Lower incisor extraction therapy in a complex case with an ankylosed tooth in an adult patient: A case report.

This case report describes a successful orthodontic therapy of an adult female treated by mandibular central incisor extraction and vestibular fixed appliances. The patient presented a skeletal Class I with normodivergent facial pattern, Class II subdivision dental relationship, extremely deep Curve of Spee and severe overbite. Moreover, during the treatment, the upper left first molar does not respond to orthodontic forces due to tooth ankylosis, augmenting the difficulty of this case. Despite this, a good occlusal relationship on both sites and an optimal extraoral outcome have been achieved after a 26-months therapy. To our knowledge no case report with such entity of Curve of Spee with contemporary tooth ankylosis has been presented.

Stable deep bite correction with true mandibular incisor intrusion in a late adolescent patient with skeletal deep bite: A case report.

The treatment of skeletal deep bite does not remain stable. The patient was a Japanese woman aged 16 years and 10 months. Her chief complaint was maxillary protrusion. The degree of overjet was + 10.5 mm and overbite was + 5.0 mm; the intermolar relationship was Angle Class II. An excessive curve of Spee was observed in the mandibular arch. A hypodivergent skeletal pattern was indicated by a small mandibular plane angle and gonial angle. The maxillary incisors were proclined and the mandibular incisors were retroclined. Based on the above findings, the patient was diagnosed with Angle Class II maxillary protrusion and deep bite with hypodivergency. Both maxillary first premolars were extracted and orthodontic treatment was performed using multi-bracket appliances. A proper overbite was achieved by 5.0 mm intrusion of the mandibular incisors. The maxillary incisors were retracted by 11.2 mm and a proper overjet was achieved. Good treatment results were obtained without apical root resorption. After 2 years of retention, the occlusion has been well maintained. This report may constitute a remarkable suggestion for treatment of an unstable deep bite.

Correction of skeletal class II severe open bite with temporomandibular joint disorder treated by miniscrew anchorage and molar extraction: a case report.

BACKGROUND: Little information is available on the treatment of open bite with temporomandibular joint disorder by intrusion of molars using miniscrews. CASE PRESENTATION: This case report describes a 42-year-old Japanese woman with a skeletal class II severe anterior open bite and temporomandibular joint disorder. The pretreatment magnetic resonance imaging of both temporomandibular joints revealed osteoarthritis and anterior disc displacement without reduction in both temporomandibular joints. A stabilization splint was used before orthodontic treatment and bilateral upper and lower premolars were extracted. Miniscrews were inserted into the palatal region to intrude the maxillary molars and avoid loss of anchorage. The maxillary left first molar was also extracted to improve the molar relationship and the dental midline. Normal overjet and overbite with Angle class I molar relationship were achieved, and the upper and lower midlines coincided. Our patient's teeth continued to be stable and her temporomandibular joint was asymptomatic after a retention period of 2 years. CONCLUSIONS: Intrusion of molars by miniscrews is available for skeletal class II severe open bite.

An unusual case of invasive cervical resorption after piezosurgery-assisted en masse retraction.

A 16-year-old patient sought orthodontic correction for profile improvement and labially inclined maxillary incisors. She had Class II malocclusion, protrusive maxillary and mandibular incisors, and increased overjet and overbite with an American Board of Orthodontics discrepancy index value of 25. She was treated with maxillary premolar extractions and miniscrew-supported en masse retraction assisted with piezoincisions. Extraction spaces (7.5 mm per side) were closed with maximum anchorage in 10 months. Total treatment time was 23 months. Twenty-seven months after debonding, a pink spot was noted at the buccocervial region of the left central incisor. Radiographic evaluation on cone-beam computed tomographic scans revealed a severe case of invasive cervical resorption on both central incisors, around which the piezosurgical cuts had been made. Treatment proceeded with a nonintervention approach and the affected teeth were reinforced with a lingual retainer.

Correlation of anterior overbite with root position and buccal bone thickness of maxillary anterior teeth: a CBCT study.

