This case report describes the orthodontic treatment of a 13-year-old female patient presenting with an open bite. After initial records and splint therapy, a new mounting revealed an open bite from the second molars bilaterally. The treatment plan involved four first bicuspid extractions, closure of extraction spaces, and intrusion of the upper molars using temporary anchorage devices. Over the course of 2 years, the open bite was corrected through space closure mechanics, intrusion of posterior teeth, and autorotation of the mandible. Careful case analysis and use of segmented models, extractions, and vertical control techniques resulted in a successful correction of the open bite.
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling.
2010 expedited correction of significant dentofacialFouadELSharaby
This case report describes the expedited correction of significant dentofacial asymmetry in a 20-year-old female using a "surgery first" approach. The patient presented with mandibular asymmetry and a Class III malocclusion. Treatment involved asymmetrical mandibular setbacks of 7mm on the left and 3mm on the right combined with a sliding genioplasty. Miniplates were placed for anchorage. Postsurgical orthodontics used the miniplates to distalize the maxillary arch and align the teeth. Treatment time was reduced to 7 months by eliminating presurgical orthodontics and taking advantage of accelerated bone turnover after surgery. The results showed good esthetic and occlusal correction of
This document discusses orthodontics and orthognathic surgery. It describes the typical treatment steps which involve orthodontic decompensation by an orthodontist, analytic model planning, the surgical operation by a maxillofacial surgeon, and case finishing by an orthodontist. Malocclusions associated with significant skeletal discrepancies often require a combination of orthodontics and jaw surgery for correction. Common facial deformities involve anteroposterior disproportion, vertical disproportion, transverse anomalies, and asymmetries. Orthodontic surgery can involve maxillary and mandibular movements to reposition the jaws. Assessment of patients for combined treatment involves comprehensive records and treatment planning.
This document discusses diagnosis and treatment planning for removable partial dentures. It begins by defining key terms like diagnosis, treatment planning, and removable partial denture. It emphasizes the importance of a thorough patient interview and medical/dental history to accurately diagnose issues and develop a treatment plan. The document outlines factors to consider in the patient interview and examining the patient's mouth, teeth and bone. It discusses how various medical conditions and medications can impact treatment and the need to consult physicians in some cases.
Full mouth fixed implant rehabilitation in a patientUE
This case report describes the full mouth rehabilitation of a 37-year old female patient who had lost most of her teeth due to generalized aggressive periodontitis. After extracting all remaining teeth, the patient received 12 dental implants, with 6 placed in each jaw. Fixed detachable prostheses were fabricated connecting all 12 implants. The patient was satisfied with the final result and remained stable at the 10 month follow up, though continuous maintenance care is critical for long term success given the risk of peri-implantitis in patients with periodontal disease.
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling.
2010 expedited correction of significant dentofacialFouadELSharaby
This case report describes the expedited correction of significant dentofacial asymmetry in a 20-year-old female using a "surgery first" approach. The patient presented with mandibular asymmetry and a Class III malocclusion. Treatment involved asymmetrical mandibular setbacks of 7mm on the left and 3mm on the right combined with a sliding genioplasty. Miniplates were placed for anchorage. Postsurgical orthodontics used the miniplates to distalize the maxillary arch and align the teeth. Treatment time was reduced to 7 months by eliminating presurgical orthodontics and taking advantage of accelerated bone turnover after surgery. The results showed good esthetic and occlusal correction of
This document discusses orthodontics and orthognathic surgery. It describes the typical treatment steps which involve orthodontic decompensation by an orthodontist, analytic model planning, the surgical operation by a maxillofacial surgeon, and case finishing by an orthodontist. Malocclusions associated with significant skeletal discrepancies often require a combination of orthodontics and jaw surgery for correction. Common facial deformities involve anteroposterior disproportion, vertical disproportion, transverse anomalies, and asymmetries. Orthodontic surgery can involve maxillary and mandibular movements to reposition the jaws. Assessment of patients for combined treatment involves comprehensive records and treatment planning.
This document discusses diagnosis and treatment planning for removable partial dentures. It begins by defining key terms like diagnosis, treatment planning, and removable partial denture. It emphasizes the importance of a thorough patient interview and medical/dental history to accurately diagnose issues and develop a treatment plan. The document outlines factors to consider in the patient interview and examining the patient's mouth, teeth and bone. It discusses how various medical conditions and medications can impact treatment and the need to consult physicians in some cases.
Full mouth fixed implant rehabilitation in a patientUE
This case report describes the full mouth rehabilitation of a 37-year old female patient who had lost most of her teeth due to generalized aggressive periodontitis. After extracting all remaining teeth, the patient received 12 dental implants, with 6 placed in each jaw. Fixed detachable prostheses were fabricated connecting all 12 implants. The patient was satisfied with the final result and remained stable at the 10 month follow up, though continuous maintenance care is critical for long term success given the risk of peri-implantitis in patients with periodontal disease.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
for online course please visit www.idalectures.com
for online interactive live courses/classes please visit
www.gotolectures.com.
The document describes two tests used by orthodontists to measure progress in treatment - the K test and condylar test. The K test measures vertical overlap of incisors to detect improvements in deep bites. The condylar test measures sagittal movement of the mandible using incisors as reference points, allowing orthodontists to track corrections of Class II malocclusions and prevent mistaken assumptions of full correction. Both tests are important for monitoring progress at each appointment and ensuring treatments are progressing as planned.
The purpose of this article is to review the principles of case management of soft tissue impacted second premolars mandibular and to illustrate their potential to respond well to the treatment. Although the scope of treatment may depend on a varying range of factors, this case report demonstrates the inherent potential for good treatment outcome in cases of soft tissue impactions
This document describes the case of a 16-year-old girl with an impacted mandibular second premolar. The tooth was impacted horizontally near the lingual sulcus and covered by gingiva. Orthodontic treatment using aligners and open coil springs created space. The impacted tooth was then surgically exposed using a closed exposure technique and attached to the archwire using a button and chain. Over months of orthodontic forces, the tooth was moved into position in the dental arch. The document reviews principles of managing impacted second premolars and concludes that with adequate treatment, even severely impacted teeth can erupt into functional occlusion.
