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1/179. Nonsurgical correction of a class II malocclusion with a vertical growth tendency.

    malocclusion, with a superimposed vertical growth tendency, is often difficult to treat without a combined surgical orthodontic approach. Certain situations, however, may preclude surgery as a treatment option. The following case report demonstrates the use of orthodontic mechanotherapy alone in successfully treating a patient that exhibited a Class II Division I malocclusion with a high mandibular plane angle and vertical growth tendency.
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keywords = bite
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2/179. Class II malocclusion correction: an American board of orthodontics case.

    A Class II open bite malocclusion with a narrowed maxilla, an increased lower anterior facial height, and a tooth size discrepancy are presented. The malocclusion was treated nonextraction in 2 phases. The mixed dentition phase of treatment was maxillary molar uprighting followed by a bonded rapid palatal expander. The vertical dimension was managed with a vertical pull chincup. The full appliance phase included buildups of the maxillary lateral incisors and mechanics to control lower incisor position.
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3/179. Case report of malocclusion with abnormal head posture and TMJ symptoms.

    Abnormal cervical muscle function can cause abnormal head posture, adversely affecting the development and morphology of the cervical spine and maxillofacial skeleton, which in turn leads to facial asymmetry and occlusal abnormality. There can be morphologic abnormalities of the mandibular fossa, condyle, ramus, and disk accompanying the imbalance of the cervical and masticatory muscles activities. Two normally growing Japanese female patients with Class II Division 1 malocclusion presented with TMJ symptoms and poor head posture as a result of abnormal sternocleidomastoid and trapezius cervical muscle activities. One patient underwent tenotomy of the two heads of the sternocleidomastoid muscle and the other patient did not. In addition to orthodontics, the 2 patients received physiotherapy of the cervical muscles during treatment. Both were treated with a functional appliance as a first step, followed by full multi-bracketed treatment to establish a stable form of occlusion and to improve facial esthetics with no head gear. This interdisciplinary treatment approach resulted in normalization of stomatognathic function, elimination of TMJ symptoms, and improvement of facial esthetics. In the growing patients, the significant response of the fossa, condyle, and ramus on the affected side during and after occlusal correction contributed to the improvement of cervical muscle activity. Based on the result, early occlusal improvement, combined with orthopedic surgery of the neck muscles or physiotherapy to achieve muscular balance of the neck and masticatory muscles, was found to be effective. Two patients illustrate the potential for promoting symmetric formation of the TMJ structures and normal jaw function, with favorable effects on posttreatment growth of the entire maxillofacial skeleton.
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keywords = jaw
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4/179. The use of pendulum appliance in the treatment of Class II malocclusion.

    A case of correction of molar Class II using the pendulum appliance is described. Upper first molars were distalized into Class I, crowding was eliminated in the upper arch and space was provided to attain Class I relationship. Treatment lasted for 18 months. A two year follow up shows stability of the occlusion.
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keywords = relation
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5/179. Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes.

    Idiopathic condylar resorption is a poorly understood progressive disease that affects the TMJ and that can result in malocclusion, facial disfigurement, TMJ dysfunction, and pain. This article presents the diagnostic criteria for idiopathic condylar resorption and a new treatment protocol for management of this pathologic condition. Idiopathic condylar resorption most often occurs in teenage girls but can occur at any age, although rarely over the age of 40 years. These patients have a common facial morphology including: (1) high occlusal and mandibular plane angles, (2) progressively retruding mandible, and (3) Class II occlusion with or without open bite. Imaging usually demonstrates small resorbing condyles and TMJ articular disk dislocations. A specific treatment protocol has been developed to treat this condition that includes: (1) removal of hyperplastic synovial and bilaminar tissue; (2) disk repositioning and ligament repair; and (3) indicated orthognathic surgery to correct the functional and esthetic facial deformity. patients with this condition respond well to the treatment protocol presented herein with elimination of the disease process. Two cases are presented to demonstrate this treatment protocol and outcomes that can be achieved. Idiopathic condylar resorption is a progressive disease that can be eliminated with the appropriate treatment protocol.
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6/179. Treatment of Class II/2 occlusion with 30-year follow-up. Case report.

    We report on a patient with deep bite and Class II occlusion who was 6 years of age on his first visit in 1953. The treatment took place in the 50s and 60s. An elastic Bimler appliance was used. In 1998, at the age of 50, he came in for a follow-up examination.
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7/179. Pediatric dental treatment for children with headache.

    This case demonstrates the safe step by step approach to treatment of pediatric patients with muscle spasm headache. If there are any neurologic signs or the LiteSplint is not effective, then a laboratory orthopedic appliance therapy may not be effective and a neurologic referral is necessary. It is always required to review the latest physical exam with the parent and physician if the symptoms do not improve in an orderly sequence. The LiteSplint acts as a screening and diagnostic aid in determining the source of head pain. For very young patients (three to six years of age) who may not be able to easily tolerate an appliance, an extra heavy coating of flowable composite that can act as a sealant on the primary molars, e.g. Revolution, may open the bite enough to alleviate headache or earache symptoms. Dental clinicians can perform a valuable service for their patients if headaches from deep bite malocclusions can be diagnosed and treated at an early age.
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8/179. Condylar resorption 2 years following active orthodontic treatment: a case report.

    We recently treated a patient with degenerative disease of the temporomandibular joint. A healthy, 12-year-old female with bilateral high maxillary canines presented for orthodontic treatment. Two years after active orthodontic treatment, at age 17, symptoms in her temporomandibular joint manifested and progressed. By the time she revisited our hospital at age 21, the patient had developed an anterior open bite with a long, slender facial appearance. Cephalometric analysis showed shortening of the ramus and backward and downward rotation of the mandible. Imaging studies revealed severe deformity and resorption of the bilateral condyles. Her occlusal and morphologic changes seemed to be caused by degenerative disease of the temporomandibular joint.
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9/179. Extraction of maxillary first bicuspids and mandibular lateral incisors, combined with orthognathic surgery to correct a severe class II skeletal malocclusion.

    This is a case report of a 21-year-old female with a Class II Division 1 malocclusion. The maxillary arch was constricted with an associated anterior open bite. The lower facial height was excessive, and the mandibular plane angle was high. The treatment options were limited due to a previously extracted mandibular right lateral incisor. The patient was successfully treated by a surgical rapid palatal expansion procedure, extraction of the mandibular left lateral incisor, extraction of the maxillary first premolars at the time of a 3-piece Lefort 1 maxillary osteotomy procedure, and a bilateral sagittal split osteotomy advancement procedure.
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keywords = bite
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10/179. Begg appliance management of a moderately crowded Angle Class 11 Division 2 malocclusion.

    A case is presented that shows Begg appliance management of an Angle Class II division 2 malocclusion. The judicious use of anchorage bends and Class II elastics enabled the successful treatment of the poor posterior and anterior relationships, at the same time addressing the chief complaint of crooked front teeth.
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keywords = relation
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