Rigid external distraction osteogenesis for a patient with maxillary hypoplasia and oligodontia.

OBJECTIVE: In this report, the orthodontic treatment combined with rigid external distraction osteogenesis in a 5.5-year-old girl with midfacial hypoplasia and oligodontia is described. PATIENT: The child presented with a reduced maxilla, protruding lower lip, skeletal Class III jaw relationship with a low mandibular plane angle, a short and flattened nose, anterior crossbite, and aplasia of 16 permanent teeth. The patient was treated with rigid external maxillary distraction osteogenesis, maxillary protraction headgear, and Class III elastics. Following treatment, the maxilla was displaced in a forward direction with new bone formation at the tuberosities and the mandible rotated backward in relation to the anterior cranial base. The anterior crossbite was corrected, and the skeletal jaw relationship changed from a Class III to a Class I skeletal pattern. The soft tissue facial profile showed that the nasal projection had been increased, the nasolabial angle increased, and the lower lip protrusion was reduced. Postoperative treatment results were acceptable. CONCLUSION: This report documents that early maxillary advancement with rigid external osteogenesis offers a promising treatment alternative for a very young patient with maxillary hypoplasia and oligodontia.     

Evaluation of the modified maxillary protractor applied to Class III malocclusion with retruded maxilla in early mixed dentition.

The purpose of this study was to evaluate the effects of orthodontic treatment with a maxillary protraction bow appliance on anterior crossbite patients with Class III malocclusion in the mixed dentition. The 29 patients treated with a maxillary protraction bow appliance (11 boys, 18 girls) were compared with 25 matched, untreated controls with anterior crossbite (10 boys, 15 girls). The mean age before treatment was 8 years 7 months (range, 6 years 3 months to 11 years 6 months). The mean treatment period to achieve a normal overjet was 10.2 months (range, 5 to 18 months). Fifty-nine cephalometric angular and linear parameters were compared between the treated group and the untreated controls using the analysis of variance and the paired t test to evaluate the effect of gender and the maxillary protraction bow appliance treatment. Skeletal and dentoalveolar advancement of the maxilla and retrusion of the mandible contributed significantly to the improvement of Class III malocclusion in the treated group. These results suggest that a maxillary protraction bow appliance is effective for correcting anterior crossbite with a retruded maxilla in the early mixed dentition.     

Management of the Class III malocclusion treated with maxillary expansion,facemask therapy and corrective orthodontic. A 15-year follow-up

The facial growth of Class III malocclusion worsens with age, in this case, the early orthopedic treatment, providing facial balance, modifying the maxillofacial growth and development. A 7.6-year old boy presented with Class III malocclusion associated with anterior crossbite; the mandible was shifted to the right and the maxilla had a transversal deficiency. Rapid maxillary expansion followed by facemask therapy was performed, to correct the anteroposterior relationship and improve the facial profile. The patient was followed for a 15-year period, after completion of the treatment, and stability was observed. Growing patients should be monitored following their treatment, so as to prevent malocclusion relapse.     

Orthodontic intervention to a patient injured in a traffic accident

This case report describes the orthodontic treatment of a 29-year-old male who lost the maxillary bilateral central incisors as a result of a traffic accident. After emergency treatment for facial fracture by a plastic surgeon, the patient visited our orthodontic clinic. He had a concave profile, Class I molar relationship with slight maxillary retrusion, and crossbite of the maxillary bilateral lateral incisors. The interdental space was insufficient for prosthetic treatment of the missing maxillary incisors. Therefore, we planned to distalize the maxillary and mandibular molars to obtain appropriate interdental space for the prosthetic treatment of the missing teeth and to correct the crowding of the mandibular anterior teeth. The anterior crossbite was corrected, and appropriate overjet and overbite were obtained with functional occlusion after prosthetic treatment. This case report shows that the favorable occlusion and facial profile are obtained by the interdisciplinary treatment and discusses the specific problems which seen after the traffic accident.     

The Function Regulator III: effects and indications for use

Analysis of 20 cases of Class III malocclusion treated with the FR.III showed that correction of the anterior crossbite was effected by adjustment of incisor inclinations and backward rotation or repositioning the mandible accompanied by an increase in face height. Subjects which responded most favourably to the FR.III were those with severe Class III malocclusion and a deep incisor overbite.     

Orthopedic/orthodontic treatment of a Class I malocclusion with a Class III skeletal pattern and maxillary deficiency. An American Board of Orthodontics case report

A case report of a Class I dental malocclusion superimposed on a Class III skeletal pattern with normal mandible and underdeveloped maxilla is presented. The patient was a 15-year-old girl whose statural growth was complete. The maxilla was deficient in anteroposterior and transverse dimensions, causing a slightly concave profile, a crossbite relationship of most of the anterior and posterior teeth, and upper anterior crowding. Sutural expansion and orthopedic advancement of the maxilla was used to reduce the maxillary deficiency. A complete 0.018-inch slot straight-wire appliance was used to align the teeth, close lower spaces, and detail the occlusion.     

