Lower premolar extraction/removable plastic Herbst treatment for mandibular retrognathia

The patient was a 12-year-old girl with a Class I malocclusion characterized by maxillary arch width constriction, dental crowding, and mandibular retrognathia. Treatment goals related to the chief compliant were anterior mandibular repositioning, maxillary arch expansion, and dental alignment. Because the preexisting overjet was minimal and prevented adequate anterior repositioning of the mandible, lower first premolar extraction was recommended to increase the overjet and allow greater anterior repositioning. Treatment was divided into four stages: (1) extraction of mandibular first premolar teeth, alignment, space closure, and an increase in the overjet, (2) anterior mandibular repositioning with a removable plastic Herbst appliance, (3) arch alignment and detailing of the occlusion with full fixed appliances and a tooth positioner, and (4) retainers. At the end of treatment, the patient had an acceptable dental alignment with a Class III molar relationship and an improvement in facial appearance.     

Unusual extraction treatment in Class II division 1 using C-orthodontic mini-implants

This paper describes the treatment of a female patient, aged 23 years and 5 months, with a Class II division 1 malocclusion, who showed severe anterior protrusion and lower anterior crowding. Specially-designed orthodontic mini-implants were placed bilaterally in the interdental space between both the upper and the lower posterior teeth. Both lower first molars showed severe apical lesions. Therefore, the treatment plan consisted of extraction of both upper first premolars and lower first molars, en masse retraction of the upper six anterior teeth, lower anterior alignment, and protraction of all the lower molars. C-implants(R) were used as substitutes for maxillary posterior anchorage teeth during anterior retraction and as hooks for mandibular molar protraction. The correct overbite and overjet were obtained by intruding and retracting the upper six anterior teeth into their proper positions. The dentition was detailed using conventional orthodontic appliances. The upper C-implants contributed to an improvement in facial balance, and the lower C-implants made it possible to protract the lower second and third molars with less effect on the axis of the lower anterior teeth. The active treatment period was 29 months and the patient's teeth continued to be stable 11 months after debonding.     

Meeting Reports

Abstract

This article describes treatment of a patient presenting with a class II malocclusion, maxillary and mandibular crowding, posterior crossbite and an increased deep bite, where the specific treatment goals were achieved in the early mixed dentition by only working on the primary teeth. A Haas-type rapid maxillary expansion (RME) appliance was modified to be anchored on the primary second molars and canines and activated once a day, with each activation equal to 0.20 mm. The appliance was blocked after 30 days and left as a retainer. After 6 months, the RME appliance was removed and bands were cemented to the primary second molars in order to apply traction with headgear. After complete eruption of the mandibular central and lateral incisors, sequential slicing of the lower primary teeth was performed to transfer the leeway space from the distal to the mesial part of the arch. When the patient had entered the permanent dentition, a dental class I relationship was achieved, the crossbite corrected and the crowding improved. The overjet and overbite were also improved. No permanent teeth were involved during this phase of treatment. The outcome of this case report shows that it is possible to work only on primary teeth in the mixed dentition and this can be an effective way to correct a class II malocclusion with deep bite, posterior crossbite and maxillary and mandibular crowding.     

Prevalence of Defined Symptoms of Malocclusion among Probands Enrolled in the Study of Health in Pomerania (SHIP) in the Age Group from 20 to 49 Years

SUBJECTS AND METHODS: SHIP is a complexly structured, population-based cross-sectional study of adults in the German region of Pomerania (age group covered: 20-79 years). Findings in a population subgroup (age group 20-49 years; n = 1777; 53.1% women; 46.9% men) were subjected to orthodontic evaluation. Graduated registration of anterior crowding, overjet, frontal overbite and sagittal intermaxillary relationship of the posterior teeth; registration of ectopic canines, posterior crowding, anterior and posterior crossbite, negative overjet, retroclination of the upper incisors, buccal nonocclusion, and lateral open bite. The prevalence of almost regular dentition and of symptoms of malocclusion as well as the frequency of orthodontic treatment (subjective patient data) undergone by men and women were recorded. The correlation between the registered symptoms of malocclusion was calculated. RESULTS: 92.2% of the subjects had symptoms of malocclusion varying in number and severity. An anatomically correct dentition was found in only 7.8% of cases, and an "almost regular dentition" (inclusion criteria defined) in 14.2%. 32.8% of the subjects had severe malocclusion (inclusion criteria defined). The most frequent symptoms were anterior crowding, increased overjet, and distoclusion. These symptoms were significantly more frequent in women, while spacing and edge-to-edge bite, excessive overbite and mesioclusion were more frequent in men. 26.7% of the probands (28.0% women, 25.3% men) reported having received orthodontic treatment. The prevalence of craniofacial malformations (cleft lip and palate, syndromes) was 0.09% in women and 0.2% in men. Increased overjet was most frequently correlated with other symptoms of malocclusion.     

