Skeletal Class II Malocclusion Treatment with Combined Twin Block and Lip Bumper Appliances: A Case Report

Functional appliances have been used over a century in clinical orthodontic treatments for skeletal Class II malocclusion patients. Its popularity is attributed to its high patient adaptability and ability to produce rapid treatment changes. The twin block and lip bumper can be combined depending on the patient’s cases. The purpose of therapy with twin block is effective in mandibular growth deficiencies to induce supplementary lengthening of mandibular by stimulating increased growth at the condylar cartilage. The patient was a ten-year-old male patient with skeletal Class II malocclusion. He had a convex facial profile, SNA (sella, nasion, A point) angle of 77.5°, SNB (sella, nasion, B point) angle of 73.0°, ANB (A point, nasion, B point) angle of 4.5°, overjet of 6.5 mm, overbite of 11/41 = 5.0 mm, 21/31 = 4.5 mm, abnormal upper labial frenulum, crossbite in the second left premolar of maxilla, crowded anterior teeth of mandibular, deficiency of mandibular growth, lower lip sucking habit, anterior teeth of maxilla with diastema and proclination. Orthodontic treatment for patient is a combination of twin block and lip bumper appliances. After seven months, frenectomy is used to eliminate and correct the spacing in the frenulum. After 10 months, the patient’s skeletal and profile had improved to skeletal Class I malocclusion, SNA angle of 78.0°, SNB angle of 75.0°, ANB angle of 3.0°, overbite and overjet of 4.0 mm, and the lower lip sucking habit had stopped. Twin block and lip bumper appliances are particularly good alternative treatment in managing selected cases of skeletal Class II malocclusion.

Mini-implant Supported Lip Bumper

Patients with a skeletal class II malocclusion are usually associated with a prognathic maxilla with orthognathic mandible or a retrognathic mandible with orthognathic maxilla or a combination of both. Patients with severe prognathic maxilla are usually associated with increased overjet which results in a lower lip trap. The lip trap should be managed the earliest as it will lead to further proclination of the upper anterior teeth and also hinder the normal growth of the mandible. To overcome the limitations of a conventional lip bumper, we arrived at an idea of fixed lip bumper supported using mini-implants.

Nonextraction Management of Severely Malaligned and Constricted Upper Arch

This case report presents the treatment of a 12-year-old female with a severely crowded upper arch, severely palatally displaced upper premolars and lateral incisors, large midline diastema, lower midline deviation to the right, class III dental and skeletal relationships due to mild maxillary deficiency, retroclined lower incisors, straight profile, and retrusive lips. A nonextraction treatment approach is described, in which the upper and lower arches were expanded to their original three dimensions using a trihelix expander, a lip bumper appliance, and a fixed orthodontic appliance. Retention was also planned in accordance with the original malocclusion, which inclued a full-time-wear upper wraparound retainer, upper and lower anterior fixed lingual retainers, upper frenectomy, and fibrotomy for rotated teeth. Conclusion. Severe malalignment of teeth does not necessarily require extraction treatment. Gaining space is an art that requires a proper assessment of the anteroposterior and transverse dimensions of alveolar arches, lip prominence, and postorthodontic stability.

Long-Term Outcomes of Nonextraction Treatment in a Patient with Severe Mandibular Crowding

Objective. To describe a clinical case with a severe mandibular crowding treated without extraction and showing a long-term outcome. Methods. A 14-year-old boy in permanent dentition showed a class I molar and cuspid relationship, a severe deep bite of 8 mm, a constricted V-shaped upper arch with moderate crowding, and a severe crowding of about 12 mm in the lower arch. The panoramic X-ray showed an impacted upper right canine. The treatment started with the placement of a transpalatal bar and 0.022×0.028 in standard edgewise appliances in the upper arch and a lip bumper bonded on the second lower molars. Initial leveling of the teeth was accomplished with light Australian round wires. Finishing was then performed with rectangular wires. The phase with fixed appliances lasted 2 years and 9 months, and the patient was motivated and cooperative throughout the treatment, although with poor oral hygiene. The patient was treated without extractions. Results. The space was gained with the first and second upper molar derotations using the transpalatal bar and the gingival lip bumper in the lower arch. The upper right canine was well positioned, and the maxillary arch form was improved. The severe lower crowding was completely corrected, and a good overbite was achieved. Conclusion. A conservative, nonextraction treatment approach for this patient with class I malocclusion with severe mandibular crowding was effective, and the results have remained stable after a long-term follow-up (10 years).

