Diagnosis: Dental Disorder.
Treatment: Braces.
The insurer denied the braces.
The determination is upheld.

The patient has a Class I occlusion with deep overbite and appropriate overjet. He has minor maxillary and mandibular spacing. He is treatment planned for 36 months of orthodontics to correct his malocclusion. At issue is the medical necessity of braces.

There is no medical reason to correct the malocclusion with braces. While the patient has spacing, 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. (1) However, 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 a Class I occlusion. (2) If his teeth were aligned it would provide a minor esthetic improvement but it would not create a medically significant improvement to the patient's health.
For these reasons, the requested treatment is not medically necessary.