American Board of Orthodontics Case Report
An American Board of Orthodontics case report: An adult nonsurgical patient whose treatment required combined dental disciplines

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Abstract

This is a case report of a 27-year-old, white woman who had a Class II, Division 2 malocclusion with 100% overbite and mild skeletal mandibular retrognathia. Missing teeth were the maxillary right canine, second premolar, and second molar; the maxillary left canine and second molar; the mandibular left first premolar and second molar; the mandibular right first premolar and second molar. The maxillary first premolars were used as canines and the molars were in an Angle Class I relationship at the end of 31 months of treatment. Bonded lingual retainers were placed: a maxillary lateral incisor-to-lateral incisor, a mandibular canine-to-canine, and a maxillary Hawley retainer. Later, a fixed restoration to replace the maxillary right second premolar was completed. Included are 3-year posttreatment records. (Am J Orthod Dentofac Orthop 1996;110:163-9.)

Section snippets

History and etiology

A 27-year-old, 10-month, white woman presented for orthodontic treatment. Her chief concern was that she did not like her overbite, crossbite, and missing teeth. Pertinent medical history included the removal of tonsils and adenoids at 6 years of age and an allergy to penicillin. Dental history included the extraction of palatally impacted maxillary canines, the maxillary right second premolar, mandibular first premolars, and all second molars. She had orthodontic treatment in high school that

Diagnosis

The concave profile was due, in part, to missing teeth and a brachycephalic skeletal pattern. Lower face height was short, and there was a fairly deep mentolabial sulcus with hypertonic lip musculature. A full smile revealed approximately 2 to 3 mm of gingiva and an asymmetrical smile (Fig. 1).

. Pretreatment facial and intraoral photographs (age 27 years, 11 months). Lateral view shows mildly retrognathic profile and mildly deep mentolabial sulcus. Frontal smiling view shows asymmetrical smile

Specific objectives of treatment (skeletal and dental)

No major facial esthetic changes were expected except for a more pleasing dental alignment when smiling. Skeletal change with mild mandibular advancement and “unlocking” of the anterior deep bite was possible but no major changes were anticipated because the patient was nongrowing.

Treatment progress

A straight wire appliance with brackets that have a 0.022 × 0.028-inch slot was used. Maxillary appliances were placed on all teeth, including the third molars with full arch wire (0.0155 inch Respond, Ormco Corp., Glendora, Calif. ) engagement to begin anterior bite opening. A transpalatal appliance was inserted into the lingual sheaths of the maxillary first molars and activated for mild expansion and rotation. The transpalatal appliance was positioned approximately 2 mm off the palate to

Results achieved

Facial changes observed (Fig. 5) were mild lip fullness in profile and mild arch width increase of the maxillary anterior teeth on smiling.

. Posttreatment facial and intraoral photographs (age 30 years, 10 months). Note improved gingival display on frontal smiling photograph and asymmetrical smile line. Mildly improved profile view with increased lower face height. Hawley retainer was inadvertently left in place for photographs. Intraoral frontal photograph shows persistent midline discrepancy.

Retention

Because of the severity of the malocclusion, bonded, lingual maxillary lateral-to-lateral and mandibular canine-to-canine retainers were placed with a light-cured resin. The 0.0215-inch twist “Wildcat” wires (GAC International Inc., Central Islip, N.Y.) were formed to casts made from impressions taken a week before removal of the appliance. The patient was advised to wear the bonded lingual wires indefinitely. She was shown how to maintain good oral hygiene with floss threaders and correct

Final evaluation

Because of the patient's excellent cooperation, a significant improvement in the dental relationship was achieved, even though the final occlusion was unconventional. The health of the TMJ may have been improved by normalizing the anterior guidance and by unlocking the severe deep bite. The patient has had no TMJ dysfunction since the posttreatment records. Favorable facial changes were seen on profile view (Fig. 9).

. Postretention facial and intraoral photographs (age 33 years, 10 months).

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