Diagnosis: Moderate crowding
treatment: Braces/monthly visits
The insurer denied braces/monthly visits.
The health plan's determination is overturned.

The patient in question is a female with moderate crowding. She presents with a skeletal Class I malocclusion. Tooth #10 is in anterior crossbite with #22 and is pushing tooth 22 to the labial. Additionally, tooth #5 is in buccal (reverse) cross bite with its antagonists. She is treatment planned for braces/monthly visits.

Braces and Monthly Visits are medically necessary for this patient.

This patient presents with an anterior crossbite on tooth 10, as well as crowding. Side effects of an untreated anterior crossbite include abnormal wear to the affected teeth and labial displacement of the mandibular incisors that can lead to periodontal defects.
Because tooth 5 is in buccal crossbite, it has no antagonist. As a result, it is extremely likely that this tooth will over erupt. Once this overeruption occurs, it is very difficult to treat.4 Buccal crossbite (also known as scissor-bite in the literature) can also negatively affect mandibular growth and should be treated as early as possible to eliminate the potential growth disturbance.

If left untreated the damage that will likely occur to the patient's teeth will be much more time consuming and costly to correct than the patient's existing orthodontic problem. If left untreated tooth 10 will keep pushing tooth 22 to the labial so that tooth 22 will develop periodontal recession. Teeth 4, 28 and 29 will also likely be compromised periodontally due to the buccal crossbite. The requested Orthodontic treatment is deemed medically necessary.