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Ortho Tribune Middle East & Africa No.4, 2016

© 2016 Ormco Corporation Order your Damon Clear2 brackets today! Visit ormcoeurope.com ClearPerformance. MoreControl. Offering the same crystal clear performance with more control,DamonClear2allowsyoutotreatawidevariety of cases with outstanding results so your practice and your patients can put their best face forward. *Variable torques for upper 3-3 brackets. **As compared to Damon Clear upper 3-3 brackets. Variable Torques* NEW! Actual Damon patients wearing Damon Clear. Treated by Dr. Todd Bovenizer. 100% CLEAR BRACKET BODY AND SLIDE for the supreme aesthetics patients demand SMOOTH, ROUNDED CORNERS for outstanding patient comfort INNOVATIVE SPINTEK™ SLIDE for easy and comfortable wire changes SELF-LIGATING BRACKET DESIGN eliminates the need for elastomerics which stain and collect bacteria FOUR SOLID WALLS with improved precision slot for 2x the rotational control** for meticulous finishing and efficient treatment November-December 2016 | No. 4, Vol. 6 PUBLISHED IN DUBAI www.dental-tribune.me Skeletal Class III Malocclusion with Canine Transposition and Facial Asymmetry By Dr. Wei Ming-Wei, Dr. Chris Chang, Singapore & Dr. W. Eugene Roberts,NZ HistoryandEtiology A 13-year-6-month-old male pre- sented with a chief complaint of prognathicmandible(Figs.1-3).There was no other contributory medical or dental history. The etiology was hereditary tendency for prognathic mandible with eruption of the max- illary central incisors into crossbite, which resulted in a functional shift of 4mm anterior and 3mm to the left. Clinical exam indicated transpo- sition of the permanent right maxil- lary canine and premolar, general crowding and anterior crossbite (Fig. 2). Extraction of all four first premo- lars was proposed to correct the ca- nine transposition and create space for retraction of lower anterior den- tition. The patient was treated to an acceptable result as documented in Figs.4-9. Diagnosis In centric occlusion, a severe dental asymmetry was noted: Class III mo- lar on the right side, Class I molar on the left side, and an intermaxillary midline discrepancy of ~7mm. There was a concave profile and asym- metrical facial form with the man- dible deviated to the left. Relative to the facial midline, the upper dental midline was 2 mm to the right, while the lower dental midline was 5 mm to the left. The anterior crossbite ex- tended from the right lateral incisor to the left 2nd premolar. Cephalo- metric and panoramic radiographs (Fig. 7), as well as anterior segment photographs (Fig. 10) document the complexityofthemalocclusion. Skeletal: • Skeletal Class III (SNA 70°, SNB 75°, ANB-5°) •Mandibularplaneangle(SN-MP37°, FMA29°) Dental: • Functional shift 4mm anteriorly and3mmtotheleft • Class III on the right and Class I mo- larrelationshipontheleft. •Maximumoverbite3mm •Maximumoverjet-3mm • Severe crowding of ~10 mm in the upper arch and 7 mm in the lower arch • Right maxillary canine blocked-out and transposed with the adjacent 1st premolar The ABO Discrepancy Index (DI) was 46 points as shown in the subse- quentworksheet. SpecificObjectives ofTreatment Maxilla(allthreeplanes): •A-P:Maintain •Vertical:Maintain • Transverse: Expand to coordinate withlowerarch Mandible(allthreeplanes): •A-P:Maintain • Vertical: posterior rotation to open theverticaldimensionofocclusion •Transverse:Maintain MaxillaryDentition: •A-P:Maintain •Vertical:Extrusionofmolars •Inter-molarWidth:Maintain MandibularDentition: •A-P:Retractionofanteriorteeth • Vertical: extrusion with increased verticaldimensionofocclusion • Inter-molar / Inter-canine Width: Maintain FacialEsthetics: • Posterior movement of chin point andlowerlip Treatment Plan Allfour1stpremolarswereextracted to create space to align the trans- posed right maxillary canine, as well as to retract the protruded lower an- terior segment, to correct the cross- bite(Fig.11).Anteriorbiteturboswere bondedonthelingualsurfacesofthe mandibular central incisors and the leftlateralincisortoopenthebitefor crossbite correction. Early light short Class III elastics were used in the ini- tialstageoftreatmenttoassistcross- bitecorrection(Fig.12). After the crossbite correction and alignment of the maxillary anterior segment, a torquing auxiliary was indicated for the maxillary right ca- nine. A mandibular pre-torqued rec- tangular NiTi wire, with vertical elas- ticswereusedtoflattenandalignthe arch (Fig. 13). A mandibular anterior torquing auxiliary and asymmetric intermaxillaryelastics(ClassIIIright, Fig1.Pre-treatment facialphotographs Fig2.Pre-treatment intraoralphotographs Fig3.Pre-treatment studymodels(casts) ÿPageC2

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