Anthropometric and Cephalometric Facial Characteristics of Adult Saudi Patients with Skeletal Class III Malocclusions.

Objectives: We aimed to assess adult Saudi patients' facial anthropometry and cephalometric characteristics with skeletal Class III malocclusions compared to Class I malocclusion patients. Materials and Methods: Our cross-sectional study included a review of the orthodontic records of 108 patients: 54 patients with skeletal Class III malocclusions and 54 patients with skeletal Class I malocclusions, equally distributed between males and females. Using anthropometric landmarks, seven angular and eight linear measurements were recorded and compared between Class III and Class I patients. In addition, we compared three horizontal facial proportions and three horizontal neoclassical canons between the two groups. Finally, we used Student's t-tests to compare continuous variables and Chi-square tests for categorical variables. Results: Class III patients had significantly larger mandibular length, mandibular plane angle, mid- and lower-anterior face height, and posterior face height (P < 0.05) compared to Class I patients. Class III patients had significantly proclined upper incisors, retroclined lower incisors, and an obtuse interincisal angle (P < 0.05). The mouth: nose ratio differed significantly between skeletal Class III and I patients (P = 0.008). The orbital canon was valid in 14.8% of Class I and 9.3% of Class III patients, respectively. The orbitonasal proportion applied only to 31.5% and 20.4% of Class I and III patients, respectively. The naso-oral canon occurred in 18.5% and 1.9% of Class I and III patients, respectively. Conclusion: Saudis with Class III skeletal profiles have some distinctive Class III characteristics not observed in most other ethnic groups. The established horizontal facial proportions, neoclassical facial canons, and Class III skeletal profile did not apply to Saudis with skeletal Class I malocclusions, indicating that these proportions and characteristics may not be suitable as references when planning the surgical treatment for these patients.

Floating norms for individualising the ANB angle and the WITS appraisal in orthodontic cephalometric analysis based on guiding variables.

PURPOSE: The sagittal skeletal relationship of maxilla and mandible (skeletal class) can generally be determined via lateral cephalograms (ANB angle or Wits appraisal) by comparing measurements to empirical norms based on the respective population mean. However, values differing from these empirical norms also enable a therapeutically desired, normal class I occlusion depending on individual craniofacial pattern, thus requiring floating norms based on guiding variables. As available regression equations consider only few predictor variables and are not up-to-date regarding a contemporary patient collective, the aim of this study was to establish improved and extended regression equations for individualising the ANB angle and Wits appraisal. METHODS: This retrospective, cross-sectional multicentre study was based on 71 Caucasian male and female subjects of any age with normal dental occlusion. We cephalometrically analysed digitised pretreatment lateral radiographs and performed multiple linear regression analyses to identify suitable skeletal predictor variables for individualising the ANB angle and Wits appraisal. RESULTS: Inter- and intrarater reliability tests showed mostly perfect measurement concordance. Both original regression equations by Panagiotidis/Witt and Järvinen could be updated for a contemporary population with new regression coefficients. The equation for individualising the ANB could be further optimised in its prediction reliability by adding the skeletal predictor variables NL-NSL, NSBa, facial axis (Ricketts) and index (Hasund), whereas the recalculated Wits equation could not be further improved by additional guiding variables. CONCLUSIONS: The improved regression formulae for individualising the ANB angle and Wits appraisal should help to improve the assessment of sagittal skeletal class in clinical orthodontic practice.

Customized lingual brackets vs. conventional labial brackets for initial alignment : A randomized clinical trial.

PURPOSE: The aim of this randomized prospective clinical study was to determine whether there are differences between customized lingual brackets and conventional labial brackets regarding the alignment of the mandibular arch and a reduction of the irregularity index during an 18-week treatment interval. METHODS: A total of 20 patients who presented with class I malocclusion for scheduled orthodontic treatment without tooth extraction were included. The patients were randomly assigned by numbered, opaque, sealed envelopes to treatment with customized lingual brackets or conventional labial brackets. During the initial alignment (T0), 0.012″ (T1), 0.014″ (T2), and 0.016″ (T3) nickel-titanium archwires were applied, respectively, and the control visits were scheduled at 6­week intervals. In all sessions, digital models were obtained by an intraoral scanning device after removal of the archwire and were analyzed by software. Little's irregularity index, intercanine width, intermolar width and arch length were evaluated at three time points and were statistically analyzed with a repeated measures analysis of variance (ANOVA). Changes in these measurements at the three intervals (T1-T0, T2-T1, T3-T2) and overall treatment effects were also compared using the Student t­test. RESULTS: Comparing the two treatments regimes, intergroup mean values at T0, T1, T2, and T3 were not significantly different regarding the irregularity index, intercanine width, intermolar width and arch length. CONCLUSION: In this pilot study, no differences between the two treatment approaches could be detected for the phase of initial mandibular alignment.

