1/7. 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) |
2/7. Mandibular symphyseal contouring in mild mandibular prognathism.Kolle's mandibular segmental osteotomy, with extraction of the bilateral first bicuspids, is often used in cases of mild mandibular prognathism. While mandibular prognathism is usually corrected by mandibular ramus osteotomy and the mandible is set back en bloc, the premolar region alone is set back by segmental osteotomy, retaining the protruding mental area. In Asians, particularly, the protruding chin is not preferred by our concepts of beauty. In mandibular segmental osteotomy, the entire mandibular symphyseal shape should be considered. Mandibular symphyseal contouring constitutes setting back the premolar region by segmental osteotomy, recession genioplasty, and chiseling out the protruding middle portion of the protruding chin. In 18 series of mild manibular prognathism in Asians patients, this procedure was used and satisfactory aesthetic results were obtained.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/7. 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) |
4/7. rehabilitation of a hemophiliac with implants: a medical perspective and case report.A patient suffering from classical hemophilia had previous surgery for ankylosis of the right temporomandibular joint. This was replaced by a costochondral graft and an overlay of temporalis muscle. A bilateral sagittal split was performed for a micrognathic mandible and a sleep apnea problem. That procedure solved the sleep apnea; however, it resulted in a prognathic mandible and an anterior open bite. The lower anterior teeth were periodontally involved with impaired alveolar support. The restricted opening of the oral cavity of 18 mm between maxillary and mandibular centrals and the potential danger of bleeding complicated the surgical and restorative procedures. The patient was prepared medically on each of 4 occasions with factor viii replacement concentrate, and oral antifibrinolytic therapy (tranexamic acid). The treatment of choice was the extraction of the remaining lower incisors and their replacement with an implant-supported temporarily cemented retrievable fixed prosthesis. Serial extractions and chairside temporization provided the surgeon with precise guides for implant placement, and enabled the patient to enjoy unimpaired function through periods of healing and osseointegration.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
5/7. Nonsurgical and nonextraction treatment of a skeletal class III adult patient with severe prognathic mandible.AIM: A patient with a skeletal Class III malocclusion, prognathic mandible, anterior open bite, large tongue, and temporomandibular disorders is presented. Treatment objectives included establishing a stable occlusion with normal respiration, eliminating temporomandibular disorder symptoms, and improving facial esthetics through nonextraction and nonsurgical treatment by creating a favorable perioral environment, restoring the harmony to the tongue and perioral environment, improving masticatory muscle function, and creating adequate tongue space for establishment of normal respiration. SUBJECT AND methods: The patient was a Japanese adult male, who had previously been advised to have orthognathic surgery, with tongue-size reduction. An expansion plate was used to expand the maxillary dentoalveolar arch. Distalization of the mandibular arch was achieved by reduced excessive posterior vertical dimension, through uprighting and intruding the mandibular posterior teeth and rotating the mandible slightly counter-clockwise. The height of the maxillary alveolar process and the vertical height of symphysis were increased slightly. The functional occlusal plane was reconstructed by uprighting and intruding the posterior teeth with a full-bracket appliance, combined with a maxillary expansion plate, with short Class III and vertical elastics in the anterior area. myofunctional therapy involved sugarless chewing gum exercises. RESULTS: The excessive posterior vertical occlusal dimension was reduced slightly, creating a small clearance between the posterior maxilla and mandible. At the same time, the interferences in the posterior area were eliminated by the expansion of the maxillary dentoalveolar arch. As a result, the laterally displaced mandible moved to a more favorable jaw relationship, with distalization of the mandibular arch. The functional occlusal plane was reconstructed and an almost-normal overjet and overbite were created. Adequate tongue space for normal respiration was established during the early stage of treatment, by 7 months. A stable occlusion, with adequate posterior support and anterior guidance, was established and maintained at more than 4 years posttreatment.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
6/7. cleidocranial dysplasia: diagnostic criteria and combined treatment.cleidocranial dysplasia (CCD) is an uncommon, generalized skeletal disorder characterized by delayed ossification of the skull, aplastic or hypoplastic clavicles, and serious, complex dental abnormalities. There are many difficulties in the early diagnosis of CCD because a majority of the craniofacial abnormalities becomes obvious only during adolescence. In the present case, a hypoplastic midface, a relative prognathia of the mandible, and close approximation of the shoulders in the anterior plane were the conspicuous extraoral findings. Prolonged exfoliation of the primary dentition, unerupted supernumerary teeth, and the irregularly and partially erupted secondary dentition produced occlusional anomalies. The presence of the second permanent molars together with the primary dentition and wide spacing in the lower incisor area were typical dental signs. Gradual extraction of the supernumerary teeth and over-retained primary teeth was the first step of oral surgery. This was followed by a surgical exposure of the unerupted teeth by thinning of the cortical bone. Orthodontic treatment was aimed at parallel growth of the jaws. Removable appliances were used to expand the narrow maxillary and mandibular arches, and a Delaire mask compensated for the lack of sagittal growth of the upper jaw. Temporary functional rehabilitation was solved by partial denture. When the jaws have been fully developed, implant insertions and bridges are the therapeutic measures. The reported case and the literature data support the importance of the early diagnosis and interdisciplinary treatment of CCD.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/7. An American Board of orthodontics case report. A nonsurgical and nonextraction approach in the treatment of a skeletal and dental Class III malocclusion in a growing patient.This case report is presented following the specifications of the American Board of orthodontics. The patient had a true maxillary retrognathism, a mandibular prognathism, and a lower anterior height deficiency. She was treated with a fixed orthopedic appliance, fixed orthodontic appliances, and intermaxillary elastics. [This case was presented to the American Board of orthodontics in partial fulfillment of the requirement for the certification process conducted by the Board.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |