Summary of Treatment
| Case Report Category #: | 4 |
| Patient's Name: | |
| DATE OF BIRTH: | 05/10/1972 |
| AGE: | 27Y 1M |
A. PRETREATMENT RECORDS
Date of Records: 06/07/99
Diagnosis:
- Skeletal: Class II division 2 skeletal malocclusion with low a mandibular plane angle reflecting
a low angle facial pattern.
- Dental: Class II right and Class I left dental malocclusion.
Severe overbite and mild overjet.
Retro-inclination of the anterior maxillary teeth and a recumbent interincisal angle.
Moderate mandibular and mild maxillary crowding with rotations in both arches.
The lower left central incisor is severely worn.
Lower midline deviation of 5mm to the right.
Bolton discrepancy of 79% (N=77%), with small maxillary lateral incisors.
- Facial: Brachycephalic facial pattern.
Lack of lip support due to retroinclination of the incisors.
Treatment Plan:
- Upper and lower full complement of fixed bidimensional edgewise appliances.
- Surgical extraction of the two maxillary right and left and the mandibular left first premolars and mandibular third molars.
- Moderate anchorage.
- Re-evaluate cosmetic recontouring for the maxillary right and left and mandibular left central incisors.
- Retention.
Treatment:
- Upper and lower full complement of fixed bidimensional edgewise appliances.
- The upper and lower appliances were placed simultaneously and the lower anterior brackets acting as a bite plate in order to aide the bite opening along with arch wire mechanism.
- Surgical extraction of the two maxillary right and left and the mandibular left first premolars and mandibular third molars.
- Aligned and leveled maxillary and mandibular arches.
- Space closure with moderate anchorage, re-inforced by inter-maxillary elastics and asymmetric mechanics.
- Finishing and detailing, cosmetic recontouring.
- Debanding and retention.
| Initiated Treatment | Date: | 07/05/99 |
| Appliance Removal | Date: | 01/26/02 |
| Active Treatment Time | Duration: | 31 Months |
B. POSTTREATMENT RECORDS
Date of Records:02/05/02
| Retention: | Upper circumferential and lower Hawley retainer to be worn each night every night. |
|
Retention Completed Date: | Ongoing |
|
Retention Duration: | Ongoing (nights only indefinetely). |
HISTORY AND ETIOLOGY:
Medical: Good overall health. There was nothing of significance in the patient medical history.
Dental: Regular dental care reported throughout life with some operative work. His oral hygiene was good and no decay was present.
Etiology: Due to the lack of significant history, the malocclusion can be considered developmental in nature with an excessive horizontal growth pattern. A contributing factor may have been an early loss of the primary teeth on the mandibular arch.
Chief complaint: "I want my teeth straight and my dentist told me I did not have a healthy bite".
DIAGNOSIS:
- Skeletal: 27 Y 1 M old male of Caucasian heritage with a Class II division 2 skeletal malocclusion with a low mandibular plane angle reflecting a low angle facial pattern.
- Dental: Class II right and Class I left dental malocclusion.
Severe overbite and mild overjet.
Retro-inclination of the anterior maxillary teeth and a recumbent interincisal angle.
Moderate mandibular and mild maxillary crowding with rotations.
The lower left central incisor is severely worn.
Lower midline deviation of 5mm to the right.
Bolton discrepancy of 79% (N=77%) with small maxillary lateral incisors.
- Facial: Brachycephalic facial pattern with low mandibular plane angle.
Lack of lip support due to retroinclination of the incisors.
TREATMENT PLAN:
- Upper and lower full complement of fixed bidimensional edgewise appliances.
- Surgical extraction of the two maxillary right and left and the mandibular left first premolars and mandibular third molars.
- Moderate anchorage and asymmetric mechanics.
- Re-evaluate cosmetic recontouring for the maxillary right and left and mandibular left central incisors.
- Retention.
SPECIFIC OBJECTIVES OF TREATMENT:
Maxilla:
- Non-growing patient- -do not attempt skeletal modification of the maxillary position.
