Orthognathic surgery case of metal allergy applied orthodontic appliances made of organic polymer

This case report presents a case that underwent orthognathic treatment with non-metallic appliances made of organic polymer. The patient was a 19-year-old female with mandibular protrusion and maxillary anterior crowding. The overbite was +3.0 mm, and the overjet ?3.0 mm. She was allergic to nickel (Ni³⁺), cobalt (Co³⁺) and cobalt–chrome (Co–Cr³⁺). The pre-surgical orthodontic treatment included the extraction of the maxillary right-and-left second premolars and mandibular right third molar. An orthodontic appliance made of organic polymer was employed. Orthognathic surgery with bilateral sagittal split ramus osteotomy was carried out. After 32 months pre-surgical orthodontic treatment, the left and right sides were set back 9 and 7 mm, respectively. Rigid fixation of the splitted mandible was employed using two absorbency screws in each side, and the inter-maxillary fixation was performed with elastic threads for 8 days. Total treatment period was 42 months. For retention, a non-metal retainer was employed for the upper and lower dentition. The consistent non-metal treatment on orthognathic case of metal allergy was attained successfully. However, the maxillary molars and the mandibular anterior teeth appeared elongated. This was considered to be caused by the low rigidity of a plastic material.     

Orthognathic treatment with maxillary and mandibular anterior segmental osteotomy

This case report presents a case that underwent orthognathic treatment with anterior segmental osteotomies on both jaws. The patient was a 26-year-old female with maxillary protrusion, lip incompetence with an everted vermilion border. The overbite was +1.0 mm, overjet +1.0 mm. The pre-surgical orthodontic treatment included the extraction of the four first premolars and a multi-bracket treatment was started. After 12 months of pre-surgical orthodontic treatment, both the anterior maxillary and the anterior mandibular segments were retracted surgically by 5.5 mm. The total treatment period was 18 months. An anterior segmental osteotomy can induce the remarkable structural changes for bimaxillary lip protrusion patients.     

A relatively minor adult case becomes significantly complex: A lesson in humility.

A 41-year-old white woman with no particular concerns about facial esthetics was first seen with bilateral Class II molar relationship, a Class I right canine, and a Class II left canine. Overjet was 3 mm and overbite was 0.5 mm, with no incisor contact. A maxillary right premolar was missing for unknown reasons and all 4 third molars had previously been extracted. The maxillary midline was 2 mm to the right of the facial midline, and the mandibular midline was 3.5 mm to the left of the maxillary midline. There was 7 mm of crowding in the maxillary arch and 6 mm of crowding in the mandibular arch, with an increased curve of Spee. The patient had a well-positioned maxilla, a retrognathic mandible with increased convexity, a Class II denture base relationship, and a vertical facial pattern. The treatment plan consisted of extracting the maxillary left first premolar and the mandibular left central incisor. After 4 months of treatment, an open bite from second premolar to second premolar was noted. After 6 months of treatment, the patient expressed concern with her chin position and mentalis hyperactivity. It was apparent that the orthodontic treatment had resulted in molar extrusion, which the musculature was not able to withstand. Treatment continued and the case was set up for posterior maxillary impaction and mandibular advancement surgical procedures.     

A patient with protrusion and multiple missing teeth treated with autotransplantation and space closure

