Diagnosis: Dental Disorder
Treatment: Braces and monthly visits x 12.
The insurer denied Braces and monthly visits x 12.
The determination is overturned.

The patient has an impacted tooth number (#) 11. This tooth is impacted in a mesioangular inclination and it is in close proximity to the root of tooth 10.
He presented with a skeletal Class III malocclusion and crowding. He is treatment planned for orthodontic treatment to address the malocclusion and impacted tooth. At issue is the medical necessity of braces and monthly visits.

The requested treatment is medically necessary. If left untreated the damage that will likely occur to the patient's teeth will be more time consuming to correct than the patient's existing orthodontic problem. Studies show that impacted canines with a mesioangular inclination have a less than 15% chance of spontaneous eruption. (2) Complications of impacted canines include potential root resorption and devitalization of the adjacent lateral incisors. (3) Given the position of teeth #10 and #11, tooth #10 would expect to be damaged if tooth #11 is not addressed.
For this reason, the requested treatment is deemed medically necessary.