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CAD/CAM - international magazine of digital dentistry

22 I I case report _ CAD/CAM lingual orthodontic system incisor, and the maxillary lateral incisors were in crossbite (Fig. 2). According to cephalometric analysis, there was a Class II jaw relationship and normal vertical facial height. The patient was in good health and his medical history showed no contra-indications to orthodontic therapy (Fig. 3). _Treatment objectives Thetreatmentobjectivesincludedcorrectionof the maxillary and mandibular crowding, improve- ment of the dentoalveolar and maxillomandibu- larrelationships,improvementoffacialaesthetics, and establishment of a stable occlusion and better smile. _Treatment alternatives Three treatment options were suggested to the patient. The first alternative entailed labial ortho- dontics using either metal or clear brackets. The secondoptionentailedlingualorthodontics,asthe aestheticdemandwasveryhighforthepatientand clear aligners would not have been able to achieve theneededresults.Bothoptions1and2werenon- extraction. The third option was to extract all four first premolars but this would have affected the facial profile negatively. After detailed discussion with the patient, we chose option 2, non-extrac- tion using a lingual appliance. _Treatment progress Treatmentbeganwithcustomised,pre-adjusted, CAD/CAM fixed lingual appliances (0.5588 mm slots) placed on both the maxillary and mandi- bular arches using an indirect bonding technique. Levelling,alignmentandexpansionofthearchwere achieved using heat-activated, super-elastic, cus- tomisedwire(14,16,16x22;and18x25).Detailing and finishing were performed using 16 x 22 stain- less-steel wire and 18.2 x 18.2 Beta III Titanium Archwire. The total active treatment time was 17 months. Patient compliance was good. For re- tention, fixed maxillary and mandibular retainers were provided, as well as an Essix retainer at night. _Treatment results The post-treatment extra-oral photographs showed general improvement in the facial pro- file. The post-treatment intra-oral photographs showed satisfactory dental alignment, Class I ca- nineandClassIIImolarrelationships,andanormal overbite and overjet. In addition, the maxillary and mandibular incisors had a normal inter-incisal angle due to the interproximal reduction in the maxillary arch. In Figure 4, we can see how accu- rate the model was compared with the final treat- ment outcome for both arches. At the end of treatment,anormalmorphologicalandfunctional occlusion was obtained, with anterior guidance in lateral and protrusive excursions. Class I canine relationships were obtained on both sides. The goodinterdentalrelationshipalsoprovidedawell- balanced facial profile with lip competence. _Discussion The treatment objectives were attained with the non-extraction treatment protocol using a Fig 4_Pretreatment Cephalometric Tracing and Measurements. Fig 5a–g_Showing Upper and Lower Initial and Final Comparing Them to Their Corresponding Set-up. CAD/CAM 3_2013 Fig. 5a Fig. 5b Fig. 5c Fig. 4