Objective:To present a patient treated with submerging autotransplantation (SA) of an immature premolar and subsequent orthodontic space closure (OSC) and to report a 10-year follow-up result.Case and Method:A 10-year-old boy had multiple missing premolars with an asymmetric pattern (maxillary right first and second premolars, teeth 14 and 15; maxillary left second premolar, tooth 25; and mandibular right second premolar, tooth 45). After considering several treatment options, tooth 35 with immature root development underwent SA into the missing site of tooth 15 at a depth 5 mm below the occlusal plane and was stabilized with sutures to create a symmetric missing condition of the premolars in the four quadrants.Results:Three months after autotransplantation, spontaneous eruption of the transplanted tooth was observed. Nine months after autotransplantation, presence of the lamina dura of the transplanted tooth was confirmed with a periapical radiograph. Active orthodontic treatment was initiated to reduce lip protrusion by closing the missing spaces of teeth 14, 25, 35, and 45 and to correct dental midline deviation. After 33 months of active orthodontic treatment, Class I canine and molar relationships were obtained. During the 10-year follow-up, the pulp vitality of the transplanted tooth was maintained without any pathologic findings, including root resorption or pulp canal obliteration.Conclusions:In a patient with lip protrusion and multiple congenitally missing premolars with an asymmetric pattern, SA of one premolar from the normal quadrant into the quadrant missing two premolars with subsequent OSC of the missing sites of the other premolars can be an effective treatment modality.     

Class III malocclusion with missing maxillary central incisor and facial asymmetry treated with orthodontics and intraoral vertical ramus osteotomy

A 28-year-old female with a Class III malocclusion and facial asymmetry was treated with orthodontics combined with intraoral vertical ramus osteotomy (IVRO). She had severe skeletal Class III (Wits: -9.7 mm). She was missing her maxillary left central incisor and had a fixed three-unit bridge on her maxillary anterior teeth. The patient presented a concave profile with a protrusive mandible. Her dental and mandibular midline was shifted 3 mm toward the left. After presurgical orthodontic treatment, IVRO was performed. The total active treatment time was 16 months including surgery. Both occlusion and facial appearance were significantly improved by the surgical-orthodontic treatment. Posttreatment records after 2 years showed excellent results with good, stable occlusion, facial balance and harmony, and long-term stability.     

Postoperative changes in mandibular prognathism surgically treated by intraoral vertical ramus osteotomy

This study investigated short- and long-term postoperative skeletal changes following intraoral vertical ramus osteotomy (IVRO) for mandibular prognathism, as determined from lateral cephalograms. The subjects were 20 patients with mandibular prognathism who had undergone surgical orthodontic treatment combined with IVRO. Lateral cephalograms were taken at six time points: 1 month before surgery, and 1 day, 3 months, 6 months, 1 year, and approximately 2 years after surgery. Intermaxillary fixation (IMF) with four monocortical screws was maintained for 1 week in all patients. Mean posterior movement of the menton (Me) was 5.9 mm at surgery. 3 months after surgery, the FMA and FH-CorMe angles had increased 6.3 and 6.2 degrees, respectively, indicating clockwise rotation of the distal segment of the mandible. This rotation was observed in all 20 patients, suggesting that postoperative rotation of the mandible in the postoperative short term is likely to occur after IVRO and could be considered an adaptation of the mastication system newly established by surgery. In the long term after IVRO, Me had moved anteriorly by only 0.9 mm and the relapse ratio was 15.3%. These findings suggest the excellent long-term stability of surgical orthodontic treatment combined with IVRO in patients with mandibular prognathism.     

Orthodontic treatment of severely protruded maxillary anterior teeth in a middle age adult female

The multi-disciplinary concept of dental care in the adult patient, especially the middle age group, has recently received considerable attention in orthodontics. The author presents the orthodontic treatment of a middle age female with severe overjet. The patient was forty-one years and eleven months old female with a Class II, Division 1, malocclusion. Besides a severe skeletal discrepancy in the anterior-posterior relationship, the U1-SN was 123.5 degrees. There were spaces in the maxillary anterior segment and a large space was present between the canine and first premolar. The mandibular right first and second premolars occluded in lingual position. Begg plastic brackets were placed in the maxilla and C.A.T. brackets were placed in the mandible. The severe curve of Spee was eliminated by the use of a tandem depression archwire system in the mandibular arch. Both light wire mechanics and edgewise straight wire mechanics were used effectively during the treatment process. The active treatment period was three years. Overjet changed from 15.5mm to 6.0mm and overbite from 7.0mm to 3.3mm. The U1-SN and U1-AP were greatly reduced. The lower anterior teeth were labially inclined, increasing the IMPA from 96.5 degrees to 107.5 degrees. The periodontal tissue suffered no damage from the mechanical orthodontic procedures. The patient was significantly pleased with the treatment results.     