PURPOSE: To investigate the correlation of anterior overbite with the sagittal root position (SRP) and buccal bone thickness (BBT) of the maxillary anterior teeth. METHODS: Cone-beam computed tomography (CBCT) data of southern Chinese patients who underwent CBCT examinations between November 2016 and December 2016 were collected. The anterior overbite was the predictor variable while the SRP and the BBT at 4 mm apical to the cementoenamel junction (CEJ-4) and midpoint of the root of the maxillary anterior teeth were set as the primary and secondary outcome variables, respectively. All measurements were done by two calibrated examiners. Correlations between variables were analyzed by the Spearman's correlation coefficient. The significance level was set at P < 0.05. RESULTS: CBCT data of 146 patients (65 men and 81 women) with a mean age of 44.2 ± 13.4 years were analyzed, and of the 876 maxillary anterior teeth evaluated, 9.8% were presented with deep overbites. Most of roots of the anterior teeth (94.9%) were positioned against the buccal cortical plate, of which, in 63.8% of them the apex was not covered by bone along the long axis of the tooth. The mean BBT at CEJ-4 was 0.89 mm at the central incisor, 0.85 mm at the lateral incisor and 0.84 mm at the canine. The overbite was positively correlated with SRP Class I subtypes and the BBT at CEJ-4 (P < 0.05). CONCLUSION: Deep overbite was more frequently accompanied by bone fenestration in the anterior maxillary areas.

High-efficiency treatment with the use of traditional anchorage control for a patient with Class II malocclusion and severe overjet.

Patients with Class II malocclusion and severe overjet are often dissatisfied with their facial disharmony. Although temporary skeletal anchorage devices (TSADs) are now widely used in orthodontic treatment, traditional anchorage devices should not be overlooked as a treatment option. Proper design of traditional anchorage can achieve 3-dimensional control of incisors and molars as efficiently as TSADs in some patients with severe malocclusion. We used traditional anchorage devices, including a transpalatal arch and a Nance palatal arch, combined with a utility arch to treat an 11-year-old Chinese girl with a skeletal Class II malocclusion and severe overjet. The space was closed in 2 steps to protect molar anchorage. Facial improvement, especially smile esthetics, and Class I molar relationship and overjet correction were achieved in 17 months of treatment. Follow-up records 22 months after treatment show that the results remained stable.

Severe unilateral scissors-bite with a constricted mandibular arch: Bite turbos and extra-alveolar bone screws in the infrazygomatic crests and mandibular buccal shelf.

A 33-year-old woman had a chief complaint of difficulty chewing, caused by a constricted mandibular arch and a unilateral full buccal crossbite (scissors-bite or Brodie bite). She requested minimally invasive treatment but agreed to anchorage with extra-alveolar temporary anchorage devices as needed. Her facial form was convex with protrusive but competent lips. Skeletally, the maxilla was protrusive (SNA, 86°) with an ANB angle of 5°. Amounts of crowding were 5 mm in the mandibular arch and 3 mm in the maxillary arch. The mandibular midline was deviated to the left about 2 mm, which was consistent with a medially and inferiorly displaced mandibular right condyle. Ectopic eruption of the maxillary right permanent first molar to the buccal side of the mandibular first molar cusps resulted in a 2-mm functional shift of the mandible to the left, which subsequently developed into a full buccal crossbite on the right side. Treatment was a conservative nonextraction approach with passive self-ligating brackets. Glass ionomer bite turbos were bonded on the occlusal surfaces of the maxillary left molars at 1 month into treatment. An extra-alveolar temporary anchorage device, a 2 × 12-mm OrthoBoneScrew (Newton A, HsinChu City, Taiwan), was inserted in the right mandibular buccal shelf. Elastomeric chains, anchored by the OrthoBoneScrew, extended to lingual buttons bonded on the lingually inclined mandibular right molars. Cross elastics were added as secondary uprighting mechanics. The maxillary right bite turbos were reduced at 4 months and removed 1 month later. At 11 months, bite turbos were bonded on the lingual surfaces of the maxillary central incisors, and an OrthoBoneScrew was inserted in each infrazygomatic crest. The Class II relationship was resolved with bimaxillary retraction of the maxillary arch with infrazygomatic crest anchorage and intermaxillary elastics. Interproximal reduction was performed to correct the black interdental spaces and the anterior flaring of the incisors. The scissors-bite and lingually inclined mandibular right posterior segment were sufficiently corrected after 3 months of treatment to establish adequate intermaxillary occlusion in the right posterior segments to intrude the maxillary right molars. The anterior bite turbos opened space for extrusion of the posterior teeth to level the mandibular arch, and the infrazygomatic crest bone screws anchored the retraction of the maxillary arch. In 27 months, this difficult malocclusion, with a Discrepancy Index score of 25, was treated to a Cast-Radiograph Evaluation score of 22 and a pink and white esthetic score of 3.