Aligner Tubes ­ uma nova opção para a correção ortodôntica sem a utilização de bráquetes / Aligner Tubes ­ a new option for orthodontic correction without the use of brackets

Resumo O número de pacientes adultos que buscam o tratamento ortodôntico tem aumentado e essa mudança no cenário da Ortodontia tem exigido dos profissionais o emprego de aparelhos estéticos que proporcionem a correção das más oclusões por meio de abordagens simplificadas, eficientes e de maior conforto. Assim sendo, este artigo tem como objetivo apresentar uma técnica alternativa que pode ser empregada pelos profissionais na correção de más oclusões simples e na resolução de recidivas de apinhamento dentário na região anterior do arco. O artigo descreve a confecção passo a passo do sistema Aligner Tubes que é constituído por tubos metálicos colados às faces vestibulares dos elementos dentários anteriores e na sequência ilustra a aplicabilidade desse método com a exemplificação de relato de um caso clínico. Conclui-se que é um sistema simplificado, estético e de baixo custo que possibilita a correção dos problemas simples, em tempo relativamente curto e com resultados satisfatórios.(AU)

Abstract The number of adult patients searching for orthodontic treatment has increased and this change in the Orthodontic routine has required from professionals the use of aesthetic devices that provide malocclusions correction through simplified, efficient, and more comfortable approaches. Therefore, this article aims to present an alternative technique that can be used by professionals in the correction of minor malocclusions and in the resolution of dental crowding recurrences in the anterior region of the arch. This article describes the step-by-step preparation of the Aligner Tubes system, which consists of metallic tubes bonded to the buccal surfaces of the anterior teeth and then illustrates the applicability of this method with one clinical case report example. It is concluded that it is a simplified, aesthetic, and low cost system that allows the correction of simple problems in a relatively short time and with satisfactory results.(AU)

Comparison of Tooth Widths, Arch Widths and Arch Lengths in Class-I Normal Dentition to Class-I and II Crowded Dentitions.

BACKGROUND AND OBJECTIVE: Dental study casts play a vital role in the diagnosis and treatment planning of various orthodontic cases. This study was carried out to compare the tooth widths, arch widths, and arch lengths in Class-I normal dentition to those in Class-I and Class-II crowded dentition in an effort to improve treatment planning and to eventually reduce treatment duration. METHODS: Total 170 patients, 12 to 40 years of age with a complete set of permanent teeth till 1st molars; who presented to the Orthodontics Department at Armed Forces Institute of Dentistry (A.F.I.D), Rawalpindi from Sep 2019 to Feb 2020, were included in the study. Non-probability purposive method of sampling was used. The dental casts obtained were used to measure tooth widths, arch widths, and arch lengths. Subjects were classified into Class-I normal and Class-I and Class-II crowded occlusion and comparison of the sum of tooth widths, arch widths, and arch length discrepancies were determined among the three occlusion groups. Data was analyzed in SPSS version 21 and independent samples t-test was used to differentiate the variables of interest. RESULTS: Out of 170 subjects, 73 (42.9%) subjects had Class-I normal occlusion while 97 (57%) had Class-I and Class-II crowded occlusions. No statistical difference was found between the occlusal groups with regard to the sum of tooth widths, inter-canine widths, inter-first premolar widths, inter-second premolar widths and inter-molar widths. However, a remarkable difference was observed between the occlusal groups with respect to arch perimeters and arch length discrepancies (p = 0.000 and 0.000 respectively). CONCLUSIONS: Results of the current study indicate that crowding of teeth occurs as a consequence of decreased arch perimeters which may lead to increased arch length discrepancies. However, no prominent difference was noticed in the sum of tooth widths and arch widths among different occlusal groups.

An orthodontic analysis of the smile dynamics with videography.

