Diagnosis: Class I skeletal malocclusion
Treatment: Braces and Monthly Visits
The insurer denied: Braces and Monthly Visits
The denial is overturned.

The patient is a teenage female requesting orthodontic benefits with monthly visits. The patient has a Class I skeletal malocclusion with Class II canines. There is moderate upper and lower jaw crowding with severe overjet. The prior denial was due to a handicapping index score of 13.

The requested health service is medically necessary.

This patient has a severe overjet where her upper front teeth are way out in front of her lower front teeth. This will make the upper front teeth more prone to trauma such as fracturing. The patient also has an open bite where her upper front teeth do not cover her lower front teeth. This will make masticating (chewing) her food more difficult. Since she does not have her front teeth
touch during the chewing cycle, there can be no "anterior guidance." This is when the lower teeth glide along the backs of the upper front teeth and allow the posterior teeth to disarticulate (open). This will cause trauma such as chipping and/or fracturing of her back teeth over time. Orthodontic treatment is needed to correct these issues, and the monthly visits are to make sure treatment progresses properly. Therefore, the requested health service is medically necessary.