Nonsurgical correction of a severe anterior open bite with mandibular molar intrusion using mini-implants and the multiloop edgewise archwire technique.

This article reports the case of a 24-year-old man with a large anterior open bite, mild mandibular crowding, increased overjet, no passive lip sealing, and Angle Class I malocclusion. The treatment results were achieved by mandibular molar intrusion using 1.8 × 8.5-mm mini-implants (C-implants) inserted between the mandibular first and second molars bilaterally. A 2.5-mm molar intrusion and open-bite closure occurred within 8 months. The multiloop edgewise archwire technique helped to intrude the posterior teeth. Total treatment time was 20 months. Fifty months postretention records are also presented. The patient achieved a suitable occlusion and satisfactory facial esthetics at the end of treatment and at the 50-month retention check.

Long-term changes of the anterior palatal alveolar bone after treatment with bialveolar protrusion, evaluated with computed tomography.

This case report describes the treatment of a 31-year-old woman with a convex profile, protrusive maxilla, retrusive mandible, and gummy smile. Four premolars were extracted, and micro-implant anchorage was used to retract the anterior teeth. Lip protrusion and the gummy smile were improved, but the computed tomography images showed dehiscence on the palatal alveolar bone of the maxillary incisors. Approximately 10 years after treatment, significant alveolar bone apposition was seen on the palatal surface of the maxillary anterior teeth.

A comparative study of the effect of the intrusion arch and straight wire mechanics on incisor root resorption: A randomized, controlled trial.

OBJECTIVE: To analyze and compare external apical root resorption (EARR) of maxillary incisors treated by intrusion arch or continuous archwire mechanics. MATERIALS AND METHODS: This cone-beam computed tomography (CBCT) study analyzed 28 deep bite patients in the permanent dentition who were randomly divided into two groups: Group 1, 12 patients with initial mean age of 15.1 ± 1.6 years and mean overbite of 4.6 ± 1.2 mm treated with the Connecticut intrusion arch (CIA) in the upper arch (Ortho Organizers, Carlsbad, Calif) for a mean period of 5.8 ± 1.27 months. Group 2, 16 patients with initial mean age of 22.1 ± 5.7 years and mean overbite of 4.1 ± 1.1 mm treated with conventional leveling and alignment using continuous archwire mechanics for 6.1 ± 0.81 months. The degree of EARR was detected in 112 maxillary incisors by using CBCT scans and a three-dimensional program (Dolphin 11.7, Dolphin Imaging & Management Solutions, Chatsworth, Calif). The CBCT scans were obtained before (T1) and 6 months after initiation of treatment (T2). Differences between and within groups were assessed by nonpaired and paired t-tests, respectively, with a 5% significance level. RESULTS: Significant differences were found for both groups between T1 and T2 ( P < .05) indicating that EARR occurred in both groups. However, there were no significant differences when EARR was compared between group 1 (-0.76 mm) and group 2 (-0.59 mm). CONCLUSIONS: The Connecticut intrusion arch did not lead to greater EARR of maxillary incisors when compared with conventional orthodontic mechanics.