BACKGROUND AND OBJECTIVES: Smile is one of the most effective means by which people convey their emotions. The objective of this study was to capture, analyse and measure the parameters through videos clips for studying the dynamics of posed and unposed smile and to measure the parameters through video clips for studying the dynamics of speech. METHODOLOGY: A total of 100 subjects seeking orthodontic treatment with Angle's Class I malocclusion were included in the study. The principal investigator selected the frames for speech and a panel of five members selected the appropriate frames for posed smile and unposed smiles. Frames after videography were used for measurements. Parameters like Maximum incisor exposure, Lower lip to upper incisor, Gingival exposure, Inter-labial gap etc were measured in "mm" for posed and unposed smile frames. Categorical data was compared using McNemar's test. p â€‹< â€‹0.05 was considered significant. RESULTS: The median of maximum upper incisal exposure (p â€‹= â€‹2.2e-16), lower lip to upper incisor (p â€‹= â€‹2.422e-13A), inter-labial gap (p â€‹= â€‹2.2e-16 A), smile width (p â€‹= â€‹5.212e-16 A) and smile index were significant (p â€‹= â€‹0.0001 A). There was a significant change from not exposed to exposed gingival exposure over posed smile to unposed smile (p â€‹= â€‹0.0008). The most posterior maxillary tooth visible in the posed and unposed groups were the second premolars in 57% and 74% patients, respectively. In both the smile groups, 55% of subjects exhibited a consonant smile. CONCLUSION: It can be concluded that the information obtained from the current video graphic study can be used as a guideline for the diagnosis and as a part of comprehensive treatment planning.

Factors affecting the stability of maxillary extraction site closure

ABSTRACT Introduction: A side effect observed in cases treated with extractions is the instability of orthodontic space closure. Objective: The aim of this study was to investigate the influence of gingival invagination, presence of third molars and facial pattern, on the stability of orthodontic space-closure in the maxillary arch. Methods: Ninety-nine subjects (41 male and 58 female) with Class I malocclusion treated with four premolars extraction were evaluated. Extraction sites reopening and gingival invaginations were evaluated in scanned dental models in the posttreatment and 1-year posttreatment stages (mean age 16.1 years). Third molars presence was evaluated at 1-year posttreatment panoramic radiographs, and the facial pattern (SN.GoGn) was evaluated in the initial lateral headfilms. Multiple logistic regression analysis was used to estimate the influence of the aforementioned independent variables on the frequency of extraction space reopening. Results: Space reopening was observed in 20.20% of the subjects 1-year post-debonding. Gingival invaginations were present in 25.73% of quadrants after debonding and in 22.80% 1-year posttreatment. The mean pre-treatment SN.GoGn was 35.64 degrees (SD=5.26). No significant influence was observed of the three independent variables on the instability of extraction site closure. Conclusions: The presence of gingival invaginations, third molars and facial growth pattern do not seem to influence maxillary extraction sites reopening.

RESUMO Introdução: Um efeito colateral observado nos casos tratados com extrações é a instabilidade do fechamento ortodôntico do espaço. Objetivo: O objetivo do presente estudo foi investigar a influência da invaginação gengival, da presença de terceiros molares e do padrão facial na estabilidade do fechamento ortodôntico dos locais de extração na arcada superior. Métodos: Noventa e nove indivíduos (41 homens e 58 mulheres) com má oclusão de Classe I tratados com extração de quatro pré-molares foram avaliados. A reabertura dos locais de extração e as invaginações gengivais foram avaliadas nos modelos dentários digitalizados nos estágios pós-tratamento e um ano pós-tratamento (idade média de 16,1 anos). A presença dos terceiros molares foi avaliada em radiografias panorâmicas de um ano pós-tratamento, e o padrão facial (SN.GoGn) foi avaliado nas radiografias laterais iniciais. Análise de regressão logística múltipla foi utilizada para estimar a influência das variáveis independentes citadas na frequência de reabertura do espaço de extração. Resultados: A reabertura do espaço foi observada em 20,20% dos sujeitos um ano após a remoção do aparelho. Invaginações gengivais estiveram presentes em 25,73% dos quadrantes após a remoção do aparelho e em 22,80% após um ano pós-tratamento. O SN.GoGn pré-tratamento médio foi de 35,64 graus (DP = 5,26). Não foi observada influência significativa das três variáveis independentes sobre a instabilidade do fechamento do local de extração. Conclusões: A presença de invaginações gengivais, terceiros molares e padrão de crescimento facial não parece influenciar na reabertura dos locais de extração maxilar.

