Unilateral Class II treatment with Damon Ultima™ System

CASE REPORT

Unilateral Class II treatment with Damon Ultima™ System using procline and retrocline variable torque prescription

This case report shows the successful use of torque teaming with Damon Ultima brackets in a class II patient.

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Dr. Markel Telletxea Iraola*, Spain

Meet Dr. Markel Telletxea Iraola*, a skilled orthodontist who graduated as a dentist in 2018 and then subsequently completed a Master’s in Orthodontics and Dentofacial Orthopedics in 2021, both at Alfonso X El Sabio University in Madrid, Spain. In 2021, he became an Associate professor of European Master of Orthodontics at his alma mater and an affiliate of the Spanish Orthodontic Society (SEDO). Since 2022, he has been practising orthodontics at his practice, LIDERA Hortz klinika – estudio dental, by Markel Telletxea in Lesaka, Navarre.

Diagnosis

The 17-year-old female patient, who had previously undergone an orthodontic treatment 4 years ago, came to the dental clinic in May 2022. She was concerned about her upper right lateral incisor tipping, which was worsening over time, making her feel uncomfortable while smiling.

The extraoral examination revealed isometric contraction of the left side muscles, mild canted maxillary occlusal plane, facial and upper midlines centered and hypodivergent facial pattern.

During intraoral examination the patient was found to have:

Unilateral class II molar and canine relationship,
Deviation of the lower midline 2 mm towards the left side,
Dentoalveolar compression of both arches with mild crowding,
Bolton discrepancy with upper maxillary excess,
A deep bite tendency with increased curve of Spee,
The upper right lateral incisor tipped.

Cephalometric analysis confirmed skeletal class I with meso-brachycephalic growth pattern, reducedmandibular plane, normoclined upper incisor and slightly retroclined lower incisor, increased interincisalangle and a correct occlusal plane

Treatment plan

Transversal developing of the arches by uprighting posterior segments
Coordination of the arches
Class II correction mechanics
Flatten Spee curve
Smile arc protection – upper incisors follow lower lip line and transition to posterior occlusion.
Correction of lower midline deviation with the upper and facial midlines (coincident).
Functional and aesthetic improvement, adjust occlusion, finishing and retention.

Start of the treatment – May 2022

Upper arch: bond and fit .014 CuNiTi wire; procline U1s and U3s; neutral UL2 and retrocline UR2
Lower arch: bond and fit .014 CuNiTi wire; retrocline L2-2 and procline L3s; turbos on L6s
No elastics

16 Weeks in treatment (Last 6 weeks on 14X275 CuNiTi wire)

Upper arch: continue 14×275 CuNiTi wire. Wire-tie U3-3 for space consolidation (nowadays Dr. Iraola would place Ultima hooks distal to U3s)
Lower arch: continue 14×275 CuNiTi wire. Space closure to the right side in favor of the lower midline centering and canine class I
Class II elastics UR5-LR7 and UL4 and LL7 – Kangaroo (3/16”, 4.5 oz) full-time wear (24h)

5 Months and 3 weeks into treatment

Pano reposition visit:

While 6 weeks with 18×275 CuNiTi upper and lower archwire, a panoramic reposition visit wasplanned, and LL1 was replaced for second-order correction. The LL8 was extracted at this momentdue to patient´s discomfort as the others were planned to be extracted after bracket debonding.

Upper arch: Fit 18×275 CuNiti; IPR U2-2 due to Bolton discrepancy
Lower arch: Fit 18×275 + Midline lace-back
Class II elastics: UR5-LR7 Kangaroo (3/16” 4.5oz) and UL4-LL7 Impala (3/16” 6oz) full time wear (24h)

8 Months into treatment

Upper arch: Fit 19×275 TMA, wire-tie UR3-UL2 and distal-out bend on UL3
Lower arch: Fit 19×275 SS; power-chain LL3-LL6
(close space distally to LR3 and center lower midline)
Class II elastics UR5-LR7 and UL4-LL7 Impala (3/16” 6oz) night-time wear

Final records – March 2023

Comparison and final conclusions

In view of the clinical and cephalometric data, nowadays, Dr. Iraola would rather use procline bracketsin lower incisions as well as in the UL2 for better vertical control of deep bite.

In spite of the mesial movement of the lower arch for class II correction during the treatment, the lowerincisors did not show any secondary proinclination as it was supposed. Therefore, additional overdrivewire would be also an option for extra torque expression.

March 2023

May 2023

Final records – March 2023

Initial records – May 2022

MKT-23-1442-ENG

* Dr. Markel Telletxea Iraola is a paid consultant for Ormco. The opinions expressed are those of Dr. Markel Telletxea Iraola. Ormco is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment intreating their patients.