This document describes a case report of a 23-year-old male patient who presented with facial asymmetry and flattening of the right side of the face due to childhood temporomandibular joint ankylosis. Treatment involved a two-stage procedure, first using orthognathic surgery (Le Fort I osteotomy) to correct occlusal cant, followed by orthomorphic surgery (extended lateral sliding genioplasty) 6 months later to correct the facial asymmetry and underdevelopment of the mandible. The combination of orthognathic and orthomorphic surgery successfully achieved functional and aesthetic goals by correcting the jaw deviation and restoring facial symmetry.
1) Oral skeletal discrepancies are common in Vietnam and the surgery-first approach has become favored over traditional orthodontics-first treatment.
2) Malocclusions are typically caused by incisor or jaw protrusion and the treatment approach depends on the specific discrepancy - orthodontics for incisors or orthognathic surgery for jaws.
3) Over 1000 orthognathic surgery cases have been performed at JW Korea Hospital using techniques like anterior segmental osteotomies, Le fort I, and BSSO to correct skeletal issues prior to orthodontic treatment.
This document discusses orthognathic surgery decision making, treatment planning, and timing of surgery. It covers collecting patient data, diagnosing issues, cephalometric analysis, developing a treatment plan, and predicting soft tissue changes. Treatment options include orthodontics, dentofacial orthopedics, and orthognathic surgery to correct jaw and facial skeletal issues.
After a complete orthodontic diagnosis is made, the next important step is treatment planning. The main objective of treatment planning is to design a strategy to correct the problems. Good strategy helps to design the best appliance indicated for the patient.
Treatment planning is an outline of all the measures that can best instituted for a patient so as to offer maximum long term benefits.
Patients seeks Orthodontic treatment planning for a variety of reasons, most commonly- Esthetics and Function.
There is no simple or fixed formula or a cook book recipe to treat a Orthodontic problem.
Every case is assessed, analysed and and a customised treatment plan is formulated to best suit the individual patient.
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
This document provides an overview of maxillary and midface osteotomies. It begins with an introduction discussing the history and goals of orthognathic surgery. It then covers various osteotomy techniques including single tooth, anterior maxillary, posterior maxillary, Lefort I, II, and III osteotomies. For each technique, it discusses the relevant history, indications, surgical approach, complications, and advances. It emphasizes the Lefort I osteotomy as the mainstay procedure, covering its evolution, blood supply considerations, rigid fixation approaches, and indications. In summary, the document comprehensively reviews different maxillary osteotomy techniques for orthognathic surgery.
This document summarizes the key aspects and considerations for autogenic dental transplants. It discusses the technique, which involves carefully dissecting rather than extracting the donor tooth and immediately placing it in the prepared recipient site while avoiding damage to the periodontal ligament. Success rates from previous studies ranging from 72-100% are reported. Factors like patient age, root development stage, fixation method, and avoidance of forces for 3-6 months are discussed as important to transplant success and outcomes like revascularization and root growth. Premolars and third molars are considered good candidates due to their dispensability and timing of development. While more common in Scandinavia, the document argues autogenic transplants can be a viable treatment option
This document discusses orthodontic treatment involving molar extractions in three clinical cases.
In the first case, a 44-year-old patient underwent extraction of the remaining three first molars to address crowding and a space resulting from extraction of the upper left first molar. Treatment goals of aligning teeth, establishing symmetry, and correcting midlines were achieved.
The second case describes treatment of a 23-year-old patient by extraction of first molars and premolars in the upper arch, and second molars and premolars in the lower arch. Treatment goals of reducing dental protrusion and establishing a correct occlusion were attained.
The third case discusses treatment of a 33-year-
Full mouth rehabilitation aims to restore the form and function of the masticatory system to as close to normal as possible. It involves restoring multiple teeth that are missing, worn down, broken, or decayed. The document discusses various classifications of patients for full mouth rehabilitation based on the degree of wear and available space. It also covers the objectives of occlusal schemes, philosophies for full mouth rehabilitation including gnathological and Youdelis approaches, and considerations for treatment planning such as examination, diagnosis and dividing treatment into pre-prosthetic, prosthetic and maintenance phases.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
1. There are several methods for predicting surgical outcomes of orthognathic surgery, including manual tracings, computer software programs, and video imaging.
2. Studies have found that current prediction methods tend to be inaccurate, especially in predicting soft tissue changes like lip and chin positions. Predictions often differ from actual outcomes by 2mm or more.
3. While prediction images can help communicate treatment plans to patients, they may also unintentionally create unrealistic expectations that are not always achieved. More accurate prediction methods are still needed.
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
This document summarizes the keynote speech given at an early treatment symposium. The speaker notes that many attendees are there due to a personal interest in early treatment, but questions what the nature of this interest is. He suggests focusing the discussion on asking questions, rather than expecting experts to provide definitive answers. Specifically, he proposes questioning whether early treatment is truly better than late treatment for Class II malocclusions. He argues there is a lack of evidence supporting many claims made about the benefits of early treatment, such as the ability of functional appliances to augment mandibular growth. The speaker concludes there may be occasional benefits to early treatment but not enough to support it as the routine approach without stronger evidence.
This case report describes the treatment of a 14-year-old patient with a skeletal Class II malocclusion, open bite, and canted occlusal plane using miniscrews. Treatment involved rapid maxillary expansion followed by intrusion of the maxillary posterior teeth bilaterally using miniscrews. For the unilateral anterior intrusion needed to correct the cant, two miniscrews were joined and used together. This achieved correction of the occlusal relationship as well as the cant and asymmetric gummy smile.
Fabrication of functional complete dentures for edentulous patients who have undergone hemimandibulectomy is a very arduous and demanding endeavor.
The most challenging situation encountered during this procedure is the deviation of the mandible to the resected side. The deviation of the mandible to the resected side is directly proportional to the loss of tissues in the area hemi-mandibulectomy has been performed.
In cases with Cantor and Curtis classes II, III, IV, and V, guide flange prosthesis would be a treatment modality. For guide flange prosthesis to be effective, the sufficient number of posterior teeth that are periodontally sound should be present in the opposite arch.
