Face Mask (FM) Protraction
with Rapid Maxillary Expansion (RME): Is this complicated modality necessary?
Lin JJ, Roberts WE.
The RME/FM approach is very e ective for correction of Class III malocclusion, but the method has some disadvantages: heavy force is needed for RME, and the FM requires excellent compliance. This section will pursue the possibility of using relatively simple edgewise mechanics to replace the complicated RME/FM approach. The alternate edgewise treatment option, that is proposed, is predicated on a proper di erential diagnosis, emphasis on relatively simple mechanics, avoidance of over-treatment, and providing realistic expectations for the patient, relative to the in uence of early treatment on severe prognathic Class III malocclusions.(Int J of Othod Implantol 2014;36:4-21)
Asymmetric Maxilla with a Functional Shift and Labially Blocked-Out Maxillary Canines
Chang A, Chang CH, Roberts WE.
The Discrepancy Index (DI) was 17 for a 12y9m male with bilateral blocked-out upper cuspids, unilateral anterior crossbite, right Class II molar relationship, and a mandibular dental midline deviated 4mm to the right. A non-extraction treatment with intermaxillary elastics for 21 months resulted in a good dental outcome: cast-radiograph evaluation (CRE) of 26 with a pink and white dental esthetics score (P&W) of 3. The patient failed to grow as expected to compensate for extrusion of mandibular, so the mandible rotated posteriorly, but lip competence was maintained. Although miniscrew osseous anchorage was recommended to correct the side e ects of Class II elastics, the patient declined because the convex pro le was acceptable. However, from an orthodontics perspective it would have been preferable to retract the maxillary dentition with extra-alveolar (E-A) miniscrews to prevent bite opening and lower incisor aring. This case teaches three important lessons: 1. obtain permission before treatment to use miniscrews if indicated, and 2. nonextraction treatment of high angle patients with Class II elastics may result in stability problems, and 3. progress records are recommended before the nishing stage to plan the nal detailing.(Int J of Othod Implantol 2014;36:26-48)
Key words: blocked-out, crossbite, functional shift, midline discrepancy, Class II malocclusion, non-extraction, miniscrew, extra- alveolar anchorage
Oligodontia and Class II Malocclusion Treated with Orthodontics, Bone Augmentation, and an Implant-Supported Prosthesis
Chen HH, Chang CH, Roberts WE
A 29 year female presented with a partially edentulous, compensated Class II malocclusion. There were twelve missing permanent teeth including two third molars; nine were congenitally missing. Cephalometrics revealed an underlying Class II skeletal pattern: facial convexity 15°, ANB angle 4° and lower incisor to mandibular plane angle of 106°. The lack of molar antagonists on the right side resulted in an unstable occlusion that was associated with a large mandibular edentulous space (area teeth #29-31) as well as extruded upper and lower molars (teeth #3 and 32). Diagnostically, this acquired malocclusion had an ABO Discrepancy Index (DI) of 18, with 3 additional points added for an unfavorable implant site, resulting in an overall interdisciplinary DI of 21 points. The patient preferred no extractions, orthodontics only in the upper arch, and decided against replacing an unesthetic maxillary anterior xed prosthesis. Interdisciplinary care involved space closure in the left quadrant and arch alignment. The maxillary right 1st molar was intruded with buccal and lingual temporary anchorage devices, augmented with a temporary implant-supported prosthesis. The lower right atrophic edentulous ridge was split and spread to receive two implants to restore teeth #29 and 30 with an implant- supported prosthesis. Despite the limitations on treatment options, an optimal occlusion was achieved, as evidenced by a Cast- Radiograph Evaluation (CRE) = 26. The atrophic lower right implant site was successfully restored as evidenced by a 5 point score on the Implant-Abutment Transition and Position Analysis. The Pink & White dental esthetics were not scored because there were no changes in the esthetic zone. (Int J Ortho Implantol 2014;36:52-69)
Key words:oligodontia, self-ligating bracket, bone splitting and spreading, implant-supported prostheses
Full Cusp Class II Malocclusion with a Deep Overbite
Lin SL, Chang CH, Roberts WE.
A skeletal and dental Class II malocclusion in a adolescent male with incompetent lips was managed with non-extraction orthodontics treatment. The impinging deep overbite was resolved with an anterior bite turbo. The skeletal and dental Class II relationships were corrected with Class II elastics and miniscrews that were inserted as anchorage in the infrazygomatic crests bilaterally. A tooth positioner was used to finish the occlusion. Overall, this moderately difficult malocclusion (DI=20) was nished in an excellent result (CRE=24) in ~21 months, but there were some side e ects associated with rapidly opening the bite.(Int J of Othod Implantol 2014;36:72-86)
Key words: Class II, deep overbite, miniscrews, tooth positioner.