Case of the Month, September 2012

This month's case will illustrate an impressive improvement of a patient's overbite due to the lower jaw being positioned too far back or posterior to the upper jaw.  This is a common problem that orthodontists have to correct and not only does it result in a more functional bite, it can greatly improve lip and facial balance.  There are many methods of correction of these types of bites and this case will demonstrate a non-surgical correction that avoids the use of headgear.

The patient was 12 years old at the start of treatment and the initial photos below illustrate the large overbite (vertical), overjet (front-back discrepancy of the front teeth) and class II occlusion (lower back teeth a full tooth behind where they should be versus the upper teeth).

The cephalometric radiograph shows the poor soft tissue profile and proclined incisor positions.

The method of bite correction used in this case was an appliance called Forsus Springs.  Once the teeth were well aligned and leveled (about 6 months), the Forsus springs were placed and worn for 6 months.  This is a great appliance when methods such as rubber band wear alone would not be expected to achieve desired treatment results and the patient does not desire to wear headgear or other less patient friendly appliances.  Patients actually do quite well with the springs, as they are flexible and allow a wide range of jaw movements, making eating almost normal.  They are also not too large and sit on the sides of the mouth and thus are not highly noticeable.  The force the springs apply is also at at low, constant level, so the discomfort is not a bad as one might think. 



Illustration of the Forsus Springs appliance.  We placed springs on both sides, but they can also be very effective placed on one side when the bite is asymmetrical and off on one side only.  The springs are not removable (probably another reason for their high effectiveness).

The results of our treatment are shown below.  The bite was fully corrected to an ideal overbite and overjet and a marked improvement in lip and facial balance can be seen on the lateral radiograph (actual facial photos of the patient are not shown for patient privacy).  The total treatment time was right at 2 years with a few months added on because we had to wait on a few teeth to finish erupting near the beginning of treatment.  Our young patient did a wonderful job and all in all we are very proud of the finished product.