Diagnosis: Dental Disorder.
Treatment: Braces.

The insurer denied the Braces. The determination is upheld.

The patient has a Class II occlusion and moderate overbite and overjet. The maxillary and mandibular arches are crowded. According to the treatment notes the second molars are blocked out. He is treatment planned for 24-30 months of orthodontics with extraction of four premolars to correct his malocclusion. At issue is whether braces are medically necessary.

There is no medical reason to correct his malocclusion with braces. The patient does have a deep bite; however, that alone is not a medical necessity to treat. There are functional problems that may occur in the dentition that become more difficult, if not impossible, to correct if not addressed in adolescence. (1) This patient presents with none of those conditions. The photographs do not illustrate any damage to the teeth or soft tissue damage from their current position. The patient has a 4 millimeter (mm) overjet, but excessive overjet does not affect oral health related quality of life unless it is greater than 6 mm. (2) If the teeth were aligned, it would provide a minor esthetic improvement but it would not create a medically significant improvement to the patient's health. For these reasons, the treatment is not medically necessary.