Inadequate presurgical orthodontics fo different surgical casesMaherFouda1
1. Inadequate pre-orthodontic planning in surgical orthodontic cases can lead to unfavorable outcomes or complications.
2. It is critical for the orthodontist and surgeon to agree on the diagnosis, treatment goals, and plan before beginning treatment to ensure success.
3. Common errors include complications related to treatment planning, inadequate dental decompensation, appliances, and postsurgical care that can result in increased treatment time or need to change the surgical plan. Careful coordination between the orthodontist and surgeon is important.
This study evaluated 14 cases of autogenous maxillary canine transplantation in young patients. Impacted or partially erupted maxillary canines were extracted and immediately transplanted to prepared recipient sites. Two years later, 12 cases showed normal mobility and lamina dura formation on radiographs, indicating successful transplantation. Two cases showed inflammatory resorption, increased mobility, and widening of the periodontal space, indicating unsuccessful transplantation. Autotransplantation of impacted or partially erupted maxillary canines can be a viable alternative to other treatments like orthodontics or dental implants when patient selection criteria are met and proper surgical technique is followed.
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.
This document discusses the Sendai surgery-first (SF) protocol for treating orthognathic cases. It begins by outlining the 15 steps of the Sendai SF protocol, focusing on the first 4 major steps: 1) Diagnosis and establishing treatment goals, 2) Model surgery to simulate surgical movements, 3) Surgery to reposition the jaws, and 4) Immediate postsurgical orthodontics using temporary anchorage devices. It then provides a detailed example of a 37-year-old female patient treated with the Sendai SF protocol, including her initial presentation, cephalometric analysis, treatment goals of mandibular setback and decompensation, model surgery simulation, and surgical splint fabrication.
JOURNAL CLUB PRESENTATION IN PROSTHODONTICS ON FEEDING APPLIANCES USED IN CLE...NAMITHA ANAND
This document describes a case report of fabricating a modified feeding plate for a newborn infant with cleft palate. A traditional feeding plate can injure soft tissues due to rigidity. The presented case fabricated a plate with a soft, flexible bulb covering the cleft palate to allow synchronized movement and prevent irritation. The plate helped the infant feed adequately and gain weight normally until surgical correction could be performed. Adjustments were made regularly to the border to allow dental arch growth without interference.
- There is no good evidence that orthodontics causes or cures temporomandibular joint dysfunction. Extracting teeth for orthodontic reasons does not inevitably alter a patient's facial profile. Better quality research is still needed in many controversial areas of orthodontics.
The document discusses how the different dental specialties can collaborate to provide treatment for complex dental cases. It provides several examples:
1. Orthodontics can work with other specialties to treat missing teeth through space closure or opening, depending on factors like buccal occlusion and tooth shape.
2. Traumatized or fractured teeth may require orthodontic extrusion before restorative treatment, and tooth transplantation is sometimes used to replace front teeth.
3. Periodontal problems causing tooth drifting can be addressed through orthodontic realignment once disease is controlled.
4. Orthodontics can be used to improve occlusion and eliminate non-working side interferences, and may close anterior
Inadequate presurgical orthodontics fo different surgical casesMaherFouda1
1. Inadequate pre-orthodontic planning in surgical orthodontic cases can lead to unfavorable outcomes or complications.
2. It is critical for the orthodontist and surgeon to agree on the diagnosis, treatment goals, and plan before beginning treatment to ensure success.
3. Common errors include complications related to treatment planning, inadequate dental decompensation, appliances, and postsurgical care that can result in increased treatment time or need to change the surgical plan. Careful coordination between the orthodontist and surgeon is important.
This study evaluated 14 cases of autogenous maxillary canine transplantation in young patients. Impacted or partially erupted maxillary canines were extracted and immediately transplanted to prepared recipient sites. Two years later, 12 cases showed normal mobility and lamina dura formation on radiographs, indicating successful transplantation. Two cases showed inflammatory resorption, increased mobility, and widening of the periodontal space, indicating unsuccessful transplantation. Autotransplantation of impacted or partially erupted maxillary canines can be a viable alternative to other treatments like orthodontics or dental implants when patient selection criteria are met and proper surgical technique is followed.
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.
This document discusses the Sendai surgery-first (SF) protocol for treating orthognathic cases. It begins by outlining the 15 steps of the Sendai SF protocol, focusing on the first 4 major steps: 1) Diagnosis and establishing treatment goals, 2) Model surgery to simulate surgical movements, 3) Surgery to reposition the jaws, and 4) Immediate postsurgical orthodontics using temporary anchorage devices. It then provides a detailed example of a 37-year-old female patient treated with the Sendai SF protocol, including her initial presentation, cephalometric analysis, treatment goals of mandibular setback and decompensation, model surgery simulation, and surgical splint fabrication.
JOURNAL CLUB PRESENTATION IN PROSTHODONTICS ON FEEDING APPLIANCES USED IN CLE...NAMITHA ANAND
This document describes a case report of fabricating a modified feeding plate for a newborn infant with cleft palate. A traditional feeding plate can injure soft tissues due to rigidity. The presented case fabricated a plate with a soft, flexible bulb covering the cleft palate to allow synchronized movement and prevent irritation. The plate helped the infant feed adequately and gain weight normally until surgical correction could be performed. Adjustments were made regularly to the border to allow dental arch growth without interference.
- There is no good evidence that orthodontics causes or cures temporomandibular joint dysfunction. Extracting teeth for orthodontic reasons does not inevitably alter a patient's facial profile. Better quality research is still needed in many controversial areas of orthodontics.
The document discusses how the different dental specialties can collaborate to provide treatment for complex dental cases. It provides several examples:
1. Orthodontics can work with other specialties to treat missing teeth through space closure or opening, depending on factors like buccal occlusion and tooth shape.