Técnica híbrida para tratamento de Classe I com apinhamento ­ relato de caso / Hybrid technique for Class I treatment with crowding ­ case report

Resumo A busca pela estética tem sido cada vez maior, alguns anos atrás o tratamento ortodôntico era de difícil aceitação devido aos bráquetes presentes na face vestibular dos dentes. Hoje, é possível utilizar muitas ferramentas e maneiras de tratar cada caso individualmente, executando um tratamento ortodôntico imperceptível, de forma segura, confortável e em menor tempo. O presente trabalho descreve uma técnica híbrida, na qual foram utilizados dois tipos de aparelhos ortodônticos realizados em um mesmo caso, 3D-BOT e alinhadores, no qual o paciente tinha queixa estética e apresentava apinhamento superior e inferior. O caso foi iniciado com o 3D-BOT e após 13 consultas foi feita a finalização do tratamento com alinhadores da empresa MYALIGNER, utilizando 4 placas superiores e inferiores. Os resultados demonstram a efetividade da ortodontia híbrida, entregando conforto, estética e otimizando o tempo de tratamento. (AU)

Abstract The search for aesthetics has been increasing, some years ago orthodontic treatment was difficult to accept due to the presence of brackets on the buccal surface of the teeth. It is possible to use many tools and ways to treat each case individually today, performing an inconspicuous, safe, comfortable orthodontic treatment and in a shorter time. The present work describes a hybrid technique, in which two types of orthodontic appliances were used in the same case, 3D-BOT and aligners, in which the patient had aesthetic complaints and presented superior and inferior crowding. The case has been started with the 3D-BOT and after 13 consultations the treatment was completed with aligners from the company MYALIGNER, using 4 upper and lower plates. The results demonstrate the effectiveness of hybrid orthodontics, providing comfort, aesthetics and optimizing treatment time. (AU)

Pista direta planas para tratamento de mordida cruzada anterior funcional ­ relato de caso / Planas direct track for functional anterior crossbite treatment ­ case report

Resumo A mordida cruzada anterior é uma má oclusão frequentemente observada nas dentições decídua e mista, pode ser classificada em dentária, esquelética ou funcional. Esta última, quando interceptada de forma precoce, pode apresentar um prognóstico satisfatório. Nesse contexto, a confecção de pistas diretas Planas têm se mostrado uma alternativa eficiente, quando poucos elementos dentários são envolvidos. Este trabalho apresenta o caso clínico de um paciente de 6 anos de idade, portador de mordida cruzada anterior unilateral do tipo funcional, cujo diagnóstico diferencial e intervenção precoce permitiram a resolução do caso. Ao manipular a mandíbula, levando os côndilos em relação cêntrica (RC), notou-se a presença de interferência oclusal entre os caninos decíduos superior e inferior do lado direito, que são as causas da anteriorização da mandíbula, com oclusão em MIH. Para correção, utilizou-se terapia de pista direta Planas confeccionada sob canino superior direito em resina composta e leve desgaste no canino inferior do lado direito. Os contatos prematuros foram removidos, criando um plano inclinado de aproximadamente 45 graus na face palatina do canino superior e um leve ajuste oclusal na face incisal do canino inferior do lado direito. O uso dessa técnica permitiu a correção da mordida cruzada anterior funcional imediatamente após a remoção da interferência oclusal. O caso relatado demonstra que o tratamento precoce de mordidas cruzadas propicia maiores chances de sucesso na reabilitação do sistema estomatognático. A utilização de pistas diretas Planas demonstrou ser uma alternativa eficaz, de baixo custo e de fácil execução para tratamento de mordidas cruzadas funcionais. (AU)

Abstract Anterior crossbite is a malocclusion frequently found in deciduous and mixed dentitions, it can be classified as dental, skeletal or functional. This last one has a favorable prognosis when the treatment occurs in early stages. Considering this, Planas direct tracks have been showing to be an effective and less invasive alternative when few dental elements are involved. This paper presents a clinical case of a 6-year-old patient with functional unilateral anterior crossbite whose differentiated diagnosis and early intervention allowed a successful treatment. By manipulating the jaw and positioning the condyles in centric relation (CR), the presence of occlusal interference between the upper and lower deciduous canines on the right side was noticed, which are the causes of mandible anterior displacement with occlusion in MIH. For correction, Planas direct track therapy was used on the upper right canine with composite resin followed by slight wear on the lower right canine. The premature contacts were eliminated, creating an inclined plane of approximately 45 degrees on the palatal face of the upper canine and a slight occlusal adjustment on the incisal surface of the lower right canine. The use of this technique allowed the correction of the functional anterior crossbite immediately after the removal of the occlusal interference. This case shows that the early treatment of crossbites increases the chances of a successful rehabilitation of stomatognathic system. The use of Planas direct tracks proved to be an effective, low-cost, and easy to implement alternative for functional crossbites correction. (AU)

Extraction versus non-extraction orthodontic treatment: Soft tissue profile changes in borderline class I patients.

