Differential Diagnosis of Skeletal Class II: Orthodontic-Surgical Approach with Surgery First

Orthodontic-surgical treatment with the “Surgery First Approach” provides immediate facial aesthetic improvements and significantly reduces the patient's orthodontic treatment time, avoiding the transient worsening of the facial profile due to dental decompensation that occurs in surgical cases. Thus, this clinical case describes the retreatment of a 22-year-old female leukoderma patient, whose main complaint was related to the proclination of upper and lower incisors. The patient used a mio-relaxing plate for 30 days, which evidenced the skeletal mandibular deficiency and the ½ bilateral Class II malocclusion. Orthognathic surgery first approach associated with the extraction of the 4 premolars was chosen considering the patient’s aesthetic demand. The use of a mio-relaxing plate in the diagnostic stage was essential for the real diagnosis of mandibular deficiency and the technique employed made it possible to conclude the treatment avoiding aesthetic commitment, with excellent results. Keywords: Malocclusion, Angle Class II. Orthognathic Surgery. Orthodontics, Corrective. ResumoO tratamento ortodôntico-cirúrgico por meio do benefício antecipado proporciona melhorias estéticas faciais imediatas e reduz de maneira significativa o tempo de tratamento ortodôntico do paciente, evitando a piora transitória do perfil facial devido à descompensação dentária que ocorre em casos cirúrgicos. Assim, este caso clínico descreve o retratamento de uma paciente com 22 anos de idade, leucoderma, sexo feminino, que apresentava queixa principal relacionada à inclinação vestibular dos dentes anteriores. Após uso de placa miorrelaxante por 30 dias, verificou-se a presença de Classe II esquelética com deficiência mandibular e ½ Classe II dentária bilateral. Considerando a demanda estética da paciente, optou-se pela abordagem ortodôntico-cirúrgica com Benefício Antecipado associada à extração de 4 pré-molares para correção da inclinação dentária anterior. O uso da placa miorrelaxante foi fundamental para o diagnóstico real da deficiência mandibular e a técnica empregada possibilitou concluir o tratamento evitando o comprometimento estético pré-cirúrgico, com obtenção de excelentes resultados. Palavras-chave: Maloclusão Classe II de Angle. Cirurgia Ortognática. Ortodontia Corretiva.

Class II correction by maxillary en masse distalization using a completely customized lingual appliance and a novel mini-screw anchorage concept – preliminary results

Background The aim of the study was to evaluate the efficacy of a novel en masse distalization method in the maxillary arch in combination with a completely customized lingual appliance (CCLA; WIN, DW Lingual Systems, Germany). Therefore, we tested the null-hypothesis of a significant deviation from an Angle-Class I canine relationship and a normal overjet defined by an individual target set-up after dentoalveolar compensation in Angle Class II subjects. Methods This retrospective study included 23 patients, (m/f 3/20, mean age 29.6 years (min/max, 13.6/50.9 years)), with inclusion criteria of an Angle Class II occlusion of more than half a cusp prior to en masse distalization and treatment completed consecutively with a CCLA in combination with a mini-screw (MS) anchorage for uni- or bilateral maxillary distalization (12 bilateral situations, totalling 35). Plaster casts taken prior to (T0) and following CCLA treatment (T3) were compared with the treatment plan / set-up (TxP, with a Class I canine relationship and a normal overjet as the treatment objective). MSs were placed following levelling and aligning (T1) and removed at the end of en masse distalization at T2. Statistical analysis was carried out using Schuirmann’s TOST [two one-sided tests] equivalence test, based on a one-sample t-test with α = 0.025 on each side (total α = 0.05). Results Ninety-seven percent of planned correction of the canine relationship was achieved (mean 3.6 of 3.7 mm) and also 97 % of the planned overjet correction (mean 3.1 of 3.2 mm), with a statistically significant equivalence (p < 0.0001) for canine relationship and overjet between the individual treatment plan (set-up) and the final outcome. Adverse effects were limited to the loss of n = 2 of 35 mini-screws. However, in each instance, the treatment was completed, as scheduled, without replacing them. Accordingly, the null-hypothesis was rejected. Conclusions The technique presented allows for a predictable correction of an Angle-Class II malocclusion via dentoalveolar compensation with maxillary en masse distalization.

