Treatment of vertical maxillary excess without open bite in a skeletal Class II hyperdivergent patient.

A 20-year-old woman visited the office complaining of a gummy smile and lip protrusion. She was diagnosed with vertical maxillary excess without open bite and skeletal Class II hyperdivergent pattern. She refused the surgical-orthodontic treatment option, although she wanted to correct the gummy smile and retruded chin. Differential intrusion of anterior and posterior teeth in both arches was necessary to maximize the skeletal treatment effects. In the maxilla, one palatal temporary anchorage device (TAD), an archwire with an accentuated curve of Spee, and a transpalatal arch were applied. In the mandible, an archwire with a reverse curve of Spee and two vertically positioned TADs were used. These simple mechanics contributed to the effective intrusion of the total upper and lower arches, correction of the gummy smile, and mandibular counterclockwise rotation, offering an alternative to orthognathic surgery for this patient.

Antero-posterior lingual sliding retraction system for orthodontic correction of hyperdivergent Class II protrusion.

BACKGROUND: This report introduces a lingual bonded retraction system (Kinematics of Lingual Bar on Non-Paralleling Technique, KILBON) for efficient sliding mechanics combined with vertical control of the anterior and posterior teeth, which is suitable for Class II hyperdivergent patients. METHODS: Design and biomechanics of the KILBON System were described. Two adults with hyperdivergent class II malocclusion were treated with the KILBON system and temporary skeletal anchorage devices (TSADs) on the palate. The first patient was treated with conventional KILBON system on the upper arch and detailed with lingual appliances. The second patient showed the modified design of the KILBON when applied to a low palatal vault. RESULTS: A large amount of intrusion and retraction of the anterior teeth and simultaneous intrusion of the posterior segment were achieved in short treatment time. Concomitant counterclockwise rotation of the mandible improved the esthetic profile. Periodontal support without dehiscence or bone loss was confirmed on anterior region in spite of large amount of retraction. CONCLUSIONS: This report presented a lingual retraction system that provides simple and effective vertical and sagittal control of both anterior and posterior teeth. The biomechanics are dependable for correcting a dentoalveolar protrusion in a patient with Class II hyperdivergent skeletal pattern.

A patient with protrusion and multiple missing teeth treated with autotransplantation and space closure.

OBJECTIVE: To present a patient treated with submerging autotransplantation (SA) of an immature premolar and subsequent orthodontic space closure (OSC) and to report a 10-year follow-up result. CASE AND METHOD: A 10-year-old boy had multiple missing premolars with an asymmetric pattern (maxillary right first and second premolars, teeth 14 and 15; maxillary left second premolar, tooth 25; and mandibular right second premolar, tooth 45). After considering several treatment options, tooth 35 with immature root development underwent SA into the missing site of tooth 15 at a depth 5 mm below the occlusal plane and was stabilized with sutures to create a symmetric missing condition of the premolars in the four quadrants. RESULTS: Three months after autotransplantation, spontaneous eruption of the transplanted tooth was observed. Nine months after autotransplantation, presence of the lamina dura of the transplanted tooth was confirmed with a periapical radiograph. Active orthodontic treatment was initiated to reduce lip protrusion by closing the missing spaces of teeth 14, 25, 35, and 45 and to correct dental midline deviation. After 33 months of active orthodontic treatment, Class I canine and molar relationships were obtained. During the 10-year follow-up, the pulp vitality of the transplanted tooth was maintained without any pathologic findings, including root resorption or pulp canal obliteration. CONCLUSIONS: In a patient with lip protrusion and multiple congenitally missing premolars with an asymmetric pattern, SA of one premolar from the normal quadrant into the quadrant missing two premolars with subsequent OSC of the missing sites of the other premolars can be an effective treatment modality.

Correction of Class II deep overbite and dental and skeletal asymmetry with 2 types of palatal miniscrews.

This case report describes the orthodontic treatment of a 31-year-old woman who had a Class II molar relationship, anterior crowding, deep overbite, maxillary dental midline deviation, vertical maxillary asymmetry, and a hyperdivergent facial pattern. The maxillary right first premolar and the left second premolar were extracted asymmetrically to correct the anterior crowding and the maxillary dental midline deviation. The maxillary molars were intruded with a midpalatal miniscrew, which helped to correct the vertical molar asymmetry and close the mandibular plane. The palatal miniscrew in the maxillary tuberosity was also used to provide anchorage reinforcement for retraction of the anterior teeth. After orthodontic treatment, dental and facial esthetics were greatly improved by treatment of anterior crowding and deep overbite, correction of the dental and skeletal asymmetry, and closure of the mandibular plane. At the 3-year follow-up, most of the treatment results had been maintained.