BACKGROUND: The decision regarding the selection of extraction or non-extraction orthodontic treatment is a common challenge in orthodontic treatment planning. OBJECTIVES: The objective of this study was to compare the effects of extraction and non-extraction orthodontic treatment on the soft tissue profile of borderline class I patients. MATERIAL AND METHODS: In this retrospective study, 70 patients were selected from among those referred to the Department of Orthodontics of the Faculty of Dentistry at Hamadan University of Medical Sciences in Iran. The inclusion criteria were skeletal class I, 4-10 mm of space deficiency, and the possibility of applying both extraction and non-extraction orthodontic treatment. All patients underwent fixed orthodontic treatment with the use of 0.022-inch-slot edgewise brackets. The patients were divided into 2 groups (n = 35) according to the 4-premolar extraction or non-extraction treatment plan. The 2 groups were compared by means of the cephalometric analysis. RESULTS: There were 11 males and 24 females at a mean age of 17.46 years in the non-extraction group, and 9 males and 26 females at a mean age of 18.46 years in the extraction group. The upper and lower incisors as well as the lower lip moved forward in the non-extraction group (lower lip to E­plane = 0.87 ±1.39 mm, U1-SN = 2.83 ±8.03°, IMPA = 4.64 ±5.47°). The incisors and the lips moved backward in the extraction group (upper lip to E­plane = -1.42 ±2.08 mm, lower lip to E­plane = -1.56 ±1.97 mm, U1-SN = -7.63 ±9.02°, IMPA = -7.05 ±6.79°). The differences were statistically significant (p < 0.05). Mentolabial sulcus became more pronounced in the non-extraction group (1.92 ±2.73 mm; p < 0.001) and shallower in the extraction group (-1.90 ±4.2 mm; p = 0.000). CONCLUSIONS: Orthodontic treatment can change the soft tissue appearance of the lower third of the face. The lips and the incisors moved forward in the non-extraction group and backward in the extraction group.

First premolar extractions in an adolescent presenting a Class I biprotrusion malocclusion with skeletal Class II: A case report.

This case report shows the orthodontic treatment of four first premolar extractions of a 14-year-old teenager presenting a dental Class I malocclusion with a severe retrognathic mandible. It reflects conflicting views on objectives between the orthodontist who takes into account the facial balance and the patient who only desires a tooth alignment.

Peculiarities of teeth size in adolescents who are diagnosed to have angle's class i malocclusion and display different somatotypes.

OBJECTIVE: Introduction: The issues on identifying criteria for teeth aesthetic and teeth size evaluation regarding body constitutional characteristics are still remaining undeveloped. The aim of this study was to specify the peculiarities of teeth size in adolescents who were diagnosed with Angle's Class I malocclusion and display different somatotypes. PATIENTS AND METHODS: Materials and methods: The study included 63 male and 66 female subjects diagnosed with Class I malocclusion by E. Angle classification (1906). RESULTS: Results: It has been determined that the 33rd tooth in hypersthenic female individuals is of a greater mesiodistal size than in normosthenic and asthenic body types (p <0.05). Left maxillary incisor in hypersthenic individuals is of a larger size than in asthenic and normosthenic (p <0,05). The normosthenic male individuals have been found out to have significantly larger size of all canines than that in the females (p <0,05). The asthenic male adolescents compared with females of the same somatotype there has been revealed the difference in the size of the left mandibular canine (p <0.05). The hypersthenic male adolescents demonstrate an increase in the size of the lateral maxillary incisors and the first right premolar (p <0,05) compared with those in female individuals of the same somatotype. CONCLUSION: Conclusions: Some peculiarities of mesiodistal size typical for adolescents with Angle's Class I malocclusion and their somatotypes should be taken into account in treatment planning and maintaining the stability of orthodontic treatment results.

