Diagnosis: Dental Problems
Treatment: Dental/Orthodontic Procedure

The patient in question is a male. He has a Class II malocclusion with severely crowded arches. Tooth 10 is in anterior crossbite. He is treatment planned for 24-30 months of orthodontics with extraction of teeth 5, 12, 21, and 29 to correct the crowding and crossbite. The medical necessity of braces is under review.

The health plan's determination is overturned. Braces are medically necessary. Tooth 22 is already developing recession, and if his bite is not corrected with orthodontics the recession will get worse. Additionally, tooth 22 is being pushed labially in the dental arch and is developing recession. Side effects of an untreated anterior crossbite include abnormal wear to the affected teeth and labial displacement of the mandibular incisors that can lead to periodontal defects. These problems are much more time consuming and difficulty to correct than the patient's current orthodontic problem.