Orthodontic Management of a Mandibular Double-tooth Incisor: A Case Report

The presence of a double-tooth requires specific complex management due to the need for differential diagnosis and following treatment choices. The aim of this report was to present a rare case of a geminated mandibular lateral incisor, treated with an orthodontic approach. A Caucasian 10.9-year-old girl presented a lower right double-tooth incisor, with a class 1 molar and a class 2 cuspid tendency on both sides. The upper arch was constricted as shown by bilaterally tendencies to cross-bite, a slightly lower midline deviation was reported and a lack of space for all four permanent cuspids was confirmed also by the panoramic X-ray. In the lower arch, there was a severe crowding of about 14 mm and a buccally ectopic left canine. Overbite was normal and Overjet minimally increased. The double-tooth was identified like a geminated tooth, for the presence of one root and one pulp canal of increased size, as shown by the radiographic examinations. The anomalous tooth was managed with an orthodontic approach associated with a progressive stripping to reshape the crown. A two-phase treatment plan was performed, based on first maxillary expansion and lip bumper and then fixed appliances, in order to achieve a proper occlusion and a better aesthetic.

Evaluation of Lower Dental Arch Crowding and Dimension after Treatment with Lip Bumper versus Schwarz Appliance. A Prospective Pilot Study

Aim: The treatment of patients with mixed dentition, with inferior moderate dental crowding (the so-called borderline cases, between extraction and expansion) is not yet clear. Two examples of widely used appliances for increasing lower dental arch dimensions are the Schwarz’s appliance and lip bumper. The aim of this prospective study was to compare dental crowding and arch dimensions from pre- to post-treatment with lip bumper versus Schwarz’s appliance. Subjects and Methods: Pre- and post-treatment orthodontic records of twenty subjects (10 males and 10 females) were analyzed in the present study. Inclusion criteria were: first/second molar class malocclusion; crowding of the mandibular arch, from mild to moderate (4–6 mm); mixed dentition; age ≤ 9 years at the beginning of the treatment; stage CS1 or CS2 of maturation of the cervical vertebrae analysis (CVM) at the beginning of the treatment. Ten subjects were treated with a lip bumper, and ten with the removable Schwarz appliance. The primary outcomes were the variations in dental crowding and arch dimensions from pre- to post-treatment. Results: Both the two appliances caused a statistically significant mean improvement/reduction in crowding, of 3.5 mm and 2.9 mm, for the Schwarz appliance and lip bumper, respectively. The Schwarz appliance resulted more effective in increasing arch dimension at the intercanine level, and arch perimeter, while the lip bumper achieves a higher increase in arch length. Conclusions: A lip bumper and Schwarz appliance are both useful in reducing crowding in mixed dentition. This improvement is due to the increase in dental arch dimensions, although the distribution of space resulted slightly differently between the two appliances.

Semi-Fixed Lip Bumper in Lesch-Nyhan Syndrome: An Interim Treatment Modality

Lesch-Nyhan syndrome is a rare X-linked, recessively inherited disorder of purine metabolism, caused by complete absence of the enzyme hypoxanthine-guanine phosphoribosyl transferase. This syndrome is characterized by 3 major features: neurological dysfunction, hyperuricemia, and cognitive and behavioral disturbances (e.g., self-mutilation, which begins at 2 to 3 years of age). Uncontrollable self-mutilation begins with biting of the perioral tissues and extends into patterns such as finger biting and head hitting. This report describes the case of a 31-month-old boy who was diagnosed with Lesch-Nyhan syndrome with severe lip injuries caused by self-mutilative behaviors. The behaviors were blocked with a semi-fixed lip bumper for a short period. The device was applied to the patient on the day of the visit without the requirement for an oral impression. It was easy to manage oral hygiene and adjust the device because it was detachable by clinicians and guardians. Therefore, a semi-fixed lip bumper may be useful as an interim appliance to block self-mutilative behaviors in children with Lesch-Nyhan syndrome.

Interim use of a maxillary lip bumper during interdisciplinary management of ectopically erupted incisor teeth

Introduction: Ectopic eruption, manifesting as an aberration in the normal path of eruption of a tooth, can adversely impact facial aesthetics, phonetics and psychosocial development. Description: This case series describes the orthodontic management of two adolescent patients with different clinical presentations of ectopically erupted maxillary central incisors secondary to trauma during the primary dentition period. The therapy primarily included periodontal soft-tissue surgery accompanied by orthodontic traction to align the ectopic incisors. Frenectomy was performed in one patient and surgical excision of a hypertrophied pseudo-pouch in the second patient. A modified maxillary lip bumper was used concomitantly for management of associated soft-tissue trauma, thus facilitating healing and aiding orthodontic traction. Results: Appropriately planned interdisciplinary management involving the interim use of a modified lip bumper allowed proper alignment of the ectopically positioned incisors with a stable outcome at three-year follow-up. Conclusion: Fixed orthodontic therapy with concurrent use of modified maxillary lip bumper is an effective approach to treat incisors erupted ectopically in relation to the upper lip and frenum.