2. Traumatized or fractured teeth may require orthodontic extrusion before restorative treatment, and tooth transplantation is sometimes used to replace front teeth.
3. Periodontal problems causing tooth drifting can be addressed through orthodontic realignment once disease is controlled.
4. Orthodontics can be used to improve occlusion and eliminate non-working side interferences, and may close anterior
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.
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
orthodontic correction of canted occlusal plane 2MaherFouda1
This document discusses occlusal plane canting and the esthetic line of the dentition across multiple sections and cases. It begins by describing the esthetic line and how it follows the facial edges of the teeth, noting that full evaluation requires considering the three rotational axes of pitch, roll, and yaw. Subsequent sections discuss specific cases where patients presented with occlusal plane canting, midline deviations, and asymmetric smiles or deep bites. The document emphasizes the importance of evaluating canting relative to both soft tissues and facial skeleton for accurate diagnosis and treatment planning.
Journal club presentation on lingualised occlusionNAMITHA ANAND
This case report describes the rehabilitation of a patient with a maxillary complete denture and mandibular removable partial denture opposing fixed restorations. A lingualized balanced occlusion scheme was used to harmonize occlusion between the fixed and removable elements. An articulator and 2.5D template were used to set up the occlusion and establish centric and eccentric contacts. Porcelain fused to metal crowns were fabricated for abutment teeth along with a metal framework removable partial denture for the mandibular arch. The treatment resulted in a lingualized balanced occlusion with minimal adjustments needed at delivery.
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
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.
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.
Two Treatment Approaches for Missing Maxillary Lateral Incisors: A CaseAbu-Hussein Muhamad
Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. The aim of the present study is to evaluate the clinical success of the transmucosal flapless implant placement and immediate loading of the implants to restore the agenic lateral incisors after completing the orthodontic treatment and during the retention period.
Rehabilitation of occlusion – science or artthakurrima
The document reviews different morphological goals and methods for occlusal rehabilitation but finds little scientific evidence to support any specific occlusal scheme or method as being superior to others in improving stomatognathic function. While certain occlusal relationships like cusp-fossa contacts are advocated to prevent trauma, no studies have proven their clinical benefits over alternatives. The literature reveals a lack of high-quality evidence evaluating different occlusal treatments, indicating that skill and experience remain important in achieving successful rehabilitation.
This document provides an overview of full mouth rehabilitation. It defines full mouth rehabilitation according to GPT-8 as restoring the form and function of the masticatory apparatus as nearly normal as possible. It discusses the objectives and indications for full mouth rehabilitation. It classifies full mouth rehabilitation into three categories based on the degree of wear and available space. It reviews different occlusal approaches, schemes, concepts and philosophies for full mouth rehabilitation including balanced articulation, group function and mutually protected articulation. It also discusses Hobo's twin table and twin stage techniques.
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
Functional and Esthetic Restoration of the Worn DentitionThe Dawson Academy
Dr. Leonard A. Hess, Senior Faculty of The Dawson Academy, shares how to restore the worn dentition while keeping function and esthetics in mind during dental treatment planning.
This document discusses who needs orthodontic treatment. It provides three main reasons for orthodontic treatment: 1) To improve dental aesthetics, 2) To correct occlusal function, and 3) To eliminate malocclusions that could damage long-term dental health. It examines various types of malocclusions that may benefit from treatment, such as large overjets which increase risk of dental trauma. Indices like IOTN are used to assess orthodontic treatment need based on aesthetics and dental health. Not all irregularities need treatment, and treatment should only be carried out if it provides clear benefit to the patient.
Pre and post surgery final /certified fixed orthodontic courses by Indian den...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Fixed and removable orthodontic appliance application for class III malocclus...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses impacted teeth, focusing on impacted canines. It notes that impacted canines can cause resorption of adjacent teeth if not diagnosed early. Interceptive measures like extracting deciduous canines can help correct some palatal impactions. Treatment of impacted canines is lengthy and involves exposing the tooth to attach a bracket or chain for traction into the dental arch. Referral should occur early if there is suspicion of an impacted tooth to minimize required treatment.
One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
This document discusses various treatment approaches for idiopathic condylar resorption (ICR), including:
1) Orthodontic treatment is contraindicated during active ICR due to risk of accelerating resorption or litigation.
2) Surgical options like orthognathic surgery place demands on compromised TMJs that may lead to relapse.
3) Combining pre- and post-operative medical management with anti-inflammatory drugs and supplements with orthognathic surgery may help control resorption.
4) Total alloplastic TMJ replacement avoids relying on compromised TMJ tissues, providing an option when other treatments aren't viable.
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.
Orthodontic correction prior to autotransplantation of impacted permanent max...Fa Nasir
1) The patient, a 19-year-old Malay male, was missing his upper left lateral incisor and canine which were impacted.
2) Orthodontic treatment using fixed appliances was used to correct crowding, spacing issues, and midline shift to create room for transplantation of the impacted teeth.
3) Autotransplantation of the impacted lateral incisor and canine was selected as the treatment approach and deemed to be a good alternative to prosthodontics given the patient's age.
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.
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.
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
orthodontic correction of canted occlusal plane 2MaherFouda1
This document discusses occlusal plane canting and the esthetic line of the dentition across multiple sections and cases. It begins by describing the esthetic line and how it follows the facial edges of the teeth, noting that full evaluation requires considering the three rotational axes of pitch, roll, and yaw. Subsequent sections discuss specific cases where patients presented with occlusal plane canting, midline deviations, and asymmetric smiles or deep bites. The document emphasizes the importance of evaluating canting relative to both soft tissues and facial skeleton for accurate diagnosis and treatment planning.
