Teixeira CC a, Abdullah F b, Sangsuwon C b, Alansari S b, Alikhani M b,c
Figure 1: Pre-treatment portrait and intra-oral photographs. Pre-treatment portrait and intraoral photographs show the patient’s occlusion when asked to slowly close his mandible until the first tooth touches. In this position, the lateral profile photograph shows a concave profile with the lower lip projecting more anteriorly than the upper lip. Frontal portrait photographs show lip competency at rest and 100% incisal display while smiling. Intraoral photographs reveal the dental interference that causes a functional shift upon closing, a constricted maxilla, anterior crossbite, severe crowding in the maxillary arch, mild crowding in the mandibular arch and the ectopic position of the maxillary right lateral incisor and canine. The maxillary right second molar was not present in the arch, but the maxillary left second molar was partially erupted, and the mandibular second molars were erupting in their correct positions.
Figure 2: Pre-treatment digital casts. Pre-treatment digital casts show the patient’s occlusal relation when the mandible shifts forward allowing posterior teeth to occlude. Cast analysis shows a Class III canine and molar occlusal relation, an anterior crossbite on the maxillary incisors, a negative overjet (-2.6 mm) and overbite (5.1 mm). Severe maxillary crowding and mild mandibular crowding were observed, with the maxillary right lateral incisor and canine blocked out of the arch. The maxillary inter-canine and inter-molar widths were 38.2 mm, 51.5 mm, respectively, and the mandibular inter-canine and inter-molar widths were 27.5 mm, 43.9 mm, respectively. The patient’s maxillary right second molar was not present in the arch, while the maxillary left second molar was partially erupted and the mandibular second molars were erupting.
Figure 3: Pre-treatment panoramic radiograph. Panoramic radiograph shows development of a complete dentition except for the absence of the upper right third molar tooth bud. The apices of several teeth were not fully formed, while first molars and incisors displayed spindle-like roots. An asymmetry of the left and right condylar neck lengths was noted.
Figure 4: Cephalometric Analysis of Pre- and Post-treatment lateral chephalograms. Angular and distance measurements were completed between craniofacial skeletal and dental landmarks identified on pre- and post-treatment lateral cephalograms (° – degrees, mm – milimeters )
Table 1: Cephalometric Analysis Pre- and Posttreatment.
Figure 5: Post-treatment portrait and intra-oral photographs. Post-treatment photographs reveal a well-balanced straight facial profile, with relaxed lip posture and improved smile esthetics. Intra-oral photographs showed expansion of the maxillary arch, development of the mandibular arch, coinciding midlines, a Class I molar and canine occlusion, the correction of the anterior crossbite into an ideal overjet and overbite relation. Both maxillary and mandibular dental midlines were aligned with the facial midline. Gingival margins were leveled and the gingival height of contour improved around the anterior teeth. Total treatment time was 28 months.
Figure 6: Post-treatment digital casts. Post-treatment digital cast analysis showed increased maxillary arch dimensions (intermolar width increased by 4.1 mm, while inter-canine width increased by 1.9 mm), coincident dental midlines, Class I molar and canine occlusal relationship, ideal overjet (2 mm) and overbite (1.7 mm).
Figure 7: Post-treatment panoramic radiograph. Panoramic radiograph at the end of treatment showed good root parallelism, relative blunting of the roots of the maxillary laterals, presence of third molar tooth buds except for the maxillary right third molar tooth bud, and improved condylar symmetry.
Figure 8: Post-treatment lateral cephalometric radiograph and analysis. Post-treatment cephalometric analysis shows overall improvement in the relation between maxillary and mandibular dental arches, correction of anterior crossbite into ideal overjet, ideal overbite, and improved soft tissue profile and lip position.
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 significant vertical maxilla and mandible growth, and significant maxillary advancement resulting in a Class I jaw relation, proclination of maxillary incisors, and extrusion of both maxillary anterior and posterior teeth (A). Superimposition based on the body of the maxilla, showed molar extrusion and uprighting and incisor extrusion with proclination (B). Superimposition based on the inferior-alveolar nerve and inner profile of the mandibular symphysis revealed incisor extrusion without significant change in inclination, molar extrusion and uprighting, and vertical growth of the mandible and condyle (C).