Vol.30-4-1 December 2018
Orthodontic Treatment Management for Congenitally Missing Maxillary Lateral Incisors
Congenitally missing of maxillary lateral incisor is one of the most common agenesis anomalies. The purpose of this review was to present the orthodontic treatment of choice for a malocclusion with missing maxillary lateral incisors. Treatment plans consist of three categories: canine substitution, single-tooth implant and tooth supported restorations. Among which the least invasive option to achieve satisfying function and aesthetics is canine substitution.
Factors such as the profile of the patient, the space analysis of dentition, and the color and shape of canine should be taken into consideration for treatment choice.
Vol.30-4-2 December 2018
Rapid Maxillary Alveolar Expansion in Maxillary Severe Space Deficiency
Although maxillary skeletal palatal expansion was efficient to correct the transverse dental deficiency, the conventional maxillary palatal expansion is still effective in some cases. This case report describes the orthodontic treatment procedure of a 15-year-old female patient who was diagnosed as Angle’s Class I malocclusion with severe space deficiency. The space deficiency of 11 mm was noted in maxillary arch in conjunction with severe overjet, blocked-in lateral incisors, high maxillary vault, posterior crossbite and V shape arch-form. The treatment plan presented non-extraction with rapid maxillary alveolar expansion in
upper arch. The Hyrax expander was used in a rhythm of 2 turns/day. The treatment outcome demonstrated 5 mm transverse expansion after 3 weeks of activation. The fixed orthodontic therapy followed the maxillary expansion. The treatment result indicated harmonious facial profile with a normal overjet and overbite occlusion. It is suggested that correct diagnosis in transverse problems and proper selection of appliance contribute to the good treatment outcome.
Vol.30-4-3 December 2018
Nonsurgical Treatment of an Adult Patient with Bilateral Scissors-bite and Class II Division 2 Malocclusion
This report illustrates a 20 years old female presented a Class II division 2 malocclusion with deep overbite, gummy smile, canted maxillary anterior occlusal plane, low mandibular plane angle and bilateral scissors-bite. Angle's Class II division 2 malocclusion needs to be treated by correcting the inclination of maxillary incisors and lower lip posture. Selective bonding of maxillary anterior teeth and molars were performed to level the occlusal plane and gingival line, thus creating a consonant smile arc. Disocclusion was necessary by using a removable bite plate. Maxillary second premolars and second molars, lower third molars were extracted. The aim was to intrude the elongated maxillary molars and upright the mandibular molars. The treatment of bilateral scissors-bite is more efficient with the help of temporary anchorage devices (TADs). Four titanium bone screws were therefore inserted at maxillary and mandibular posterior regions to intrude and upright the molars even without patient’s compliance. At the end of treatment, a harmonized smile and stable occlusion were accomplished. After one-year retention period, the treatment results still maintained well.
Vol.30-4-4 December 2018
Surgical-Orthodontic Correction in Skeletal Class III Anterior Open Bite with an Ankylosed Maxillary Molar
This case report describes the treatment of a 24-year-old woman with chief complaints of anterior open
bite and long lower jaw. She had a skeletal Class III with concave facial profile, hyperdivergent facial pattern,
long lower facial height, and excessive anterior open bite. Intraoral examination revealed 26 tooth ankyloses
and 32, 42 congenital missing teeth. The 26 was highly-locked, showing root penetrating into the sinus floor.
Treatment was performed with a modified surgery-first approach, which included 5 months of presurgical
alignment phase to upright the 27 mesially-tilted tooth and to correct upper dental midline by 14 extraction.
The surgeries included 3-pieces LeFort I impaction by using 14 and 26 extraction spaces as well as bilateral
sagittal split ramus osteotomies setback with closing rotation and genioplasty. Upper and lower arches
coordinated well soon after surgery. The posterior open bite settled well during postsurgical orthodontic phase.
Appropriate vertical facial proportion and solid interdigitation were achieved after treatment. The treatment had
successfully corrected the anterior open bite and long face problems, concomitantly solved her difficult molar
ankyloses issue during the time of surgery, no further prostheses were required. Pleasing esthetic outcomes
were achieved, contributing to patient’s psychosocial satisfaction.
Vol.30-4-5 December 2018
Orthodontic Treatment Combined with Maxillary Posterior Subapical Osteotomy in Severe Anterior Open Bite
A 29-year-old woman presented with severe anterior open bite (−6 mm). Eight-month presurgical orthodontic treatment involving arch rounding and leveling was performed, with the upper arch treatment from canine to canine only. Bilateral maxillary posterior subapical osteotomy (PSO) for posterior intrusion was performed for 6-week fixation. Postsurgical orthodontic treatment followed, resulting in a total treatment time of 19 months. Cephalometric X-ray superimposition revealed that the anterior overbite was corrected by 9 mm (from -6mm to +3 mm), and the lower mandibular plane angle changed from 38.4° to 35.4°. Therefore, counterclockwise rotation of the mandible improved the facial profile. In conclusion, orthodontic treatment combined with upper posterior intrusion through PSO was useful for correcting severe anterior open bite; it simultaneously achieved a short treatment time and prevented open bite relapse.
Vol.30-4-6 December 2018
Management of Tipped and Impacted Mandibular Second Molars
This is a 12Y11M old girl with mesial tipping of left and right mandibular second molars. The chief compliant was crowding of the teeth. The clinical examination revealed crowding of lower anterior teeth, 13, 23 block out and 47, 37 mesial tipping. The diagnosis was Angle Class I malocclusion with lower anterior crowding and 37, 47 mesial tipping. The treatment plan was four 1st premolars extraction. The treatment goal was to align anterior teeth and upright 37, 47. Two different uprighting spring were applied, one was a hand-bending lever arm appliance on the right second molar, and the other was a prefabricated upright spring on the left second molar. Total treatment duration was 4 months for the 37 and 47 uprighting. Correction of the mesial tipped mandibular molars is important for better oral hygiene care, improving occlusion and chewing function, and facilitating the prosthodontic rehabilitation. The aim of this case report was to interpret etiology of the tipped mandibular molars, and to enumerate the treatment options for uprighting of the mesial tipped mandibular molars.
Vol.30-4-7 December 2018
Decision Making on Tooth Extraction in Orthodontics
Extraction or non-extraction is an issue that we face in our daily orthodontic practice. Before deciding the
treatment plan, we have to examine the case carefully. Orthodontic tooth extraction involves more than just the
need to create space in the arches but also the concerns of facial esthetics and treatment stability. The report
presented a case of teenage boy with severe external root resorption of tooth 27, 37, 46, 47 which caused
by impaction of third molars and a supernumerary premolar. Patient already had orthodontic treat-ment
before and did not favor a comprehensive orthodontic treatment again. Tooth extraction of 27, 37, 47 and the
supernumerary premolar were conducted. The lingual holding arch with hook was used to upright the mesially
erupted third molar. The opinion and philosophy of the tooth extraction decision making was discussed.
(Taiwanese Journal of Orthodontics. 30(4): 247-255, 2018)