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ePaper created 2017-03-17, 13:11:17 | version 1.38.0
application of the Sagittal First concept case report | Fig. 2a Fig. 2b Fig. 2c Fig. 3a Fig. 3b Fig. 3c Fig. 4a Fig. 4b Fig. 4c Fig. 5a Fig. 5b Fig. 5c Fig. 6a Fig. 6b Fig. 6c Case 1 Diagnosis and treatment plan A female, age 23 years, 5 months, presented for treatment exhibiting a moderate Class III malocclu- sion with negative overjet, proclined lower lip with flat supramentale sulcus, open bite and crowding in the lower arch. The treatment plan was to distalise the lower dentition into a Class I occlusion (Sagittal First) using the Carriere Motion CL III Appliance, then gen- erate space to alleviate the lower arch crowding and close the bite, utilising light-force archwires in a pas- sive, self-ligating system. While tongue trainers would be bonded in conjunction with the fixed appliances later in treatment, the patient would also engage in tongue training exercises to correct her improper tongue positioning, especially while swallowing. In- correct tongue positioning can compromise a satis- factory result. Bite closing would be accomplished by action of the archwires in the PSL brackets, not by use of any vertical elastics. Vertical elastics would be em- ployed only during the finishing phase of treatment. In this way, gentle forces would be acting on the roots, minimising stress to the periodontal ligament. Figs. 2a–c: Situation after 1 month of correction with Sagittal First approach. Figs. 3a–c: Situation after 2 months of correction. Figs. 4a–c: Situation after 3 months of correction. Figs. 5a–c: Final wares engaged. Figs. 6a–c: Situation after 12 months of treatment. Treatment sequence Motion Class III appliance bonded Treatment commenced with the Motion Class III appliance bonded directly to the lower canines and first molars with 6 oz, ¼ intraoral elastics engaged for Class III traction to molar tubes bonded to the ortho 1 2017 25