Jc 13


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Jc 13

  1. 1. Regaining leeway space and anterior cross bite correction with a modified maxillary molar distalizing appliance Park JH, Tai K, Ikeda M, Kanao A J Clin Pediatr Dent 2013:37(3);329-334
  2. 2. Introduction • Second primary molars – lost prematurely • Leeway space – fundamental factor
  3. 3. • Anterior cross bite • Dental / skeletal •     Result in Fractures of anterior teeth Abnormal enamel abrasions Periodontal pathology Poor esthetics
  4. 4. Case report • 9yr 5month old male • Mesofacial symmetrical face and slightly concave profile • Maxillary first molars – mesially tilted and rotated • Class II molar with -25mm overjet and 30% overbite • Mandibular dental midline deviated to the right by 1mm • Gingival recession on mandibular right central incisor • Etiology – combination of heredity and environmental factors
  5. 5. Lateral cephalometric analysisSkeletal class III (ANB = - 2.7˚) Hypodivergent growth pattern (SN – MP: 31.6˚) Maxillary incisors – slight retroclination (U1 to SN: 101.5˚) • Mandibular incisors – retroclined (IMPA: 85.4˚) • • • •
  6. 6. Treatment objectives • Stimulate growth of maxilla • Establish class I molar relation by distalizing maxillary molars • Correct anterior crossbite • Improve gingival recession of the mandibular right central incisor • Improve the patients smile and facial esthetics • Monitor the development of permanent dentition
  7. 7. Primary treatment objectives • Correction of crossbite • Treatment options • Facemask therapy – stimulate maxillary growth forward and improve the overjet • Skeletal discrepancies with unfavourtable growth pattern – surgical treatment
  8. 8. Appliance design • Modified maxillary molar distalizing appliance (MMMDA) • Fabricated with 0.032” ss wire
  9. 9. Results • Two phase treatment was planned • Reactive force produced by distalizing components corrected anterior crossbite and regained leeway space in 5months
  10. 10. • W – Arch fixed expander – to maintain space to correct posterior crossbite • Permanent teeth erupted after Phase 1 treatment
  11. 11. • Phase II treatment – 13yrs and 2month old • 13months of treatment – class I molar and canine relation • Acceptable overjet and overbite • After treatment – 0.0175 inch twistflex • Panoramic radiograph – root parallelism with no significant sign of root or bone resorption
  12. 12. Discussion • • • • Orthodontic problems – 7 to 11yrs Premature loss of primary molars Maxilla – space loss greater Mandible – continous space loss
  13. 13. • Primary 2nd molar premature loss – second premolar impact • Anterior crossbites referred for early treatment • Dental class III – alteration of incisor inclination • Skeletal class III – face mask therapy • Results of early treatment – depends on the etiology of crossbite and initial age of intervention
  14. 14. • More skeletal and less dental movement – facemask therapy • Gu et al – treatment effects of simple fixed appliance and facemask in correction of anterior crossbites • Facemask – combination of skeletal (40%) and dental changes (60%) • MMMDA – proclination of maxillary anterior teeth and skeletal changes (Wits changes = -9.3mm to 3.2mm)
  15. 15. • Hagg et al – early treatment in patients with anterior crossbite (dental) – stable • Skeletal class III – difficult to treat – greater intervention • Simple dental corrections are not effective
  16. 16. • Rabie and Gu - Dental class III – class I molar and canine relationship with anterior crossbite • Skeletal class III – class III molar and canine relationship with anterior crossbite
  17. 17. • Fixed orthodontic appliance with open coil springs
  18. 18. Conclusion • Simple appliance that can be used effectively for regaining leeway space in earlyor late mixed dentition period and correction of crossbites
  19. 19. Urban Ha¨gg, DDS, Odont Dr, FHKAM Agnes Tse, MOrth;b Margareta Bendeus A. Bakr M. Rabie, Cert Orth Northwestern A Follow-up Study of Early Treatment of Pseudo Class III Malocclusion Angle Orthod 2004;74:465– 472 • Long-term outcome of 27 patients diagnosed with pseudo Class III malocclusion treated 2 by 4 appliance • 27 patients, 25 patients (93%) were examined at the fiveyear follow-up. • 20 patients - no other treatment other than treatment with 2 by 4 appliance • five patients - additional comprehensive fixed appliance therapy because of crowding. • Lateral cephalograms • 5yr follow-up all 25 patients - positive overjet.
  20. 20. • Zuisei Kannoa; Yoonji Kimb; Kunimichi Somac Early Correction of a Developing Skeletal Class III Malocclusion • Japanese girl aged 11 years 10 months who had a severe Class III malocclusion with a concave facial profile. She presented hypodivergent skeletal pattern with a 4.0mm anterior crossbite and a deep overbite. facial asymmetry attributed partly to the lateral mandibular shift to avoid incisal interferences. The treatment plan included a monoblock appliance, rapid palatal expansion, and fixed edgewise appliances at the final stage. The monoblock appliance was used to redirect the growth of the mandible to a clockwise direction and simultaneously correct the incisal relationships along with fixed edgewise appliances. Good incisal relationships were achieved, and facial esthetics was greatly improved after 28 months of treatment. Stability of the treatment result was excellent in the 3-year 9-month followup at the age of 18. • • • • •
  21. 21. Pre treatment
  22. 22. Investigations
  23. 23. Post treatment
  24. 24. • Patrick K. Turley Managing the developing Class III malocclusion with palatal expansion and facemask therapy Am J Orthod Dentofacial Orthop 2002;122:349-52 Facemask treatment timing • There is a small window of opportunity for treating the young Class III patient • Baccetti et al examined the differences in early vs late treatment in 2 groups of children treated with bonded maxillary expanders and facemasks • Saadia and Torres, Suda et al, Merwin et al earlier treatment produces a more favorable result
  25. 25. Stability of facemask therapy • Wisth et al- the posttreatment growth of 22 children treated with facemask and quad-helix, and compared them with 40 Class I controls - growth is normalized after facemask therapy. • McGill, Chong et al, Gallagher et al - facemask therapy does not normalize growth - treated patients resume a Class III growth pattern, characterized primarily by deficient maxillary growth
  26. 26. Benefits of palatal expansion • Benefits  Expansion of a narrow maxilla and correction of posterior crossbite,  increase in arch length,  bite opening,  Loosening or activation of circummaxillary sutures, and  Initiating downward and forward movement of the maxillary complex • Randomized clinical trial • Without other reasons for expansion, such as maxillary width or space deficiency, expansion does not significantly aid in Class III correction
  27. 27. Timing of phase 2 orthodontics • After the permanent second molars have erupted • Pubertal growth spurt • Boys show a greater relapse tendency • Latent mandibular growth • Condylar growth continues for approximately 2 years after sutural growth of the maxilla has ceased, and even after growth in height has ceased • Men show a much greater anterior movement of the mandible