Journal club presentation on lingualised occlusionNAMITHA ANAND
This case report describes the rehabilitation of a patient with a maxillary complete denture and mandibular removable partial denture opposing fixed restorations. A lingualized balanced occlusion scheme was used to harmonize occlusion between the fixed and removable elements. An articulator and 2.5D template were used to set up the occlusion and establish centric and eccentric contacts. Porcelain fused to metal crowns were fabricated for abutment teeth along with a metal framework removable partial denture for the mandibular arch. The treatment resulted in a lingualized balanced occlusion with minimal adjustments needed at delivery.
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
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.
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.
Two Treatment Approaches for Missing Maxillary Lateral Incisors: A CaseAbu-Hussein Muhamad
Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. The aim of the present study is to evaluate the clinical success of the transmucosal flapless implant placement and immediate loading of the implants to restore the agenic lateral incisors after completing the orthodontic treatment and during the retention period.
Rehabilitation of occlusion – science or artthakurrima
The document reviews different morphological goals and methods for occlusal rehabilitation but finds little scientific evidence to support any specific occlusal scheme or method as being superior to others in improving stomatognathic function. While certain occlusal relationships like cusp-fossa contacts are advocated to prevent trauma, no studies have proven their clinical benefits over alternatives. The literature reveals a lack of high-quality evidence evaluating different occlusal treatments, indicating that skill and experience remain important in achieving successful rehabilitation.
This document provides an overview of full mouth rehabilitation. It defines full mouth rehabilitation according to GPT-8 as restoring the form and function of the masticatory apparatus as nearly normal as possible. It discusses the objectives and indications for full mouth rehabilitation. It classifies full mouth rehabilitation into three categories based on the degree of wear and available space. It reviews different occlusal approaches, schemes, concepts and philosophies for full mouth rehabilitation including balanced articulation, group function and mutually protected articulation. It also discusses Hobo's twin table and twin stage techniques.
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
Functional and Esthetic Restoration of the Worn DentitionThe Dawson Academy
Dr. Leonard A. Hess, Senior Faculty of The Dawson Academy, shares how to restore the worn dentition while keeping function and esthetics in mind during dental treatment planning.
This document discusses who needs orthodontic treatment. It provides three main reasons for orthodontic treatment: 1) To improve dental aesthetics, 2) To correct occlusal function, and 3) To eliminate malocclusions that could damage long-term dental health. It examines various types of malocclusions that may benefit from treatment, such as large overjets which increase risk of dental trauma. Indices like IOTN are used to assess orthodontic treatment need based on aesthetics and dental health. Not all irregularities need treatment, and treatment should only be carried out if it provides clear benefit to the patient.
Pre and post surgery final /certified fixed orthodontic courses by Indian den...Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Fixed and removable orthodontic appliance application for class III malocclus...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses impacted teeth, focusing on impacted canines. It notes that impacted canines can cause resorption of adjacent teeth if not diagnosed early. Interceptive measures like extracting deciduous canines can help correct some palatal impactions. Treatment of impacted canines is lengthy and involves exposing the tooth to attach a bracket or chain for traction into the dental arch. Referral should occur early if there is suspicion of an impacted tooth to minimize required treatment.
One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
This document discusses various treatment approaches for idiopathic condylar resorption (ICR), including:
1) Orthodontic treatment is contraindicated during active ICR due to risk of accelerating resorption or litigation.
2) Surgical options like orthognathic surgery place demands on compromised TMJs that may lead to relapse.
3) Combining pre- and post-operative medical management with anti-inflammatory drugs and supplements with orthognathic surgery may help control resorption.
4) Total alloplastic TMJ replacement avoids relying on compromised TMJ tissues, providing an option when other treatments aren't viable.
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.
Similar to Extreme skeletal open bite correction with vertical elastics Marco Antonio Cruz-Escalantea ; Aron Aliaga-Del Castillob ; Luciano Soldevillac ; Guilherme Jansond ; Marilia Yatabee ; Ricardo Voss Zuazolaf
Orthodontic correction prior to autotransplantation of impacted permanent max...Fa Nasir
1) The patient, a 19-year-old Malay male, was missing his upper left lateral incisor and canine which were impacted.
2) Orthodontic treatment using fixed appliances was used to correct crowding, spacing issues, and midline shift to create room for transplantation of the impacted teeth.
3) Autotransplantation of the impacted lateral incisor and canine was selected as the treatment approach and deemed to be a good alternative to prosthodontics given the patient's age.
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.
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.
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.
ORTHODONTIC CORRECTION OF OCCLUSAL PLANE CANTING MaherFouda1
This document summarizes the orthodontic treatment of a 22-year-old patient with a canted occlusal plane, facial asymmetry, and mandibular prognathism. Miniscrews were implanted to intrude extruded teeth and correct the cant. After decompensation with elastics, the patient underwent bilateral sagittal split ramus osteotomy and genioplasty. Post-treatment, the patient's occlusion, facial asymmetry, and cant were significantly improved, though a two-jaw approach may have achieved better results. Miniscrews were effective for intrusion but require careful placement between roots to avoid complications.
This document describes a case study of using titanium screw anchorage to successfully treat a 31-year-old female patient with a severe anterior open bite of 7 mm. Mini screws were implanted in the maxilla and mandible to provide anchorage for intruding the upper and lower first molars by 3 mm each over 19 months of active treatment. This led to a counterclockwise rotation of the mandible which corrected the open bite and improved her retrognathic facial profile. The results suggest titanium screws are useful for intruding molars and treating anterior open bites in adult patients.
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.
