Diagnosis: Overjet
Treatment: Braces
The insurer denied the braces.
The denial is overturned.

The patient is a male. The request is for dental benefits for orthodontic treatment (Braces). The patient presents with excessive overjet, greater than 9mm (millimeters) and micrognathia of the mandible.

Yes, the proposed treatment of orthodontic therapy (Braces) is medically necessary.

As evidenced by the patient's study models and x-rays, the Patient has an extremely excessive overjet of greater than 9mm (millimeters). Normal overjet is 1-3mm (millimeters).

Any significant overjet beyond the normal puts the Patient at risk for increased trauma due to the protrusion of these upper front teeth, sleep apnea, speech impediments and possible damage to the soft tissue (gums) from the position of the lower front teeth contacting the upper gums.

Therefore, given the above, the braces are medically necessary.

The severity of the overjet, if left untreated can have a severe long term negative impact on the Patient's ability to have normal chewing and speech function.