Combined orthodontic and surgical treatment of severe mandibular laterognathie with bimaxillary protrusion: case report

This article summarizes the treatment progress for a patient with a severe dolichofacial pattern with a convex profile, severe lip incompetency, and concomitant mouth breathing. Her maxillary occlusal plane had a cant and the maxillary and mandibular midlines were shifted 2 and 4 mm to the left side, respectively. The treatment plan summary was as follows: (1) maxillary rapid expansion for the elimination of maxillary constriction; (2) extraction of maxillary right first molar; (3) extraction of mandibular first premolars; (4) preoperative orthodontic treatment to correct dental protrusions; (5) surgical repositioning of the maxilla and mandible; and (6) postoperative orthodontic treatment and retention. Orthodontic treatment lasted a total of 28 months, with a good intercuspation and significantly improved facial esthetics at the end of treatment. The 1-year postretention lateral cephalometric measurements did not indicate any significant relapse. Dental protrusion and crowding in both jaws were eliminated. Facial and dental asymmetry was resolved and the profile was improved. The cant of the occlusal plane and the lips were corrected. Evaluation of pre- and posttreatment profiles revealed a decrease in convexity. Dentally, Class I canine and Class III molar relationships were present at the end of the treatment. Maxillary and mandibular incisors were uprighted, improving the interincisal angle and the bite relationship.     

Talon cusp associated with other dental anomalies: a case report

Talon cusp is an uncommon dental anomaly referring to an accessory cusp projecting from the cingulum area, or cemento-enamel junction of maxillary or mandibular anterior teeth, in both the primary and permanent dentition. This paper reports a rare case of talon cusp affecting the mandibular right central incisor and maxillary right lateral incisor, together with other dental abnormalities, viz. an inverted impacted migrating mandibular right second premolar; complete agenesis of the maxillary and mandibular third molars, the maxillary right second permanent molar, and the mandibular left permanent central incisor; severe crowding; deep bite; hypoplastic teeth; bilateral reverse cross-bite in the premolar region; and a retrognathic mandible. The presence of this number of dental anomalies in a single patient is rare.     

An occlusal and cephalometric analysis of maxillary first and second premolar extraction effects

The purpose of this study was to examine dimensional changes in the maxillary arch following the extractions of maxillary first or second premolars. Pre- and posttreatment records of 71 patients treated by one experienced orthodontist were randomly selected from completed premolar extraction cases. Forty-five patients involved the extraction of maxillary first premolars; of these, 15 also had extractions of mandibular first premolars and 30 had extractions of mandibular second premolars. Twenty-six patients involved the extraction of maxillary second premolars, and all of these also had extractions of mandibular second premolars. Pretreatment factors that seemed to suggest a basis for the extraction choice in this sample included incisal overjet, molar relationship, and maxillary incisor protrusion. Mean reductions with treatment in the anteroposterior arch dimension were similar within all premolar extraction groups. There was evidence of greater mean maxillary intermolar-width reduction following the extractions of maxillary second premolars than following extractions of maxillary first premolars. Greater mean maxillary incisor retraction was found in the maxillary first premolar extraction group than in the maxillary second premolar group. A wide range of individual variation in incisor and molar changes did, however, accompany treatment involving both maxillary premolar extraction sequences.     