An Interdisciplinary Approach for Improved Esthetic Results in the Anterior M...Abu-Hussein Muhamad
This document describes a case study of an interdisciplinary approach used to treat a maxillary midline diastema. A 42-year-old woman presented with uneven spaces between her front maxillary teeth, asymmetrical tooth positioning, and malocclusion. An evaluation determined tooth size discrepancies and improper clinical crown lengths were contributing factors. The treatment plan involved initial orthodontic treatment using brackets and springs to align the teeth. This was followed by porcelain laminate veneers to further improve esthetics. The veneers required only minimal tooth preparation and provided conservative, esthetic results. Through this coordinated orthodontic and restorative approach, the interdental spaces were closed and a pleasing smile was achieved to satisfy
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
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. (
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
1. The study assessed the effectiveness of an orthodontic tongue crib appliance in treating 18 growing children with Class 3 malocclusion and open bite.
2. Cephalometric analysis found that after 12 months of treatment, patients had significant forward growth of the maxilla and improved maxilla-mandibular relationships.
3. The tongue crib was effective at improving the maxillary complex growth and facial esthetics in growing patients with skeletal Class 3 and open bite malocclusions.
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.
Esthetic Evaluation of ImplantsPlaced after Orthodontic Treatment in Patients...Abu-Hussein Muhamad
Congenitally missing teeth are frequently presented to the dentist. Interdisciplinary approach may be needed for the
proper treatment plan. Several treatment options exist for the replacement of congenitally missing lateral incisors.
These options include canine substitution, resin bonded fixed partial dentures, cantilevered fixed partial dentures,
conventional fixed partial dentures and single tooth implants. Depending on which treatment option is chosen, a
specific criterion has to be addressed. Interdisciplinary treatment plays a vital role to achieve an excellent, esthetic
result for a most predictable outcome. This article aims to present a case report of replacement of bilaterally
congenitally missing maxillary lateral incisors with dental implants
Key words: congenitally missing lateral incisor, interdisciplinary treatment, dental impla
Prosthodontic-Orthodontic Treatment Plan with Two-Unit Cantilevered Resin-Bon...Abu-Hussein Muhamad
Abstract: Congenitally missing lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Selecting the appropriate treatment option depends on many factors, such us the malocclusion, the anterior relationship, specific space requirements, bone volume, root proximity, the condition of the adjacent teeth, and esthetic prediction mainly when the canine must be reshaped.Resin bonded bridges were considered to be doomed owing to their very high decementation rate, have come alive once again because of newer resin based cements. This article will discuss the variety of treatment managements in case of space opening and treated with two 2-unit cantilevered resin-bonded fixed partial dentures supported by the cuspids. This conservative treatment plan was cost-effective without having any significant biological cost. Keywords: Agenesis, Resin- bonded fixed partial denture, interim prosthesis.
1. A study compared long-term stability of adolescent versus adult surgery for treatment of mandibular deficiency, finding that beyond 1 year post-surgery, younger patients showed significantly greater changes in horizontal and vertical positions of mandibular landmarks and angles.
2. Early mandibular advancement surgery may be less stable long-term than performing the same surgery on older, growth-completed patients.
3. Younger patients undergoing two-jaw surgery experienced even greater long-term changes than those receiving isolated mandibular advancement.
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.
This case report discusses the treatment of a patient with congenitally missing upper lateral incisors. There were two treatment options considered: opening the spaces for prosthetic replacement or closing the spaces via canine substitution. The parents chose to close the spaces orthodontically. Fixed appliances were used to retract the canines into the lateral incisor spaces and extract mandibular premolars to relieve crowding. After treatment, the canines were reshaped to resemble lateral incisors. The final result had a Class I occlusion and improved esthetics. The report evaluates considerations for treating missing lateral incisors cases.
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Extreme skeletal open bite correction with vertical elastics Marco Antonio Cruz-Escalantea ; Aron Aliaga-Del Castillob ; Luciano Soldevillac ; Guilherme Jansond ; Marilia Yatabee ; Ricardo Voss Zuazolaf
1. Case Report
Extreme skeletal open bite correction with vertical elastics
Marco Antonio Cruz-Escalantea
; Aron Aliaga-Del Castillob
; Luciano Soldevillac
; Guilherme
Jansond
; Marilia Yatabee
; Ricardo Voss Zuazolaf
ABSTRACT
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. (Angle Orthod. 2017;87:911–923.)
KEY WORDS: Open bite; Corrective orthodontics; Elastics
INTRODUCTION
The etiology of anterior open-bite (AOB) malocclu-
sion may be attributable to a combination of genetic
and environmental factors.1,2
Some characteristics of
AOB are divergent maxillary and mandibular occlusal
planes, mesial angulation of the posterior teeth, and
increased skeletal vertical dimension.1,3,4
Treatment in
the permanent dentition depends on the balance
between dentoalveolar and skeletal characteristics. If
there is a predominance of skeletal imbalance, the
greater will be the chance of a need for combined
surgical–orthodontic intervention.5,6
Sometimes pa-
tients may refuse the surgical option for various
reasons, and in these cases orthodontic camouflage
may be attempted.7
Conventional orthodontics can be performed with or
without extractions, with anterior teeth extrusion6,8
or
with combined posterior teeth uprighting and anterior
teeth extrusion with elastics.3,9,10
Intrusion of the
posterior teeth allows autorotation of the mandible
and consequently AOB closure.11–13
Temporary an-
chorage devices (TADs) are a good option when
posterior teeth intrusion is planned.11–15
The multiloop
edgewise archwire (MEAW) technique could be used
as an alternative to achieve proper vertical positioning
of the anterior teeth, acceptable inclination of the
maxillary and mandibular occlusal planes, and upright-
ing with vertical control of the posterior teeth.3,10
The
use of MEAW requires patient compliance with
continuous use of elastics. This treatment approach
a
Assistant Professor, Department of Orthodontics, Faculty of
Dentistry, Universidad Nacional Mayor de San Marcos, Lima,
Per´u.
b
Graduate Student, Department of Orthodontics, Bauru
Dental School, University of Sa˜o Paulo, Bauru, SP, Brazil.
c
Associate Professor, Department of Orthodontics, Faculty of
Dentistry, Universidad Nacional Mayor de San Marcos, Lima,
Per´u.
d
Professor and Head, Department of Orthodontics, Bauru
Dental School, University of Sa˜o Paulo, Bauru, SP, Brazil.
e
Postdoctoral Fellow, Hospital of Rehabilitation of Craniofa-
cial Anomalies, University of Sa˜o Paulo, Bauru, SP, Brazil.
f
Associate Professor (retired), Department of Orthodontics,
Faculty of Dentistry, Universidad de Valpara´ıso, Valpara´ıso,
Chile.
