1/30. Orthodontic correction of a class III malocclusion in an adolescent patient with a bonded RPE and protraction face mask.A case report of a 14-year-old Hispanic male with a Class-III skeletal profile and dental malocclusion with a long mandibular body and ramus and retrusive maxilla. The patient was initially referred for a surgical evaluation for a LeFort I maxillary advancement, but he wanted to avoid surgery. The Class-III malocclusion was corrected with a bonded rapid palatal expander and a maxillary protraction mask followed by nonextraction orthodontic treatment. A Class-I molar and canine relationship was achieved, and the facial profile improved. This case report demonstrates the orthodontic correction of a Class-III malocclusion in an adolescent patient with a bonded rapid palatal expander and protraction face mask. This case was presented to American Board of orthodontics as partial fulfillment of the requirements for the certification process conducted by the Board.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/30. Molarization of the lower second premolars.This paper presents a case of extreme tooth variation. The patient was first observed during the mixed dentition period, when she presented a mild Class II malocclusion with increased overjet and acceptable overbite. In a panoramic radiograph, the presence of lower second premolars of disproportionate dimensions was discovered. When these oversized premolars erupted, the Class I malocclusion tended toward Class III, with an edge-to-edge bite. This created an unstable occlusion and the possible need for extractions.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/30. Nonsurgical and nonextraction treatment of skeletal Class III open bite: its long-term stability.Two female patients, aged 14 years 5 months and 17 years 3 months with skeletal Class III open bite and temporomandibular dysfunction are presented. They had previously been classified as orthognathic surgical cases, involving first premolar removal. The primary treatment objective was to eliminate those skeletal and neuromuscular factors that were dominant in establishing their malocclusions. These included abnormal behavior of the tongue with short labial and lingual frenula, bilateral imbalance of chewing muscles, a partially blocked nasopharyngeal airway causing extrusion of the molars, with rotation of the mandible and narrowing of the maxillary arch. Resultant occlusal interference caused the mandible to shift to one side, which in turn produced the abnormal occlusal plane and curve of Spee. As a result, the form and function of the joints were adversely affected by the structural and functional asymmetry. These cases were treated by expanding the maxillary arch, which brought the maxilla downward and forward. The mandible moved downward and backward, with a slight increase in anterior facial height. Intruding and uprighting the posterior teeth, combined with a maxillary protraction, reconstructed the occlusal plane. A favorable perioral environment was created with widened tongue space in order to produce an adequate airway. myofunctional therapy after lingual and labial frenectomy was assisted by vigorous gum chewing during and after treatment, together with a tooth positioner. Normal nasal breathing was achieved.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
4/30. Non-extraction treatment of a thirteen-year-old boy with a Class III skeletal discrepancy and severe crowding in both the upper and lower dentitions.A thirteen-year-old boy presented with a Class III skeletal tendency in association with severe crowding in both the upper and lower arches. Whilst there was not a frank posterior crossbite, it was felt that the upper arch was narrow and that the lower arch was similarly constricted. Taking this into account along with the fact that his upper lip was flat and the nasolabial angle obtuse, it was decided to pursue a non-extraction treatment, with the aim of providing by expansion an extra 16 mm of space in the upper arch and 8 mm in the lower arch to accommodate the full dentition, and with a view to extracting third molar teeth later. This proved to be successful, albeit over an extended period of time, with active treatment taking nearly three and a half years. A realistic alternative would have been to remove four bicuspid teeth and pursue an orthodontic/surgical approach to treatment. In retrospect, and with the benefit of reviewing his records without surgical intervention, the treatment plan decided upon has been well justified.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
5/30. Second molar extraction therapy--two case reports.As in many areas of dentistry, the topic of second molar extraction therapy has its followers and its critics. Besides the problem of accurately predicting the eruption position of the third molars, I have also been concerned about the effect on the cranium and the temporo-mandibular joints. The majority of my patients with mild or moderate crowding are treated without extractions. The third molars, if present, are kept under observation. There is, however, one group of patients that responds well to the loss of second molars and for which, in my opinion, any alternative extraction pattern would compromise the patient with regard to function and facial appearance. This group is the mild Class III skeletal pattern with buccally crowded canines.- - - - - - - - - - ranking = 7keywords = extraction (Clic here for more details about this article) |
6/30. Lower incisor and second molar extraction in Class III treatment.Although not fully accepted as routine orthodontic therapy, second molar and lower incisor extraction is well documented in the literature. The following cases show how both procedures can be used successfully to simplify the treatment of Class III malocclusion, while preserving the facial profile.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