Introduction of "vario plates" for retention after mandibular distraction osteogenesis

This report introduces a new removable orthodontic appliance called "vario plates" for retention following distraction osteogenesis of the mandible. The "vario plates" consist of removable orthodontic appliances in the maxilla and the mandible. These are fabricated out of self-curing resin with typical wire elements. They are connected with telescoping maxillomandibular guidance rods, which have a smoothly variable length, from the maxillary molar region to the mandibular premolar region on each side. The telescope on both sides is adjustable in this length by means of a protrusion nut. Thus, it is possible to move the mandible forward an exactly controlled amount. The "vario plates" are in function for 24 hours a day in the patient for the first 6 months after mandibular distraction osteogenesis and subsequently only at night. The application of the plates is demonstrated in a patient with Goldenhar syndrome. Application of "vario plates" after distraction osteogenesis makes it possible to hold the mandible in a stable position. The combination of maxillofacial surgery with distraction osteogenesis and orthodontic treatment and retention leads to an improvement in therapy of patients with severe dentofacial anomalies.     

Correction of Unilateral Condylar Hyperplasia and Posterior Open Bite with Proportional Condylectomy and Fixed Orthodontic Treatment

A 29-year-old female patient with unilateral condylar hyperplasia (UCH) of the left side presented with facial asymmetry, maxillary transverse occlusal plane (MXTOP) cant, posterior open bite, and Class III relationship. Treatment consisted of proportional condylectomy of the left condyle for management of UCH, and fixed orthodontic treatment with intrusion of the left maxillary molars to correct the MXTOP cant and remaining chin point deviation (CPD). Proportional condylectomy with a 14-mm resection of the left condylar head improved the CPD from 11.5 mm to 7.8 mm and resolved the posterior open bite on the left side. However, it produced a Class II relationship on the right and left sides, posterior open bite on the right side, and anterior open bite. Fixed orthodontic treatment with 1.8-mm intrusion of the left maxillary molars using miniscrews corrected the MXTOP cant from 3.5 mm to 1.7 mm, reduced the remaining CPD from 7.8 mm to 3.7 mm, produced counterclockwise rotation of the mandible, and resolved the posterior open bite on the right side and the anterior open bite. After 16 months of total treatment, normal overbite/overjet and Class I relationship were obtained. Treatment results were well maintained after 5 years of retention. For the correction of UCH, it is important to determine the amount of condylar head resection and accurately simulate the correction of CPD and MXTOP cant through intrusion of the maxillary molars.     

Surgical versus orthodontic correction of skeletal Class II malocclusion in adolescents: effects and indications.

To clarify the effects of orthodontic versus surgical treatment and to distinguish more clearly those Class II patients who can be treated successfully with orthodontics alone, we compared three groups of adolescents: forty patients treated successfully with orthognathic surgery, 40 patients treated successfully with orthodontics alone, and 21 patients whose orthodontic treatment was judged to be unsuccessful. Successful surgical treatment was accomplished largely by bringing the mandible forward, but this involved vertically repositioning the maxilla, alone or in combination with advancing the mandible, in 40% of the patients. Successful orthodontic treatment resulted from a combination of retraction of the maxillary incisors and protraction of the mandibular incisors; most of the successfully treated group also had significant vertical growth, and 40% had greater than 2 mm anteroposterior growth. The unsuccessfully treated orthodontic patients initially had greater overjet, more severe mandibular deficiency, and greater anterior facial height than those treated successfully; they also had less retraction of the maxillary incisors and less growth during treatment. In Class II adolescents beyond the growth spurt, surgery is likely to be needed for successful correction of the malocclusion if the overjet is greater than 10 mm, especially if the distance from pogonion to nasion perpendicular is 18 mm or more, mandibular body length is less than 70 mm, or facial height is greater than 125 mm.     