Relationship Between Occlusal Features and Enzyme Replacement Therapy in Patients With Mucopolysaccharidoses.

PURPOSE: The aim of this study was to describe the relation between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses. MATERIALS AND METHODS: A cross-sectional study was conducted. The sample consisted of 20 patients with mucopolysaccharidoses, 10 of whom were undergoing treatment at a hospital in northeast Brazil. Occlusal features were evaluated by clinical examination and panoramic radiography. A structured questionnaire was administered to evaluate the dental care of each patient. Pearson χ2, Fisher exact, and Mann-Whitney tests were used for data analysis, with a level of significance of 5%. RESULTS: Marked overjet (75%) and anterior open bite (70%) were the most frequent occlusal alterations, and 15% had Class III disorders. Radiography visualized the presence of impacted teeth (75%) and prolonged retention of deciduous teeth (65%). Patients with enzyme replacement therapy had a lower average maximum protrusion (P = .033). A total of 75% of mothers said they had not been advised to take their children to the dentist and 10% of children had never been to the dentist. CONCLUSION: Patients with mucopolysaccharidoses exhibited notable occlusal alterations, especially marked overjet and anterior open bite. Enzyme replacement therapy seems to influence the maximum protrusion of patients.

Combined orthodontic-orthopedic treatment of an adolescent Class II Division 2 patient with extreme deepbite using the Forsus Fatigue Resistant Device.

Class II Division 2 malocclusion is often characterized by severe, traumatic deepbite with lingually inclined and overerupted incisors. Combined orthodontic-orthopedic treatment of this malocclusion is a challenging issue for orthodontists. This case report describes the combined orthodontic-orthopedic treatment of an adolescent Class II Division 2 patient with an extreme deepbite and a retrognathic mandible using the Forsus Fatigue Resistant Device.

Miniscrew-assisted customized lingual appliances for predictable treatment of skeletal Class II malocclusion with severe deep overbite and overjet.

This report describes the use of miniscrew-assisted customized lingual fixed appliances in a patient with severe skeletal Class II malocclusion. The patient was a 12-year-old Chinese girl with the chief complaint of protrusive lips and anterior teeth. Her diagnosis included a skeletal Class II relationship with maxillary protrusion, a backward-rotated mandible, a full Angle Class II molar relationship, and severe deep overjet and overbite. Four premolars were extracted, and miniscrew anchorage was placed in the maxillary posterior lingual segment to provide maximum anchorage and to achieve vertical control of the intruding molars. The customized lingual fixed appliance and temporary anchorage devices created a smooth and invisible treatment progress, resulting ultimately in a well-aligned dentition with ideal intercuspation and a dramatically improved profile. The 3-year follow-up examination indicated that the excellent treatment outcome was stable.

Cranial morphology in the brachygnathic sheep.

BACKGROUND: Craniofacial morphology of sheep with phenotypically observed mandibular distocclusion was analysed using the multivariate techniques principle component analysis and cluster analysis in order to test whether different types of craniofacial malformations can be distinguished. RESULTS: The results showed 8 principal components with a variance of 82.72% in the database. The method creates new variables then used in the Cluster analysis indicating 7 clusters with 3 different facial types: Normal, prognathia inferior and brachygnathia inferior. CONCLUSION: The brachygnathic facial type was mainly characterised as a shortened mandible, the upper jaw is not significantly involved. The correlations to the temporomandibular joint were shown. Molar and premolar malocclusions were revealed in two of three Clusters. Phenotypical distocclusion was not a single criterion for the affected sheep.

Influence of maxillary posterior discrepancy on upper molar vertical position and facial vertical dimensions in subjects with or without skeletal open bite.

