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Kimberly Clarissa Oetomo
Kimberly Clarissa Oetomo
Main Instructor Ida Bagus Narmada
Department / Institution Orthodontic Department, Dentistry Faculty, Airlangga University, Surabaya, Indonesia
Classification Case report
Introduction: A 46-year-old female came to our clinic with a chief complaint of irregular teeth and severe midline shift. She already had orthodontic treatment when she was 15. Two bicuspids extraction were done on the upper and lower left.
Diagnosis: Intraoral examination revealed bilateral Angle Class II molar and canine relationships with midline shift to the left in the upper (3 mm) and lower (4 mm), missing 24 and 34 because of extraction in previous treatment, and severe crowding in the anterior. Extraoral findings included a convex profile. Cephalometric analysis showed retrusive maxilla and mandible with skeletal class II.
Treatment overview: Non-extraction treatment and 0.022” slot Damon Q bracket system (Ormco) with low torque brackets were bonded on both arches. Interproximal reduction was performed to correct the midline shift and relieve the crowding on both arches. Up and down elastics were prescribed before debonding to detail the occlusion. Fixed retainer for the lower and clear retainer for both arches were planned to retain the correct dentition. After 15 months of active treatment, an ideal arch coordination and midline shift correction were achieved and the patient was satisfied with the treatment outcome.
Conclusion: Severe midline shift and crowding correction can be done with interproximal reduction without any extraction. Passive self-ligating brackets were chosen because of its ability to expand the arch without RPE and low friction.  

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