Corresponding Author: Dr Marco Antonio Cruz-Escalante,
Department of Orthodontics, School of Dentistry, Universidad
Nacional Mayor de San Marcos, Av. Germa´n Am´ezaga N8 375,
Ciudad Universitaria, Lima, 15081, Per´u
(e-mail: marcocruz244@hotmail.com)
Accepted: July 2017. Submitted: April 2017.
Published Online: September 12, 2017
Ó 2017 by The EH Angle Education and Research Foundation,
Inc.
DOI: 10.2319/042817-287.1 Angle Orthodontist, Vol 87, No 6, 2017911
2. has been shown to be efficient, providing stable results
in severe AOB correction.10,16,17
The treatment choice
would depend on the patient’s chief complaint and
compliance level, AOB severity, and professional skills.
This case report presents the nonsurgical treatment
of a severe AOB malocclusion by means of posterior
teeth uprighting and intrusion combined with anterior
teeth extrusion using the MEAW technique and vertical
elastics.
Diagnosis and Etiology
An 18-year-old male patient presented to the
orthodontic clinic with chief complaints of ‘‘severe open
bite and self-esteem and speech problems.’’ He had a
history of tooth extractions. The clinical examination
showed a straight to convex profile, vertical growth
pattern, mild chin deviation to the left, lack of maxillary
incisor exposure upon smiling, lip incompetence at
rest, and an infantile swallowing pattern. He had an
open bite involving the anterior (10 mm) and posterior
teeth up to the first molars, bilateral posterior crossbite,
bilateral Class III molar and left Class II canine
relationships, 2 mm of maxillary dental midline devia-
tion to the right and 6mm of mandibular dental midline
deviation to the left in relation to the midfacial plane,
mild anterior crowding, and an absence of the maxillary
right canine and mandibular left first premolar (Figures
1 and 2).
Cephalometric examination showed a skeletal Class
III sagittal relationship, large mandible, steep mandib-
ular plane, increased lower anterior face height, and
maxillary and mandibular incisors with normal and
lingual inclinations, respectively (Figure 3, Table 1). He
was in the last maturational stage.18
The temporoman-
dibular joint showed no symptoms and had normal
function and structure. There were no signs of active
periodontal disease (Figure 4). He had no contributory
medical history, and he expressed a strong desire to
avoid orthognathic surgery.
The patient was diagnosed with a severe Class III
skeletal open-bite malocclusion, increased lower ante-
rior face height, steep mandibular plane, bilateral
posterior crossbite, dental midline deviations, lip
incompetency, and infantile swallowing pattern.
Treatment Objectives
The primary orthodontic treatment objectives were to
close the AOB, correct the posterior crossbite and
dental midline deviations, achieve Class I canine and
functional molar relationships as well as ideal overbite
and overjet, improve facial esthetics, and obtain
passive lip competence.
Figure 1. Pretreatment facial and intraoral photographs.
Angle Orthodontist, Vol 87, No 6, 2017
912 CRUZ-ESCALANTE, ALIAGA-DEL CASTILLO, SOLDEVILLA, JANSON, YATABE, ZUAZOLA
3. Treatment Alternatives
The following three treatment options were consid-
ered: (1) surgical orthodontic treatment (ideal option),
which could correct the vertical, transverse and sagittal
problems and improve facial appearance; (2) com-
bined maxillary and mandibular posterior teeth intru-
sion with TADs11–15
and anterior teeth extrusion with
elastics6,8
; (3) vertical control and uprighting of the
posterior teeth combined with anterior teeth extrusion
Figure 2. Pretreatment dental casts.
Figure 3. Pretreatment records: (A) 3D automatically reformatted image, (B) lateral ceph image generated from cone-beam computed
tomography, (C) ceph tracing, (D) panoramic radiograph generated from cone-beam computed tomography.
Angle Orthodontist, Vol 87, No 6, 2017
OPEN BITE CORRECTION WITH VERTICAL ELASTICS 913
4. with MEAW mechanics and elastics.3,10,16
The two
nonsurgical options included dentoalveolar posterior
expansion for posterior crossbite correction, maxillary
right canine space creation, and mandibular right first
premolar extraction to correct the maxillary and
mandibular dental midline deviations, respectively,
and to obtain acceptable overjet and bilateral functional
Class III molar relationships.19–21
These treatment alternatives were discussed with
the patient and the third option was chosen.
Treatment Progress
Before treatment began, the mandibular third molars
were extracted to improve the prognosis for mandibular
posterior uprighting mechanics. Treatment was initiat-
ed with 0.022 3 0.028-inch slot standard edgewise
appliances placed in both dental arches. After the
mandibular right first premolar was extracted, 0.014,
0.016, and 0.016 3 0.022-inch nickel-titanium (NiTi)
archwires were used for leveling and alignment.
Concomitantly, maxillary right canine space was
created with an open NiTi coil spring (Figure 5A).
