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ePaper created 2018-03-13, 09:28:55 | version 1.38.0
case report | Fig. 2a Fig. 2b Fig. 2c Fig. 3a Fig. 3b Fig. 3c Fig. 4a Fig. 4b Fig. 4c Figs. 2a–c: After five months of sagittal treatment, the negative overjet had corrected to an end-on position. Mild extrusion of the mandibular canine can be observed, which was expected and a positive sign of the effects of the sagittal correction. The result was an anticlockwise rotation of the posterior occlusal plane, producing significant improvement in the prognathic profile. Figs. 3a–c: After bonding the mandibular brackets. Figs. 4a–c: After 14 months of treat- ment, the case demonstrated a corrected overjet, overbite and intercuspation. The canines occupied the positions of the congenitally missing lateral incisors. Treatment plans for cases of maxillary hypoplasia with agenesis of the lateral incisors often call for open- ing space for implants. The greatest problem with such plans is that it is impossible to predict when, to what degree, or in which patients unattractive soft- and/or hard-tissue changes around implant-supported porce- lain crowns, especially noticeable in the maxillary ante- rior teeth, will occur. Biological and technical complica- tions are frequent and can appear even after only a few years.12 Space closure with protraction of the maxilla and later re-anatomisation of the canines to replace the congen- itally missing lateral incisors can be a good alternative. Handled carefully, this option avoids gingival retraction that can accompany implant placement or metal show- through on crowns, bridges and implants that can occur in some restorations after a period. Clinicians treating Class III patients with maxillary hypoplasia have tradi- tionally avoided space closure because of the poten- tially adverse effects on the profile. The combined use of the Motion 3D Class III Appliance and SLX Brackets for applicable cases biomechanically eliminates these side- effects by optimising the relationship between the max- illa and the mandible, both occlusally and aesthetically,11 for better results than simply neutralising the potentially adverse effects of opening space for implants. Camouflage orthodontic treatment can result in pro- trusion8 of the maxillary incisors (giving an appearance of a short upper lip), as well as retro-inclination of the mandibular incisors, with deleterious effects on the peri- odontium. The actions of the Carriere Motion 3D Class III Appliance is distalisation of the mandibular segments from molar to canine as a unit, with intrusion of the man- dibular molars, extrusion of the mandibular canines and retraction of the mandibular incisors, the result of which is an anticlockwise rotation of the posterior occlusal plane, producing a significant improvement in the prognathic profile.11 In Class III cases, choosing brackets rather than an aligner for anchorage and bonding them simultane- ously with the functional appliance produces distalisa- tion of the mandibular posterior segment while achiev- ing torque control of the maxillary incisors11 and space closure, yet with a protractor effect on the maxilla that develops upper lip fullness. ortho 1 2018 17