Patient presented as a 20-year-old female with a severe anterior tongue thrust. Her chief complaints included the aesthetics of her smile and her inability to bite on the front teeth. Complete records were made at her initial appointment.
The Bimler cephalometric analysis revealed a skeletal Class I mandible auto rotated into a Class II relationship. Both TMJs demonstrated anterior displaced disks that were diagnosed as Self Reducing Type II.
The initial maxillary appliance was a RN-Sagittal modified with occlusal coverage of acrylic, tongue guards, and tongue spinner. The patient was instructed to wear the appliance full time except for hygiene. Myofunctional therapy was also used to teach the patient to swallow with the Trigeminal nerve and the muscles of mastication.
An upper.020 x .020 segmented thermal Niti arch was placed cuspid to cuspid to align the anterior teeth as the maxilla was being modeled with the RN-Sagittal appliance.
The initial mandibular appliance was an ALF in conjunction with Delta Force. These were used to model the lower alveolar process and level, align, and torque the teeth.
The upper RN-Sagittal appliance was followed with an ALF appliance in conjunction with full delta Force. Vertical elastics were worn in a triangle at the cuspids to rotate the mandibular condyles back into their correct position on the disks.
Retraction elastics were used to reduce the upper and lower protrusion created by the anterior tongue thrust.
The case was retained with a bonded lower 3×3 retainer and upper and lower functional retainers. The active treatment time was 30 months.
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