The anterior open bite decreased by 3 mm after this
first phase of treatment (6 months). Then 0.016 3
0.022-inch blue elgiloy multiloop archwires with 58 tip-
back activations per loop (generating an accentuated
and reverse curve of Spee of 258 in the maxillary and
mandibular arches, respectively) were placed, and
short Class III anterior elastics (3/16-in, 6.5 oz) were
prescribed to be used full-time by the patient (Figure
5B). The activated maxillary multiloop archwire was
expanded before insertion to control the transverse
dimension.
After 2 months of MEAW mechanics, a significant
reduction of the anterior open bite by 7 mm was
achieved (Figure 5C). Posterior crossbite correction
was initiated with an overlay 0.036-inch blue elgiloy
expanded archwire placed in the maxillary first molar
tubes in addition to intermaxillary palato-buccal cross-
elastics until an acceptable posterior transverse
relationship was obtained (Figure 5D). During this
phase (6 months), MEAW mechanics continued until
the overbite was quite satisfactory. At that time,
compensation bends (progressive flattening of the
posterior tip back bends) were made and a 0.018 3
0.025-inch stainless steel archwire was placed in the
mandibular arch for space closure (Figure 5E). Then
0.018 3 0.025-inch blue elgiloy multiloop archwires
were placed in both arches, with some individual
bends, and intercuspation elastics were used during
the finishing phase (Figure 5F). The patient received
orofacial myofunctional therapy during the last 6
months of treatment. The total orthodontic treatment
time was 24 months.
Table 1. Cephalometric Variables
Variablesa
Initial Final F-I
Maxillary Component
SNA, 8 81.6 81.5 À0.1
Mandibular Component
SNB, 8 77 81.7 4.7
SND, 8 75.4 80.5 5.1
Maxillomandibular Sagittal Relationship
Facial Convexity (NAP),8 6.6 À2.8 À9.4
Wits appraisal, mm À11.5 À6.9 4.6
Anteroposterior Dysplasia Indicator (APDI),8 82.8 92.4 9.6
ANB, 8 4.6 À0.2 À4.8
Vertical Relationship
FMA (FH-MP),8 38.7 33.2 À5.5
Occl Plane-SN, 8 20.4 14.5 À5.9
SN-GoGn, 8 45.8 39.8 À6
PP-MP, 8 37.3 31.8 À5.5
Y-axis (NSGn), 8 75.8 70.7 À5.1
Overbite Depth Indicator (ODI), 8 60.6 56.5 À4.1
Anterior Face Height (NaMe), mm 132.3 127.8 À4.5
Lower Anterior Face Height, mm 83.4 77.8 À5.6
Dentoalveolar Component
Mx1-NA, 8 22 32.6 10.6
Mx1-NA, mm 2.4 6.5 4.1
Mx1-PP, mm 28.2 30.5 2.3
Mx6-PP, mm 27 26.3 À0.7
Md1-NB, 8 21 11 À10
Md1-NB, mm 5.3 2.1 À3.2
IMPA (L1-MP), 8 75.5 66.3 À9.2
Md1-MP, mm 41 45 4
Md6-MP, mm 35.7 34.2 À1.5
Overbite, mm À10 2.9 12.9
Soft Tissue Component
Holdaway Angle (NB to H-line), 8 10.1 9.2 À0.9
Upper Lip À S Line, mm À0.2 À1.8 À1.6
Lower Lip À S Line, mm 0.5 À1 À1.5
a
F-I, Final – Initial; SND, evaluates the anteroposterior location of
the anterior portion of the mandible and is obtained from the angle
formed by SN to ND lines where D is a point located at the center of
the cross section of the body of the symphysis;22
APDI, evaluates the
skeletal relationship and is obtained from the algebraic sum of the
angles N-Pg-FH (Facial Plane) plus/minus the angle AB-Facial Plane
(it is positive when point B is ahead of point A and negative when
point A is ahead of point B); and plus/minus the angle FH-PP (palatal
plane; it is negative when PP is tilted upward and positive when tilted
down);23
ODI, evaluates the open bite tendency and is obtained from
the algebraic sum of the angles AB-MP plus/minus the angle FH-PP
(palatal plane; it is negative when PP is tilted upward and positive
when tilted down).24
Figure 4. Cone-beam computed tomography synthesized panoramic
view of maxillary (A) and mandibular (B) anterior teeth at pretreatment.
Angle Orthodontist, Vol 87, No 6, 2017
914 CRUZ-ESCALANTE, ALIAGA-DEL CASTILLO, SOLDEVILLA, JANSON, YATABE, ZUAZOLA
5. Figure 5. Treatment progress: (A) leveling and alignment, (B) multiloop edgewise archwire mechanics, (C) after 2 months of multiloop edgewise
archwire mechanics, (D) elastics for crossbite correction, (E) space closure, (F) finishing.
Angle Orthodontist, Vol 87, No 6, 2017
OPEN BITE CORRECTION WITH VERTICAL ELASTICS 915
6. Treatment Results
The patient had significant facial improvements as
demonstrated in the extraoral photographs. The profile
was balanced with lip competence at rest and an
esthetic smile with maxillary incisor exposure upon
smiling (Figure 6). The intraoral and dental cast
photographs showed satisfactory overbite, adequate
overjet, Class III functional molar relationships, Class I
canine relationship on the left side, adequate space for
the maxillary right canine restoration, corrected dental
midline deviations, and limited correction of the posterior
crossbite (Figures 6 and 7). Periodontal heath was
satisfactorily maintained. There were no signs of
periodontal disease at the end of treatment (Figure 8).
