the tweed profile - The Charles H. Tweed International Foundation

The panoramic X-ray (Fig 3) shows no pathology. The third
molars are present. The pretreatment cephalometric tracing
(Fig 4) shows an ANB of 8°and an AO-BO of 4mm—a reflection
of the class II problem. The FMA is a normal 27°,
but an IMPA of 117°and FMIA 36° indicate severe dental
protrusion. The 49°Z angle also reflects the facial protrusion.
Total space analysis was 44.8mm. The total difficulty was
136.8.
Fig 5
Fig 3
Fig 6
Fig 4
To correct the open bite and the protrusion, four first premolars
were extracted. Even after first premolars were removed,
a space deficit existed due to the class II correction
requirement. Therefore, it was necessary to study the posterior
denture area. The mandibular third molars were extracted
so that maximum anchorage could be prepared during
treatment. After maxillary space closure and mandibular
anchorage preparation the malocclusion was re-evaluated.
For patients with an end on or a full step class II relationship
of the buccal segment, a new system of forces must be used
to complete denture correction. It is necessary to make a final
diagnostic decision for class II correction based on 1) the
ANB relationship, 2) a maxillary posterior space analysis,
and 3) patient cooperation. The maxillary second molars
were extracted for this patient to provide space for maxillary
posterior distal tooth movement. The total active treatment
time was 39 months.
The posttreatment facial photographs (Fig 5) show a dramatic
facial change and a favorable smile line.
The posttreatment intraoral photographs (Fig 6) show the
class I interdigitation of the buccal segments and the openbite
correction.
Fig 8
Fig 7
The posttreatment cephalometric tracing (Fig 7) confirms
that the mandibular incisors were uplighted since the FMIA
increased from 36.0° to 56.0°. The Z angle improved from
49.0° to 64.0°.
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