Bone-anchored maxillary protraction long-term outcomes in UCLP:: A case report

This case report presents a 12-year-old boy with unilateral complete cleft lip and palate and severe maxillary retrusion treated with bone-anchored maxillary protraction (BAMP) therapy followed by fixed appliances. The follow-up period extended until the end of growth. Initially, the patient demonstrated a Goslon 4 interarch relationship with an overjet of −3.5 mm and a Wits appraisal of −7.9 mm. Six months after the secondary alveolar bone graft, Bollard miniplates were fixed bilaterally at the infrazygomatic region in the maxilla and between the canines and lateral incisors in the mandible. Class III elastics were used bilaterally full time for 12 months. After treatment, the overjet increased 5.9 mm. Significant maxillary advancement (SNA +3.2°) and skeletal convexity improvement (NA-APo +12.4°) were observed. Retrusion of the anteroposterior position of the mandible was observed (SNB –2.1°). Comprehensive orthodontic treatment was performed after BAMP therapy with nighttime bone-anchored Class III elastics as active retention until the end of growth. Occlusion and facial esthetics were satisfactory at the end of orthodontic treatment and growth. Le Fort I surgery for maxillary advancement was not required. BAMP therapy demonstrated an adequate orthopedic outcome, preventing the need for orthognathic surgery in unilateral complete cleft lip and palate.     

种植微螺钉支抗矫治下颌磨牙缺失患者的上牙前突伴拥挤

目的探讨微螺钉种植体作为支抗用于下颌磨牙缺失患者矫治上牙前突伴拥挤的临床效果。方法选择下颌单侧磨牙缺失、上牙前突伴拥挤的成年错!患者8例（年龄22~38岁）,在每位患者下颌磨牙缺失侧的第二前磨牙远中11~13 mm颊侧牙槽嵴处各种植1枚纯钛微螺钉,并以栓道固位方式在微螺钉的龈上部分附着自制微螺钉牵引帽,利用微螺钉牵引帽依次牵引同侧的下颌前磨牙、尖牙、切牙向远中移位,并利用牵引帽上的牵引钩行颌间Ⅱ类牵引。结果采用种植微螺钉作为支抗的8例患者治疗后均达到较理想的效果,前牙覆盖覆!和后牙尖窝关系均正常。疗程最长者24个月,最短者15个月,平均20.8个月。结论微螺钉种植体支抗可以用于下颌磨牙缺失的上牙前突伴拥挤患者的矫治。     

Postoperative stability for surgery-first approach using intraoral vertical ramus osteotomy: 12 month follow-up

The aim of this study was to evaluate the postoperative stability of the surgery-first approach using intraoral vertical ramus osteotomy (IVRO). We retrospectively studied a sample derived from the patients who were treated by the surgery-first approach using a LeFort I osteotomy and IVRO for correction of class III dentofacial deformity from 2008 to 2012. Lateral cephalograms taken preoperatively and 2 days, 6 months, and 12 months postoperatively were traced, and the skeletal and dental variables at different time points were analysed. The study sample comprised 37 subjects, mean (SD) age 23 (4) years. The mean (SD) total duration of treatment including postoperative orthodontics was 14 (6) months, and surgical movement of the maxillary A point was 0.75 (1.3) mm anteriorly, and 0.21 (1.79) mm superiorly. The surgical change in the position of the maxillary first molar was 1.01 (1.57) mm superiorly. The mean (SD) movement of mandible was 11.15 (5.4) mm posteriorly at pogonion and 1.02 (1.79) mm inferiorly at menton. There were no significant change in maxillary skeletal variables during the first year postoperative period. The surgical relapse of mandible at pogonion was 0.63 (2.31) mm anteriorly (p = 0.01), however, the relapse in superior direction at menton was 2.86 (1.39) mm with statistical significance (p = 0.01). The total duration of orthodontic treatment with surgery-first was roughly 5 months shorter than conventional preoperative and postoperative orthodontic treatment. The surgery-first approach using IVRO is effective and predictable, and shortens the overall duration of treatment. Anterior relapse of the mandible was less than 1 mm, and increased superior relapse can be compensated for with appropriate preoperative planning to provide a reliable outcome. This study was limited to 12 months’ follow-up, and a long term follow-up study is indicated.     