7/30. Treatment of severe mandibular prognathism in combination with maxillary hypoplasia: case report.We performed a Le Fort I osteotomy and sagittal split ramus osteotomy (Obwegeser-Dal Pont) combined with mandibular anterior segmental osteotomy without tooth extraction for a patient with severe mandibular prognathism accompanied by a hypoplastic maxilla, anterior open bite and normal anterior mandibular vertical dimension. The results of facial appearance and occlusion were excellent. This combined surgical method appears to be satisfactory for treating severe mandibular prognathism with hypoplastic maxilla.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/30. An unexpected growth pattern: considerations in management.A case study spanning 16 years is presented. Routine treatment with serial extraction and an edgewise appliance for a Class I crowded occlusion began when the patient was 8 years old. By the time the patient was 17, his dentition had evolved, because of unanticipated growth, into a Class III malocclusion with complete-arch crossbite. The question of whether it is most appropriate to treat this patient in one or two surgical procedures is discussed, and some controversial aspects and concerns are presented.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/30. A European Board of orthodontics case report. Case category: severe skeletal discrepancy.OBJECTIVES: this 18.1 year-old girl presented with a chief complaint of progressive worsening of facial and dental esthetics, crowding, headache and facial pain. MATERIALS AND methods: clinically, she was at the end of her growth and exhibited a severe facial asymmetry, but with normal sagittal and vertical cranial relationships. Clicking in the right TMJ was evident. This was accompanied by a deviation upon opening, and pain in the joint. The pain she experienced during jaw movement, and upon palpation, was significant. There was a shift to the right from centric relation to intercuspal position. Intraorally, the tissues were normal, with mild tetracycline staining, still present primary canines, impacted third molars and upper permanent canines. Her first molars had fillings. Orthodontically, her occlusion was a severe Class III subdivision left, with a severe right-side crossbite, lower midline deviation to the right 6 mm, and a 1 mm lateral shift in intercuspal position. She also exhibited severe crowding and asymmetry in both arches. The sequence of her treatment was as follows: (a) extraction of primary canines and impacted third molars, surgical exposure of impacted canines, (b) lower occlusal splint for TMJ dysfunction and an upper arch fixed appliance for ideal alignment and leveling, (c) upper occlusal splint for the maintenance of TMJ function and lower arch fixed appliance for ideal alignment and leveling, (d) surgical skeletal correction, (e) post-surgical orthodontic finishing, (f) post-treatment retention.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
10/30. Utilization of third molars in the orthodontic treatment of skeletal class III subjects with severe lateral deviation: case report.AIM: This clinical report discusses the importance and use of third molars in the adult patient by presenting a case in which their use during orthodontic treatment allowed occlusal improvement. SUBJECT AND TREATMENT PLAN: The patient was a Japanese adolescent boy who had a skeletal Class III malocclusion with severe lateral deviation of the mandible, significant loss of posterior occlusal vertical dimension, due to premature loss of the maxillary and mandibular left first molars, and furthermore, both first molars had advanced carious lesions that had resulted in reduced crown heights and bilateral chewing surfaces. The mandible had shifted to the left, with a bilateral chewing pattern and a lack of posterior vertical alveolar height, which in turn had produced an abnormal occlusal plane and curve of Spee. The maxillary arch was expanded, the maxilla was moved downward and forward, and the mandible was moved slightly backward and rotated open to increase posterior vertical alveolar and crown height. The reconstruction of a functional occlusal plane was achieved by uprighting the posterior teeth to correct asymmetric posterior vertical alveolar and crown height, using a full multibracket system incorporating four third molars and closing the space from the missing first molars and extraction of the questionable first molars. RESULTS: A normal overbite and overjet and adequate posterior support and anterior guidance were established, achieving a better intercuspation of the posterior teeth. A favorable perioral environment was created, with widened tongue space to produce an adequate airway. A well-balanced lip profile and almost symmetric face were achieved using the four wisdom teeth without extraction of the four premolars. Subsequent mandibular growth, with development of posterior vertical alveolar height and temporomandibular joint adaptation, has resulted in an almost symmetric posterior vertical height and joint structure between right and left sides. These factors have contributed to the occlusal stability maintained for more than 5 years. CONCLUSION: In the growing patient, with missing and/or early advanced caries of the first molars, it may be more beneficial to plan occlusal improvement through extraction of the questionable first molar rather than premolar extraction. This method of treatment can equalize posterior vertical dimension and does not restrict tongue space. In addition, this treatment method addresses the clinician's concern about postorthopedic relapse due to tongue habits and eruption of the third molars.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
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