The skeletal changes included an increase in
mandibular projection, decreases in facial convexity,
and apical base sagittal relationship and vertical
relationship (Figures 9 and 10, Table 1).22–24
Regarding
the dentoalveolar changes, there was labial inclination
and extrusion of the maxillary incisor; lingual inclina-
tion, retrusion, and moderate extrusion of the mandib-
ular incisor; mild intrusion of the maxillary first and
second molars; uprighting and mild intrusion of the
mandibular first molars; and uprighting and moderate
intrusion of the mandibular second molars (Figures 9
and 10, Table 1). There was a decrease in soft tissue
convexity and concomitant protrusion of the upper and
lower lips (Figure 10).
Cone-beam computed tomography (CBCT) total
superimpositions at the cranial base registration25
showed a counterclockwise pitch rotation of the
mandible and mandibular residual growth (Figure
11A, Table 2). Maxillary regional superimposition26
confirmed the cephalometric changes: small maxillary
changes and posterior teeth extrusion (Figure 11B).
Mandibular regional superimposition27
also supported
the results described, and residual growth of the
mandible was noted. No evidence of condylar remod-
eling was observed (Figure 11C).
Based on the cephalometric and CBCT superimpo-
sitions, there was posterior teeth intrusion that contrib-
uted to produce a counterclockwise rotation of the
mandible (Figures 10 and 11).
A modified wrap-around prosthetic retainer with an
orifice in the incisive papillae region to help correct the
positioning of the tongue in the rest position (learning in
the orofacial myofunctional therapy) and a lingual fixed
retainer including second premolars were placed in the
maxillary and the mandibular arches, respectively
(Figure 12). The maxillary retainer was prescribed to
be used until definitive restoration of the maxillary right
canine could be performed. Then a new wraparound
with the same palatal orifice was used.
Figure 6. Posttreatment facial and intraoral photographs (after 24 months of treatment).
Angle Orthodontist, Vol 87, No 6, 2017
916 CRUZ-ESCALANTE, ALIAGA-DEL CASTILLO, SOLDEVILLA, JANSON, YATABE, ZUAZOLA
7. The 2-year posttreatment follow-up records showed
stability of the open-bite correction and of the Class III
functional molar relationship. The posterior transverse
relationship did not worsen (Figures 13 and 14).
Periodontal evaluation showed a healthy condition at
the 2-year posttreatment follow-up as well (Figure 15).
DISCUSSION
A combined surgical–orthodontic treatment ap-
proach could have been ideal for this patient, simulta-
neously correcting the vertical, transverse, and sagittal
relationships.5
Nevertheless, because the patient
refused the surgical option, the treatment alternatives
were reduced to TADs and conventional orthodontics.
However, the patient did not want to use TADs as well.
Counterclockwise mandibular rotation could have
been expected when performing posterior teeth intru-
sion, which helps to improve the open-bite malocclu-
sion. This is normally achieved with TADs.11–15
However; when conventional orthodontics is planned,
as in this case, posterior teeth intrusion is difficult to
obtain. Treatment mechanics are based on maintaining
vertical control of the posterior teeth, with different
appliances, to control the vertical dimension, and the
anterior open bite is generally corrected by means of
extrusion of the anterior teeth.6,8
In the present case, anterior teeth extrusion com-
bined with uprighting and vertical control of the
posterior teeth was planned using MEAW and anterior
elastics. The activated multiloop archwires generated
an accentuated and reverse curve of Spee in the
maxillary and mandibular aches, respectively. This
activation effect alone could aggravate the open-bite
malocclusion. However, short Class III anterior elastics
were used to extrude the anterior teeth and correct the
Class III relationship. These anterior extrusive forces
counterbalanced the MEAW activations and achieved
vertical control of the posterior teeth by means of
uprighting and intrusion.3,10,16
Maxillary anterior teeth
extrusion was necessary to increase maxillary incisor
exposure and achieve a harmonious smile (Figure 6).
However, in addition to the uprighting and vertical
control of the posterior teeth that the MEAW technique
and anterior elastics provided to the case, different
degrees of intrusion of the posterior teeth were
Figure 7. Posttreatment dental casts.
Figure 8. Cone-beam computed tomography synthesized panoramic
view of maxillary (A) and mandibular (B) anterior teeth at
posttreatment.
Angle Orthodontist, Vol 87, No 6, 2017
OPEN BITE CORRECTION WITH VERTICAL ELASTICS 917
8. observed. Mild intrusion of the maxillary first and
second molars and mandibular first molar was
achieved. In addition, greater intrusion of the mandib-
ular second molars was noted. Before treatment, the
patient only had occlusal contact between the man-
dibular second molars and the maxillary first and
second molars. Therefore, intrusion of these teeth
contributed to the achievement of satisfactory results.
Posterior teeth intrusion was achieved using activated
MEAWs and using anterior elastics as anchorage, thus
Figure 9. Posttreatment records: (A) 3D automatically reformatted image, (B) lateral ceph generated from cone-beam computed tomography, (C)
ceph tracing, (D) panoramic radiograph generated from cone-beam computed tomography.
Figure 10. Cephalometric superimpositions: black line, pretreatment; red line, posttreatment.
Angle Orthodontist, Vol 87, No 6, 2017
918 CRUZ-ESCALANTE, ALIAGA-DEL CASTILLO, SOLDEVILLA, JANSON, YATABE, ZUAZOLA
9. Figure 11. Cone-beam computed tomography superimpositions: red color: pretreatment; white color: posttreatment. (A) Superimposition at the
cranial base, (B) maxillary regional superimposition, (C) mandibular regional superimposition.
Table 2. Mandibular Length Measurements
Mandibular Length, mm Initial Final
2 Years
Posttreatment F-Ia
2 Years
Posttreatment – Final
Right Condylion-Menton 122.7 125.8 127.2 3.1 1.4
Left Condylion-Menton 124.4 128.4 130.9 4.0 2.5
a
F-I, Final – Initial.