Tooth extractions in Orthodontics: first or second premolars?

ABSTRACT Tooth crowding and protrusions demand rigorous attention during orthodontic planning that includes the extraction of first and second premolars. Some characteristics, such as dentoalveolar bone discrepancies, maxillomandibular relations, facial profile, skeletal maturation, dental asymmetries and patient cooperation, are important elements of an orthodontic diagnosis. This study discusses the options of treatments with extractions and describes the correction of a Class I malocclusion, bimaxillary protrusion, severe anterior crowding in both dental arches and tooth-size discrepancy, using first premolar extractions.

RESUMO Apinhamentos e protrusões dentárias têm requerido rigor durante o planejamento ortodôntico envolvendo exodontias de primeiros e segundos pré-molares. Algumas características como discrepância entre dentes e suas respectivas bases ósseas, relacionamento maxilomandibular, perfil facial, maturação esquelética, assimetrias dentárias, patologias e cooperação do paciente têm sido consideradas elementos importantes de diagnóstico ortodôntico. Sendo assim, o presente artigo teve por objetivo discutir as opções de tratamento com extrações dentárias e apresentar a correção de uma má oclusão de Classe I, biprotrusão, com severo apinhamento anterior em ambas as arcadas e discrepância de tamanho dentário, por meio da exodontia de primeiros pré-molares.

Fechamento de espaço de molar inferior com ancoragem através de aparelho de protração mandibular ­ relato de caso / Mandibular molar space closure with anchorage through mandibular protraction appliance ­ case report

O objetivo deste trabalho é apresentar um relato de caso clínico de fechamento de espaço de molar inferior, utilizando como ancoragem o Aparelho de Protração Mandibular instalado unilateralmente. A paciente do sexo feminino, 24 anos de idade, relatou como queixa principal os múltiplos diastemas e o espaço correspondente ao primeiro molar inferior esquerdo extraído. Apresentava má oclusão de Classe I, perfil reto, selamento labial passivo, simetria facial, linhas médias coincidentes, giroversões, diastemas entre incisivos laterais e caninos nos arcos superior e inferior, entre caninos e primeiros pré-molares inferiores e espaço referente ao primeiro molar inferior esquerdo extraído. Foi proposto o fechamento do espaço através da mesialização do segundo e terceiro molar com alça de Bull, utilizando o Aparelho de Protração Mandibular (APM) como ancoragem dos dentes anteriores inferiores. A técnica Multiloop Edgewise Archwire (MEAW) com elásticos intermaxilares 1/8 força média foi utilizada para corrigir os efeitos colaterais provocados pelo uso unilateral do APM. Ao final do tratamento, foi obtido o fechamento de todos os diastemas e do espaço correspondente ao primeiro molar inferior esquerdo. O Aparelho de Protração Mandibular utilizado unilateralmente mostrou eficácia como dispositivo de ancoragem durante o fechamento de espaço do elemento posterior extraído (AU)

The aim of this work is to present a clinical case report of lower molar space closure using as anchorage Mandibular Protraction Appliance unilaterally installed. A female patient, 24 years old, reported as main complaint multiple diastemas and the space corresponding to the extracted lower left first molar. She presented Class I malocclusion, straight profile, passive labial sealing, facial symmetry, coincident median lines, gyroversions, diastemas between lateral incisors and canines in the maxillary and mandibular arches, between canines and lower first premolars and space of the extracted lower first molar. It was proposed closure of the space through mesialization of the second and third molars with Bull loop, using the Mandibular Protraction Appliance (MPA) as anchorage of lower anterior teeth. Multiloop Edgewise Archwire (MEAW) technique with 1/8 medium strength intermaxillary elastics were used to correct the side effects caused by unilateral use of MPA. At the end of treatment, all diastemas and the space corresponding to the first lower left molar were closed. The Mandibular Protraction Appliance used unilaterally proved to be effective as an anchor device during space closure of the extracted posterior element (AU)

Management of Dento-Maxillary Disharmony in Angle Class I Malocclusion with anterior crowding, midline shifting, and deep bite: A case report

@#Dento-maxillary disharmony is characterized as disproportion between tooth size and dental arch. This case report describes the treatment progress of a patient with dento-maxillary disharmony with Class I malocclusion using fixed orthodontic appliances. The patient is a 19-year-old female who came with chief complaint of crowding and ectopic upper canines. Correction of crowding and deep bite was achieved by fixed appliance with extraction. In Class I malocclusion, severity, etiology, and type of disharmony guide the treatment plan for optimal results.

