Surgery-first in interdisciplinary class II cases.

OBJECTIVES: To present an interdisciplinary case treated with a surgery-first orthognathic approach, followed by orthodontic and prosthodontic treatment. CLINICAL CONSIDERATIONS: After an accurate pre-operative virtual planning, a young patient with skeletal class II, retrognathia, and an anterior open bite was treated with bimaxillary orthognathic surgery without pre-surgical orthodontic decompensation. Orthodontic treatment was carried out post-operatively. The treatment was completed with a prosthodontic phase to improve the final esthetic outcome of the smile. CONCLUSIONS: A surgery-first approach allowed to achieve esthetic and functional results in a reduced treatment duration that remained stable over the course of 1 year. The outcomes were consistent with prior research in terms of advantages brought by following an accurately planned surgery-first protocol. Nevertheless, longer-term follow-up was required to evaluate the treatment stability. CLINICAL SIGNIFICANCE: An accurately planned surgery-first approach significantly helped in shortening the duration of the treatment, while providing a stable, functional, and esthetic solution to the patient's problems.

Surgical-orthodontic with atypical extraction pattern as a treatment for an anterior open bite: A case report.

This case report described th e surgical- orthodontic interdisciplinar y t reatment of a patie nt with skeletal anterior open bite, class III skelet al pa ttern, steep mandibular plane, increa sed lower face heigh t, and thin mandibular sym physis. The or thodontic p reparation included an unusual extraction pattern (maxillary right first molar, maxillary left second premolar, and mandibular right central incisor), combined with two-jaw surger y comprised of maxillar y advancement and d ifferential impac tion, b ilateral malarplasty augme ntation and man dib ula r asymmetric bilateral sagittal split osteotomy setback. The follow-up of a rare complication of surgical hooks breakage during surgery is reported. Guided by 3- dimesional digital platforms, treatment planning and execution, resulted in a more ba lan ced a nd proportionate face with functional occlusion, and the case stability is shown i n a 32-m onth follow-up.

Comparison of Class II open bite correction by temporomandibular joint prostheses or bimaxillary orthognathic surgery.

INTRODUCTION: The aim of this study was to evaluate the outcome of skeletal Class II and anterior open bite patients who received simultaneous Le fort I osteotomies with temporomandibular joint (TMJ) prostheses or bimaxillary orthognathic surgery. MATERIALS AND METHODS: Patients with condylar resorption (CR) were treated by TMJ prostheses and orthognathic surgery and divided into two groups. Cephalometric radiographs were obtained before and after operation to find out the surgical alteration by comparing measures at different time points. RESULTS: 23 patients were included. Mean overbite of the patients was increased by 3.39 mm in TMJ prostheses group and 3.24 mm in orthognathic group. Occlusal plane angle was averagely rotated -6.06° and 1.31°; mandibular plane counterclockwise rotated 12.23° and 5.81°, respectively. The increase of ramus height in TMJ prostheses group were significantly greater than orthognathic surgery group (8.02 ± 1.96 mm vs. -0.09 ± 1.29 mm). The overall treatment effect was stable in both groups during the 1-year follow up. DISCUSSION: Two surgical plans seem to be reliable treatments of anterior open bite and mandibular retrognathism caused by temporomandibular disease. TMJ prostheses with simultaneous Le fort I osteotomies close open bite by lengthening the height of ramus and rotating maxillo-mandibular complex counterclockwise, while bimaxillary orthognathic surgery by rotating maxilla clockwise and mandible counterclockwise without rebuilding ramus.

Surgical vs nonsurgical treatments in patients with anterior open-bite have similar effects in occlusal function: A 2-year follow-up study.

