Early treatment of a severe Class II Division 1 malocclusion

This case report shows the effects of functional therapy at an early age in a severe Class II, division 1 malocclusion. Favorable changes in the profile and in the lip seal were achieved. The dental irregularity was treated by fixed appliances and extraction therapy. The patient and her parents were pleased with the final outcome.     

Treatment of a Class II Division 1 malocclusion.

This case was presented as part of the American Board of Orthodontics case displays at the 1999 AAO meeting. It was selected to be submitted for the publication in the American Journal of Orthodontics and Dentofacial Orthopedics by the ABO.     

Treatment of a Class II Division 1 malocclusion with miniscrew anchorage

This case report describes the treatment of a 30-year-old woman with a Class II Division 1 malocclusion, characterized by a large overjet, a deep overbite, and a V-shaped maxillary dental arch. She had a convex profile with a retrognathic mandible and marked lip protrusion. Treatment involved extraction of 4 first premolars and miniscrew implant anchorage for space closure. The total treatment time was about 20 months. Ideal overjet and overbite relationships were established, and the facial profile was improved substantially. The 2-year follow-up records show a morphologically and functionally stable result.     

Treatment decision in adult patients with Class III malocclusion: orthodontic therapy or orthognathic surgery?

Class III malocclusion is one of the most difficult anomalies to understand. Because not all Class III patients are candidates for surgical correction, patient assessment and selection remain main issues in diagnosis and treatment planning. The purpose of this study was to separate Class III patients who can be properly treated orthodontically from those who require orthognathic surgery. A large sample size was a necessary to obtain a sufficiently robust model. Thus, a multicentric study design was chosen (Orthodontic Departments of the Universities of Frankfurt, Heidelberg, and Würzburg, Germany). The cephalograms of 175 adult patients with Class III malocclusions were analyzed. The orthodontic group comprised 87 patients, and the surgery group, 88 patients. Twenty linear, proportional, and angular measurements were made. Stepwise discriminant analysis was applied to identify the dentoskeletal variables that best separate the groups. The discriminant function model was highly significant (P <.0001); 92% of the patients were correctly classified. The following variables were extracted: Wits appraisal, length of the anterior cranial base, maxillary/mandibular (M/M) ratio, and lower gonial angle. The resulting equation was: Individual score = -1.805 + 0.209. Wits + 0.044. S-N + 5.689. M/M ratio - 0.056. Go(lower). By means of discriminant analysis, correct classification of adult Class III malocclusion patients succeeded to a very high degree. Of all the variables, the Wits appraisal was the most decisive parameter.     

Treatment of a Class II Division 1 malocclusion with a high mandibular angle.

This case was presented as part of the American Board of Orthodontics case displays at the 1999 AAO meeting. It was selected to be submitted for publication in the American Journal of Orthodontics and Orthopedics by the ABO.     

Treatment of a Class III anterior open bite malocclusion: a combined orthodontic and orthognathic surgical approach.

Case report of an adult Caucasian female aged 23 years and nine months who complained of some difficulty in chewing and talking. Patient was diagnosed to have a mild Class III skeletal malocclusion with an anterior open bite of 4 mm. Treatment included combined orthodontic and orthognathic surgical approach. Surgery included surgically assisted maxillary expansion, advancement and impaction, a mandibular setback and a vertical, antero-posterior reduction genioplasty. The present case report illustrates a coordinated orthodontic and orthognathic surgical approach in the treatment of skeletal open bite deformities.     

Psychologic implications of orthognathic surgery in patients with skeletal Class II or Class ill malocclusion

The psychologic profile of 100 consecutive patients undergoing orthognathic surgery for correction of Class II or Class III malocclusion was monitored in a prospective observational study. Patients and their relatives or friends completed questionnaires about their self-image before surgery, 6 weeks postoperatively, and 6 months postoperatively. Preoperatively, patients with Class III malocclusion felt significantly less attractive (P = .03), had slightly higher attention to physical appearance, and had slightly stronger feelings of insecurity regarding their facial appearance compared with Class II patients. Grading of attractiveness/self-confidence improved significantly in Class III patients at 6 weeks postoperatively (P = .006), while in Class II patients the improvement was less pronounced and only significant at 6 months postoperatively (P = .002). Grading of attractiveness/self-confidence by relatives/friends of patients with Class II and Class III was similar preoperatively, but was significantly higher for Class III patients 6 weeks postoperatively in comparison with Class II patients (P = .048). These data indicate that the psychologic profiles are significantly different between Class II and Class III patients preoperatively and show different dynamics postoperatively.     

Class III malocclusion with severe facial asymmetry, unilateral posterior crossbite, and temporomandibular disorders.

A 22-year-old woman had a Class III malocclusion with severe facial asymmetry, unilateral posterior crossbite, and temporomandibular disorders. A clicking sound was noted in the temporomandibular joint on the posterior crossbite side during jaw opening, and she complained of pain in the masticatory muscles on both sides. The articular disc on the crossbite side was displaced anteriorly without reduction. The patient was treated orthodontically with edgewise appliances and surgically with LeFort I and intraoral vertical ramus osteotomies. The result of the combined surgical-orthodontic treatment was facial symmetry and optimal occlusion. The displaced articular disc moved into a normal position, and most of the temporomandibular disorder symptoms improved. At the 2.5-year follow-up, the temporomandibular joint conditions had been maintained.     

Category 5: Class II Division 1 malocclusion.

This case report was part of a display of cases sponsored by the ABO after the board-certification process. The Summary of Treatment and records are reprinted here with minimal editing and reformatting, so the presentation resembles the actual documents submitted to the board.