Diagnosis: Dental Problems
Treatment: Dental/Orthodontic Procedure
The health plan denied the treatment of braces as not medically necessary.
The reviewer has overturned in whole the health plan's determination.

The patient in question is presenting with a skeletal Class I malocclusion with maxillary and mandibular crowding. She is missing teeth 4, 13, and 21. She has a 4 millimeter (mm) anterior open bite. She is treatment planned for 24-30 months of orthodontics including extraction of A, J, K, T, and 29 to address the open bite, but the treatment was denied due to lack of medical necessity. The family has appealed this ruling.

Orthodontic treatment is medically necessary for this patient.
Anterior open bite patients are among the most difficult patients to treat.[1] One side effect of anterior open bite is reduced maximum bite force with less muscle activity while chewing than patients without an open bite.[2] Additionally, orthodontic treatment is medically necessary for this patient due to the fact that this is not something that will self-correct without orthodontic intervention.