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Case Studies www.thebrace.com The Brace Orthodontic Practice would like to present to you a series of case studies. This booklet is divided into NHS and Privately treated patients and includes information on the Index of Orthodontic Treatment Need (IOTN) to help you determine when to refer patients for NHS treatment. 2 NHS patients NHS treatments are available to children who are assessed and start treatment before their 18th birthday and meet IOTN criteria. Aesthetic Component The IOTN comprises 2 components; Aesthetic Component and Dental Health Component. The Aesthetic component (AC) consists of 10 photographs showing different levels of dental attractiveness on a scale of 1-10; 1 being the most attractive and 10 the least attractive. NHS treatment is only available to those children judged to be 6 and above on the scale. Dental Health Component The Dental Health Component (DHC) categorises the detrimental effects of abnormal occlusal traits and categorises the severity of malocclusion into 5 grades; 1 being very mild malocclusions and 5 being very severe malocclusions. As an example, an increased overjet over 9mm, missing or impacted teeth would all classify as IOTN 5. IOTN 1 would be a very mild deviation from normal. 3 Before After Mr C 4 Patient information: 12 year old Male Diagnosis: Class I malocclusion with severe upper arch and mild lower arch crowding. Anterior crossbites without displacements were present. IOTN: 4 Treatment plan: Extraction of all first premolars and upper and lower fixed appliances. Treatment time: 19 months Before After Mr H Patient information: 12 year old Male Diagnosis: Class 2 division 1 malocclusion with an increased overjet of 10mm, crowding in both arches and a congenitally absent upper right second premolar. IOTN: 5 Treatment plan: Twin block functional braces followed by extraction of all UL5, URE, LL5 and LR5 and upper and lower fixed appliances. Treatment time: 34 months - this treatment time is reflective of the severity of this case as 2 appliances were required in addition to extractions. 5 Before After Mr A 6 Patient information: 12 year old Male Diagnosis: Class I malocclusion with severe crowding of both arches and poor prognosis of LR6. IOTN: 4 Treatment plan: Extraction of all LR6, LL4, UL4 and UR4 and upper and lower fixed appliances. Treatment time: 15 months Before After Mr R Patient information: 17 year old Male Diagnosis: Class 3 malocclusion with severe crowding of the upper arch and mild crowding of the lower arch. Anterior and posterior crossbites were present. IOTN: 4 Treatment plan: Extraction of all first premolars and upper and lower fixed appliances. Treatment time: 19 months 7 Private patients There are no restrictions on private treatment, it is available to all. Typically our private patients are people over the age of 18 and children who do not meet IOTN requirements for NHS treatment. We offer some discounts for private treatments delivered to those under the age of 18, more information can be found on our website www.thebrace.com. 8 Before After Miss P Patient information: 29 year old Female Diagnosis: Class I malocclusion with crowding of both arches and anterior and posterior crossbites with displacement. Appliance type: Ceramic (tooth coloured) upper and lower fixed braces Treatment plan: Create space using expansion and interproximal enamel reduction (IPR). Treatment time: 20 months 9 Before After Miss G 10 Patient information: 26 year old Female Diagnosis: Class I malocclusion with mild crowding of both arches and posterior crossbite without displacement. Appliance type: Invisalign Treatment plan: Create space using expansion and interproximal enamel reduction (IPR). Treatment time: 13 months Before After Mr L Patient information: 34 year old Male Diagnosis: Class II division 1 malocclusion with spaced arches and large midline diastema. Appliance type: Invisalign Treatment plan: Close space using and reduce overjet with interproximal enamel reduction (IPR) as required. Photos are presented at invisalign refinement stage so this case is not quite finished and we are now in the process of fully closing the last millimetre of midline diastema. Treatment time: 12 months 11 Before After Miss D Patient information: 25 year old Female 12 Diagnosis: Class II division 1 malocclusion with 8mm overjet and mild crowding complicated by previous orthodontic treatment involving extraction of premolars and veneers to the upper front teeth. Appliance type: Lingual (Incognito) and miniscrew implants Treatment plan: Extract upper third molars and use miniscrew implants to distalise the upper arch to create space to reduce the overjet. The photos demonstrate how temporary implants were placed into the alveolar bone and used as anchors to allow the upper back teeth to be pushed back against the bone thereby preventing the upper front teeth from coming forward and increasing the overjet. Treatment time: 30 months 13 Before After Mr A Patient information: 24 year old Male Diagnosis: Class 1 malocclusion with spaced arches and retained ULC and palatally placed UL3. Appliance type: Invisalign combined with ceramic fixed braces Treatment plan: Extract ULC and moved UL3 into position with a localised upper fixed appliance and complete treatment with invisalign and IPR as required. Treatment time: 14 26 months Before After 15 The Brace, 15 Artillery Passage, London E1 7LJ Tel: 020 7247 5768 Email: [email protected] www.thebrace.com