后牙区正畸托槽定位高度的研究

目的测量正畸患者后牙段牙齿边缘嵴到牙尖的垂直高度,为后牙托槽的定位提供参考。方法选择采用非拔牙矫治且矫治后符合Andrews正常标准的60例患者为研究对象,男女各30例,平均年龄13.2岁。取矫治后的研究模型,利用激光三维测量仪测量每副模型后牙段牙齿边缘嵴到近中牙尖最高点的垂直距离。数据输入SPSS6.0软件进行统计分析。结果相同牙位不同性别的数据无统计学差异;上下颌左右侧相同牙位边缘嵴到牙尖的高度无统计学差异（P>0.05）。上颌第一前磨牙、第二前磨牙和第一磨牙边缘嵴到牙尖的高度分别为（1.70±0.50）、（1.24±0.45）、（0.83±0.40）mm,三者间比较均有统计学差异（P<0.01）;下颌第一前磨牙、第二前磨牙和第一磨牙边缘嵴到牙尖的高度分别为（2.25±0.45）、（1.55±0.45）、（1.18±0.40）mm,三者间比较均有统计学差异（P<0.01）。将本研究得出的数值按最接近0.5 mm倍数的数值进行舍入,得到推荐的托槽垂直定位高度。结论为了获得良好的矫治效果,使矫治后后牙边缘嵴处于同一平面,后牙托槽的垂直定位高度推荐为：若第一磨牙颊面管高度为X mm,则第二前磨牙托槽的垂直高度为（X+0.5）mm,第一前磨牙则为（X+1.0）mm。     

自攻型微螺钉支抗在上颌前突正畸矫治中的应用

目的探讨自攻型微螺钉作为正畸强支抗矫治上颌前突的治疗效果。方法选择上颌前突患者50例,上牙弓均拔除2颗第一前磨牙,采用自攻型微螺钉加强支抗,微螺钉均植入到上颌双侧第一磨牙与第二前磨牙颊侧根尖部的牙槽间隔处,植入后以每侧加0．98N的力滑动内收上前牙,关闭间隙。于治疗前后行X线头影测量分析。结果1）治疗过程中所有微螺钉均稳固;2）所有病例矫治后拔牙间隙均关闭,牙弓突度得到明显改善,上颌切牙明显直立和内收,平均内收7．57mm,上中切牙长轴与前颅底平面（SN）相交的下内角平均减少13．40°,上中切牙长轴与鼻根点至上牙槽座点（NA）平面之间的上交角平均减少12．82°,上、下中切牙长轴的后交角平均增大20．56°,前牙覆盖平均减少7．94mm,上唇突点至审美平面的线距平均减少5．52mm,治疗前后的差异均有统计学意义,上颌第一磨牙矢状向、垂直向的位移分别为0．01、0．09mm,治疗前后差异无统计学意义;3）所有病例矫治后均获得理想的侧貌改变,前牙覆衿覆盖正常,后牙尖窝锁结关系良好。结论自攻型微螺钉是一种稳固、舒适、高效的支抗,可即刻受力,能使支抗磨牙处于稳定状态,最大限度地内收上颌前牙,有效矫治上颌前突畸形。     

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.     

Treatment of dentoskeletal bimaxillary protrusion: additional extraction of maxillary second molars

This case report describes the orthodontic treatment of an 18-year-old female patient with Class II malocclusion with dentoskeletal bimaxillary protrusion. An acceptable treatment result was obtained with a four first premolar extraction and an additional maxillary two second molar extraction plan. Standard edgewise appliances were placed after the premolars were extracted. A positive soft tissue response to treatment was achieved, and the patient’s profile was improved, with a reduction of lip protrusion and mentalis strain. Dentally, the interincisal angle improved significantly as both the maxillary and mandibular incisors were uprighted after space closure. The occlusion remained stable during 2 years of follow-up.