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Ortho Tribune Middle East & Africa No.3, 2016

Dental Tribune Middle East & Africa Edition | 5/2016 ORTHO tribune 2 Burstone’s segmented arch technique ByDrIanniFilho,Brasil Patient L.S.C.O. was a 14 years and 10 months old, African, and female, who sought orthodontic treatment and complained of excessive dental projection that made it very difficult to close her lips and a major dissat- isfaction in regards to her aesthetics and facial profile. The facial analysis revealed an incompetent lip closure, severe protrusion of the upper and lower lips, and a considerably re- ducednasolabialangle(52º). The patient had a malocclusion of Angle class I with severe dentoalveo- lar biprotrusion, generalized diaste- mas, enclosed left maxillary canine, marked overjet, anterior open bite, andadaptedtongueinterposition. The analysis of the teleradiograph in the lateral view showed severe den- talbiprotrusionwithcephalometrics measurements of 1.NA = 43º, 1.NA = 20mm,1.NB=62ºand1-NB=24mm and an interincisal angle of 63º, con- firming severe vestibule formation and protrusion of the maxillary and inferior incisors. The maxilla was skeletally protruded with SNA = 94º. The jaw, well located with SNB = 83º and ANB = 11º, confirmed the poor maxillomandibularskeletalrelation. Treatment objectives Normally, for cases with severe den- toalveolar biprotrusion and severely compromised facial aesthetics, our treatment objectives focus on ob- tainingthemaximumanteriorteeth retraction, to promote lip retraction andhavesignificantimpactonfacial aesthetics. Along with the correction of the bi- protrusion and improvements of the patient’s facial aesthetic charac- teristics, our second objective was to eliminate and/or limit the negative psychological consequences associ- ated with a disfigured face that was causedbymalocclusion. Figure 3.3 A, B and C: Frontal view, close-up profile and incompetent lip closure in the pre-treatment phase. Figure3.3.1.Severeoverjet. Figure3.3.6A:TMACantilever toextrude theenclosedcanine. B:Toothpost-traction,locatedin theposteriorsegment of themaxillaryarch. Figure3.3.7.TypeATHandles,suggestedbyMarcotte. B:Measurement of the14.14mmextractionspacein theright maxillaryquadrant. Figure3.3.9.Ianni- typeIradialcorrectionhandle.B:Continuousarchofrealignment. Figure3.3.8.Closureoftheextrac- tion space with Marcotte type A mechanics. Figure 3.3.4. Initial cephalometric telera- diographshowingseverebiprotrusion. Figure3.3.2.AngleclassI. Figure3.3.5A:Dentalalignment andlevelingphase,and thestart of thediastemasclosure.B:Severegingivalhyperplasia. C:Gingivoplasticsurgery. Figure3.3.3.Diastemasandanterioropen bite. “Whenthefaceispleasant, orthodontictreatmentconsists oftreatingtheocclusionwithout modifyingtheprofileof softtissues.“ ÿPage 3

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