OBJECTIVES: To determine the influence of maxillary posterior discrepancy on upper molar vertical position and dentofacial vertical dimensions in individuals with or without skeletal open bite (SOB). MATERIALS AND METHODS: Pre-treatment lateral cephalograms of 139 young adults were examined. The sample was divided into eight groups categorized according to their sagittal and vertical skeletal facial growth pattern and maxillary posterior discrepancy (present or absent). Upper molar vertical position, overbite, lower anterior facial height and facial height ratio were measured. Independent t-test was performed to determine differences between the groups considering maxillary posterior discrepancy. Principal component analysis and MANCOVA test were also used. RESULTS: No statistically significant differences were found comparing the molar vertical position according to maxillary posterior discrepancy for the SOB Class I group or the group with adequate overbite. Significant differences were found in SOB Class II and Class III groups. In addition, an increased molar vertical position was found in the group without posterior discrepancy. LIMITATIONS: Some variables closely related with the individual's intrinsic craniofacial development that could influence the evaluated vertical measurements were not considered. CONCLUSIONS AND IMPLICATIONS: Overall maxillary posterior discrepancy does not appear to have a clear impact on upper molar vertical position or facial vertical dimensions. Only the SOB Class III group without posterior discrepancy had a significant increased upper molar vertical position.

The effectiveness of the Herbst appliance for patients with Class II malocclusion: a meta-analysis.

OBJECTIVE: To systematically investigate review in literature the effects of the Herbst appliance for patients with Class II malocclusion patients. METHOD: We performed a comprehensive literature survey on PubMed, Web of Science, Embase, CENTRAL, SIGLE, and ClinicalTrial.gov up to December 2014. The selection criteria: randomized controlled trials or clinical controlled trials; using any kind of Herbst appliances to correct Class II division 1 malocclusions; skeletal and/or dental changes evaluated through lateral cephalograms. And the exclusion criteria: syndromic patients; individual case reports and series of cases; surgical interventions. Article screening, data extraction, assessment of risk of bias, and evaluation of evidence quality through GRADE were conducted independently by two well-trained orthodontic doctors. Consensus was made via group discussion of all authors when there is inconsistent information from the two. After that, sensitivity analysis and subgroup analysis were performed to evaluate the robustness of the meta-analysis. RESULTS: Twelve clinical controlled trials meet the above-mentioned criteria, and were included in this analysis. All included studies have eleven measures taken during both active treatment effect and long term effect periods, including four angular ones (i.e., SNA, SNB, ANB, mandibular plane angle) and seven linear ones (i.e. Co-Go, Co-Gn, overjet, overbite, molar relationship, A point-OLp, Pg-OLp) during active treatment effect period were statistically pooled. Meta-analysis and sensitivity analysis demonstrated that all these measures showed consistent results except for SNA, ANB, and overbite. Subgroup analysis showed significant changes in SNA, overbite, and Pg-OLp. Publication bias was detected in SNB, mandibular plane angle, and A point-OLp. CONCLUSION: The Herbst appliance is effective for patients with Class II malocclusion in active treatment period. Especially, there are obvious changes on dental discrepancy and skeletal changes on Co-Gn. As to its long-term effects, more evidence is needed to draw conclusions.

Comparative study of dental cephalometric patterns of Japanese-Brazilian, Caucasian and Mongoloid patients.

INTRODUCTION: The objective of this study was to identify the patterns of dental variables of adolescent Japanese-Brazilian descendants with normal occlusion, and also to compare them with a similar Caucasian and Mongoloid sample. METHODS: Lateral cephalometric radiographs were used to compare the groups: Caucasian (n = 40), Japanese-Brazilian (n = 32) and Mongoloid (n = 33). The statistical tests used were one-way ANOVA and ANCOVA. The cephalometric measurements used followed the analyses of Steiner, Tweed and McNamara Jr. RESULTS: Statistical differences (P < 0.05) indicated a smaller interincisal angle and overbite for the Japanese-Brazilian sample, when compared to the Caucasian sample, although with similar values to the Mongoloid group. CONCLUSION: The dental patterns found for the Japanese-Brazilian descendants were, in general, more similar to those of the Mongoloid sample.