Extreme skeletal open bite correction with vertical elastics

Severe skeletal open bites may be ideally treated with a combined surgical–orthodontic approach. Alternatively, compensations may be planned to camouflage the malocclusion with orthodontics alone. This case report describes the treatment of an 18-year-old man who presented with a severe open bite involving the anterior and posterior teeth up to the first molars, increased vertical dimension, bilateral Class III molar relationship, bilateral posterior crossbite, dental midline deviation, and absence of the maxillary right canine and the mandibular left first premolar. A treatment plan including the extraction of the mandibular right first premolar and based on uprighting and vertical control of the posterior teeth, combined with extrusion of the anterior teeth using multiloop edgewise archwire mechanics and elastics was chosen. After 6 months of alignment and 2 months of multiloop edgewise archwire mechanics, the open bite was significantly reduced. After 24 months of treatment, anterior teeth extrusion, posterior teeth intrusion, and counterclockwise mandibular rotation were accomplished. Satisfactory improvement of the overbite, overjet, sagittal malocclusion, and facial appearance were achieved. The mechanics used in this clinical case demonstrated good and stable results for open-bite correction at the 2-year posttreatment follow-up.     

Severe Class II division 1 malocclusion treated by orthodontic miniplate with tube

A miniplate with tube (C-tube) was placed in the interdental spaces between both left and right upper second premolars and first molars in a 15-year-8 month-old male patient with a Class II malocclusion who with severe anterior protrusion and lower anterior crowding. The treatment plan consisted of extracting both upper first premolars, en masse retraction of the upper six anterior teeth and lower anterior decrowding. C-tubes were used as substitutes for posterior dental anchorage during upper anterior retraction. The particular design of the C-tubes made it possible to retract fully with minimal gingival irritation. The correct overbite and overjet were obtained by intruding and retracting the maxillary incisors to their proper positions and this correction remained stable for at least 27 months after debonding. Also, facial balance was improved. The active treatment period was 14 months. The application of this new appliance, consideration of case selection, and sequence of treatment are presented.     

Extraction as a treatment alternative follows repeated trauma in a severely handicapped patient

Abstract – Handicapped patients with protruding maxillary incisors are prone to repeated dental trauma. A 13-year-old girl with cerebral palsy, severe mental retardation and seizure disorder was referred to our department for restoring the traumatized anterior teeth. Despite drug combination, the frequency of seizure attack was around 10 times a month. The oral examination showed multiple caries, gingival hyperplasia, class II malocclusion with 14 mm overjet and deep overbite. During the first 3 years of a 7-year follow-up period, six episodes of anterior tooth trauma due to seizure attack occurred. The trauma-related treatment performed included endodontic therapy, multiple composite restorations, apical repositional flap, and finally extraction of all four upper incisors with fabrication of a semi-fixed band-retained denture. The denture restored normal overbite and overjet with improved esthetics. For 4 years following the fabrication of denture, no trauma occurred to the anterior teeth in later seizure attacks. Considering inadequate control of seizure disorder, little ability of the patient to receive comprehensive orthodontic treatment, poor prognosis of restorations, and possible future injuries, the removal of non-functional, non-esthetic, trauma-susceptible incisor teeth can be justified as an alternative to tooth preservation.     