Classification of Angle Class III malocclusion and its treatment modalities

To obtain the best results in the treatment of patients with Angle Class III malocclusion, the etiologies of the malocclusion should first be clarified, and then an appropriate treatment modality should be decided. Angle Class III malocclusions in 120 subjects who had orthognathic surgery were analyzed with cephalometrics and facial photos and classified into 3 categories based on the abnormalities of the maxilla. Type A is true mandibular prognathism, which means that the maxilla is normal but the mandible is overgrown. Type B is characteristic of the overgrown maxilla and mandible with anterior crossbite. Type C indicates a hypoplastic maxilla with anterior crossbite. Treatment modalities should be differentially decided according to this new classification of Angle Class III malocclusions.     

Geometric morphometric assessment of treatment effects of maxillary protraction combined with chin cup appliance on the maxillofacial complex

The aim of this study was to investigate the treatment effects on the maxillofacial complex by maxillary protraction combined with chin cup therapy among growing children. An effective geometric morphometric assessment of cephalometric radiographs, using Procrustes analysis and thin-plate spline analysis, was applied to evaluate shape change in the craniofacial and midfacial configurations of a treated sample of 20 children with skeletal Class III malocclusion. This was compared with matched untreated skeletal Class III controls. Marked treatment induced change involved the maxilla and the mandible. Major deformation consisted of forward advancement of the maxillary complex with negligible rotation of the palatal plane and a forward direction of growth of the mandibular condyle associated with a restriction in sagittal advancement of the chin. Considerable dentoalveolar components contributed to the correction of anterior crossbite. Further detailed study of skeletofacial remodelling in response to maxillary protraction in other skeletal components, including the cranial base and the mandibular complex that contribute to Class III skeletal discrepancies, is warranted.     

前方牵引治疗替牙期骨性Ⅲ类错的牙颌结构变化研究

目的:观察前方牵引在替牙期骨性Ⅲ类错牙合的应用及治疗前后的牙颌结构变化。方法:选择替牙期骨性Ⅲ类错牙合患者9名,应用前方牵引矫治前牙反牙合,正畸前后进行头影测量分析。统计学分析采用配对t检验。结果:SNA角增大4.2°,ANB角增加5.4°,NA-PA增加5.0°,A-VL增加6.1mm,SNB角减少1.2°,B-VL减少0.2mm,1-SN增加6.2°。结论:前方牵引可有效促进上颌骨向前生长,抑制下颌骨生长,同时可导致下颌骨向下向后旋转,上前牙唇倾,下切牙轻度舌倾。     

Interdisciplinary treatment of Class III malocclusion: a case report

The case report describes the multidisciplinary treatment of a 25-year-old male patient with a Class III malocclusion. Anterior and bilateral posterior crossbites were present. To correct the posterior crossbite a surgically assisted rapid maxillary expansion was performed. The significant three dimensional skeletal discrepancy was solved in a second phase with a surgical advancement of the maxilla. Functional and aesthetic occlusion in an improved facial profile was achieved with an interdisciplinary treatment that included orthodontic treatment, maxillofacial and periodontal surgery, and direct composite restorations.     

Orthodontic-surgical treatment of Class III malocclusion with mandibular asymmetry

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone discrepancy may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 15 years and 1 month with Class III skeletal malocclusion, having narrow maxilla, posterior open bite on the left side, anterior crossbite and unilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the maxillary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patient's final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.     

Early correction of a developing skeletal Class III malocclusion

This case report describes the treatment of a Japanese girl aged 11 years 10 months who had a severe Class III malocclusion with a concave facial profile. She presented hypodivergent skeletal pattern with a -4.0-mm anterior crossbite and a deep overbite. She also had facial asymmetry attributed partly to the lateral mandibular shift to avoid incisal interferences. The treatment plan included a monoblock appliance, rapid palatal expansion, and fixed edgewise appliances at the final stage. The monoblock appliance was used to redirect the growth of the mandible to a clockwise direction and simultaneously correct the incisal relationships along with fixed edgewise appliances. Good incisal relationships were achieved, and facial esthetics was greatly improved after 28 months of treatment. Stability of the treatment result was excellent in the 3-year 9-month follow-up at the age of 18.     

