Chris' Top 11 Cases: Skeletal Class III Crowded Malocclusion Treated with the Insignia
Skeletal Class III Crowded Malocclusion Treated with the Insignia® Custom Bracket System
Abstract
Chief Complaint (CC): A 18-year-old female presented with a CC of poor personal confidence due to an unesthetic smile.
Diagnosis and Etiology: Facial form was concave (G-SN-Pg’ -3º) with decreased, but acceptable lip protrusion (E-Line -2/-1mm). An intermaxillary discrepancy of ANB -2º was the sum of slight maxillary deficiency (SNA 81º) and modest mandibular protrusion (SNB 83º). The maxillary arch was asymmetric: (1). Class I on the right, (2). 4mm Class III on the left, (3). 3mm anterior crossbite, and (4). 2mm upper midline deviation to the right. Both arches were functionally underdeveloped which was manifest as severe dental crowding of -10mm/-6mm in the upper and lower arches, respectively. The intermaxillary arch length deficiency resulted in mesial-out rotation of the lower canines, and the upper canines were blocked out to the labial.
Treatment: The Insignia® system was utilized to digitally plan an ideal intermaxillary alignment, following extraction of all four 1st premolars, that was based on the 3D image of each tooth. The digital set-up was then reverse engineered to construct a full fixed, self-ligating appliance with a custom bracket for each tooth, that produced ideal alignment once the full size archwires were placed. Each tooth was bonded with a custom jig designed for ideal positioning of the bracket on each tooth. This digital method is designed to eliminate repositioning of brackets and archwire adjustments. Comprehensive treatment with progressive stock and custom archwires was accomplished with 10 appointments in 15 months. One finishing bend was required during the detailing phase because of a preventable error during the pre-treatment digital set-up.
Outcomes: The excellent alignment, comfortable occlusion, and pleasing smile substantially increased the patient’s poise and personal confidence. This skeletal Class III malocclusion, with a Discrepancy Index (DI) of 28, was treated in 15 months to a Cast-Radiograph Evaluation (CRE) of 16 and a Pink & White Esthetic Score of 1.
Conclusions: Insignia® is a precise method for a direct path to outstanding clinical outcomes with minimal chair time, adjustments and treatment duration. The rate of tooth movement is enhanced, and the incidence of root resorption is reduced, by controlling PDL stress and repetitive episodes of necrosis via progressive relatively flexible archwires, that require few if any detailing adjustments. (Int J Orthod Implantol 2017;47:52-69)
Key words:
Insignia® system, digital bracket positioning, passive self-ligating bracket, archwire sequence, custom bracket, custom torque, low periodontal ligament (PDL) stress, necrosis, ectopic eruption, Class III malocclusion, crowding, occlusal bite turbo, dental esthetics
11 сен 2024
