Case ReportEDWARD L. MITCHELL, D.D.S.Indianapolis, IndianaAt the time of examination thisseventeen year old boy possessed goodgeneral and oral health. His maloc-clusion was classified as Class I. Exceptfor the maxillary incisal area, case ex-hibited well-developed upper and lowerarches with normal well-balanced buc-cal occlusion. The upper anterior teethfrom the left cuspid to the right lateralincisor had been deflected to the lingualand were almost entirely hidden by themandibular incisors and cuspids. Therewas more than a millimeter of spacebetween the lower cuspids and firstbicuspids.ETIOLOGYEvidently, prolonged retention of theupper deciduous teeth had forced theupper incisors and left cuspid to eruptto the lingual of the mandibular in-cisors. This, in turn, carried the sixlower anterior teeth labially and cre-ated a space distal to the lower cuspids.The overbite was in reverse. The lowerincisors and left cuspid covered theentire labial surface of the same teethin the maxillary arch.PLAN OF TREATMENTFirst, it was necessary to open thebite before bands could be placed onthe upper incisors, as they were in closecontact to the lingual of the lower in-cisors. Next, the upper incisors andleft cuspid should be moved into properarch alignment, until they are inlabial relation to the lowers. Finally,after accomplishing this and allowingthe teeth to close normally, the spacesbetween the lower cuspids and firstbicuspids should gradually close with-out appliances.APPLIANCE THERAPYThe plan of treatment was carriedout as follows - first, a splint, asshown in Figure 1, was constructedby placing the casts in occlusion on anarticulator which was adjusted to openthe bite in the incisal region aboutseven millimeters. Steel clasps, ,030,were fitted to the lower first molars anda lingual bar fashioned by bending aFig. 1Acrylic splint and original casta with splint in place.41 42MitchellJanuary, 1959 Vol. 29, No. ICase Report43Fig. 3Left, before trea.tment. Right, after t.reatment.Fig. 8after removal OP appliances.Le before treatment. Center, at end of active treatment. Right, twenty months 44 Mitchell January, 1959steel wire .055 in diameter (not touch-ing the lower incisors). The case waswaxed to fit the occlusal fourth of thelower bicuspid and molars and theocclusal of the upper posterior teeth.From this, an acrylic splint was process-ed to be worn constantly until the up-per incisors were in normal occlusal re-lation. An edgewise appliance was plac-ed on the upper arch only from firstmolar to first molar. With the bite open,there was nothing to antagonize thelabial movement of the upper anteriorteeth. As a result, they were moved intoa harmonious arch relation in a fewmonths.When these teeth were far enoughforward to close in normal labial rela-tion to the lower incisors, the splint wasremoved. The labial relation of the up-per incisors to the lowers soon closedthe spaces distal to the lower cuspids.When the upper bands were removed,after ten months of treatment, therewas some spacing of the upper incisorsto conform to the lowers which hadpreviously been carried labially by theupper teeth.No retention was used and aftertwenty months the spaces distal to thelower cuspids had entirely closed.COMMENTDue to the fact that the upper lipcovered the incisal fourth of the lowerincisors, there was little change in thelip position. The case would have beendifficult to treat without the splint;however, with the splint, it proved tobe quite simple with no lower applianceand without retention.701 Hume Mansur Building