前方牵引对于乳牙期骨性Ⅲ类错牙颌结构的影响

目的探讨前方牵引在乳牙期的应用以及治疗前后的牙颌结构变化。方法选择乳牙期骨性Ⅲ类错(牙合)患者8名,男5名,女3名,年龄范围4.5-5.5岁,平均年龄5.2岁,患者前牙反(牙合),上颌相对于下颌后缩,乳磨牙末端呈现近中阶梯,不存在明显的功能性下颌移位。应用前方牵引矫治前牙反(牙合),进行正畸前后头影测量分析,统计学分析采用配对t检验。结果对乳牙期骨性Ⅲ类错(牙合)的前方牵引治疗能够促进上颌骨生长、下颌骨轻度向下向后旋转、面形改善。SNA显著增大,平均增大2.0度。ANB角增大3.0度。治疗后上切牙唇倾,下切牙舌倾。结论 初步结果表明前方牵引治疗乳牙期骨性Ⅲ类错(牙合)十分有效,有利于Ⅲ类骨骼畸形的调整。长期疗效还需要进一步观察。     

Treatment response and long-term dentofacial adaptations to maxillary expansion and protraction

The purpose of this article is to summarize the short-term and long-termresults of the authors' clinical prospective study on the treatment of Class III maloclusion using the protraction facemask. An attempt is made to answer questions pertaining to this treatment modality. Twenty patients with skeletal Class III malocclusion were treated consecutively with maxillary expansion and a protraction facemask. A positive overjet was obtained in all cases after 6 to 9 months of treatment. These changes were contributed to by a forward movement of the maxilla, backward and downward rotation of the mandible, proclination of the maxillary incisors, and retroclination of the mandibular incisors. The molar relationship was overcorrected to Class I or Class II dental arch relationship. The overbite was reduced with a significant increase in lower facial height. The treatment was found to be stable 2 years after removal of the appliances. At the end of the 4-year observation period, 15 of the 20 patients maintained a positive overjet or an end-to-end incisal relationship. Patients who reverted back to a negative overjet were found to have excess horizontal mandibular growth that was not compensated by proclination of the maxillary incisors. A review of the literature showed that maxillary expansion in conjunction with protraction produced greater forward movement of the maxilla. Maxillary protraction with a 30° forward and downward force applied at the canine region produced an acceptable clinical response. The reciprocal force from maxillary protraction transmitted to the temporomandibular joint did not increase masticatory muscle pain or activity. Significant soft tissue profile change can be expected with maxillary protraction including straightening of the facial profile and better lip competence and posture. However, one should anticipate individual variations in treatment response and subsequent growth changes. Treatment with the protraction facemask is most effective in Class III patients with a retrusive maxilla and a hypodivergent growth pattern. Treatment initiated at the time of initial eruption of the upper central incisors helps to maintain the anterior occlusion after treatment.     

Maxillary expansion and protraction in correction of midface retrusion in a complete unilateral cleft lip and palate patient

A 7-year-old girl with a cleft lip and palate had a midface retrusion due to growth inhibition of the maxillary complex. She presented for correction of a severe total crossbite with a Class III skeletal pattern. Initially, maxillary expansion was provided to widen the maxilla and then maxillary protraction headgear was worn to improve the sagittal skeletal relation. Fixed orthodontic appliances were placed to align the dentition and Class III elastics were used to establish intercuspation and stability. The maxillary expansion and protraction usually provide effective improvement in skeletal Class III patients with repaired cleft lip and palate patients. The success of the orthopedic procedure essentially depends on the individual growth of the maxilla and the mandible. This case report shows the significant growth of the mandible after maxillary expansion and protraction in late adolescence.     

Prevalence of malocclusions in the 13-20-year-old categories of football athletes

The dentist can offer athletes improvement in their physical performance through the maintenance of oral health, preventing and treating any and all changes in the stomatognathic system, such as dental malocclusions, that compromise the athletes' performance. The objective of this study is to research the presence of dental malocclusions in athletes of the category between 13 and 20 years of age, from the S?o Paulo Football Club. 84 athletes participated in this study, dealing with the following topics: molar relation (Angle's classification); presence of overbite; underbite; overcrowding; abnormal spacing; open bite; and anterior, posterior, bilateral and unilateral crossbite; midline deviation and facial type (mesofacial, brachyfacial and dolichofacial). Only one table was made, showing percentages. In regard to Angle's molar relation, 89% are in Class I, 8% in Class II, 3% Class III, 9% of the athletes had overbite, 4% had underbite, 13% had overcrowding and 21% had abnormal spacing. In regard to the bite, 11% presented anterior open bite. In regard to crossbite, 7% presented unilateral crossbite on the right side and 2% on the left side; 5% presented posterior crossbite and 4% anterior crossbite. In regard to midline deviations, 4% presented deviation in the maxilla and 33% in the mandible. In regard to facial type: 39% are dolichofacial, 4% brachyfacial and 57% mesofacial. Based on the results shown, proposals for the implementation of dental, phoniatric, and Ear, Nose and Throat (ENT) practices are already being discussed with the multidisciplinary team of the club involved.     