In patients where reconstruction is not done after resection of the mandible, scar tissue formation occurs over a period of time that stiffens the tissues and worsens prosthetic rehabilitation, leading to compromised treatment planning.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
for online course please visit www.idalectures.com
for online interactive live courses/classes please visit
www.gotolectures.com.
The document describes two tests used by orthodontists to measure progress in treatment - the K test and condylar test. The K test measures vertical overlap of incisors to detect improvements in deep bites. The condylar test measures sagittal movement of the mandible using incisors as reference points, allowing orthodontists to track corrections of Class II malocclusions and prevent mistaken assumptions of full correction. Both tests are important for monitoring progress at each appointment and ensuring treatments are progressing as planned.
The purpose of this article is to review the principles of case management of soft tissue impacted second premolars mandibular and to illustrate their potential to respond well to the treatment. Although the scope of treatment may depend on a varying range of factors, this case report demonstrates the inherent potential for good treatment outcome in cases of soft tissue impactions
This document describes the case of a 16-year-old girl with an impacted mandibular second premolar. The tooth was impacted horizontally near the lingual sulcus and covered by gingiva. Orthodontic treatment using aligners and open coil springs created space. The impacted tooth was then surgically exposed using a closed exposure technique and attached to the archwire using a button and chain. Over months of orthodontic forces, the tooth was moved into position in the dental arch. The document reviews principles of managing impacted second premolars and concludes that with adequate treatment, even severely impacted teeth can erupt into functional occlusion.
This document describes a case report of a 23-year-old male patient who presented with facial asymmetry and flattening of the right side of the face due to childhood temporomandibular joint ankylosis. Treatment involved a two-stage procedure, first using orthognathic surgery (Le Fort I osteotomy) to correct occlusal cant, followed by orthomorphic surgery (extended lateral sliding genioplasty) 6 months later to correct the facial asymmetry and underdevelopment of the mandible. The combination of orthognathic and orthomorphic surgery successfully achieved functional and aesthetic goals by correcting the jaw deviation and restoring facial symmetry.
1) Oral skeletal discrepancies are common in Vietnam and the surgery-first approach has become favored over traditional orthodontics-first treatment.
2) Malocclusions are typically caused by incisor or jaw protrusion and the treatment approach depends on the specific discrepancy - orthodontics for incisors or orthognathic surgery for jaws.
3) Over 1000 orthognathic surgery cases have been performed at JW Korea Hospital using techniques like anterior segmental osteotomies, Le fort I, and BSSO to correct skeletal issues prior to orthodontic treatment.
This document discusses orthognathic surgery decision making, treatment planning, and timing of surgery. It covers collecting patient data, diagnosing issues, cephalometric analysis, developing a treatment plan, and predicting soft tissue changes. Treatment options include orthodontics, dentofacial orthopedics, and orthognathic surgery to correct jaw and facial skeletal issues.
After a complete orthodontic diagnosis is made, the next important step is treatment planning. The main objective of treatment planning is to design a strategy to correct the problems. Good strategy helps to design the best appliance indicated for the patient.
Treatment planning is an outline of all the measures that can best instituted for a patient so as to offer maximum long term benefits.
Patients seeks Orthodontic treatment planning for a variety of reasons, most commonly- Esthetics and Function.
There is no simple or fixed formula or a cook book recipe to treat a Orthodontic problem.
Every case is assessed, analysed and and a customised treatment plan is formulated to best suit the individual patient.
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
This document provides an overview of maxillary and midface osteotomies. It begins with an introduction discussing the history and goals of orthognathic surgery. It then covers various osteotomy techniques including single tooth, anterior maxillary, posterior maxillary, Lefort I, II, and III osteotomies. For each technique, it discusses the relevant history, indications, surgical approach, complications, and advances. It emphasizes the Lefort I osteotomy as the mainstay procedure, covering its evolution, blood supply considerations, rigid fixation approaches, and indications. In summary, the document comprehensively reviews different maxillary osteotomy techniques for orthognathic surgery.
This document summarizes the key aspects and considerations for autogenic dental transplants. It discusses the technique, which involves carefully dissecting rather than extracting the donor tooth and immediately placing it in the prepared recipient site while avoiding damage to the periodontal ligament. Success rates from previous studies ranging from 72-100% are reported. Factors like patient age, root development stage, fixation method, and avoidance of forces for 3-6 months are discussed as important to transplant success and outcomes like revascularization and root growth. Premolars and third molars are considered good candidates due to their dispensability and timing of development. While more common in Scandinavia, the document argues autogenic transplants can be a viable treatment option
This document discusses orthodontic treatment involving molar extractions in three clinical cases.
In the first case, a 44-year-old patient underwent extraction of the remaining three first molars to address crowding and a space resulting from extraction of the upper left first molar. Treatment goals of aligning teeth, establishing symmetry, and correcting midlines were achieved.
The second case describes treatment of a 23-year-old patient by extraction of first molars and premolars in the upper arch, and second molars and premolars in the lower arch. Treatment goals of reducing dental protrusion and establishing a correct occlusion were attained.
The third case discusses treatment of a 33-year-
Full mouth rehabilitation aims to restore the form and function of the masticatory system to as close to normal as possible. It involves restoring multiple teeth that are missing, worn down, broken, or decayed. The document discusses various classifications of patients for full mouth rehabilitation based on the degree of wear and available space. It also covers the objectives of occlusal schemes, philosophies for full mouth rehabilitation including gnathological and Youdelis approaches, and considerations for treatment planning such as examination, diagnosis and dividing treatment into pre-prosthetic, prosthetic and maintenance phases.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
1. There are several methods for predicting surgical outcomes of orthognathic surgery, including manual tracings, computer software programs, and video imaging.
2. Studies have found that current prediction methods tend to be inaccurate, especially in predicting soft tissue changes like lip and chin positions. Predictions often differ from actual outcomes by 2mm or more.
3. While prediction images can help communicate treatment plans to patients, they may also unintentionally create unrealistic expectations that are not always achieved. More accurate prediction methods are still needed.