INTRODUCTION: This study aimed to investigate changes in bite force (BF) and occlusal contact area after anterior open-bite (AOB) treatment and compare the changes in surgical vs nonsurgical treatment. METHODS: This retrospective study included patients with AOB compared with normal occlusion. AOB was corrected by either intrusion of the maxillary molars (intrusion group, n = 19) or orthognathic surgery (surgery group, n = 37). The control group (n = 35) had a normal overbite relationship. Records of lateral cephalograms, BF, and occlusal contact area taken before (T0), immediately after (T1), and 2 years after (T2) orthodontic treatment were compared within and among the 3 groups. RESULTS: The open-bite group, including intrusion and surgery groups, had a lower BF and less occlusal contact area than the control group at T0 and T1 (P <0.001). However, there were no significant differences among the 3 groups at T2 (P >0.05). The intrusion and surgery groups showed no significant differences throughout the observation period extending from T0 to T2 (P >0.05). Although BF and occlusal contact area decreased at T1 compared with T0, they increased during retention and showed higher values at T2 than at T0. CONCLUSIONS: Treatment of AOB improved BF and occlusal contact area 2 years posttreatment. Orthognathic surgery and molar intrusion using orthodontic miniscrews can improve occlusal function similarly. Orthodontists can select either method depending on malocclusion severity and patient demand.

Associations between the timing of tongue reduction surgery, (Epi)genotype, and dentoskeletal development in patients with Beckwith-Wiedemann syndrome.

Tongue reduction surgery is often pursued to manage the adverse effects of macroglossia in patients with Beckwith-Wiedemann syndrome (BWS). This study characterized dental outcomes in patients with BWS based on surgical timing and molecular diagnosis. A retrospective study was designed to include patients with BWS over the age of two who had clinical or radiographic documentation of dental development. Patients were grouped by history of tongue reduction surgery and surgical timing (early: <12 months). One hundred three patients were included (55 no tongue reduction, 18 early, 30 late). Patients who underwent late surgery had lower odds of class I occlusion (OR 0.11, 95% CI 0.02-0.58, p = 0.009) and higher odds of anterior open bite (OR 7.5, 95% CI 1.14-49.4, p = 0.036). Patients with clinical diagnoses and negative molecular testing had anterior open bite less frequently than patients with imprinting center 2 loss of methylation and paternal uniparental isodisomy of 11p15.5 (p = 0.009). Compared to reference values, patients who had tongue reductions had an increased mandibular plane angle (32.0 ± 4.5° versus 36.9 ± 5.0°, p = 0.001), indicative of hyperdivergent growth. The results of this study help to understand the complex nature of dentoskeletal growth in BWS and shed insight on how surgical timing and molecular diagnosis influence prognosis.

Dentoskeletal features and growth pattern in Beckwith-Wiedemann spectrum: is surgical tongue reduction always necessary?

OBJECTIVES: The role of tongue reduction surgery (TRS) in preventing excessive mandibular growth and anterior open bite in children with Beckwith-Wiedemann Spectrum (BWSp) is still controversial. This cross-sectional study aimed at comparing craniofacial growth pattern in children affected by BWSp either treated or not treated with early TRS for severe macroglossia. Considering the invasive nature of such surgery, the present study could help in clarifying the need for TRS to reduce or prevent growth disturbances. MATERIALS AND METHODS: Orthopantomography and lateral skull x-ray images were taken either from surgically treated or non-surgically treated patients, aged 5 to 8 years, to compare dentoskeletal features and craniofacial growth by cephalometric analysis. Molecular testing results were collected from their medical records. RESULTS: Eighteen BWSp patients were consecutively recruited: 8 underwent TRS at 14.9 ± 2.2 months of age, while 10 did not. Anterior open bite and dental class III were more frequently observed in the surgically treated group, but none showed skeletal class III. No statistically significant differences were observed in growth pattern, but children treated with TRS showed a tendency towards both maxillary and mandibular prognathism with protruding lower lip. Growth pattern seemed to be not related to molecular subtypes. CONCLUSIONS: These preliminary data suggest that early TSR does not improve craniofacial growth pattern and dentoskeletal features in BWSp children. CLINICAL RELEVANCE: Reductive glossectomy may not be justified for preventing or avoiding oro-facial deformities in BWSp; therefore, early monitoring of maxillofacial development of each affected child has a great clinical significance.

Comparison of regional soft tissue changes after bimaxillary rotational surgery between class III deformity with overbite and open bite: A 3D imaging analysis.

