Interdisciplinary Management of Deep Bite Malocclusion with Excessive Curve of Spee and Severely Abraded Lower Incisors
Shih YH, Lin JJ, Roberts WE.
It is di cult to restore severely abraded lower incisors in adult patients with a deep bite, that is associated with an excessive curve of Spee in the lower arch and a reverse curve in the upper arch. Orthodontics is the rst step in an effective interdisciplinary treatment plan. Intrusion of the incisors in both arches is required to level the plane of occlusion and correct the deep bite without increasing the vertical dimension of occlusion (VDO). Once the occlusion is aligned, the restorative dentist can restore the severely abraded lower incisors. Incisor extraction or extensive enamel stripping in the lower arch were treatment options for resolving the anterior tooth size discrepancy, which was expected to become more severe as the curve of Spee was leveled. Extraction of the lower right central incisor was the best option because it had a root fracture. The extraction space was closed and the anterior segment was aligned over the apical base of bone by intruding the incisors and leveling the curve of Spee. Anterior bite turbos (raisers) were placed on the maxillary central incisors to open the bite and intrude the lower incisors. Class II elastics were required for anterior-posterior correction of the buccal interdigitation. Pre-restorative orthodontic treatment optimally aligned the dentition for a more predictable esthetics and function for this 54 year old male patient. Correcting extruded lower incisors in older adults is particularly important because the lower anterior dentition is increasingly visible with age. This challenging malocclusion, with Discrepancy Index (DI) of 13, was treated to an excellent result, Cast-Radiograph Evaluation (CRE) of 10. (Int J Ortho Implantol 2015;37:4-16) .
Key words: Deep bite, abraded incisors, lower incisor extraction, bite turbos, passive self-ligating brackets
Implant-Supported Crowns to Replace Congenitally Missing Lateral Incisors:2B-3D Rule for Ideal Implant Position
Chang MJ, Chang CH, Roberts WE.
A 29-year-old male patient presented for orthodontic consultation concerned with multiple spaces in the maxillary and mandibular dental arches. Clinical evaluation revealed modest Class II buccal segments, generalized anterior spacing, congenital absence of both maxillary lateral incisors, but there were no other manifestations of malocclusion. The malocclusion Discrepancy Index (DI) was 12, but implant site de ciencies added an additional 8 points, resulting in an overall Interdisciplinary DI of 20. A diagnostic wax set-up showed that implant replacement was esthetically superior to canine substitution bilaterally. A full xed orthodontic appliance with passive self ligating brackets was used to correct the malocclusion and prepare the implant sites. Open coil springs in the edentulous areas closed the midline diastema and consolidated the space at the desired location of the implants. Because of the Class II buccal segments, pre-implant alignment of the maxillary anterior region produced overjet. Extra-alveolar (E-A) bone screws were inserted bilaterally in the infrazygomatic crests to provide osseous anchorage to retract the entire maxillary arch to Class I. Implants were placed with bone augmentation to increase the width of the alveolar process to cover the endosseous portions of the xtures. The posttreatment Cast-Radiograph Evaluation (CRE) was a near ideal 7, and the Pink & White dental esthetic score was 5. (Int J Ortho Implantol 2015;37:22-57) .
Key words:Congenitally missing maxillary lateral incisors, OrthoBoneScrew, extra-alveolar bone screws, maxillary midline diastema, passive self-ligating brackets, early light short elastics (ELSE), Atherton’s patch, apical fenestration, bone augmentation, GBR (guiding bone regeneration), 2B-3D rule.
Full-Cusp Class II Malocclusion with Bilateral Buccal Crossbite (Scissors-Bite) in an Adult
Chang MJ, Wei MW, Chang CH, Roberts WE.
Full-cusp Class II malocclusion with posterior buccal crossbite and an overjet exceeding 10mm, usually requires orthognathic surgery for an optimal correction. However, the use of extra-alveolar bone screws for anchorage has expanded the therapeutic envelope for conservative, nonextraction treatment. The dentoalveolar correction was facilitated by a 5-7mm retraction of the entire maxillary arch to achieve a Angle Class I molar relationship. Near ideal dental alignment was accomplished with passive self-ligating brackets, early light short elastics, posterior cross elastics, and bite turbos on lower molars. This challenging malocclusion with a discrepancy index (DI) of 22 was treated in 26 months to a Cast-Radiograph Evaluation (CRE) score of 22 and a Pink & White Esthetic Score of 3. (Int J Ortho Implantol 2015;37:60-79).
Key words:excessive overjet, Angle Class II molar relationship, OrthoBoneScrew, extra-alveolar miniscrews, posterior buccal crossbite, Damon self-ligating brackets, early light short elastic, posterior criss-cross elastics, posterior bite turbos.