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
This document summarizes the keynote speech given at an early treatment symposium. The speaker notes that many attendees are there due to a personal interest in early treatment, but questions what the nature of this interest is. He suggests focusing the discussion on asking questions, rather than expecting experts to provide definitive answers. Specifically, he proposes questioning whether early treatment is truly better than late treatment for Class II malocclusions. He argues there is a lack of evidence supporting many claims made about the benefits of early treatment, such as the ability of functional appliances to augment mandibular growth. The speaker concludes there may be occasional benefits to early treatment but not enough to support it as the routine approach without stronger evidence.
This case report describes the treatment of a 14-year-old patient with a skeletal Class II malocclusion, open bite, and canted occlusal plane using miniscrews. Treatment involved rapid maxillary expansion followed by intrusion of the maxillary posterior teeth bilaterally using miniscrews. For the unilateral anterior intrusion needed to correct the cant, two miniscrews were joined and used together. This achieved correction of the occlusal relationship as well as the cant and asymmetric gummy smile.
Fabrication of functional complete dentures for edentulous patients who have undergone hemimandibulectomy is a very arduous and demanding endeavor.
The most challenging situation encountered during this procedure is the deviation of the mandible to the resected side. The deviation of the mandible to the resected side is directly proportional to the loss of tissues in the area hemi-mandibulectomy has been performed.
In cases with Cantor and Curtis classes II, III, IV, and V, guide flange prosthesis would be a treatment modality. For guide flange prosthesis to be effective, the sufficient number of posterior teeth that are periodontally sound should be present in the opposite arch.
In patients where reconstruction is not done after resection of the mandible, scar tissue formation occurs over a period of time that stiffens the tissues and worsens prosthetic rehabilitation, leading to compromised treatment planning.
Two Way Approach For Enucleation Of Maxillary Radicular Cyst.iosrjce
This document describes a case study of a 39-year-old male patient who presented with pain and swelling in the left upper back tooth region. Clinical and radiographic examination revealed a large radicular cyst extending from the upper left canine to third molar region. The cyst was initially enucleated through an intraoral approach. Later, a functional endoscopic sinus surgery was performed through the maxillary antrum to inspect for any residual cyst lining, since the patient also had a deviated nasal septum requiring septoplasty. No residual cyst was observed during endoscopy. This case report demonstrates that large maxillary radicular cysts can be effectively treated through both conventional intraoral enucleation and an end
Multidisciplinary Approach in the Rehabilitation of Congenitally Maxillary C...Abu-Hussein Muhamad
Objective: This case report describes the multidisciplinary
approach to treat a congenitally missed maxillary canine, how to
improve patient’s smile using orthodontic fixed appliance, endosseous
dental implant, and porcelain veneer to achieve the treatment results of
function and esthetic.
Materials and procedures: Unilateral agenesis of the permanent
maxillary canines in healthy individuals is extremely rare. This
paper presents the case of a female patient diagnosed with congenital
unilateral agenesis of the permanent maxillary canines as well as
occlusal abnormalities in the form of left-side crossbite. To restore the
proper aesthetics and function, interdisciplinary therapeutic treatment
was implemented. In the case presented in this paper, the aim of
oral rehabilitation was to restore a functional balance by obtaining
proper skeletal relationships, creating optimal occlusal conditions and
obtaining arch continuity.
Conclusion: Interdisciplinary treatment combined of orthodontics,
implant surgery, and prosthodontics was useful to treat a nonsyndromic
oligodontia patient. Especially, with the new strategy, implantanchored
orthodontics, which can facilitate the treatmentand make it
more simply with greater predictability.
1. The document discusses the management of implant placement in sites with cysts, comparing cyst treatment with marsupialization versus enucleation.
2. A case study describes using decompression for 6 months followed by enucleation of a large dentigerous cyst, with adequate bone regeneration 18 months later to allow placement of two dental implants.
3. The document provides several case studies of implant placement after cyst treatment, finding it can be a predictable treatment to replace teeth when grafting is not needed due to adequate bone regeneration.
This case report describes the replacement of congenitally missing bilateral maxillary lateral incisors and a right mandibular premolar with dental implants in a 22-year old female patient. The treatment involved first extracting retained primary canines and using orthodontics to gain space between teeth for implant placement. Implants were then surgically placed and allowed to heal, followed by the placement of abutments and final prosthesis. The treatment achieved excellent esthetic and functional results through an interdisciplinary approach between orthodontics, periodontics, and prosthodontics.
Modern Treatment for Congenitally Missing Teeth : A Multidisciplinary Appro...Abu-Hussein Muhamad
The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisors using dental implants. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics
Anterior openbite diagnosis and managment (oral surgery)dentalcare3
1. The document discusses the diagnosis and treatment of anterior open bite malocclusion. It defines anterior open bite and lists its causes such as skeletal, dental, soft tissue, and habits.
2. Treatment depends on the cause and age of the patient, and can include appliances, headgear, fixed appliances, extractions, and sometimes surgery. For growing patients, habit correction and arch expansion may work.
3. In skeletally mature patients, open bite can be corrected orthodontically by extruding incisors, intruding molars, and expanding the maxilla. Stability is a concern and compromise of facial aesthetics is possible.
4. Surgical options are discussed for cases involving
This document describes the orthodontic treatment of a 31-year-old female patient with a gummy smile. To correct the gummy smile, the orthodontist intruded the entire maxillary dentition rather than just the anterior teeth. A midpalatal absolute anchorage system and modified lingual arch were used to achieve posterosuperior movement of the maxillary dentition over 18 months. This corrected the gummy smile and crowding. Follow-up after 21 months showed the results were stable despite the patient not wearing a maxillary retainer as prescribed.
full mouth rehabilitation of partially and fully edentulous patient with crow...Merenguita
This case report describes the full mouth rehabilitation of a patient with short clinical crowns in the mandibular anterior teeth and edentulous maxilla. A thorough examination including diagnostic wax-up determined 2mm of additional crown length was needed via crown lengthening surgery. Single crowns were placed on the anterior teeth along with a maxillary complete denture and mandibular removable partial denture with a lingual plate. The treatment aimed to prevent extrusion of the anterior teeth and reduce forces on the maxilla to avoid combination syndrome. A 4 month recall found healthy gingiva and the patient was satisfied with function and esthetics.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Treatment concept by Watted for a controlled alignment of palatally impacted ...Abu-Hussein Muhamad
It is known that maxillary canines remain impacted more often than the mandibular canines, and the inclusion can be
buccal or palatal. The treatment focuses mainly on the exposure and on the orthodontic realignment of the impacted
tooth. There are situations when canines erupt spontaneously after their surgical discovery. The present paper has the
purpose of approaching aspects related to impacted upper permanent canines by a literature review, including
localization and treatment conducts.
