PDF: CLASS I MALOCCLUSION with severe double rotrusion treated with first premolars extraction

Angle Class I malocclusion with bimaxillary protrusion is characterized by severe buccal tipping of incisors, which causes upper and lower lip protrusion.

First premolars extraction is recommended to reduce facial convexity as a result of anterior teeth retraction, which keeps canines and first molars in key to occlusion.

In order to yield orthodontic results that are compatible with ideal esthetic and cephalometric outcomes, the space closure phase needs to be carried out with overbite and incisors torque control. 

The majority of cases also requires maximum anchorage of posterior teeth. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as a requirement for the title of certified by the BBO.

This paper reports the case of a 38-year and 6-month-old female patient who sought orthodontic treatment to improve facial esthetics and smile. Her medical history revealed no significant issues, except for allergy to iodine. 

Additionally, her clinical exams revealed that, even though the patient had good oral hygiene habits, she was susceptible to calculus formation - especially between mandibular incisors- and generalized gingival recession that included her upper central incisors.

She had proper functional relationship between the tongue and the perioral muscles, associated with a nasal breathing pattern. Functional analysis of occlusion revealed that lateral guidance was performed by the canines on the right side, and by the first premolars on the left side.