Dental Problems
Dental/Orthodontic Procedure

Diagnosis: Class I occlusion
treatment: braces
The insurer denied braces. The health plan's determination is upheld.

The patient in question is a male with a Class I occlusion with 3 millimeter (mm) overbite and 2mm overjet. He has minor maxillary and mandibular crowing. He is treatment planned for braces to correct his malocclusion.

There is no medical reason to correct his malocclusion with braces. While the patient is crowding, there is no anterior or posterior crossbite. There is no evidence of wear or periodontal recession. There are functional problems that may occur in the dentition that become more difficult, if not impossible, to correct if not addressed in adolescence. This patient presents with none of those conditions. Aligning his teeth will likely not increase chewing efficiency since masticatory efficiency is already highest in patients with skeletal Class I occlusion. If his teeth were aligned it would provide an esthetic improvement but it would not create a medically significant improvement to the patient's health. Braces are not medically necessary.