Key words: Impacted canine, periodontal, surgical-orthodontic treatment.
1) The document discusses different types of scissor bites (malocclusions where the maxillary teeth are positioned buccal to the mandibular teeth), including definitions, classifications, causes, and treatment options.
2) Scissor bites can be caused by factors like microglossia, abnormal tooth germ position, and skeletal Class II issues. Treatment depends on a patient's age and severity of the scissor bite, ranging from removable appliances to orthodontic devices to orthognathic surgery.
3) The document presents several case studies as examples. One case discusses using a bonded constriction quad-helix appliance to reduce the maxillary arch width in a growing patient with a bilateral scissor
Treatment of gingival recession using coronally advanced flapShruti Maroo
This document describes a case study evaluating the efficacy of the coronally advanced flap technique for treating gingival recession. A 27-year old male patient presented with Miller's Class I gingival recession on teeth 22 and 23, along with sensitivity. The coronally advanced flap procedure was performed, involving incisions and elevation of a partial-thickness flap. One month and three months post-operatively, the patient showed uneventful healing and 100% root coverage, with reduction in sensitivity and no probing defects. The coronally advanced flap technique alone can successfully treat gingival recession when residual gingiva is thick and wide, resulting in good esthetic and functional outcomes.
Change in the Vertical Ralation in Class II Deformity with Skeletal Open Bite...Abu-Hussein Muhamad
This document summarizes the treatment of a 21-year-old female patient who presented with a Class II deformity, open bite, and long lower face. The treatment plan involved a combined orthodontic-surgical approach including:
1. Presurgical orthodontics to align the teeth and prepare for surgery.
2. Orthognathic surgery consisting of a LeFort I osteotomy to impact the maxilla 4mm dorsally and 2mm ventrally, and a sagittal split osteotomy to advance the mandible 6mm on the right and 2mm on the left with 4.5mm left shift.
3. Postsurgical orthodontics to settle the occlusion, followed by
Diagnosis and conservative treatment of skeletaldentalid
A man, aged 28 years 9 months, came for an orthodontic consultation for a skeletal Class III malocclusion
(ANB angle, 3) with a modest asymmetric Class II and Class III molar relationship, complicated by an anterior
crossbite, a deepbite, and 12 mm of asymmetric maxillary crowding. Despite the severity of the malocclusion
(Discrepancy Index, 37), the patient desired noninvasive camouflage treatment. The 3-Ring diagnosis showed
that treatment without extractions or orthognathic surgery was a viable approach. Arch length analysis indicated
that differential interproximal enamel reduction could resolve the crowding and midline discrepancy, but a
miniscrew in the infrazygomatic crest was needed to retract the right buccal segment. The patient accepted
the complex, staged treatment plan with the understanding that it would require about 3.5 years. Fixed appliance
treatment with passive self-ligating brackets, early light short elastics, bite turbos, interproximal enamel
reduction, and infrazygomatic crest retraction opened the vertical dimension of the occlusion, improved the
ANB angle by 2, and achieved excellent alignment, as evidenced by a Cast Radiograph Evaluation score of
28 and a Pink and White dental esthetic score of 3. (
This document describes a case of a patient with microstomia (reduced oral aperture) due to extensive post-surgical facial scarring. Standard impression techniques could not be used due to the small mouth opening. The dentists innovatively used impression compound on an articulator bite fork to create a preliminary impression, allowing for complete denture construction. The patient was ultimately satisfied with the functional and aesthetic outcome, though she continues to experience recurring skin cancers. The technique of using a bite fork with compound is recommended for similar microstomia cases where small stock trays do not fit.
Temporary Splinting in secondary trauma from occlusion followed by vestibular...dbpublications
Background: A 27 year old female patient presented with the chief complaint of pain and mobility in mandibular anterior teeth. An extremely shallow vestibule with less width of attached gingiva was observed with marginal gingival recession in 31, 32 and 41. Secondary trauma from occlusion was observed clinically with respect to 31. Methods: After adequate oral prophylaxis, the trauma from occlusion on 31 was relieved by selective grinding. The mobile mandibular anterior teeth were splinted with a temporary splint material (26 gauge stainless steel wire). The mandibular labial vestibule was extended using the lip switch procedure or the Edlan-Mejchar technique. Results: The procedure yielded a considerable gain in the width of the attached gingiva, which maintained itself even 9 months after the surgical procedure. Mobility was reduced with complete resolution of injury to the supporting tissues leading to improved function of the mandibular anterior teeth. Conclusion: Patients presenting with secondary trauma from occlusion and a shallow vestibule, treatment options such as oral prophylaxis, selective grinding, splinting combined with Edlan-Mejchar technique leads to complete resolution of mobility along with maintenance of the width of the attached gingival for a considerable period of time.
2007 daher tratamiento no quirurgico en un adulto con clase iiimarangelroque
This case report describes the nonsurgical treatment of a 43-year-old man with a Class III malocclusion. Treatment options included orthognathic surgery, nonextraction treatment, premolar extractions, and mandibular incisor extraction. The patient opted for nonsurgical treatment, which included maxillary expansion and extraction of a mandibular central incisor. Over 2 years of treatment with braces and a facemask, the crossbite was corrected and a good occlusion with normal overjet and overbite was achieved through advancement of the maxilla and retraction of the mandibular incisors.
2007 daher tratamiento no quirurgico en un adulto con clase iiimarangelroque
This case report describes the nonsurgical treatment of a 43-year-old man with a Class III malocclusion and crossbite. Treatment options included orthognathic surgery, nonextraction treatment, premolar extractions, and mandibular incisor extraction. The patient opted for nonsurgical treatment, which included maxillary expansion and extraction of a mandibular central incisor. Over 2 years of treatment with braces and a facemask, the crossbite was corrected and a good occlusion was achieved without the need for surgery.
