Dentistry Commons^™

Orthodontic Retreatment Of Class Ii Division 2 Malocclusion With Deep Bite And Gummy Smile Using Miniscrews, Hsin-Yi Lo, Hung-Jen Wang, Yu-Lian Lin

Taiwanese Journal of Orthodontics

Orthodontic treatment of Class II Division 2 malocclusion with gummy smile and deep bite is a challenge under the circumstances of lacking skeletal anchorage device. In this case report, we illustrated a miniscrew-assisted orthodontic retreatment of a 29-year-old female patient, who came to our department with a chief complaint of her unpleasant smile. The patient had previously undergone orthodontic treatment with 4-bicuspid extractions to correct her protrusive incisors. The clinical examination revealed a Class II division 2 malocclusion, 100% overbite, and a gummy smile. The philosophy of the orthodontic retreatment in this case was to correct Class II molar relationship …

Improved Super-Elastic Ti-Ni Alloy Wire For Nonsurgical Treatment Of Skeletal Class Iii Malocclusion Combined With Anterior Crowding And Anterior Crossbite Case, Po-Jui Lin, Yuan-Hou Chen, Ming-Ke Tsai, Chang-Chiang Yu, Jian-Hong Yu

Taiwanese Journal of Orthodontics

The article reported the use of improved super-elastic Ti-Ni alloy wire (ISW), which was developed by Tokyo Medical and Dental University, to correct a case of skeletal Class III malocclusion combined with anterior crowding and anterior crossbite. An 18-year-old male with a chief complaint of poor dental alignment and protruded lower incisors showed up in our clinic for treatment. Clinical examination revealed skeletal Class III facial profile. Anterior crowding and anterior crossbite could be also noted. Because the patient refused orthognathic surgery, we tried camouflage orthodontic treatment. First, we used ISW crossbite arch to eliminate the anterior interference in order …

Surgical-Orthodontic Treatment Of Class Iii Malocclusion With Anterior Open Bite, I-Ting Chiang, Cheng-Yu Wang, Yi-Jan Hsia, Chien-Cheng Chen, Yi-Horng Chen

Taiwanese Journal of Orthodontics

A 21-year-old female came with chief complaints of inability to incise food and poor esthetics. The patient presented with a concave facial profile, long face with a steep mandibular angle, incompetent lip closure, and acute nasolabial angle. Intraorally, she had negative 6 mm overjet, 3 mm open bite and dental crowding. She was diagnosed as severe skeletal Class III malocclusion and anterior open bite. The treatment plan included orthodontic treatment with orthognathic surgery and extraction of maxillary second molars, which were supra-erupted and tipped buccally. The pre-operative orthodontic alignment took 11 months. The surgical correction included maxillary Le Fort I …

Treatment Of Class Iii Malocclusion With Facial Asymmetry And Impacted Second Molar: A Case Report, Wei-Yu Chen, Chen-Jung Chang, Jen-Bang Lo, Pei-Ju Wu, Tung-Yiu Wong

Taiwanese Journal of Orthodontics

Symmetry is an important factor affecting facial attractiveness. The majority of subjects with facial asymmetry also exhibit Class III (CIII) malocclusion. However, the method used for three-dimensional analysis of facial asymmetry remains controversial. The optimal symmetry plane (OSP) method was developed to eliminate the identification errors that occur when using traditional orthodontic landmarks. Orthodontic treatment can become complicated in the presence of mandibular second molar impaction. Several parameters should be taken into consideration during the treatment planning, such as position of impacted tooth relative to anatomical structures and adjacent tooth and preexisting conditions in the impacted teeth. In this report, …

Treatment Strategy Of Mandibular Second Molar Impaction: A Literature Review, Heng-Tzu Shen, Johnson Hsin-Chung Cheng, Daniel De-Shing Chen

Taiwanese Journal of Orthodontics

Purpose: This literature review aimed to investigate the treatment consideration and strategy of mandibular second molar (MM2) comprehensively, which can be of great assistance on managing and solving such a rare disturbance. Methods: Previous studies were identified in PubMed or Embase database using the keywords “orthodontic,” “molar impaction,” and “uprighting molar.” To enrich the contents of every aspect of the topic, other several related articles were also reviewed and included. Results: Forty-six articles were included and systematically discussed in this review, which were arranged according to prevalence, etiology, diagnosis, treatment strategy, and clinical methods. The incidence of MM2 impaction is …