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OPEN BITE CORRECTION WITH VERTICAL ELASTICS 919
10. producing occlusal plane rotation and a consequent
mandibular counterclockwise rotation that contributed
to open-bite correction and resulted in improvements to
the patient’s facial profile as a result of increased chin
projection after treatment (Figures 10 and 11).
CBCT superimpositions corroborated all of the
changes observed in the cephalometric tracing super-
impositions (Figures 10 and 11). CBCTs were super-
imposed at the cranial base to visualize the skeletal
displacements of the maxilla and mandible.25
Regional
superimpositions at the maxilla and mandible26,27
were
performed to observe the intrinsic changes in the apical
bases. Reproducibility and reliability of the methods
used to perform the three-dimensional superimposi-
tions have been demonstrated.25–27
Based on the findings, it can be assumed that the
mechanics described produced dentoalveolar changes
and rotational modifications of the mandible in this
particular case that contributed to the closing of the
open bite (Figures 6 to 11). An increase of 2.13 mm in
Figure 12. Wrap-around prosthetic and functional retainer with an orifice in the region of the incisive papilla in the maxillary arch and a second
premolar to second premolar lingual fixed retainer in the mandibular arch.
Figure 13. Facial and intraoral photographs at 2 years posttreatment.
Angle Orthodontist, Vol 87, No 6, 2017
920 CRUZ-ESCALANTE, ALIAGA-DEL CASTILLO, SOLDEVILLA, JANSON, YATABE, ZUAZOLA
11. the overbite for each millimeter of reduction of posterior
molar height (combined sum of maxillary and mandib-
ular second molar heights) was reported previously
when occlusal adjustment was performed.28
In addition,
counterclockwise rotation of the mandible between 2.38
and 3.98 consequent to maxillary and mandibular molar
intrusion with TADs was reported.29
In this particular
case, open-bite correction was obtained by a combi-
nation of extrusion of the anterior teeth (greater for the
mandibular incisors), intrusion of the posterior teeth
(greater for the mandibular second molars), and
counterclockwise rotation of the mandible, consequent
to posterior teeth intrusion (Figures 10 and 11).
Similar results have been reported with other
treatment approaches without the use of TADs. The
use of NiTi archwires with accentuated curve of Spee
in the maxillary arch and reverse curve of Spee in the
mandibular arch combined with anterior elastics
showed efficiency for the open-bite correction.9
Anoth-
er option could be to mesially angulate the accessories
on the posterior teeth to obtain the MEAW effect.6
Obviously, the use of anterior elastics is a critical factor
for treatment success because they will deliver the
required force to distally angulate and sometimes to
intrude the posterior teeth.3,6,9
The dental midline deviations were corrected by
creating adequate space for the maxillary right canine
and by closing the space following the mandibular left
first premolar extraction. After dental midline deviation
corrections were made and when some overbite was
present, the combined mesial movement of the
mandibular posterior teeth and retraction of the
mandibular incisors were necessary to obtain ade-
quate overjet and Class III functional molar relation-
ships in both sides (Figure 5).19–21
The combination of
mandibular left first premolar extraction, retrusion of the
mandibular incisors, and mesial movement of the
mandibular posterior teeth may have contributed to
the overbite correction and counterclockwise mandib-
ular rotation as well.
Bilateral posterior crossbite correction was initially
planned. However, it was only achieved for the
maxillary right second premolar and mandibular right
first molar. End-to-end transverse relationships were
obtained for the maxillary first molar and mandibular
Figure 14. Two-year posttreatment dental casts.
Figure 15. Two-year posttreatment periapical radiographs.
Angle Orthodontist, Vol 87, No 6, 2017
OPEN BITE CORRECTION WITH VERTICAL ELASTICS 921
12. second molar on the right side and for the maxillary
second premolar and mandibular first molar on the left
side. The crossbite between the maxillary first molar
and the mandibular second molar on the left side could
not be corrected. Despite these limitations, the amount
of vertical and facial improvements was considerable,
and the patient’s chief complaints were satisfied.
Premature occlusal contacts were eliminated to ensure
that this posterior transverse relationship did not impair
the occlusion.
Although the patient was advised to pursue implant-
supported fixed prosthetic restoration for the right
maxillary canine area, he decided on a conventional
tooth-supported fixed prosthesis. Unfortunately, that
procedure was not under our control and was
performed during the follow-up period.
Anterior open-bite treatment stability of 94.4% and
90% in growing and nongrowing patients, respectively,
has been reported for the treatment approach de-
scribed.16,17
Stability greater than 75% for different
conventional orthodontic treatments has been report-
ed.6,8,17
In addition, it has been reported that posterior
teeth intrusion with TADs results in a relapse of
between 20% to 30% and that the greatest percentage
of that relapse occurs during the first posttreatment
year.11,12,14
For this reason, the patient’s records at the
2-year posttreatment follow-up were considered es-
sential.
Satisfactory overbite correction, orofacial myofunc-
tional therapy, and the customized retainer were
considered to be important contributors to the stability
observed at the 2-year posttreatment follow-up. Al-
though there was some residual mandibular growth in
the posttreatment period, it did not impair the stability of
the results (Table 2). As a result of the amount of
overbite observed at the 2-year posttreatment follow-
up, long-term stability should be expected (Figures 13
and 14).
CONCLUSIONS
Treatment of an adult patient with a severe skeletal
open bite malocclusion was performed using MEAW
mechanics and elastics (without using any TADs) by
means of posterior teeth uprighting and intrusion
along with anterior teeth extrusion, which produced a
counterclockwise rotation of the mandible.
This treatment approach demonstrated efficiency
and good stability for open bite correction over the
period observed.
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