El objetivo de este curso es presentar al profesional formas prácticas y actuales del tratamiento ortodóncico mediante la prescripción Face que incorpora los avances de los estudios tomográficos de Cone Beam referente a la calidad y cantidad del hueso alveolar y las tablas óseas
Dictantes: Drs. Jorge Ayala, Pedro Córdova, Rodolfo de la Flor, Iván Naccha Fecha: Lunes 23 y Martes 24 de Julio del 2018
Lugar: Centro de Convenciones Real Audiencia
Dirección: Avenida Del Parque Nor te 1194 San Borja. Lima PERÚ Horarios:
Lunes de 8.00 a 13.00 y de 3.00 a 7.00
Martes de 8.30 a 13.00
El documento detalla la biografía académica y profesional del Dr. Santiago Quijano, incluyendo sus estudios de posgrado en endodoncia y membresía en sociedades odontológicas. También anuncia una conferencia del Dr. Quijano el 19 de mayo sobre el sistema MTWO de endodoncia rotatoria simplificada y eficiente.
La terapia pulpar en dientes deciduos siempre es un desafio, tanto para los pacientes como para el dentista. la aplicacion de la nueva tecnología hace que los tratamientos sean mas rapidos, eficientes y predecibles, la cual garantiza el éxito y pronóstico de los mismos.
La Dra. Shereen Awuapara es Mg. en Ortodoncia y especialista en Odontopediatría. Cuenta con amplia experiencia y evidencia científica utilizando aparatos de protracción. En su próximo taller ampliará nuestra visión con respecto al uso del dispositivo BBC y las ventajas del mismo, con el objetivo de mejorar nuestra práctica clínica.
Este documento describe el caso de Juan José, quien recibió 9 meses de tratamiento ortodóncico para corregir una desviación dental superior de 44 grados e inferior de 60 grados, logrando al final del tratamiento correcciones a 58 y 67 grados respectivamente.
Este documento anuncia un curso de dos días sobre detalle y finalización en ortodoncia que se llevará a cabo los días 21 y 22 de mayo en Lima, Perú. La instructora será la Dra. Carol Weinstein Kron, cirujano dentista y ortodoncista con experiencia en Chile y Estados Unidos. El curso cubrirá varios temas relacionados con la finalización del tratamiento ortodóncico incluyendo factores de diseño del tratamiento, uso de brackets, elásticos y alineadores, y ajuste oclusal
FORESATDENT® le da la más cordial bienvenida a este 3er. Meeting
FORESTADENT® América Latina a realizarse en México el cual ha sido
diseñado pensando en usted y su práctica clínica.
FORESTADENT® es una empresa alemana con más de 100 años
de experiencia en la fabricación de productos de alta precisión;
comprometida no tan solo con la calidad de nuestros productos, sino
también con usted y sobre todo con un “actor” fundamental en esta
fascinante historia, el paciente.
Los temas abordados en este magno evento se dividen en dos partes:
Por un lado, el reconocido Doctor Richard McLaughlin (USA) nos explica
por medio de su experiencia clínica que su misión ha sido crear
siempre un sistema de tratamiento “ideal”. McLaughlin Bennett 5.0 es la
última versión de dicho sistema y el cual se describe en su último libro,
“Fundamentos de la mecánica del tratamiento ortodóncico”.
Por otro lado nos acompaña también el reconocido Doctor Hugo Trevisi
(Brasil) quien nos hablará de la armonía facial y oclusión funcional. El
hecho de lograr un resultado ortodóncico con armonía facial y buena
oclusión funcional depende del diagnóstico, plan de tratamiento,
posicionamiento de brackets y la prescripción del aparato ortodóncico
Sabemos lo importante que es marcar la diferencia de su consultorio
frente al universo de los tantos que se encuentran a su alrededor, por
tal razón hemos pensado en incluir 4 temas adicionales como son:
„Ortodoncia Lingual 2D: Una pequeña herramienta de grandes
alcances“ a cargo de la Doctora Lina Ma. Quintero (Colombia); „Sistema
Ortho Easy PRO para anclaje cortical” a cargo del Doctor Patrick
Borbely (Venezuela); „Doble arco, fuerzas ligeras” a cargo del Doctor
Luis Pablo Cruz (México) y “ORTOMARKETING - Conquiste el corazón de
sus pacientes y deje de bajar precios” por cuenta del Lic. Federico Orozco
(México - Alemania).
Una vez más, sea bienvenido a la familia FORESTADENT®.
Afectuosamente
El equipo Internacional de FORESTADENT
El Dr. Renzo Nazario ofrecerá un curso sobre retratamiento endodóntico con Reciproc el lunes 19 de marzo de 9:00 am a 1:00 pm en la sala de conferencias Dentoshop. El costo es de 300 soles e incluye obsequios. El Dr. Nazario es especialista en endodoncia con estudios en varias universidades. Los interesados pueden inscribirse contactando a Dentoshop.
Complete Clinical Orthodontics (CCO) es el más moderno sistema de arco recto que reúne lo mejor de las diferentes prescripciones para lograr un resultado único con eficiencia, calidad y consistencia. Integra lo mejor del arco recto usando brackets de autoligado y maximizando las propiedades de los alambres termodinámicos.
El Ortodoncista a través de mecánicas muy simples, precisas y efectivas es capaz de resolver los diferentes tipos de maloclusión con los mejores resultados posibles.
Ofertas de Navidad válidas del 15 de noviembre al 15 de enero del 2018, incluyendo tubos Balance Adherir para ortodoncia a precio reducido de S/. 40.43. El próximo curso será el 4 de diciembre, Día de la Odontología Peruana, donde se podrá llevar todo a buen precio.
Algunas cosas llegan a nuestra especialidad y son pasajeras, otras realmente llegan para establecer filosofías que perdurarán en el tiempo; es el caso de la cinemática reciprocante.
Conoce más del sistema #RECIPROC
Invitamos a toda la comunidad odontológica a participar en el 1er Reencuentro de Estudiantes de Ortodoncia en Sistema CCO.
Expositor invitado: Luis Nelson Núñez - Uruguay
Lugar: Auditorio de la Universidad San Martín de Porres - Santa Anita.
