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 248Vol. 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 with250 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