BACKGROUND: This prospective study aimed to compare regional soft tissue changes between patients with class III overbite and open bite deformities treated with bimaxillary surgery involving clockwise and counter-clockwise mandibular setback, respectively. MATERIAL AND METHODS: Class III deformity adults receiving Le Fort I and bilateral sagittal split osteotomies were grouped according to the incisal occlusion: overbite (n = 30) and open bite (n = 30). Combined cone-beam CT scans and 3D facial photographs preoperative and at least 1-year postoperative were taken to assess the soft tissue changes. RESULTS: Postoperative changes for the overbite and open bite groups included anterior repositioning of nose (-0.8 ± 1.2 mm and -1.1 ± 1.1 mm, respectively) and cheek (-1.9 ± 1.3 mm and -1.7 ± 2.6 mm, respectively), posterior repositioning of chin (5.2 ± 4.0 mm and 4.9 ± 3.2 mm, respectively), and medial (-1.7 ± 2.0 mm and -1.9 ± 2.1 mm, respectively) and posterior (2.7 ± 1.4 mm and 2.8 ± 2.3 mm, respectively) repositioning of bilateral angles. Posterior (1.2 ± 2.0 mm and 5.1 ± 3.3 mm) and inferior (-1.4 ± 2.2 mm and -2.4 ± 2.7 mm) repositioning of upper lip and lower lip occurred in overbite group. Inferior (-2.3 ± 2.4 mm) and superior (3.7 ± 3.4 mm) repositioning of chin occurred in the overbite and open bite groups, respectively. CONCLUSIONS: Treatment of class III overbite and open bite deformities with bimaxillary rotational surgery resulted in comparable regional soft tissue changes, except for upper lip, lower lip and chin.

Substantial Improvements in Facial Morphology through Surgical-Orthodontic Treatment: A Case Report and Literature Review.

Background and Objectives: The long face type is associated with excessive vertical facial growth and most often with anterior open bite. In many cases of anterior open bite of high severity associated with bimaxillary dento-alveolar protrusion, lips are unable to form an adequate seal at rest. This leads to many issues, including facial dysmorphism. The aim of this study was to describe the case of a 15 year old girl who addressed the orthodontist in November 2015, having complaints related to the skeletal and dental open bite. Case Description: A 15.7 year old patient required a consultation with the orthodontic service for impaired dento-facial aesthetics at rest, smile and speech due to an exaggerated superior protrusion of the upper frontal teeth, labial incompetence with excessive gingival exposure at rest and smile associated with upper and lower anterior teeth crowding. The orthodontic diagnostic consisted of skeletal open bite with a hyperleptoprosop morphological facial type, high degree of hyperdivergence, bimaxillary dento-alveolar protrusion, 7 mm skeletal open-bite, 3 mm vertical inocclusion of the anterior teeth, skeletal class II relationships, bilateral half cusp class II molar and canine relationships, labial incompetence, highly increased interlabial gap, facial asymmetry, excessive gingival exposure of 7 mm at smiling and bimaxillary anterior crowding. Because the patient initially refused orthognathic surgery, prior to starting the orthodontic treatment, the patient was recommended to receive a bilateral extraction of the first upper premolars. Key objectives of pre-surgical orthodontic treatment were to achieve a retroclined position of the upper incisors under their normal inclination for the planned upward maxillary rotation, to maintain slightly lower incisor proclination. The orthognathic surgery consisted of Le Fort I impaction osteotomy with 8 mm anterior impactation, bilateral sagittal split osteotomy, and mandibular repositioning using occlusal splint. Conclusions: At the end of the orthodontic-surgical treatment, the patient presented significant improvement in dento-facial aesthetics, and optimal skeletal, muscular and dental balance.

Posttreatment stability of an anterior open-bite by molar intrusion compared with 2-jaw surgery - a retrospective study.