Mandible
- Non-growing patient- -do not attempt skeletal modification of the mandibular position.
Maxillary Dentition
- Align and level maxillary arch while creating more ideal incisor angulation.
- Retract anterior maxillary teeth in a bodily manner in order to compensate for the Class II skeletal pattern.
Mandibular Dentition
- Align and level the mandibular arch while attempting to correct the midline deviation.
- Maintain the mandibular incisor angulation.
Occlusion
- Create more ideal overbite and overjet relations (eliminate 100% deep bite malocclusion and incisor retro-inclination).
- Improve posterior occlusal relations to achieve Class I canine occlusion bilaterally with cuspid guidance and Class II molar relationship.
Facial Esthetics
- Attempt to improve lip posture and depth of the mento-labial fold via attainment of improved incisor angulation and bite opening.
- Improve smile esthetics.
TREATMENT PROGRESS:
- Upper and lower full complement of fixed bidimensional edgewise appliances.
- The upper and lower appliances were placed simultaneously and the lower anterior brackets acting as a bite plate in order to aid the bite opening along with arch wire mechanism.
- Surgical extraction of the two maxillary right and left and the mandibular left first premolars and mandibular third molars.
- Align and level maxillary and mandibular arches creating a more ideal incisor angulation.
- Space closure with moderate anchorage, re-inforced by inter-maxillary elastics and asymmetric mechanics.
- The upper canines were retracted with Class I forces with a 16x22 steel arch wires with stops mesial to the molars and the anchorage was supported with Class II elastics from the hooks of the wire.
- The maxillary incisors were also retracted with Class I forces with a 18x22 steel in a bodily manner by means of sliding mechanics and the posterior teeth were supported with Class II elastics from the upper canines when the ideal posterior occlusion was achieved.
- Finishing and detailing and cosmetic recontouring on the maxillary central incisors and mandibular incisors.
- Debanding and retention.
RESULTS ACHIEVED:
Maxilla:
- Non-growing patient- -did not change A-P, Vertical, or Transverse positions of the maxilla.
Mandible
- Non-growing patient- - did not change A-P, Vertical, or Transverse positions of the mandible, except for a downward rotation reflected by an increase of the mandibular plan angle.
Maxillary Dentition
- Aligned and leveled maxillary arch while creating more ideal incisor angulation.
- Retraction of the anterior maxillary teeth in a bodily manner in order to compensate for the Class II skeletal pattern.
- Achieved dento-alveolar broadening of the maxillary arch in the bicuspid segment.
Mandibular Dentition
- Aligned and leveled the mandibular arch and midline correction as well as some extrusion of the molars.
- Maintained the mandibular incisor angulation.
- Achieved dento-alveolar broadening of the mandibular arch in the bicuspid segment.
Occlusion
- Eliminated 100% deep bite occlusion while achieving more ideal overbite and overjet relations.
- Improved posterior occlusal relations to achieve Class I canine occlusion bilaterally with cuspid guidance and Class II molar relationship.
Facial Esthetics
- Improved upper and lower lip support and relationship.
- Reduced depth of the mento-labial fold.
- Improved smile esthetics with broadening of the maxillary and mandibular arches.
RETENTION: Upper circumferential and lower Hawley retainers to be worn each night and every night.
FINAL EVALUATION OF TREATMENT:
Complex and asymmetric malocclusion treated to a good result.
The original objectives to correct the overjet, the deep bite, the crowding and the midline deviation had all been achieved. However, some blunting of the roots of the maxillary incisors is observed.
Due to the Bolton discrepancy there is a weak Class I occlusion, especially on the left side where the lateral is slight smaller. The patient did not want any "build-up", veneers or spaces left.
Although major corrections were achieved, I would like to see a better root angulation of the maxillary right lateral incisor and left canine and mandibular right first premolar.
The prognosis for stability is good and dental corrections should be maintained by proper retainer wear.
I have learnt from this case that a skeletal and asymmetric malocclusion can be orthodontically corrected with a proper diagnosis and a good extraction selection and excellent cooperation.