Transverse Malocclusions: Etiology, Development, Diagnosis And Treatment, Ib Leth Nielsen

Taiwanese Journal of Orthodontics

Malocclusions that involve the transverse dimension are very common in the orthodontic office. They can be as simple as a crossbite of the posterior teeth or as severe as a Class III malocclusion with a mandibular asymmetry. Transverse malocclusions can vary from being a simple dento-alveolar problem to a more complex challenge as represented by a skeletal asymmetry that has developed after puberty and causing temporomandibular disorder (TMD) problems. In this review we shall address the most common types of transverse malocclusions and review their etiology and development. The most typical etiology of transverse anomalies will be discussed, and we …

Multidisciplinary Retreatment Of Skeletal Class Ii Malocclusion With Obstructive Sleep Apnea And Multiple Prosthesis, Si-Rong Chen, Cheng-Hui Lin, Ellen Wen-Ching Ko

Taiwanese Journal of Orthodontics

Obstructive sleep apnea (OSA) is a common sleep disorder syndrome, especially in the middle-aged, obese men population. Patients suffer from an interrupted sleep at night, which could be life-threatening. Treatment alternatives include continuous positive airway pressure, mandible advanced device, nasal surgery and maxillo-mandibular advancement surgery. This article presented a patient who came with chief complaints of lower jaw retrusion, poor sleep quality, unsatisfactory occlusion and old prosthesis. The patient had declined the surgical-orthodontics in 12 years ago, and went for another camouflage orthodontic treatment with extraction of teeth and multiple prosthesis. He presented with skeletal Class II with retrognathic mandible …

Camouflage Treatment Of Skeletal Anterior Open Bite With Tongue Training, Cheng-Han Sie, Wen-Ken Tai, Chih-Chen Chou, Po-Yu Yang, Jung-Chun Yeh, Chun-Te Ho, Chia-Tze Kao

Taiwanese Journal of Orthodontics

The aim of this case report was to present an adult patient who suffered from poor occlusal function and poor aesthetic appearance due to skeletal anterior open bite. After orthodontic treatment, she was satisfied with improvements of mastication and esthetics. A case of 20-year-old female with skeletal Class II jaw relationship, mandible retrognathism and anterior open bite without signs and symptoms of temporomandibular disorder. Intraoral examination showed premature contact over bilateral posterior teeth and the forward resting position of tongue. Our treatment plan was orthodontic camouflage with extraction of all first premolars and tongue training. As forward resting position of …

Quality Of Life Changes In Taiwanese Patients With Dentofacial Deformities Undergoing Orthognathic Surgery, Jing Hao Ng, I-Chen Lee, Becky Chiang-Lin Liu, Ellen Wen-Ching Ko

Taiwanese Journal of Orthodontics

Objectives: The evaluation of orthognathic surgery (OgS) is shifting towards a coherent approach for patient care that balances objective clinician-defined measures with patient-centred outcome assessments, including health-related quality of life (QoL). This aim of this study adds to the pool of literature in East Asian subjects by studying the longitudinal QoL changes in Taiwanese patients with dentofacial deformities (DFD) undergoing OgS, using two standardized questionnaires at three different treatment stages. Materials and Methods: This prospective cohort study comprised 113 consecutive Taiwanese OgS patients who underwent surgical-orthodontic treatment between 2015 and 2018. The subjects completed SF-36 and OHIP-14 standardized questionnaires with …

Comparison Of Bone Thickness In Infrazygomatic Crest Area At Various Miniscrew Insertion Angles: A Cone-Beam Computed Tomographic Study, Rajju Dangal, Rabindra Man Shrestha, Jyoti Dhakal, Sujita Shrestha, Alka Gupta, Shreya Shah

