Class I malocclusion involving
extraction of second bicuspids
Joun S. Ratupone, D.DS.,
Santa Barbara, California
Since the advent of extraction in
Orthodontic procedure, there has arisen
the term “borderline cases”. These so
called borderline cases have created a
great deal of discussion as whether to
extract or not to extract. For this
reason, they often become our problem
cases. It is weil to remember that the
question of diagnosis in these cases be-
comes more important and that the
end result of our treatment should more
than justify our treatment procedure.
This case report is of that type. It is
not presented as showing the treatment
of a severe malocclusion, but instead,
as a “borderline case” where the de-
cision of whether to extract or not was
‘of utmost importance. This case report
is a Class I malocclusion which involved
the extraction of second bicuspids.
R. T., White male, Age 9 years, 10
months, first examined January 31,
1948,
Dracnosis:
Class I malocclusion with a mild
maxillary protrusion and a very deep
overbite. Mixed dentition with all sec-
ond deciduous molars, the upper de-
ciduous first molars, and the upper
right deciduous cuspid present. The
mandibular arch presented an exagger-
ated curve of spee, square arch form,
slight buckling in the cuspid area with
the lower anteriors in good position to
the base bone but fan shaped in ap-
pearance. The maxillary arch presented
no curve of spee, tapering arch form,
and good alignment with a mild pro-
trusion. Some soreness in the palate
area lingually to the upper anteriors
was present because of the deep over-
bite.
The mandibular angle was approxi-
mately 30 degrees; face pattern was
long and tapering, with sufficient verti-
cal height even though the malocclusion
presented a deep overbite. Profile pre-
sented a silght fullness in the lip area,
but not objectionable in this boy's long
tapering face.
History anp GENERAL CLINIC
Picture:
This boy was mentally alert with ex-
cellent posture and excellent physical
condition, He had had the usual child-
hood diseases of measles and chicken
pox. Tissue tone was good, with hygiene
and general dental condition excellent.
The family background was excellent,
with no history of any previous ortho-
dontic correction in the family.
Etro.ocy:
I was unable to trace any one factor
as the cause of this malocclusion, and
therefore feel that the etiology is un-
known. The most prominent factor
which could be mentioned, would be
hereditary in view of the mother’s Class
II malocclusion, and the verbal word
that the father had excellent teeth.
GeneRat PLAN; OnjEctives oF
TREATMENT:
1. to correct the deep overbite
2. to reduce the mild maxillary pro-
trusion
248Vol. 22, No. 4
Fig. 1.
. to re-establish the curve of spee
. to correct localized dental anom-
alies
5, to re-establish the integrity of both
dental arches
6. to maintain facial balance.
re)
‘TReatMENT PLAN:
Because of the mixed dentition, I
felt it unwise to place a full hook-up of
any appliance at this time, so divided
my treatment plan into two stages:
First, the use of the Hawley retainer
with a bite plane until all the perma-
Class I Malocclusion
249
Original models previous to any treatment.
ment teeth erupted. The bite plate was
placed March 12, 1948, and worn with
corrections and additions to the bite
plate until April 1, 1949, or approxi-
mately one year. The purpose of the
bite plate was to relieve the palate of
any irritation from the lower anteriors
until a better occlusion plane could be
established. Second, this phase of
treatment followed after the eruption
of all remaining permanent teeth, which
was in April of 1949. A full edgewise
appliance was placed in April 1949, and
leveling arches tied in, beginning with250
Fig. 2.
previous to any band placement.
018 round steel arches. This was in-
creased to .020 round steel arches and
approximately six weeks after hook-up,
rectangular steel arches of .021 x .025
were adapted and seated in the brack-
ets. At this time, it was noted that
there was still insufficient space for the
lower right second bicuspids, and that
due to the placement of a full hook-up
and leveling off of the arches, a con-
siderable change had occurred in
facial balance. This resulted in the in-
ability of the patient to close his lips
J. S. Rathbone
October, 1952
Models following the bite plane after all permanent teeth have erupted and
in a relaxed position, and gave him a
much fuller profile.
Therefore, I felt I had the choice of
instituting Class III mechanics sup-
plemented by a headgear or the extrac-
tion of four bicuspids. My decision was
to extract four second bicuspids not
originally planned in my treatment.
This decision was based on first; loss
of facial balance, second; the partially
blocked out right second bicuspid, and
originally the partially blocked cuspid,
third; the belief that in borderline cases