Class II Division I, 9 mm overjet

Read about how Dr. Aron Dellinger’s treatment with the Roncone PhysioDynamic System (PDS) helped end a patient’s self-consciousness about her protruding incisors.

Dr. Aron Dellinger discusses treatment with the Roncone PhysioDynamic System (PDS) application of the 20/20 molar bracket

Initial impressions utilizing the PDS QuicKlear with 20/20 molar bracket

Figure 1: Pre- and posttreatment frontal photos

The active clip maintains excellent engagement of the double .014 archwire and provides significant control from the start of treatment. Due to excellent wire retention in the slot, fewer visits are needed to keep the wires engaged. The 20/20 molar prescription creates excellent control of molar position in maximum anchorage cases and increases the effectiveness of early short Class II elastics.

History and etiology

This 10 year 11-month-old young lady presented to my practice with concerns about overjet. There was a family history of Class II. She reported her brother teasing about her protruding upper incisors. She was eager to pursue orthodontic treatment. She had no history of thumb or finger habit. She did present with a lip trap and reported that the condition was getting worse.

Skeletal diagnosis

  • Mild Class II skeletal with A point slightly forward
  • Mild vertical maxillary excess (VME)
  • Normal gonial angle
  • Horizontal occlusal plane
  • V-shaped maxilla
  • Normal mandibular form

Dental diagnosis

  • Late mixed dentition/maxillary E’s still present, arch space available for distalizing the upper 3’s
  • Class II end on molar bilaterally/maxillary 6’s rotated mesial in
  • Class II canine, beyond end on bilaterally
  • Figure 2: Pre- and posttreatment buccal segments

    Overjet 9 mm

  • Overbite 70%, deep curve of Spee
  • Maxillary and mandibular premolars lingually tipped
  • Maxillary incisors severely proclined
  • Mandibular incisors proclined
  • Upper 1-1 diastema, UL 1 slight incisal edge chip (mesial mamilon)

Facial diagnosis

  • Convex profile
  • Chin projection soft, minimal pogonion projection
  • Mentalis strain with lips together
  • Good symmetry, vertical proportions WNL
  • Mild maxillary gingival excess (at lateral incisors), evident altered passive eruption
  • Nasal tip turned upward, nasiolabial angle obtuse, nares symmetrical, no deviation
  • Full upper lip nicely positioned in E plane, lower lip forward of E plane

Treatment sequence

Figure 3: Pre- and posttreatment profile photos
  • Remove upper E’s to allow 5’s to erupt
  • Bond x/ 6-6 with PDS QuicKlear brackets utilizing 20/20 maxillary molar bracket to facilitate control of anchorage and prevent mesial molar slip
  • Composite turbos on upper 1’s, bond /x 6-6 with PDS QuicKlear® brackets, start short Class II elastics on day one, x/x double .014 NiTi wires
  • Allow to work for 6 months with double .014 and continue short Class II elastics
  • x/x 19×25 NandAlloy wires, start long Class II elastics, bond x/x 7’s
  • Segment posterior to allow settling
  • Direct composite to restore chipped UL1
  • x/x retainers
  • 20 months

Posttreatment

  • Full correction of Class II molar
  • Overjet ideal
  • Decreased gingival display of upper laterals
  • Mentalis strain eliminated
  • Lower lip to E plane improved
  • Total of 3 upper wires and 2 lower wires
  • 20 months total treatment time
For a more in-depth look at the Roncone PhysioDynamic System (PDS), see Dr. Ron Roncone’s article in Orthodontic Practice UShttps://orthopracticeus.com/a-40-year-odyssey-in-an-orthodontic-practice/

Aron Dellinger, DDS, MSD, graduated from Indiana University School of Dentistry and Saint Louis University orthodontics. He returned to Northern Indiana to practice with his dad, Gene, brother, Eric, and uncle, Jack Hamilton. Dr. Dellinger has now practiced there for 20 years. He was approached early in his career to serve as Indiana director to the Great Lakes Association of Orthodontists (GLAO) in which he has served as president. He has also served on the AAO House of Delegates and as the president of the Indiana Association of Orthodontists (IAO). During his time as IAO president, the AAO started the Donated Orthodontic Services (DOS) program. Dr. Dellinger has been on the DOS board from its inception and helped start the DOS program in Indiana as one of the first five pilot states. Dr. Dellinger is ABO-certified and volunteers for the ABO. He is also an Angle Midwest Affiliate. Drs. Gene and Aron Dellinger worked together to invent and develop a new orthodontic tooth retention appliance; together, they hold several patents and a trademark for the MagneTainer appliance.

 

Disclosure: Dr. Dellinger is the founder of MagneTainer which Forestadent has the exclusive rights to sell and manufacture.

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