Agradecemos a todas las universidades que eligieron a CCO como sus sistema de autoligado.
Gracias al auspicio de: Dentsply Sirona Orthodontic, GCare, USMP.
FACE la evolución de la Filosofía Roth incorporando los últimos avances científicos, que en estos últimos años han permitido realizar tratamientos en forma más biológica en beneficio de nuestros pacientes, mejorando así la labor del ortodoncista.
Curso donde el participante aplicará y usará los mini-implantes de anclaje temporal.
La biomecánica se realizará con mini- implantes en tipotronics. Usted tendrá la ventaja de simular todos los movimientos que suceden en la boca.
Curso - Taller: “Determinación de la Longitud de Trabajo en Endodoncia”
. Evaluación radiográfica y tridimensional del tercio apical.
. Protocolo para la determinación radiográfica de la longitud de trabajo.
. Protocolo para el uso de localizados electrónicos para determinar la longitud de trabajo.
More from DENTOSHOP - La Tienda del Profesional Dental en Perú (20)
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. Weinstein, et al.: Open bite case report
146 APOS Trends in Orthodontics | Volume 7 | Issue 3 | May-June 2017
the mandible was in an accommodated position which was
“hiding” a severe open bite.
Case Report
A 13‑year‑old female presented with a chief complaint of
continuing treatment. She had had early treatment with palatal
expansion in our practice. She presented [Figures 1 and 2] with
Class I skeletal pattern [Figures 3-6]. Slight facial asymmetry
with larger right side than left side, Class II molar relationship
on the right side, and Class I on the left side (due to segment
migration). There was 3 mm of midline discrepancy: upper
midline deviated 1 mm to the right and lower midline deviated
2 mm to the left. There was biprotrusion of upper and lower
incisors. She had 1 mm overbite and 5 mm overjet in initial
mounted casts [Figure 7], slight crowding 2 mm in the upper
and 2 mm in the lower arch, right temporomandibular joint
with opening click, and lateral movements with group function
and balancing interferences.
Figure 1: Pretreatment photos
Figure 2: Pretreatment photos
Figure 3: Pretreatment panoramic film
Figure 4: Pretreatment lateral cephalogram
Figure 5: Anteroposterior cephalogram Figure 6: Pretreatment cone beam temporomandibular joints
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A magnetic resonance imaging was requested which
revealed right disc displacement with reduction. The
image of the right condyle presented with irregular and flat
surface compatible with degenerative joint disease. Models
were mounted in a Panadent articulator and the mandible
was shifted to a backward and more open position with
first tooth contact in right second molars.
Treatment objectives
Splint therapy was suggested to stabilize mandibular
position [Figure 8]. After 5 months, new records were taken
to reevaluate the case. The new mounting revealed open
bite from second molar to second molar [Figures 9-12].
Segmented casts were used to evaluate whether the open
bite could be closed orthodontically achieving an occlusion
with appropriate overbite and overjet.
Treatment alternatives
A visual treatment objective was prepared with four first
bicuspid extractions [Figure 13]. Space closure was planned
with medium anchorage to reduce incisor biprotrusion and
help bite closure, by moving molars forward and closing
Figure 7: Initial mounted casts
Figure 8: Full‑coverage splint
Figure 9: Bite change after 3 months of splint therapy Figure 10: Lateral cephalogram after splint therapy
Figure 11: Ricketts cephalometric analysis Figure 12: Jarabak and soft‑tissue cephalometric analysis
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148 APOS Trends in Orthodontics | Volume 7 | Issue 3 | May-June 2017
the wedge, as part of a vertical control strategy.[9‑11]
Intrusion of upper molars, with transpalatal arches, was also
planned to close the open bite by generating mandibular
autorotation and counterclockwise closure of the mandible.
Further extractions and skeletal anchorage were left for
future evaluation. A nonextraction plan was discarded
as a possibility since it would have increased incisor
proclination and would not help for bite closure.
Treatment progress
Once extractions of all first bicuspids were made, fixed self-
ligated appliances were cemented. GAC, Complete Clinical
Orthodontics prescription was used [Figure 14]. The case began
Figure 13: Visual treatment objective with four bicuspid extractions
Figure 14: Fixed appliances, complete clinical orthodontics prescription
0.014 lower heat activated nitinol wire, upper arch with closed coil to center
midlines during alignment
Figure 15: Midlines almost centered during leveling and aligning phase.
Anterior segment tied as a unit
Figure 16: Midline correction during alignment
Figure 17: Lower stainless steel in upper arch 0.019 × 0.025 for width
coordination. Remanent extraction space: 4, 5 mm left and 2 mm right.
Lower space closure with sliding mechanics. Transpalatal arch for intrusion
Figure 18: Progressive mounting with segmented casts
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5. Weinstein, et al.: Open bite case report
APOS Trends in Orthodontics | Volume 7 | Issue 3 | May-June 2017 149
by leveling and aligning the arches with 0.014 heat activated
nitinol wires. Closed coils were placed to help midline
correction simultaneously with tooth alignment [Figures 15
and 16]. Archwire sequence included 0.020 × 0.020 heat
activated NiTi, stainless steel 0.021 × 0.025 in the lower arch
and 0.019 × 0.025 in the upper arch [Figure 17]. Transpalatal
arches were used in the upper first and second molars. Sliding
mechanics with lower coils activated to the lower first molar
were used to close residual space in the lower arch.
After 9 months of active treatment, progress records were
taken [Figure 18]. The case was remounted with segmented
models. At this point, lower spaces were closed and the
open bite was still present. Arbitrary marks were made in
the upper and lower casts at the level of the second molars.
Figure 19: (a) Distance between two arbitrary dots in upper and lower casts,
without tooth contact in posterior teeth. (b) Distance between two arbitrary
dots with first molar contact
Figure 20: Upper second molar extractions, segmented upper arch, mini
screws placement and activation
Figure 21: Intrusion of posterior segment. Retrusion of anterior segment
using temporary anchorage devices
Figure 22: Vertical control
Figure 23: Progressive mounting for detail and finish stage
Figure 24: Right upper 5I was repositioned, lower stripping to help upper
space closure triangular elastics
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150 APOS Trends in Orthodontics | Volume 7 | Issue 3 | May-June 2017
A right and left vertical measurement was recorded on
each side between the upper and lower reference. Posterior
teeth were then removed [Figure 19] from the pinned
models and the same measurements between the upper
and lower arbitrary marks were recorded a second time.