The prevalence of malocclusal traits and their correlations in mixed dentition children: results from the Italian OHSAR Survey

PURPOSE: To know the prevalence of malocclusal traits and their correlation in Italian mixed dentition children. MATERIALS AND METHODS: A sample of 1,198 children 7 to 11 years old, who had never undergone orthodontic treatment, were included in the Italian Oral Health of Schoolchildren of the Abruzzo Region (OHSAR) Survey. Canine and molar classes, overbite, overjet, dental crowding, maxillary midline diastema, crossbite and scissorbite were recorded. The canine and molar classes were considered as dependent variables, and their separate correlations with all of the other occlusal traits were analysed by multivariate methods. RESULTS: Over 90% of the children showed at least one malocclusal trait; the mean +/- SD of malocclusal traits was 3.5 +/- 1.8. Gender did not affect the prevalence of any malocclusal traits. Dental class II was correlated with increased overbite and overjet, and negatively correlated with the maxillary midline diastema; dental class III was correlated with decreased overbite and overjet, and crossbite. Asymmetrical dental class was correlated with increased overjet and crossbite. Dental crowding showed very little correlation. CONCLUSIONS: The prevalence of malocclusal traits in Italian children is very high, and more effort is needed to implement early interventions, including close monitoring and modifications of lifestyle.     

Absolute anchorage with universal t-loop mechanics for severe deepbite and maxillary anterior protrusion and its 10-year stability

An adult patient with severe maxillary protrusion and deepbite who was congenitally missing two mandibular incisors was treated successfully by maximum retraction of the maxillary anterior teeth after extraction of the maxillary first premolars using a moment differential between the anterior and posterior segments created by a universal T-loop. Anterior teeth were moved with controlled tipping, and little anchorage loss of the posterior segments was experienced using the universal T-loop spring. Reduction of overbite was performed by absolute intrusion of both maxillary and mandibular anterior teeth. With retraction of the maxillary anterior teeth and recontouring of the mandibular canines, proper overjet and overbite were achieved. This report shows the 10-year stability of the case treated with the universal T-loop for the first time.     

Long-term outcome of skeletal Class II Division 1 malocclusion treated with rapid palatal expansion and Kloehn cervical headgear.

The treatment of a patient with a skeletal Class II Division 1 malocclusion, with excessive overjet, complete overbite, airway obstruction, and severe arch length deficiency in the mandibular dental arch, is presented. The maxilla was narrow compared with the mandible, and the posterior teeth were compensated, with the maxillary teeth inclined buccally and the mandibular teeth inclined lingually. The palatal vault was extremely high. Treatment included rapid palatal expansion to correct the transverse maxillary deficiency and Kloehn cervical headgear to correct the anteroposterior skeletal discrepancy. Long-term stability (12-year follow-up) is reported.     

En-masse retraction dependent on a temporary skeletal anchorage device without posterior bonding or banding in an adult with severe bidentoalveolar protrusion: seven years posttreatment

This report describes a novel concept of en-masse retraction with temporary skeletal anchorage devices in place of posterior bonding or banding. The patient was a Korean woman, aged 24 years 4 months, with a Class II Division 1 malocclusion with severe mandibular anterior crowding. Both molars showed decalcification of the cervical areas. Partial osseointegration-based C-implants and C-tube plates were placed bilaterally between the maxillary second premolars and the first molars and in the posterior mandible. These temporary skeletal anchorage devices were used as independent appliances for full retraction of the maxillary and mandibular anterior teeth 3-dimensionally without the assistance of posterior bonded appliances. The posterior occlusion was not changed during treatment, and Class I occlusal relationships with optimal overjet and overbite were achieved. The 7-year posttreatment records showed a stable result.     

双颌前突用无托槽隐形矫治器矫治1例

患者为安氏I类、均角的牙列轻度拥挤伴双颌软组织前突,拔除4个第一前磨牙,应用国产无托槽隐形矫治器矫治,解除牙列拥挤,内收上下前牙,建立前牙正常覆覆盖及尖牙、磨牙中性咬合关系,前突侧貌改善明显。     

Occlusal Changes Following Posterior Tooth Loss in Adults. Part 2. Clinical Parameters Associated with Movement of Teeth Adjacent to the Site of Posterior Tooth Loss

