Dental Problems
Dental/Orthodontic Procedure

The patient is a female with a Class I occlusion and slightly high overjet and overbite. The maxillary and mandibular arches have some crowding. She is treatment planned for 24-30 months of orthodontics to correct her malocclusion. The provider notes that the patient has a traumatic deep bite with severe soft tissue damage. Full braces are being requested and is the subject of this review.

The health plan's determination is upheld. Braces are not medically necessary. There is no medical reason to correct her malocclusion with braces. The patient does have a deep bite, however, that alone is not a medical necessity to treat. The photographs do not illustrate any damage to the teeth or soft tissue damage from their current position. There are many ways to correct patients with a deep bite, and there is strong evidence that one treatment is not better than another. Furthermore, deep bites may be corrected in adulthood, so it is not as if she will lose the ability to correct her malocclusion should she choose to do so as an adult.