Diagnosis: Dental Disorder
Treatment: Braces
The insurer denied Braces.
The determination is overturned.

This is a female patient with a Class II(two) Division 1 malocclusion with maxillary and mandibular crowding. She has an 8-millimeter (mm) overjet and 3 mm overbite. She is treatment planned for 24-30 months of orthodontics with extraction of teeth 5 and 12 to correct her malocclusion. At issue is the medical necessity of braces.

This patient, like fifteen percent of the population, exhibits an Angle's Class II bite. (1) Patients with a Class II malocclusion exhibit prominent maxillary teeth and a retrusive mandible. There is strong medical evidence that that early correction of patients with prominent maxillary front teeth can reduce the risk of incisal trauma. (2) Evidence shows early treatment will reduce the chances of damage to the maxillary incisors and the associated costs and morbidity of repairing these teeth. Furthermore, there is scientific evidence that oral health quality of life is reduced in patients with 6 plus (+) mm overjet, which this patient has. (3) For these reasons orthodontic treatment is deemed medically necessary.