Tratamento orto-cirúrgico de má oclusão de Classe I com retrognatismo mandibular ­ relato de caso / Orthodontic surgical treatment of Class I malocclusion with mandibular retrognathia ­ case report

Muitos pacientes adultos que buscam tratamento ortodôntico apresentam problemas dentários e esqueléticos. Para esses pacientes, o tratamento orto-cirúrgico é uma alternativa que promove inúmeros benefícios. Este trabalho teve por objetivo relatar o tratamento de um paciente adulto com má oclusão de Classe I com retrognatismo mandibular. O paciente era do sexo masculino, leucoderma, com 21 anos de idade. Sua queixa era de que os dentes anteriores estavam muito mal posicionados. No exame clínico, observou-se que o paciente apresentava perfil convexo e ausência de selamento labial. A relação molar era de Classe I. Havia apinhamento na região anterior dos arcos superior (-2,5mm) e inferior (-6,0 mm). A telerradiografia lateral e o traçado cefalométrico mostraram que o paciente apresentava retrusão mandibular. A maxila estava bem posicionada e os incisivos superiores e inferiores protruídos. Optou-se pelo tratamento com a exodontia de dois pré-molares inferiores, cirurgia ortognática de avanço da mandíbula e mentoplastia. O tratamento resultou numa oclusão adequada, além de uma grande melhora no perfil do paciente e na capacidade de obter selamento labial sem forçar os músculos peribucais. Pode-se concluir que a extração de dois pré-molares inferiores seguida do avanço cirúrgico da mandíbula constitui-se numa excelente solução para os casos de Classe I com retrusão mandibular em pacientes adultos. (AU)

Many adult patients seeking orthodontic treatment have dental and skeletal problems. For these patients ortho-surgical treatment is an alternative that promotes numerous benefits. This study aimed to report the treatment of an adult patient with Class I malocclusion with mandibular retrognathism. The patient was male, caucasian, 21 years old. His complaint was that his anterior teeth were very poorly positioned. At the clinical examination, it was observed that the patient had a convex profile and absence of labial sealing. The molar relationship was Class I. There was crowding in the anterior region of the upper (-2.5mm) and lower (-6.0mm) arches. Lateral teleradiography and cephalometric tracing showed that the patient presented mandibular retrusion. The maxilla was well positioned and the upper and lower incisors were protruded. Treatment chosen was extraction of two lower premolars, mandible orthognathic advancement and mentoplasty. After treatment an adequate occlusion was observed, in addition to a great improvement in patient's profile and in the ability to obtain lip seal without forcing the peribucal muscles. It can be concluded that the extraction of two lower premolars followed by the mandibular surgical advancement constitute an excellent solution for Class I cases with mandibular retrusion in adult patients (AU)

Mandibular incisor extraction treatment in Angle's Class I malocclusion with peg-shaped maxillary lateral incisors.

Accurate diagnosis and treatment planning are essential for obtaining ideal treatment result in cases involving mandibular incisor extraction. This case report describes a 15-year-old female with balanced soft-tissue profile, peg-shaped maxillary lateral incisors, and moderate mandibular anterior crowding treated with a mandibular incisor extraction. Ideal overbite and overjet were achieved. "Black triangle" formation was avoided due to the bodily movement of mandibular incisors and the use of uprighting springs for ideal axial inclination of mandibular incisors. A mandibular incisor extraction can be an effective treatment option in carefully selected clinical situations.

Comparative evaluation of soft tissue changes in Class I borderline patients treated with extraction and nonextraction modalities

Abstract Objective: To compare soft tissue changes in Class I borderline cases treated with extraction and nonextraction modalities. Methods: A parent sample of 150 patients with Class I dental and skeletal malocclusion (89 patients treated with premolar extraction and 61 patients without extraction) was randomly selected and subjected to discriminant analysis which identified the borderline sample of 44 patients (22 extraction and 22 nonextraction patients). Pretreatment and post-treatment cephalograms of the borderline subsample were analyzed using 22 soft tissue parameters. Results: Upper and lower lips were more retracted and thickness of the upper lip increased more in the borderline extraction cases (p < 0.01). The nasolabial angle became more obtuse and the interlabial gap was reduced in the borderline extraction cases (p < 0.01). Lower lip, interlabial gap and nasolabial angle showed no changes in the borderline nonextraction cases. Conclusion: The soft tissue parameters which can be used as guideline in decision making to choose either extraction or nonextraction in Class I borderline cases are upper and lower lip protrusion in relation to the E-plane and Sn-Pg' line, lower lip protrusion in relation to the true vertical line (TVL), upper lip thickness, nasolabial angle and interlabial gap.

