Combining different treatment philosophies and techniques to reach the desired treatment goal using butterfly system: Customizing orthodontic treatment

Dhavalranjitbhai Lekhadia,Gautham Hegde

doi:10.4103/ijor.ijor_14_17

Abstract

This case report describes the orthodontic treatment of an 18-year-old male patient who presented with straight profile, tongue thrust habit, proclined upper incisors, generalized spacing in the upper and lower arches, Katz Class II premolar relation unilaterally, and Class II canine relation unilaterally with increased overjet and overbite. A butterfly system was used for the treatment combined with frictionless biomechanics in the initial stage of the treatment followed by continuous arch mechanics in the later part of the treatment. A tongued crib was used to stop the tongue thrust habit along with one elastic swallow exercise. Micro-implant anchorage was used unilaterally in the upper arch for retraction of the entire segment and correction of the unilateral Class II canine and premolar relationship. To avoid a dished-in profile, a nonextraction treatment was executed. Final correction of distally tipped canines was achieved using conventional Begg's uprighting auxiliaries in the vertical slots of the butterfly system in the finishing stage. The case was finished using bite-settling elastics. The total treatment time was 1 year and 2 months. Esthetic and functional goals were achieved satisfactorily with proper selection of biomechanics.

Highlights

A butterfly system was used in the treatment combined with frictionless biomechanics in the initial stage of treatment followed by continuous arch mechanics in the later part of treatment
Orthodontic practitioners and beginners in orthodontics often have many questions in mind: which philosophy to use? What bracket prescription is appropriate for a particular case? When to use a straight archwire and segmented mechanics? Is it appropriate to combine the various treatment philosophies and techniques to reach the final treatment outcome? Making an accurate diagnosis of the changes observed in patients is of utmost importance.It is essential that an effective treatment plan is executed in order to treat the malocclusion within a shorter period of time, with as little injuries to protective and supporting tissues as possible
Andrews made extensive measurements on untreated excellent occlusions (McLaughlin RP et al.2001).Molar anchorage loss has been shown to occur during the early stages of alignment with preadjusted appliances (Rajesh M et al 2014, Su H et al 2014).Low friction is most advantageous during initial alignment, whereas friction is needed for control in finishing and torque expression

Summary

Introduction

Orthodontic practitioners and beginners in orthodontics often have many questions in mind: which philosophy to use? What bracket prescription is appropriate for a particular case? When to use a straight archwire and segmented mechanics? Is it appropriate to combine the various treatment philosophies and techniques to reach the final treatment outcome? Making an accurate diagnosis of the changes observed in patients is of utmost importance.It is essential that an effective treatment plan is executed in order to treat the malocclusion within a shorter period of time, with as little injuries to protective and supporting tissues as possible. At the end of space closure, conventional Begg’s uprighting springs were used on upper and lower canines to achieve final correction of the canine tip (Fig. 27-29). This assisted us in achieving a Katz class I premolar and a Class I canine relation without disturbing the molars. An open bite was observed at the end of space closure which was because of the tongue thrust habit This was corrected using box elastics in the anteriors (Fig. 26) and tongue crib. Finishing was done using triangular elastics with hooks in vertical slots on a light 0.016” NiTi wires in upper and lower arches

Discussion

Conclusion