Treatment of a Deep Bite with Bilateral Palatally Impacted Maxillary Canines
Shih YH, Lin JJ, Roberts WE.
Impacted maxillary canines is a common malocclusion. A 14 year female presented with a Class I deep bite malocclusion, complicated with impacted maxillary canines, bilaterally. The right maxillary primary canine was retained. The Discrepancy Index (DI) for the malocclusion was 15, but 16 points were added for the di cult position of the impactions, resulting in a total DI of 31. Extraction of the primary canine prior to orthodontics treatment helped the axial inclination and position of the right impacted canine. After opening up space for the upper canines, surgical exposure was performed by a periodontist to remove the soft tissue and bone covering the crowns of the impactions to permit spontaneous eruption of the impactions. A cone-beam computed tomography (CBCT) image was obtained immediately prior to the surgery to provide accurate localization of the impactions relative to the adjacent teeth. Glass ionomer-cement bite turbos (GIBT) were bonded on the upper central incisors to open the bite at the beginning of active treatment. To allow the cuspids to pass out of crossbite, GIBTs were placed on the mandibular rst molars and the bite turbos on the upper central incisors were removed. The patient’s dentition was well aligned as evidenced by a Cast Radiograph Evaluation (CRE) of 18. The overall treatment time was 31 mo. Opening the bite with GIBTs is bene cial for patients with low to average divergency of the jaws, and competent lips. (Int J Orthod Implantol;39:4-19)
Key words:Palatally impacted maxillary canines, surgical exposure, spontaneous eruption, CBCT, deep bite, Glass Ionomer Bite Turbos (GIBT)
Class III Malocclusion with Camouflage Treatment and Implant Site Development
Chang A, Chang CH, Roberts WE.
A 28-year-old woman presented for orthodontic evaluation with a concave pro le, anterior cross-bite, multiple missing teeth, and a skeletal Class III malocclusion. The ABO Discrepancy Index (DI) was 50. Because of asymmetric tooth loss in the lower arch, space was closed for a fixed prosthesis on the right side, but the left side was prepared for an implant, by moving the second premolar distally to develop a more favorable implant site. A passive self-ligating appliance, with bite turbos and bone screw anchorage, achieved optimal occlusal function and pleasing esthetics. This severe mutilated malocclusion was treated to an acceptable dental outcome in 49 months: cast-radiograph evaluation (CRE) of 32 with a pink and white dental esthetics score (P&W) of 3. (Int J Orthod Implantol;39:24-49)
Key words:Implant site development, anterior cross-bite, Class III malocclusion, non-extraction, miniscrews, extra-alveolar anchorage.
Crowding, Protrusion and Scissors Bite: Extractions and Extra-Alveolar Bone Screws
Chen HH, Chang CH, Roberts WE.
A 16 year female presented with marked functional and esthetic deficits secondary to crowded, asymmetric malocclusion with bimaxillary protrusion and incomplete, bilateral posterior buccal cross-bite (scissors bite). The Discrepancy Index (DI) was 29 for this severe malocclusion. All four first premolars were extracted to resolve crowding and lip protrusion. The buccal crossbites were corrected with trans-arch elastics anchored by extra-alveolar (E-A) OrthoBoneScrews (OBSs) placed in the mandibular buccal shelves, bilaterally. Alignment was achieved with a passive self-ligating appliance and bite turbos. This severe malocclusion was corrected with only 21 months of active treatment. Outcomes for the pleasing result were a Cast-Radiograph Evaluation of 24, and a pink & white dental esthetics score of 4. Follow-up records one year after treatment documented the stability of the result. (Int J Orthod Implantol;39:54-70)
Key words:Self-ligating xed appliance, bilateral buccal crossbite, bite turbos, bone screw anchorage, mandibular buccal shelf.
Simplified Open-window Technique for a Horizontally Impacted Maxillary Canine with a Dilacerated Root
Chang A, Chang CH, Roberts WE.
A left maxillary canine with a dilacerated root is horizontally impacted in the palate. Extraction is undesirable, so the preferred option is efficient surgical exposure and orthodontic alignment.1 For palatal impactions, the open window technique is a common surgical approach.2,3 There are multiple surgical and orthodontic options to customize the process for a specific patient.4-6 This article illustrates the step-by-step surgical procedures as a checklist to assist clinicians in e ciently recovering palatally-impacted maxillary canines.