RESUMO Objetivo: comparar as alterações sofridas nos tecidos moles em casos limítrofes de Classe I tratados com extrações e sem extrações. Métodos: uma amostra inicial de 150 pacientes com má oclusão esquelética e dentária de Classe I (89 pacientes tratados com extrações de pré-molares e 61 pacientes tratados sem extrações) foi aleatoriamente selecionada e submetida a uma análise discriminante, a qual permitiu selecionar uma amostra de 44 pacientes limítrofes (22 tratados com extrações e 22 tratados sem extrações). Telerradiografias obtidas antes e depois do tratamento dessa subamostra de pacientes limítrofes foram analisadas, utilizando-se 22 grandezas em tecidos moles. Resultados: nos casos limítrofes tratados com extrações, houve maior retração dos lábios superior e inferior e um maior aumento na espessura do lábio superior (p < 0,01); bem como o ângulo nasolabial tornou-se mais obtuso e o espaço interlabial sofreu redução (p < 0,01). Já nos casos limítrofes tratados sem extrações, o lábio inferior, o espaço interlabial e o ângulo nasolabial não apresentaram alterações significativas. Conclusão: as grandezas em tecidos moles que podem ajudar na tomada de decisão entre o tratamento com e sem extrações nos casos limítrofes de Classe I são: protrusão dos lábios superior e inferior em relação ao plano E e em relação à linha Sn-Pg', protrusão do lábio inferior em relação à linha vertical verdadeira (LVV), a espessura do lábio superior, o ângulo nasolabial e o espaço interlabial.

Angle Class I malocclusion with anterior negative overjet

ABSTRACT This clinical case report describes the orthodontic treatment of an 8-year and 9-month old female patient with Angle Class I malocclusion, anterior crossbite and canine Class III relationship. Orthodontic treatment was carried out in two stages. The first one was orthopedic, while the second one included the use of a fixed appliance and the need for space gain for reshaping of maxillary lateral incisors. The two-stage treatment combined with multidisciplinary Restorative Cosmetic Dentistry allowed excellent esthetic and functional outcomes to be achieved. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as a requirement for the title of certified by the BBO.

RESUMO O presente caso clínico relata o tratamento ortodôntico de uma paciente com oito anos e nove meses de idade, portadora de má oclusão de Classe I de Angle, com mordida cruzada anterior e relação de classe III entre os caninos. O tratamento ortodôntico foi realizado em duas etapas, sendo a primeira ortopédica e a segunda constando de aparatologia fixa, havendo necessidade de ganho de espaço para reanatomização dos incisivos laterais superiores. O tratamento em duas etapas, aliado à multidisciplinariedade com a Dentística Restauradora, permitiu a obtenção de excelente resultado final estético e funcional. O presente caso clínico foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) como parte dos requisitos para obtenção do título de Diplomado pelo BBO.

Treating dental crowding with mandibular incisor extraction in an Angle Class I patient

Mandibular dental crowding often encourages patients to seek orthodontic treatment. The orthodontist should decide between protrusion of incisors or decrease in dental volume so as to achieve proper alignment and leveling. The present study reports the treatment of an Angle Class I malocclusion adolescent female brachyfacial patient with severe mandibular dental crowding, increased curve of Spee and deep overbite. The patient was treated with extraction of a mandibular incisor. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as a requirement for the title of certified by the BBO.

O apinhamento dentário inferior, com frequência, motiva os pacientes a buscarem tratamento ortodôntico. Ao ortodontista cabe a decisão entre protruir os incisivos ou diminuir o volume dentário, a fim de obter o adequado alinhamento e nivelamento. O presente relato aborda o tratamento de uma má oclusão Classe I de Angle, em paciente adolescente, sexo feminino, braquifacial, com severo apinhamento na arcada inferior, curva de Spee e sobremordida aumentadas, e tratada com exodontia de um incisivo inferior. Esse caso clínico foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) como parte dos requisitos para a obtenção do título de Diplomado pelo BBO.