PURPOSE: Much anecdotal evidence is available on tooth positional changes following loss of an adjacent tooth, but only a few studies are available. In Part 1 of this series, supraeruption was assessed and Generalized Linear Models were made to determine the clinical parameters associated with the supraeruptive process. The models demonstrated that clinical parameters were not only associated with the extent of supraeruption, but also with the type of eruption present. This investigation of tooth positional changes adjacent to sites of posterior tooth loss attempts to provide increased understanding of the magnitude, direction, and associated features that may be helpful in decision making and treatment planning in the clinical setting. MATERIALS AND METHODS: One hundred patients with an unopposed posterior tooth, with 100 age, sex, and bone level matched controls, were drawn from patients undergoing routine restorative care at Leeds Dental Institute. Study models were scanned, and the extent of eruption, type of eruption of the unopposed tooth, the overbite, overjet, buccal occlusion, and degree of crowding in the dentition, tipping, rotation, and buccal movement of the teeth associated with the edentulous site were recorded. Generalized Linear Models were developed to examine associations between each tooth movement and patient or dental factors. RESULTS: A statistical significance in the degree of tipping of teeth both mesial and distal to the extraction site was detected between the subject and control groups. There was also a significant difference in rotation of the tooth mesial to the site. Four Generalized Linear Models were produced of the types of non-vertical movements found in teeth associated with sites of tooth loss. CONCLUSIONS: Teeth adjacent to the site of tooth loss may undergo non-vertical movements. Teeth mesial to the extraction site had a tendency to tip distally. The degree of tipping was increased in upper teeth and in subjects with a cusp-to-cusp buccal occlusion. Rotation of teeth mesial to the extraction site was more prevalent in the lower arch. Tipping of the tooth distal to the extraction site could be extreme and was found to be more prevalent in subjects with a reduced (Code 1) overbite and in the lower arch. Rotation of teeth distal to the extraction site was greater in the upper arch and was also associated with a reduced (Code 1) overbite. It also had an association with rotation of the tooth mesial to the extraction site. Models of non-vertical movement are likely to be of limited value due to overdispersion, indicating a high degree of variability within the model.     

A mini-implant for orthodontic anchorage in a deep overbite case

This article describes the orthodontic treatment of a 19-year-old female patient with anterior crowding. There was a moderate arch length discrepancy in the lower dental arch, a significant deep overbite, and a "gummy smile." We inserted an orthodontic mini-implant as anchorage for the intrusion of the upper incisor segment, followed by alignment of the upper and lower dental arches with an edgewise appliance without tooth extraction. The overbite was corrected from +7.2 mm to +1.7 mm by upper incisor intrusion, and the gummy smile was improved. Good occlusion and facial esthetics were achieved, and these results have been maintained for two years after completion of the active treatment.     

Long-term spontaneous changes following removal of all first premolars in Class I cases with crowding

The purpose of the study was to evaluate the result in adults of Class I malocclusion cases who had all their first premolars extracted as the sole treatment of space deficiency in the mixed or early permanent dentition. The mean age at premolar removal was 10 1/2 years. Forty-two out of 44 cases were re-examined at a mean age of 30 years and 4 months. Observations of dental occlusion and oral health were compared to observations of control samples. The average malocclusion in the adults, as judged by a score method, was similar to that reported for an appliance-treated sample. Marked spontaneous arch alignment and residual space closure with age was seen in most cases. Despite earlier tooth removal, on average crowding developed to about the same degree as that of an non-extraction normal occlusion sample. No detrimental effects were seen with regard to overjet or overbite. Neither did the figures for lower incisor position at the follow-up examination differ from that of the normal occlusion sample. Although tipping of adjacent teeth towards the extraction site was frequent, especially in the mandible, no effect on marginal bone height was evident as judged by comparison with a non-extraction control sample. The results reveal a significant capacity for spontaneous improvements with age in dental arch morphology and relationship in extraction cases, provided that specific features have been looked for in case selection.     

