Diagnosis: Class I crowding
Treatment: Braces/monthly visits

The insurer denied braces/monthly visits.
The health plan's determination is overturned.

The patient in question is a male with a diagnosis of Class I crowding. His bite is deep. He has multiple impacted supernumerary teeth: one in the region of teeth 21/22, one in the region of teeth 27/28, and another likely one in the region of teeth 6/7.

Braces and Monthly Visits are medically necessary. Once the impacted teeth are dealt with, the patient is still left with a deep overbite where the lower incisors are contacting the palate of the upper incisors in occlusion. This is a traumatic occlusion. Not only does it have a positive correlation with periodontal disease, but studies also indicate an increased appearance of periodontal radiolucencies on the maxillary incisors. It is believed these periodontal lesions are related to gingival surface injury and food impaction due to the deep bite. Therefore, correcting the patient's malocclusion with orthodontic treatment will create a clinically significant improvement in the patient's periodontal health. Braces/monthly visits are medically necessary.