OBJECTIVES: This study aimed to compare post-treatment stability in patients with anterior open-bite (AOB) between those treated surgically (orthognathic 2-jaw surgery) and non-surgically (molar intrusion using orthodontic miniscrews). MATERIALS AND METHODS: All subjects had initial overbite (OB) < -1 mm and lateral cephalograms taken before treatment (T0), immediately after AOB correction (T1), after orthodontic treatment (T2), and at least 1 year after treatment (T3). The non-surgical group was enrolled retrospectively; then, the surgical group was matched by OB, sex, and age to the non-surgical group (n = 21 each). Changes in cephalometric measurements during treatment (T1-T0), finishing (T2-T1), and retention (T3-T2) periods were compared between two groups. RESULTS: OB increased by 4.5-5.1 mm during the treatment period with 3.3 mm upward movement of the maxillary first molar (U6) in both groups. Changes in OB were not significantly different between the groups: 0.5-0.9 mm increase during the finishing period but 1.0 mm decrease during the retention period (P > 0.05). U6 moved 0.5 mm downward in non-surgical group and 0.1 mm upward in the surgical group during the finishing period, and 1.0 mm and 0.4 mm downward in the non-surgical and surgical groups, respectively, during the retention period. CONCLUSIONS: Post-treatment stability of AOB was similar for surgical and non-surgical methods (76.8 - 78.7%), although U6 moved more downward in the non-surgical group than in the surgical group. CLINICAL RELEVANCE: AOB without severe skeletal deformity can be treated by either molar intrusion or orthognathic surgery with similar treatment outcome and stability.

Surgical Reduction of Chronic Bilateral Traumatic Dislocation of the Mandibular Condyles With Erosion of the Middle Fossa Floor: Case Report With Surgical Video.

BACKGROUND: Dislocation of the mandibular condyle (MC) is not a common condition, but when a traumatic case involves erosion of the middle fossa floor, it becomes a much more complicated and even rarer pathology. OBJECTIVE: To describe the management of traumatic dislocation of the MCs with erosion of the middle fossa floor. We provide a step-by-step surgical video demonstrating reestablishment of the condylar position and occlusion. METHODS: A 65-yr-old woman with rheumatoid arthritis presented after a ground-level fall. She was admitted to the intensive care unit with simultaneous complex medical conditions, intubated, and medically treated for over a month. She was seen in outpatient follow-up 2 mo later and noted to have an anterior open bite and bilateral temporomandibular joint pain. Computed tomography of the face showed bilateral dislocation of the MCs with erosion of the middle fossa floor. RESULTS: Open surgical treatment with bilateral eminectomies was performed to obtain adequate reduction, involving a multidisciplinary team including neurosurgery, oral-maxillofacial surgery, and otolaryngological surgery. She did well postoperatively. CONCLUSION: Multiple factors predispose a patient to MC dislocation, but we believe the catalyst in this case was significant manipulation of the jaw during endotracheal intubation. A chronic postoperative open bite can lead to much more difficult treatment, given bony erosion and fibrotic tissue formation. This case highlights the challenges of diagnosis and treatment of a bilateral traumatic dislocation and provides a surgical video reference description of repair and resolution.

Combined orthodontic and surgical open bite correction.

OBJECTIVES: To examine the stability of combined surgical and orthodontic bite correction with emphasis on open-bite closure. All study patients were treated with strict and consistent orthodontic and surgical protocols. MATERIALS AND METHODS: Study inclusion required all patients to have anterior open bites, maxillary accentuated curve of Spee, 36-month minimum follow-up, and no temporomandibular joint pathology. Thirty patients met the inclusion/exclusion criteria. Importantly, segmental upper arch orthodontic preparation (performed by EG) was used. Surgery consisted of a multisegment Le Fort I (MSLFI) combined with a bilateral sagittal osteotomies (BSSO). Surgery was performed (by ADA and LT) at the Department of Dentistry and Maxillofacial Surgery of the University of Verona, Italy. RESULTS: The long-term open bite and overjet relapse were not statistically significant. The mean transverse relapse of the upper and lower molars was statistically significant. Of great importance, the upper and lower arch widths narrowed together, maintaining intercuspation of the posterior dentition which prevented anterior open bites from developing. CONCLUSIONS: This study revealed stability of three-dimensional occlusal correction including anterior open bite. Stable open bite closure was achieved by using rigid protocols for orthodontic preparation, surgical techniques, surgical follow-up, and orthodontic finishing.

Computer-aided surgical workflow in a surgery - First orthognathic approach to correct anterior open bite in a young adult with temporomandibular disorders.

An 18-year-old female patient with temporomandibular disorders (TMD) history sought medical care in orthodontic-orthognathic interdisciplinary department with chief complaint of anterior open bite. After splint therapy to seat the condylar into the musculo-skeletally stable position, a surgery-first approach was formulated assisted by 3D virtual planning and transferred to the surgery by computer-aided manufacturing splint. No TMD symptom reoccurrence was reported or noted. Stable occlusion and satisfactory facial aesthetics were achieved. In the 18-month follow-up, no clinically significant open bite relapse occurred. This case report describes the remarkable role that computer-assisted surgical simulation could play throughout the surgical-orthodontic procedure to correct the skeletal open bite deformity.

Vertical stability of different orthognathic treatments for correcting skeletal anterior open bite: a systematic review and meta-analysis.

BACKGROUND: Several orthognathic procedures have been applied to correct skeletal anterior open bites (SAOB). Which method is most stable has been debated and no consensus has been reached and there is no conclusive evidence for clinicians to use. OBJECTIVE: To analyse whether maxillary, mandibular, or bimaxillary surgery provides a better stability. MATERIALS AND METHODS: A systematic search was conducted up to December 2020 using PubMed, EMBASE, Medline, Scopus, Web of Science, Cochrane CENTRAL, and Google Scholar. We made direct comparisons among the controlled trials and also made indirect comparisons via subgroup analysis on the aspects of occlusional, skeletal, and dento-alveolar stability to assess the overall stability of each method. RESULTS: Finally 16 cohort studies were identified. At the occlusional level, pooled change in overbite was 0.21 mm in maxillary surgery, 0.37 mm in bimaxillary surgery, and -0.32 mm in mandibular surgery. At the skeletal level, pooled sella-nasion-Point A angle (SNA) was -0.12 degrees in bimaxillary surgery, -0.37 degrees in maxillary surgery and -0.20 degrees in mandibular surgery. The sella-nasion to palatal plane angle (SNPP) relapsed to a statistically significant degree in all samples received single maxillary surgery. Relapse of the sella-nasion-Point B angle (SNB) was 0.47 degrees in mandibular setback, -1.8 degrees in mandibular advancement, and -0.48 degrees in maxillary surgery. The Sella-Nasion to mandibular plane angle (SNMP) relapsed more in procedures involving bilateral sagittal split osteotomy than in other procedures. As for dento-alveolar changes, intrusion of molars and extrusion of incisors took place in most patients. CONCLUSIONS: Bimaxillary surgery produced the most beneficial post-operative increase in overbite, maxillary surgery led to a lesser but still positive overbite change, and mandibular surgery correlated with some extent of relapse. Skeletally, bimaxillary surgery was more stable than maxillary surgery at both SNA and SNPP; SNB was more stable in mandibular setback than advancement; and SNMP was unstable in both mandibular and bimaxillary surgeries versus maxillary surgery with comparable surgical changes. Dento-alveolar compensation helped maintain a positive overbite. REGISTRATION NUMBER: CRD42020198088.

Vertical segmental anterior mandibular distraction to aid closure of a severe anterior open bite associated with an accentuated reverse curve of Spee.

BACKGROUND: The correction of severe anterior open bite is technically challenging, often requiring the use of complex orthodontic mechanics and/or orthognathic surgery and has a relatively high risk of relapse. A marked reverse curve of Spee in the lower arch presents additional challenges when correcting a severe anterior open bite. METHODS AND MATERIALS: A 22.2-year-old Caucasian man presented with concerns relating to poor anterior occlusion associated with a 1.3-cm anterior open bite. There was an accentuated reverse curve of Spee to the lower arch, an increased maxillary-mandibular plane angle and increased lower face height. Multidisciplinary treatment involving the use of segmental anterior mandibular distraction to level the curve of Spee before undertaking a Le Fort I posterior maxillary impaction is described in this case report. RESULTS: Long-term post-treatment records showed stable anterior open bite correction. CONCLUSIONS: This case report illustrates the successful use of segmental anterior mandibular vertical distraction followed by conventional Le Fort I posterior impaction surgery to correct a severe anterior open bite associated with an accentuated reverse curve of Spee and high maxillary-mandibular plane angle.