涉及正畸拔除病变第一磨牙矫治牙列拥挤前突的临床研究

目的探讨涉及正畸拔除病变第一磨牙矫治牙列拥挤、伴牙弓前突的方法及设计原则。方法选自第四军医大学口腔医学院正畸科牙列拥挤病例24例，男性9例，女性15例，平均年龄21．3岁。其中单纯牙列拥挤15例，拥挤伴牙弓前突9例，拔除病变第一恒磨牙或残根、残冠来替代拔除健康的前磨牙矫治。所有病例均使用标准方丝弓技术进行矫治。结果矫治时间为16—25个月，平均22．5个月，矫治后患者前牙覆[牙合]、覆盖正常，后牙咬合关系良好，第三磨牙均已萌出并建立良好的咬合关系，牙弓间隙全部关闭，面部侧貌协调。结论通过正畸治疗涉及拔除病变第一磨牙的错袷病例，重建完整健康的牙列，达到了功能、美观及稳定的目标。     

正畸拔牙与不拔牙疗效对比的初步探索

目的　比较患者拔牙与不拔牙正畸治疗在牙齿排列、咬合关系、面形和疗程方面的差异。方法　 5位正畸专家根据治疗前资料挑选出的既可采用拔牙 ,又可采用不拔牙治疗的 39例错畸形患者为研究对象。评价患者的治疗效果 ,再根据患者实际是否采用拔牙治疗进行分组比较。结果　拔牙组与不拔牙组患者 ,在牙齿排列、覆覆盖、中线、侧方咬合关系方面的评分及平均疗程上均无显著性差异 (P >0 0 5 ) ;只有侧貌美观的评分 ,拔牙组高于不拔牙组 ,两组间有显著性差异 (P =0 0 0 1 )。结论　对于临界病例 ,拔牙与不拔牙治疗在牙齿排列、咬合关系方面都能在基本相同的治疗时间取得类似的疗效 ;但拔牙患者 ,无论是拔第一前磨牙还是拔第二前磨牙 ,都比不拔牙患者获得了更加令人满意的面形。     

Treatment of a Case of Skeletal Class II Malocclusion with Temporomandibular Joint Disorder Using Miniscrew Anchorage

Abstract

At the present time, there are no reports in the literature on the treatment of temporomandibular joint disorder (TMD) by intrusion of molars using mini-screws. This case report describes the treatment for a female patient, aged 19 years seven months, with a TMD and an excessive lower anterior facial height. Overjet and overbite were +5.0 mm and +0.5 mm, respectively. The patient had a history of orthodontic treatment in which her first premolars were all extracted. During the first orthodontic treatment, a clockwise mandibular rotation was observed as a result of the increase of posterior dentoalveolar height. She had temporomandibular joint (TMJ) pain during mouth opening and complained of difficulty in eating due to masticatory dysfunction. The pretreatment Schüller views of both TMJ showed a posterior condyle position. In order to correct the overjet, molar relationship and the mandibular condyle position, a miniscrew was inserted into the palatal region of the upper first molar to intrude the upper posterior teeth. As the upper molars were intruded, the overjet was decreased, and a class I molar relationship was achieved by a counterclockwise mandibular rotation. After one year of treatment, an acceptable occlusion was achieved, and the condyle moved into centric position in the glenoid fossa. The patient’s teeth continued to be stable, and she had no pain in TMJ after a retention period of three years. The result of this treatment showed that molar intrusion using miniscrew anchorage is effective for treatment of a TMD patient with a posterior condyle position.     

Mandibular first premolar teeth extraction in skeletal Class III malocclusion

The patient was a 12-year-old girl with a skeletal class III malocclusion characterized by mandibular protrusion, a high mandibular plane angle, severe negative overjet and deep overbite. The patient's mandibular first premolar teeth were extracted following the standards of edgewise mechanotherapy. The total active treatment time was 19 months, however, retention was needed until the patient was 19 years old. The malocclusion has been treated satisfactorily resulting in correction of the functional and esthetic flaws without orthognatic surgery.     

Nonsurgical treatment of adult skeletal Class III malocclusion with crowding and missing four premolars corrected with extraction of mandibular first molars

An adult male patient was present with anterior cross bite. He was referred to Orthodontic Clinic of Niigata University Medical and Dental Hospital for recommendation of surgical orthodontic treatment by general practitioner. The patient was diagnosed as skeletal Class III with anterior crowding and missing four premolars. To correct anterior cross bite and crowding, surgical orthodontic treatment was considered, but the patient refused orthognathic surgery. We therefore determined that nonsurgical treatment with mandibular bilateral first molar extraction would be indicated.After treatment, suitable overjet, overbite and proper functional occlusion were attained with Class I molar relation. Active treatment was 34 months, and the treatment result remained stable 2 years and 4 months after debonding.