Teixeira CC a , Abdullah F b, Billings D b, Sangsuwon C b , Alansari S b, Nervina JM b , Alikhani M b,d
Figure 1: Pre-treatment portrait and intra-oral photographs. Lateral profile photograph shows a convex profile, a decrease in the mandibular facial third, a retrusive chin, and deficient maxillary and mandibular lip position. Frontal portrait photographs show large dark buccal corridors, 100% incisal display upon smiling, maxillary dental midline deviated 1.5 mm to the left in relation to the facial midline, mandibular midline coincident with facial midline upon opening. Intraoral photographs reveal a constricted maxilla and mandible, crowding in the maxillary and mandibular arches, severe deep bite, retroinclined maxillary anterior teeth, buccal crossbite at the maxillary right second molar, gingival recession on mandibular anterior teeth, and missing third molars.
Figure 2: Pre-treatment digital casts. Pre-treatment digital casts show a Class II molar and canine relationship on both sides with a severe deep bite. The maxillary dental arch shows a reverse Curve of Spee and the mandibular dental arch shows an accentuated Curve of Spee. Both maxillary and mandibular dental arch widths were constricted. Severe crowding was found in both dental arches. A Bolton discrepancy due to a maxillary excess was also observed. A buccal crossbite was present on the maxillary right second molar. Measurements indicated a cant of the incisal plane elevated on the left side.
Figure 3: Pre-treatment panoramic radiograph. Panoramic radiograph shows a complete dentition except for the third molars. Bone loss is clear around mandibular anterior teeth. Short condylar processes with some degree of flattening of their anterior surface is observed. Mandibular morphology shows prominent gonial angles.
Figure 4: Pre-treatment lateral view of cone-beam computed tomography (CBCT) scan. Pre-treatment lateral view of CBCT scan shows a skeletal Class II relation, hypodivergent profile, retroclined maxillary and mandibular anterior teeth and severe deep bite.
Table 1: Cephalometric Analysis of Pre- and Post-treatment lateral chephalograms. Angular and linear measurements were completed between craniofacial skeletal, dental and soft tissue landmarks identified on pre- and post-treatment lateral cephalograms (° – degrees, mm – millimeters).
Figure 5: Post-treatment and intra-oral photographs. Post-treatment photographs demonstrate an improvement in the facial profile, with an increase in the lower facial height, improved smile esthetics, correction of the incisal plane cant, and improved maxillary and mandibular lip position. Intra-oral photographs show maxillary and mandibular arch development, aligned dentition in the maxillary and mandibular arches, normalized incisal inclination into an ideal overjet and overbite relation, and Class I molar and canine occlusal relationship on the left side. Both maxillary and mandibular dental midlines are aligned with the facial midline. Gingival margins and heights of contour improved around the anterior teeth. Lingual fixed retainers are shown extending from canine to canine in both arches.
Figure 6: Post-treatment digital casts. Post-treatment digital cast analysis showed Class I molar and canine relation on the left and significant improvement in Class II relation on the right side. Maxillary and mandibular transverse dimensions were increased, dentition was aligned on both arches, coincident dental midlines, and an ideal overjet and overbite were established.
Figure 7: Post-treatment panoramic radiograph. Panoramic radiograph at the end of treatment showed good root alignment and no additional bone loss.
Figure 8: Post-treatment lateral view of cone-beam computed tomography (CBCT) scan. Post-treatment lateral view of CBCT scan showed an overall improvement in the maxillary and mandibular relationship, improved mandibular plane angle, correction of the deep bite into an ideal overjet and overbite.
Figure 9: Superimposition of pre- and post-treatment cephalometric tracings. Cephalometric superimposition of pre-treatment (black tracing) and post-treatment (red tracing) on the anterior cranial base shows extrusion of the maxillary and mandibular molars, Class I jaw relation, improvement of inclination of maxillary and mandibular incisors, intrusion and palatal root movement of the maxillary and mandibular anterior teeth, and flattening of the occlusal plane (A). Superimposition on the body of the maxilla shows maxillary molar extrusion and uprighting, with intrusion and improvement of the incisor inclination (B). Superimposition based on the inferior-alveolar nerve and inner profile of the mandibular symphysis reveals mandibular molar extrusion and uprighting with intrusion and improvement of mandibular incisor inclination (C).
Figure 10. Root length analysis. (A) The height of each tooth was measured along its long axis. The distance between the incisal edge to the apex of the teeth was measured in the sagittal view radiographs. (B) Hard tissue 3D images of maxillary anterior teeth segment before and after treatment, were constructed from CBCT scans.
Table II: Pre- and Post-treatment Tooth Length Analysis. Length of maxillary and mandibular anterior teeth was measured in radiographic views of pre- and post-treatment CBCT scans for anterior and posterior teeth (mm – millimeters) as described on Figure 10.