Orthognathic surgery with two-segment le fort i and sagittal split ramus osteotomies of open bite deformity in an amelogenesis imperfecta patient via virtual planning: A case report.

Amelogenesis imperfecta (AI) is an enamel defect and is often associated with the anterior open bite (AOB) and transverse maxillary deficiency. It is known that in such cases when AI and AOB appeared together, posterior maxillary impaction with or without bilateral mandibular ramus osteotomies is a frequently preferred treatment option. Virtual planning is more reliable rather than the conventional model surgery planning, especially for complicated cases. Usage area of virtual 3D anatomical models reconstructed from Cone Beam Computed Tomography (CBCT) data is expanding day by day for both diagnosis and surgical planning. The aim of this study is to present a patient with AI and AOB and transverse maxillary deficiency and management of this case with virtually planned two-segment Le fort I and sagittal split ramus osteotomies followed by prosthetic rehabilitation.

Comprehensive treatment approach for bilateral idiopathic condylar resorption and anterior open bite with customized lingual braces and total joint prostheses.

This case report describes the successful treatment of a 14-year-old girl with severe bilateral idiopathic condylar resorption and resultant mandibular retrusion, increased overjet, and anterior open bite. The nonextraction treatment plan included (1) aligning and leveling the teeth in both arches, (2) performing Le Fort I maxillary osteotomy, bilateral condylectomy, and mandibular joint replacement, and (3) postsurgical correction of the malocclusion. The orthodontic treatment was initiated with the use of custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Patient-fitted and customized temporomandibular joint implants were designed and manufactured based on the patient's stereolithic bone anatomic model. Treatment was concluded with detailed orthodontic finishing. Optimum esthetic and functional results were achieved with the cooperation of 2 specialties and the use of state-of-the-art technology.

Corrección de la mordida abierta anterior mediante técnica multiloop / Correction of anterior open bite by multiloop technique

La mordida abierta anterior esquelética representa un escenario clínico de complejo abordaje para el ortodoncista. Actualmente, existen numerosas alternativas terapéuticas para su manejo, pero aún se tiene escasa evidencia respecto a su efectividad y estabilidad. Este reporte de caso describe el tratamiento de una mujer de 22 años con diagnóstico de mordida abierta esquelética severa que involucraba los dientes anteriores y posteriores hasta el segundo premolar, relación molar bilateral Clase III y mordida cruzada posterior bilateral. El plan de tratamiento consistió en realizar disyunción maxilar asistida quirúrgicamente, SARPE (acrónimo de Surgically Assisted Rapid Palatal Expansion) y posterior manejo con terapia mecánica de arcos multiloop con elásticos, terapia MEAW (Multiloop Edgewise Archwire). Dentro del período de estabilización de la disyunción, se comenzó la mecánica de arcos multiloop con elásticos, con lo que se redujo significativamente la mordida abierta. Después de 14 meses de tratamiento se consiguieron el control vertical y el sagital. La rápida y efectiva evolución de este caso indica que es posible que el procedimiento SARPE provoque aceleración de la terapia ortodóncica, en este caso MEAW, lo que se traduce clínicamente en resultados favorables para la corrección de la mordida abierta(AU)

