Condylar remodelling in a severe class II deep bite dento-skeletal malocclusion treated with an ortho-surgical approach: A five-year follow-up case report.

Condylar displacement and remodelling are phenomena closely related to orthognathic surgery and critically involved in occlusal and skeletal stability. The aim of the present case report is to describe over time condylar displacement and surface remodelling after bilateral split sagittal osteotomy (BSSO) in an adult patient with severe class II skeletal malocclusion treated with ortho-surgical approach. A male of 21years comes to our observation. The extraoral examination shows a symmetrical square-shaped face, a convex profile, an acute nasolabial angle and a deep labiomental fold. Intraoral examination reveals a class II division 2 with a 2mm deviation of the mandibular midline to the left and the presence of a scissor bite of the bicuspids between quadrants II and III. The Spee curve and overbite are extremely accentuated (OV 14.3mm) as the overjet (11.1mm). Axiographic reconstructions of CBCT show a normal shape and position of both condyles. The cephalometric analysis shows a reduced lower facial height, a normal upper jaw position, a mandibular underdevelopment masked by a very developed symphysis and an extremely low divergence (FMA 11.2°). BSSO for mandibular setback was performed in the 13th month of orthodontic therapy. Original CBCT data before surgery (T0), at the end of treatment (T1), 2years postoperatively (T2) and 5years postoperatively (T3) were collected and reconstructed for 3-dimensional (3D) qualitative analyse. At the end of the surgical-orthodontic treatment (26months), good function and good aesthetics were achieved. The qualitative and comparative analysis of the superimpositions and the cuts made on the CBCT at T0, T1, T2, T3 showed a physiological remodelling and adaptation of the condyles.

Periodontal evaluation of palatally impacted maxillary canines treated by closed approach with ultrasonic surgery and orthodontic treatment: a retrospective pilot study.

Aim of this study is the evaluation of the periodontal status of impacted canines treated by closed approach with ultrasonic surgery and orthodontic treatment compared with contralateral spontaneously erupted teeth. The periodontal conditions of the teeth adjacent to the canines (lateral incisors and first premolar) were also considered. 17 patients (9 females and 8 males; mean age: 15.2 years) with unilateral palatal impaction of maxillary canine were selected. All patients were treated by closed-flap surgery with ultrasonic instruments. Periodontal status was evaluated by assessing probing depth (PD), gingival recession and width of keratinized tissue (KT) 4.6 months after the end of the orthodontic treatment, on average. Test group was composed by impacted elements and adjacent teeth and control group by contralateral spontaneously erupted canines and adjacent teeth. Student's t-test was used to compare test and control group values of PD and width of KT. Significance threshold for Student's t-test was set at p < 0.05. The average probing depth values show no significant clinical differences between the test and control groups. Probing depths recorded at the mesiovestibular and distopalatal sides of the impacted canine were statistically significant compared to the control elements (p < 0.05). No gingival recession was detected on the treated canines. The measurement of KT did not differ significantly between the test and the control groups. In conclusion, the ultrasonic surgery for disinclusion associated with a closed approach and orthodontic traction allows the alignment of an impacted palatal canine without damaging the periodontium.

Management of the Herbst splint appliance in Class II malocclusion with different growth pattern.

Class II malocclusion treatment can be successfully performed with the Herbst appliance stabilized with acrylic splints. Using this kind of stabilization a posterior open bite is always present when the appliance is removed. Two case reports are presented to illustrate how it is possible to manage the post- Herbst phase in different types of growth pattern in order to obtain the best aesthetical and functional results.

Osteoarthritis of the temporomandibular joint in an adult patient with Hashimoto thyroiditis: case report.

This case report documents the treatment of a female patient, 37 years 6 months of age, with a Class II open bite malocclusion with severe osteoarthritis of the temporomandibular joint associated with Hashimoto disease, a chronic inflammatory disease of the thyroid in which autoimmune factors play a prominent role. The simultaneous treatment of both pathologies (malocclusion and thyroiditis) led to the cessation of pain and dysfunctional symptoms in both temporomandibular joints.

Treatment of an upper impacted cuspid using ultrasonic surgery and a modified RPE. A case report.

This case report describes the possibility to use a modified rapid palatal expander like anchorage to reposition an included maxillary cuspid. Moreover it is enphasized the use of an ultrasonic device during surgery to expose the impacted tooth.

Long-term follow-up of a young adult patient with a Class II malocclusion treated with a Herbst appliance.

A 13-year, 9-month-old girl presented with the chief complaint of crowding and protrusion of her anterior teeth. She was dolichofacial with a Class II Division 1 occlusion and had reached the final phase of her skeletal growth. Clinical symptoms and tomograms were indicative of a TMJ dysfunction. Because orthognathic surgery was not accepted by the patient and her parents, a Herbst appliance became the choice of treatment. An optimal occlusion and a good facial appearance were achieved after 24 months of treatment. TMJ tomograms at the end of treatment showed a more physiologic condylar position. Long-term follow-up 7 years after the end of treatment showed a very stable occlusion and an acceptable facial appearance.