my having experience to predict a successful result, this patient cooperated and taught me valuable lessons in Class II treatment and eventually was used as an American Board case in 1972.

      Table 1-3 Archwire sequence

      Table 1-4 Individualized forces

      Case 1-2

      Figs 1-3a to 1-3c Pretreatment facial views, age 7 years. (a) Soft tissue profile shows retrognathic mandible. (b) Frontal view shows lips strained. (c) Smile shows flared anterior teeth.

      Figs 1-3d to 1-3f Pretreatment intraoral models show a Class II molar relationship, an overbite of 4 mm, and an overjet of 7 mm.

      Figs 1-3g and 1-3h Pretreatment occlusal models. Initial maxillary intermolar width: 28.6 mm; initial mandibular intercanine width: 25.5 mm. (g) Maxillary midline diastema is present, along with flared anterior teeth. (h) Mandibular discrepancy of 4 mm.

      Fig 1-3i Pretreatment cephalometric tracing shows a Class II, Division 1 malocclusion and a retrognathic mandible.

      Figs 1-3j to 1-3l Final facial views, age 10 years. (j) Soft tissue profile is balanced. (k) Frontal view shows lips together with no strain. (l) Smile shows nice balance.

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