The anterior skeletal open bite represents a complex clinical scenario for the orthodontist. Currently there are numerous therapeutic alternatives for its management, but there is still little evidence regarding its effectiveness and stability. This case report describes the treatment of a 22year-old woman with a diagnosis of severe skeletal open bite involving anterior and posterior teeth up to second premolar, bilateral Class III molar relationship and bilateral posterior crossbite. The treatment plan consisted of performing Surgically Assisted Rapid Palatal Expansion (SARPE) and subsequent management with mechanical Multiloop Edgewise Archwire therapy with elastics (MEAW therapy). Within the period of stabilization of the disjunction, the mechanics of multiloop arches with elastics was started, thereby significantly reducing the open bite. After 14 months of treatment, vertical and sagittal control was achieved. The speedy and effective evolution of this case indicates that it is possible that SARPE procedure causes orthodontic therapy acceleration, the MEAW therapy in this case, which is clinically translated into favourable results for the correction of the open bite(AU)

Tratamento fechado em fratura mandibular: parassinfisária e côndilar bilateral ­ relato de caso clínico / Closed treatment in mandibular fracture: bilateral parasymphyseal and condyle ­ clinical case report

Objetivo: relatar um caso de fratura na região parassinfisária e côndilar bilateral após acidente ciclístico, tratada pela técnica de bloqueio maxilomandibular. Relato de caso: paciente do gênero feminino, 21 anos, deu entrada no Hospital Municipal Waldemar das Dores, Barão de Cocais, MG, vítima de acidente ciclístico, apresentando fratura de esmalte e dentina nos dentes 11 e 21, mordida aberta anterior, com incapacidade de atingir a máxima intercuspidação, juntamente com uma limitação de excursão lateral para o lado direito. Após exames tomográficos, foi constatada fratura completa de colo de côndilo direito, fratura em galho verde em côndilo esquerdo e fratura de cortical lingual parassinfisária. Por se tratar de uma paciente jovem e por apenas uma de suas fraturas apresentar-se completa (colo do côndilo direito), foi proposto tratamento fechado, por meio do bloqueio maxilomandibular. Conclusão: o bloqueio maxilomandibular foi considerado um tratamento eficaz no caso em questão, no qual foi possível estabelecer a consolidação das fraturas sem ocorrência de complicações pós-tratamento.(AU)

Objective: to report a case of fracture in the bilateral parasymphyseal and condylar region after a cycling accident, treated with the maxillomandibular block technique. Case report: a 21-yearold female patient was admitted to the Waldemar das Dores Municipal Hospital, Barão de Cocais, MG, Brazil, victim of a cycling accident, showing enamel and dentin fracture in teeth 11 and 21, anterior open bite, inability to reach maximum intercuspation, and a lateral excursion limitation to the right side. Tomographic examinations showed complete fracture of the right condyle neck, greenstick fracture in the left condyle, and parasymphyseal lingual cortical fracture. Considering it is a young patient with only one complete fracture (neck of the right condyle), a closed treatment was proposed through maxillomandibular block. Conclusion: maxillomandibular block was considered an effective treatment for the case in question, allowing to establish fracture consolidation without post-treatment complications.(AU)

A comprehensive treatment approach for idiopathic condylar resorption and anterior open bite with 3D virtual surgical planning and self-ligated customized lingual appliance.

INTRODUCTION: We report the successful treatment of a 38-year-old woman with bilateral idiopathic condylar resorption and anterior open bite. She had incompetent lips, a gummy smile, increased lower facial height, high mandibular plane angle, skeletal and dental Class II malocclusion with mild mandibular crowding, increased overjet, and mandibular midline deviation to the right. METHODS: The treatment plan included: (1) presurgical alignment and leveling of the teeth in both arches; (2) jaw motion tracking (JMT) to detect mandibular movement; (3) 3-piece maxillary osteotomies with mandibular reconstruction and bilateral coronoidectomies; and (4) postsurgical correction of the malocclusion. The orthodontic treatment was performed with the use of custom lingual braces and clear brackets and the orthognathic surgery was planned with the use of virtual surgical planning. RESULTS: The idiopathic condylar resorption and anterior open bite were treated, crowding was eliminated in the lower anterior segment, correction of skeletal and dental Class II malocclusion was obtained, mandibular plane angle was reduced, and facial profile improved. CONCLUSIONS: The results suggest that esthetic and functional results can be achieved with the cooperation of 2 specialties and with the use of state-of-the-art technology.