the tweed profile - The Charles H. Tweed International Foundation

CLASS II DIVISION 1 HYPER-DIVERGENT MALOCCLUSION CORRECTION
DENNIS WARD
AVON LAKE, OHIO
At the time of examination Claire was a fourteen year
old Caucasian female. She presented with a Class II
division 1 malocclusion. Diagnostic records consisted
of cephalometric and panoramic radiographs, study
models, and facial and intra oral photos.
The hallmark of the Tweed-Merrifield Directional
Force technique is its organized and meticulous diagnostic
regimen. The face, skeletal pattern and dentition
are analyzed individually and then collectively to
assimilate a treatment plan.
In the mid 1970s Dr. Ed Noffel coined the phrase
"Faces First.” The effect orthodontics can have on
the subsequent appearance of the human face is of
primary focus and importance. From the lateral aspect
Claire presents with her facial thirds in balance, an
obtuse nasolabial angle, a bulbous lower lip, relative
retrognathia and a shallow Z angle (Figure 1). The
frontal aspect displays an asymmetric relationship, a
bulbous orbicularis oris, a hypertonic mentalis and a
lack of proportion between her upper and lower lips
(Figure 2). The degree of irregularity, lack of harmony
and imbalance are evident when viewing her smile
photograph (Figure 3).
Figure 1 Figure 2
Figure 3
The second section of the diagnostic process is an
evaluation of the skeletal pattern. When Claire's
cephalometric radiograph is examined, the excessive
overjet, steep mandibular plane, deep curve of Spee
and retrusive mandible are easily discernible (Figure
4). The cephalometric measurements and tracing can
be seen in figure 5. The very short ramal height and
55
Figure 4