Abdullah Fa, Teixeira CCb, Alikhani Ma,c
Figure 1: Pre-treatment portrait and intra-oral photographs. Lateral profile photograph shows a straight profile with retrusive maxillary and mandibular lips. Frontal portrait photographs show 50-90% incisal display upon smiling; the maxillary dental midline coincides with the facial midline, and the mandibular midline is deviated 1.5 mm to the left in relation to the maxillary midline. Intraoral photographs reveal an open bite on the maxillary left central, lateral, and canine. The incisal edges of the maxillary left central and lateral teeth showed signs of fracture, and the maxillary left lateral was slightly discolored and ankylosed, producing a solid sound upon percussion. A diastema was noted between the maxillary centrals, and the crown of the left maxillary first premolar was fractured with a temporary filling. The marginal gingiva was not aligned, with the gingival height of contour improperly positioned. The maxillary third molars were not present. Occlusal photographs show symmetrical maxillary and mandibular arches, buccal displacement of the dento-alveolar segment in the maxillary left central, lateral, and canine teeth, and the presence of mandibular tori on the lingual area of premolars and first molar.
Figure 2: Pre-treatment digital casts. Pre-treatment digital casts show a Class I molar and canine relationship on the right side, a Class I molar relation on the left side, and a Class II canine relation on the left side with an open bite on the maxillary left central, lateral, and canine. Both maxillary and mandibular dental arch widths were mildly constricted, with mild crowding in the mandibular arch. We can also observe marginal ridge discrepancies on both maxillary and mandibular arches, and a Bolton discrepancy due to a maxillary anterior teeth excess.
Figure 3: Pre-treatment panoramic radiograph. Panoramic radiograph shows a complete dentition except for the absence maxillary third molars, with the roots of all teeth fully developed. Signs of blunting on the maxillary left central, and a fracture at the tip of the apex on the maxillary left lateral incisor can be observed. Remodeling of the condyles is also visible. Mandibular morphology shows prominent gonial angles.
Figure 4: Pre-treatment lateral cephalometric radiograph and analysis. Pre-treatment lateral cephalometric radiograph shows a skeletal Class I jaw relation (ANB is 2°), hypo-divergent mandible (FMA is 19.5°), and upper and lower incisor inclination within normal limits. Soft tissue analysis indicates that the distances from the maxillary and mandibular lips to the E-line were increased, suggesting lip retrusion.
Table I: Cephalometric Analysis Pre- and Post-treatment. 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 portrait and intra-oral photographs. Post-treatment photographs show a significant improvement in the smile esthetics, correction of the smile line, and symmetric vertical incisor display. 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, and Cass I molar and canine occlusal relation. Both maxillary and mandibular dental midlines are aligned with the facial midline. Gingival margins and heights of contour improved around the anterior teeth. The morphology of the displaced dento-alveolar bone that affected the maxillary left central incisor, lateral incisor, and canine, was significantly improved. Lingual fixed retainers are shown extending from canine to canine on both arches.
Figure 6: Post-treatment digital casts. Post-treatment digital cast analysis showed Class I molar and canine relationships on both sides. And ideal overbite and overjet were established, marginal ridges were leveled, the dentition was aligned, and both arches were developed transversely.
Figure 7: Post-treatment panoramic radiograph. Panoramic radiograph at the end of treatment showed proper root alignment with no further root resorption of the maxillary left central and lateral incisors. The maxillary left lateral incisor underwent root canal treatment and received a permanent restoration.
Figure 8: Post-treatment lateral cephalometric radiograph. Post-treatment cephalometric radiograph shows an ideal overjet and overbite, slight retroclination of the maxillary incisors (98.5°) and minimal proclination of the mandibular incisors (100.2°). The sagittal and vertical relation of the jaws were maintained.
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 incisors, Class I jaw relation (A). Superimposition on the body of the maxilla shows maxillary incisor extrusion & retrusion (B). Superimposition based on the inferior-alveolar nerve and inner profile of the mandibular symphysis reveals maintained lower molar & incisor positions (C).