上颌前牵引联合快速扩弓矫治儿童骨性Ⅲ类错前后软硬组织变化

目的:探讨上颌前牵引联合快速扩弓对儿童骨性Ⅲ类错的矫治效果。方法:对28例儿童骨性Ⅲ类错病人(7～10岁)进行上颌前牵引治疗,在前牵引前快速扩弓1周。分别在治疗开始(T0)和结束(T1)时拍摄头颅定位侧位片,进行定点测量分析。结果:①硬组织变化:ANB角增加5.37°(P<0.05),Wit’s值增加5.74 mm(P<0.05),Ptm-A增加2.49 mm(P<0.05),Yaxis增加1.82°(P<0.05);SNB角减小0.75°(P>0.05),Go-Me、Co-Gn分别增加0.64 mm、2.21 mm,但P>0.05,SN-PP减小0.61°(P>0.05),PP-MP增加5.54°(P<0.05),下面高、下面高/全面高分别增加3.98(P<0.05)、1.61(P>0.05);U1-NA角增加3.10°(P<0.05),L1-NB角减小1.23°(P<0.05),Ms6-PP距增加1.13 mm(P<0.05);②软组织测量项目变化:面型角增大5.98°,颏唇角减小2.45°、H角增大5.2°,上唇-E线距增大1.42 mm,下唇-E线距减小1.18 mm(P<0.05)。结论:前牵引联合快速扩弓矫治儿童骨性Ⅲ类错,可产生显著治疗效果,能促进上颌骨的生长,使面型改善,但下颌出现顺时针旋转,高角病人慎用。     

Extreme dentoalveolar compensation in the treatment of Class III malocclusion

The orthodontic treatment of an adult patient with a skeletal Class III malocclusion, increased anterior facial height, negative overjet, and bilateral posterior crossbite is presented. Treatment options included mandibular first premolar or third molar extractions with dentoalveolar compensation or combined surgical-orthodontic treatment. Mandibular third molar extraction with dentoalveolar compensation was the treatment choice. Biofunctional brackets, with accentuated lingual crown torque on the maxillary incisors and accentuated buccal crown torque on the mandibular incisors, were used. The anterior crossbite was corrected with intermaxillary elastics from the palatal aspect of the maxillary incisors to the labial aspect of the mandibular incisors. Class III elastics moved the maxillary teeth mesially and assisted in retruding the mandibular teeth. Patient compliance with the elastics was excellent, and satisfactory dentofacial esthetics were achieved. This treatment protocol has rigorous indications, and it is not a routine plan. The mechanotherapy and the pros and cons of this approach are discussed.     

Epidemiologic panorama of dental occlusion

The purpose of this study was to explore the possible significant sex difference in occlusion, provide information about the occlusal variation among Egyptians, and present an epidemiologic panorama of dental occlusion among different ethnic world populations. The hypothesis was that the occlusal variation is not independent of sex. A sample of 501 female and male adult subjects was studied. Normal occlusion, Angle's classification of malocclusion, and the Dewey-Anderson modifications for typifications were recorded. Chi-square tests were used. The results obtained from this study indicate that a significant sex difference in occlusion exists for normal occlusion, Angle Class I, and Angle Class III. Further, considering an anterior crossbite as the sole indicator of an Angle Class III malocclusion is erroneous; an anterior crossbite may exist in other classes, and Angle Class III type 1 (edge-to-edge) is more prevalent than either Class III type 2 (normal anterior overbite) or type 3 (anterior crossbite). Although numerically different, occlusal variation follows a universal general distributional pattern for most world populations. Some speculations are presented for clinical implications and for research suggestions.     

Nonsurgical correction of an adult skeletal class III and open-bite malocclusion

This case report presents an adult skeletal Class III and open-bite malocclusion case treated without surgical intervention using fixed edgewise technique, reverse headgear, and Class III and anterior box elastics. The patient was a 16-year-old Turkish female who had completed her growth and development. She had a four mm open bite, maxillary retrognathia, a crossbite in the anterior and left posterior, and hypoplasia of the maxillary laterals. In addition, the patient's first molars had previously been extracted because of caries, and extraction spaces were present. We applied a Roth edgewise appliance and a reverse headgear to be used at night only for the first six months. The objective in using a reverse headgear was to displace the maxillary teeth toward the mesial and to rotate the maxilla in a clockwise direction. In the mandible, we retracted the mandibular incisors and canine teeth and moved the second molars mesially toward the first molar extraction space. There would thus be no need for any prosthetic restoration in the mandible. At the end of treatment, we obtained a Class I dental relationship, an ideal occlusion relationship, and an esthetic dental and facial relationship. Treatment of the patient was completed in 20 months.