Sangsuwon Ca, Abdullah Fa, Alansari Sa, Alikhani Ma, Nervina JMa, Teixeira CCb, Alikhani Ma,c
Figure 1: Pre-treatment portrait and intra-oral photographs. Lateral profile photograph shows a straight profile, increased lower facial third height, and deficient maxillary lip position. Frontal portrait photographs show an open bite, increased buccal corridors, and 50% incisal display upon smiling. The maxillary dental midline coincides with facial midline; however, the mandibular dental midline deviates 1.5 mm to the left in relation to the maxillary midline. Intraoral photographs reveal a constricted maxilla and mandible, crowding in the maxillary and mandibular arches, an open bite from second premolar to second premolar, proclined maxillary anterior teeth, and absent third molars.
Figure 2: Pre-treatment digital casts. Pre-treatment digital casts show a Class III molar and canine relationship on both sides with an open bite from the second premolar to second premolar. The maxillary dental arch shows a moderate reverse Curve of Spee. Both maxillary and mandibular dental arches were constricted. Severe anterior crowding was found in both dental arches. A Bolton discrepancy due to an anterior maxillary deficiency was also observed.
Figure 3: Pre-treatment panoramic radiograph. Panoramic radiograph shows a complete dentition with unerupted third molars, and spindle-like dental roots. No bone loss was observed. Condylar asymmetry was also noted with the condylar head on the left side flatter than the right side.
Figure 4: Pre-treatment lateral view of cephalometric radiograph. Pre-treatment lateral cephalometric radiograph shows a skeletal Class III relation, hyperdivergent profile, proclined maxillary incisors, and a skeletal open bite.
Table 1: Cephalometric Analysis Pre- and Post- Treatment. Angular and linear measurements were taken on 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 improved facial profile, maxillary lip position, smile esthetics, and correction of open bite. 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 on both sides. 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 both sides and significant improvement in Class III 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 bone loss.
Post-treatment lateral cephalometric radiographs. Post-treatment lateral cephalometric radiograph shows an overall improvement in the maxillary and mandibular relationship, improved mandibular plane angle, correction of the open bite into an ideal overjet and overbite, with improved maxillary incisor inclination.
Figure 9: Superimposition of pre- and post-treatment cephalometric tracings. (A) Cephalometric superimposition of pre-treatment (black tracing) and post-treatment (red tracing) on the anterior cranial base shows counter-clockwise rotation of the mandible by intrusion of the mandibular molars, Class I jaw relation, improved maxillary and mandibular incisor inclination, intrusion and palatal root movement of the maxillary and mandibular anterior teeth, and flattening of the occlusal plane. (B) Superimposition on the body of the maxilla shows maxillary molar extrusion and uprighting, with extrusion and improvement of the incisor inclination. (C) Superimposition based on the inferior alveolar nerve and inner profile of the mandibular symphysis reveals mandibular molar intrusion and uprighting with extrusion and improvement of mandibular incisor inclination.