Interestingly, the bite closed after removing the back teeth
showed an adequate overjet and overbite relationship of
the front teeth. By performing this diagnostic exercise, it
was concluded that the patient presented an open bite that
could be corrected orthodontically, since it required 3 mm
of intrusion of the back teeth. This movement is a feasible
task that can be attempted with orthodontic mechanics. As
stated by Proffit,[12,13]
it is within the envelopes of possible
orthodontic correction.
Since the patient presented with upper third molars, it was
decided to remove upper second molars [Figure 20] in order
to avoid having to do intrusion mechanics of these teeth.
TADs were placed in the upper arch, in a buccal and palatal
position, to intrude first molars and second premolars.
The upper arch was segmented and the posterior section
was loaded with the miniscrews.[14]
In addition, the upper
anterior segment was retracted using the TADs [Figure 21].
Lower teeth had stripping to improve the overbite.
Treatment results
Once spaces were closed and the desired intrusion was
obtained [Figure 22]; continuous mechanics were resumed
as part of the detail and finishing stage [Figure 23]. Brackets
Figure 25: Stripping of lower incisors to close black triangles. Lower c‑chain Figure 26: Appliance removal
Figure 27: Retainer placement with rap around arch. Note occlusal stop in
mandibular arch to avoid extrusion in second molar area Figure 28: Final panoramic film
Figure 29: Final lateral cephalogram
Figure 30: Frontal and overjet photographs (a) Pretreatment. (b) After
splint. (c) Posttreatment
c
b
a
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were repositioned in the premolars and some posterior
stripping was made to correct tooth size discrepancies of
second upper and lower premolars [Figure 24]. Occlusal
adjustment and elastics were also used as part of the
detailing strategies [Figure 25]. The case was debonded
after 2 years of active orthodontic therapy [Figures 26-29].
Discussion
To select the correct open bite treatment strategy for this
case, segmented models played a significant role. Pinned
models were the diagnostic tool that indicated the feasibility
of treating this case with orthodontic mechanics avoiding
Figure 35: Right profile (a) Pretreatment. (b) After splint. (c) Posttreatment
cba
Figure 36: Lateral cephalogram (a) Pretreatment. (b) After splint. (c)
Posttreatment
cba
Figure 34: Upper and lower occlusal photographs. (a) Pretreatment.
(b) Posttreatment
ba
Figure 32: Lateral photographs (a) Pretreatment. (b) After splint.
(c) Posttreatment
c
b
a
Figure 31: Frontal view casts (a) Pretreatment. (b) After splint.
(c) Posttreatment
c
b
a
Figure 33: Lateral view casts (a) Pretreatment. (b) After splint.
(c) Posttreatment
c
b
a
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152 APOS Trends in Orthodontics | Volume 7 | Issue 3 | May-June 2017
the patient having to undergo an orthognathic surgery
procedure. Pinned models as used in restorative dentistry
are an extremely valuable tool to assure offering realistic
expectations and mechanical strategies to the patient. In this
particular case, the strategy to accomplish a 3 mm [Figure 19]
decrease in posterior vertical dimension was a combination
of second molar extractions and the use of TADs to intrude
molars and premolars[15,16]
in combination. If pinned models
would have revealed that 8 mm of intrusion were required
to close the patient’s open bite, orthognathic surgery would
have been our suggestion to correct the case.[17]
The second molar extraction treatment is also considered
an effective alternative for open bite closure.[18]
However,
it has the inconvenience that third molars not always erupt
next to the first molars, and therefore, sometimes, minor
Figure 38: Superimposition of pretreatment and after splint tracing: Facial
axis opens
Figure 37: Superimposition of pretreatment and final tracing: Facial axis
is maintained
Figure 39: Superimposition of after splint and final tracing: Facial axis
closes
Figure 40: Analysis of facial axis changes when comparing different
mandibular positions
Figure 41: Superimposition areas between after splint and final tracings
Figure 42: Six‑month follow‑up
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APOS Trends in Orthodontics | Volume 7 | Issue 3 | May-June 2017 153
orthodontics is required to bring them into position.[19,20]
Timing is also an issue since third molars might not be
erupted by the time active therapy is finished.[21]
In this
case, at the time of appliance removal, precaution had to
be taken in the lower retainer design to place a stop in the
occlusal surface of the second molars to avoid extrusion
due to a lack of tooth contact with the upper arch.
Superimposition analysis: When comparing the tracings, it
can be observed that the patient presented with ideal upper
exposure at rest and therefore her case had to be assessed
with posterior intrusion rather that anterior extrusion.
Comparison between initial and final lateral cephalometric
clearly shows a significant improvement of lower incisor
position [Figure 36]. After mandibular autorotation, the
lower incisor coupled better with the upper and the incisal
edge became closer to upper stomion. As stated by Ayala
and Gutiérrez, this is a key factor in improving facial
profile as wells as upper and lower lip contour.[8,22]
The final mounting shows a successful open bite closure
with stable mandibular position. A careful comparison
of before and after records needs to be made in order to
adequately quantify the changes [Figure 30-35]. In the
cephalometric analysis, to evidence the real modification,
it is very important to compare the final result to the
postsplint position of the mandible. When superimposing
the initial records of the patient with the final records, we
can observe that the facial axis was maintained [Figure
37]. However, the whole key in this case is that the patient
was initially in an accommodated position of her mandible
that was evidenced by the use of split therapy before
her orthodontic treatment [Figure 38]. When comparing
the postsplint open bite with the final treatment tracing
[Figure 39], it is evident that the mandible autorrotated
[Figures 40 and 41]. The vertical dimension was controlled
and the facial axis was closed.
Conclusion
Thorough case workup is needed to provide patients with a
successful treatment for open bite cases. This case was treated
orthodontically with four bicuspid and upper second molar
extractions as well as vertical control with TADs [Figure 42].
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The
patients understand that their names and initials will not
be published and due efforts will be made to conceal their
identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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