Limitations in the surgical treatment of skeletal Class II deep bite malocclusions.

The present article illustrates a treatment option for managing the skeletal Class II malocclusion complicated by a deep bite and short face in an adult and emphasizes the limitations of such an approach and its potential complications. The patient had an inadequate tooth display upon smiling and a deep lower curve of Spee. Treatment consisted of a double jaw surgery with a maxillary three-piece LeFort to expand, downgraft, and advance the maxilla and a bilateral sagittal split osteotomy to advance the mandible. Treatment was staged so that the leveling of the mandibular arch was completed postsurgically by extrusion of the mandibular buccal segments. During surgery, the mandible was rotated clockwise at the osteotomy site to bring the chin down. This treatment approach resulted in a dramatic increase in the lower facial height, as well as an improvement in skeletal and occlusal relationships, with a much improved tooth display upon smiling, despite the few complications that occurred.

Nonsurgical treatment of an adult with mandibular asymmetry and unilateral posterior crossbite.

The patient was a woman, 24 years 8 months old, with mandibular asymmetry resulting in a unilateral posterior crossbite. In addition to moderate crowding in the mandibular arch, the malocclusion was further complicated by an asymmetric maxillary arch, a consequence of an extracted maxillary left second premolar. The mandibular arch was skewed, and there were severe dental compensations. The patient was treated nonsurgically, with unilateral extractions of teeth and asymmetric mechanics. Pretreatment and posttreatment records are shown, and the treatment strategy resulting in few side effects is described.

Microbial profile on metallic and ceramic bracket materials.

The placement of orthodontic appliances creates a favorable environment for the accumulation of a microbiota and food residues, which, in time, may cause caries or exacerbate any pre-existing periodontal disease. The purpose of the present study was to compare the total bacterial counts present on metallic and ceramic orthodontic brackets in order to clarify which bracket type has a higher plaque retaining capacity and to determine the levels of Streptococcus mutans and Lactobacillus spp on both types of brackets. Thirty-two metallic brackets and 24 ceramic brackets were collected from orthodontic patients at the day of debonding. Two brackets were collected from each patient; one from a maxillary central incisor and another from a maxillary second premolar. Sixteen patients who used metallic brackets and 12 patients who used ceramic brackets were sampled. Bacterial populations were studied using "checkerboard" DNA-DNA hybridization, which uses DNA probes to identify species in complex microbial samples. The significance of differences between groups was determined using the Mann-Whitney U-test. Results showed no significant differences between metallic and ceramic brackets with respect to the caries-inducing S mutans and L acidophilus spp counts. Mean counts of 8 of 35 additional species differed significantly between metallic and ceramic brackets with no obvious pattern favoring one bracket type over the other. This study showed higher mean counts of Treponema denticola, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum ss vincentii, Streptococcus anginosus, and Eubacterium nodatum on metallic brackets while higher counts of Eikenella corrodens, Campylobacter showae, and Selenomonas noxia were found on ceramic brackets.