The patient in question with a Class I occlusion. The patient has space in the maxillary arch, excessive overjet, and a deep bite causing soft tissue damage on her palate. Tooth #25 appears to have some recession. The patient has treatment planned for 18-24 months of orthodontics to correct the malocclusion.Overturn in whole the health plan's determination of medical necessity.

Yes, the requested treatment of braces is medically necessary for this patient. A deep bite on its own is not a reason to treat with orthodontics. However, the patient is already damaging the soft tissue of the palate. The patient is also developing recession on #25. This will worsen with time if left untreated and can lead to periodontal problems in the future (3) that will be more invasive to correct than the orthodontic problem the patient currently has.

The patient's orthodontist has documented that the patient is damaging the soft tissue of the palate due to the deep overbite, and the cephalometric radiograph confirms a palatally-impinging overbite. Palatal tissue damage is a known side effect of deep bite malocclusions. (1) Additionally, the patient's protrusive incisors are at an increased risk of trauma (2)