Conservative Non-Surgical Management of Horizontal Root-Fractured Maxillary Incisors in a Young Male with Angle Class II, Division 2, Malocclusion

Horizontal root fractures are a rare emergency in a dental office. The injury involves periodontal ligament, cementum, dentine and pulp. The healing is influenced by the location of the root fracture, the displacement of the fragments and the status of the pulp. This report presents a clinical case of horizontal fractures to both maxillary central incisors due to an act of violence. The type of occlusion has avoided a severe diastasis of the coronal parts with a subsequent damage to the pulp and periodontum. The fractures were treated with an orthodontic splint without any further therapy and hard tissue healing was observed. A careful diagnosis and well-timed treatment planning usually allow a cost-efficient and biologically-oriented therapy with a favorable outcome.

THE PREVALENCE OF SECONDARY DENTO-MAXILLAIRE DEFORMITIES ASSOCIATED WITH UNCOMPENSATED DENTITION DEFECTS IN CHILD POPULATION

The aim is to determine the prevalence of dentition defects and secondary dento-maxillaire deformities in different periods of formation of the dento-maxillary system among the child population of Kyiv and the need for their therapeutic and prophylactic prosthetics, assess the level of prosthodontics care provided to them. Materials and methods. To determine the prevalence of dento-maxillary anomalies, dentition defects, and secondary dento-maxillary deformities, we examined 2276 children and adolescents aged 4 to 17 years in educational institutions in Kyiv for the 2017-2018 period. Results of the research. The prevalence of dento-maxillary anomalies among child population is 65.2%. Angle class I holds first place with 45,8% (among the anomalies of individual teeth), Angle class II comes second with 15,2%, the third place is occupied by Angle class III with 4,2%. Secondary dento-maxillary deformities caused by the early loss of both permanent and especially temporary teeth have become more common among the child population. The main reason for their occurrence is timely uncompensated dentition defects, which was confirmed by mass examinations of children aged 4 to 17 years in schools and kindergartens. Dentition defects of various sizes and localization were observed in 359 out of 2276 children, which is 15.8% of the total number of those examined. Tooth loss is most often caused by caries, its complications, and trauma, a little less often – by retention and anodontia. Secondary dento-maxillary deformities (dento-maxillary lengthening of teeth that have lost their antagonists; the inclination of the teeth towards the defect with displacement) were found in 278 children, which amounted to 12.2% of the total number of examined children, and 77.4% of the detected dentition defects (359 children). The obtained data indicate deterioration in the organization and implementation of oral cavity sanitation among the child population, which requires immediate measures to implement programs aimed at early identification and prevention of severe morphological and functional disorders of the dentition. Conclusions. The results of the obtained findings show a high prevalence of dento-maxillary anomalies among the child population – 65.2% (1484 people), and only 34.8% (792 people) had no orthodontic pathology. Dentition defects were diagnosed in 359 people, which is 15.8% of the total number of the examined children. Secondary dento-maxillary deformities were diagnosed in 278 people of the total number of the examined children (2276 people), that is 12.2% of the total number of the diagnosed dentition defects (359 cases) – 77.4%. Most often, secondary deformities occur between 6 and 11 years of age, that is, in the mixed dentition period of occlusion. The main reason for their occurrence was the inefficient prosthesis of dentition defects or its absence. Dentition defects are caused by premature removal of temporary teeth due to complications of caries, trauma, retention, and congenital absence of teeth.

Effect of cervical headgear on dental arch area, shape and interarch dimensions

Purpose The goal was to study the effects of early cervical headgear treatment on maxillary and mandibular dental arch area, shape and interarch dimensions. Methods The total study group comprised 67 children aged 7.6 years (standard deviation 0.3) with Angle class II malocclusion collected between 1992 and 1996. The children were randomly divided into two groups of equal size. In the first group, cervical headgear treatment was started immediately and undertaken for 2 years. The remaining patients served as untreated controls. Dental casts were taken and scanned at the beginning of treatment (T0) and at the 2‑year (T1) and 4‑year follow-up (T2). Three-dimensional landmarks describing the positions of maxillary and mandibular incisors, canines, first and second premolars and first molars were used to calculate and visualize the maxillary and mandibular dental arch area and shape using the polynomial equation y = Ax6 + Bx2. Results Significant changes in the shape and area of both maxillary and mandibular dental arches were induced with cervical headgear. The headgear increased dental arch area, sagittal dimensions at the mid-sagittal line and transversal dimensions at all of the measured levels in both dental arches compared to the control group. Conclusions Cervical headgear is an effective treatment device to gain space in both dental arches. Furthermore, when used as an early phase treatment, relapse is relatively small compared to the gained space.