Changes in skeletal and dental relationship in Class II Division I malocclusion after rapid maxillary expansion: a prospective study.

OBJECTIVE: To assess skeletal and dental changes immediately after rapid maxillary expansion (RME) in Class II Division 1 malocclusion patients and after a retention period, using cone beam computed tomography (CBCT) imaging. METHODS: Seventeen children with Class II, Division 1 malocclusion and maxillary skeletal transverse deficiency underwent RME following the Haas protocol. CBCT were taken before treatment (T1), at the end of the active expansion phase (T2) and after a retention period of 6 months (T3). The scanned images were measured anteroposteriorly (SNA, SNB, ANB, overjet and MR) and vertically (N-ANS, ANS-Me, N-Me and overbite). RESULTS: Significant differences were identified immediately after RME as the maxilla moved forward, the mandible moved downward, overjet increased and overbite decreased. During the retention period, the maxilla relapsed backwards and the mandible was displaced forward, leaving patients with an overall increase in anterior facial height. CONCLUSION: RME treatment allowed more anterior than inferior positioning of the mandible during the retention period, thus significantly improving Class II dental relationship in 75% of the patients evaluated.

Condylar response to functional therapy with Twin-Block as shown by cone-beam computed tomography.

OBJECTIVE: To evaluate the condylar changes through cone-beam computed tomography (CBCT) images in patients treated with Twin-Block functional appliance. MATERIALS AND METHODS: In this retrospective study, CBCT images of 30 patients who were treated with the Twin-Block appliance were used. Mandible was segmented and pretreatment and posttreatment (T0 and T1) condylar volume was compared. The angle between sella-nasion-Point A (SNA), angle between sella-nasion-Point B (SNB), angle between Point A-nasion-Point B (ANB), midfacial length (Co-A), mandibular length (Co-Gn), and the distances from right condylion to left condylion (CoR-CoL) were also measured on three-dimensional images. Differences were analyzed with Wilcoxon signed rank tests, and Mann-Whitney U-tests were used to compare the scores of male and female participants. Significance was set at P < .05. RESULTS: In this study, a decrease in SNA and ANB (P < .05 and P < .01, respectively) and an increase in SNB (P < .01) were found. Additionally, CoR-CoL, Co-Gn, and condylar volume increased at both the left and right sides (P < .01). However, increase at Co-A was not statistically significant (P > .05). Comparison of differences by sex was not statistically significant for all measurements (P > .05). CONCLUSION: Twin-Block appliance increases condylar volume, mandibular length, and intercondylar distance by stimulating growth of condyle in an upward and backward direction.

Long-term occlusal changes assessed by the American Board of Orthodontics' model grading system.

INTRODUCTION: The purpose of this study was to assess the long-term posttreatment changes in all criteria of the American Board of Orthodontics' (ABO) model grading system. METHODS: We used plaster models from patients' final and posttreatment records. Thirty patients treated by 1 orthodontist using 1 bracket prescription were selected. An initial discrepancy index for each subject was performed to determine the complexity of each case. The final models were then graded using the ABO's model grading system immediately at posttreatment and postretention. Statistical analysis was performed on the 8 criteria of the model grading system, including paired t tests and Pearson correlations. An alpha of 0.05 was considered statistically significant. RESULTS: The average length of time between the posttreatment and postretention records was 12.7 ± 4.4 years. It was shown that alignment and rotations worsened by postretention (P = 0.014), and a weak statistically significant correlation at posttreatment and postretention was found (0.44; P = 0.016). Both marginal ridges and occlusal contacts scored less well at posttreatment. These criteria showed a significant decrease in scores between posttreatment and postretention (P <0.001), but the correlations were not statistically significant. The average total score showed a significant decrease between posttreatment and postretention (P <0.001), partly because of the large decrease in the previous 2 criteria. CONCLUSIONS: Higher scores for occlusal contacts and marginal ridges were found at the end of treatment; however, those scores and the overall scores for the 30 subjects improved in the postretention phase.