Taiwanese Journal of Orthodontics

Introduction: The infrazygomatic crest (IZC) is an alternative site for miniscrew anchorage. It is important to analyze the anatomy of the region during preoperative planning to minimize the risk of unwanted tooth movement and injury to the vital structures. The literatures on the clinical application of miniscrew in IZC is scarce. Objective: To determine bone thickness, height and angle of insertion of miniscrew in the IZC region. Materials and methods: This cross-sectional observational comparative study included 44 patients above18 years. IZC bone thickness and height of miniscrew insertion were measured on cone-beam computed tomographic (CBCT) records. Student t-test was done …

Cephalometric Analysis: History And Clinical Application, Ib Leth Nielsen

Taiwanese Journal of Orthodontics

When roentgen cephalometry was first introduced to the orthodontic profession in 1931 by Broadbent in the USA and Hofrath in Germany it was a major milestone in terms of new diagnostic tools available to orthodontists. Until that time only clinical observation and study casts of the patients had been available to the clinician but now a more in depth understanding of the facial makeup became possible. This meant that each patient’s malocclusion could now be related to their facial skeletal and dental morphology. The dentoalveolar components could now be studied in detail and better treatment plans could be developed that …

Using Clear Aligners For Asymmetric Dental Decompensation In Skeletal Class Iii Facial Asymmetry Before Orthognathic Surgery, Yu-Ming Liang, Szu-Ching Lee, Fong Jenny, Tzu-Ying Wu

Taiwanese Journal of Orthodontics

In this case report of orthodontic combined with orthognathic surgery, we demonstrate the effectiveness of an aligner system in the treatment of asymmetric arch form. Without the help of temporary anchorage device and inter-arch elastic, unilateral arch expansion and opposite side arch constriction were achieved successfully. Cone-beam computed tomography was used to assess to evaluate the outcome and key to success was discussed.

Substitution Of A Dilacerated Impacted Maxillary Central Incisor With A Deep Horizontal Impacted Canine, Wei-Lun Chang, Szu-Ching Lee, Hsuan-Hung Chen, Man-Tin Lui, Tzu-Ying Wu

Taiwanese Journal of Orthodontics

The treatment of multiple impacted anterior teeth is challenging. Proper treatment plan, meticulous biomechanics design and close collaboration with interdisciplinary team work are key factors to achieve better esthetic and periodontal outcomes. For impacted tooth cases, CBCT images can provide more detailed information about the location of the impacted tooth and its surrounding periodontal conditions during treatment. This case report described the treatment of a mild skeletal Class III, facial asymmetry teenager with dilacerated impacted maxillary left central incisor. Because of the unpredictable prognosis of dilacerated impacted central incisor, our treatment goal was to forced erupt the deeply horizontal impacted …

Correction Of Extruded Upper First Molars And Bimaxillary Protrusion By Temporary Anchorage Device, Ignatia Wulandari, Retno Widayati

Taiwanese Journal of Orthodontics

Early loss of the lower first molar may cause extrusion of the upper first molar and mesial tipping of the lower second molar. It could be locked by the mesial contour of the upper second molar, causing the door-wedge effect which impedes the intrusion of the upper first molar. Skeletal Class II malocclusion, canting, and the need for anterior retraction on the upper arch was adding space requirement and anchorage problem to the case. Treatment by using absolute anchorage would be the most efficient way to treat this case. This case report aims to show how to manage molar extrusion, …

Mandibular Expansion Appliances And Their Activation Protocols, Tivanani Venkata Durga Mahendra, Vyshnavi Mulakala, Manda Anoosha

Taiwanese Journal of Orthodontics

A tooth size-arch length discrepancy (TSALD) occurs when there is an imbalance between the size of the teeth and the space available in the dental arches to accommodate them. Relief of crowding through expanding the arch is the most employed non-extraction method in orthodontics. Because of the absence of a midline suture and the resistance of the mandibular body, resolving crowding in the lower arch is more complex than in the upper arch. However, numerous researchers have devised innovative techniques and methods to successfully bring about the desired and stable changes through mandibular expansion. The advantage of this procedure was …

Factors Affecting Mandibular Growth And Displacement And Their Effect On Treatment Outcome, Ib Leth Nielsen

Taiwanese Journal of Orthodontics

Orthodontists often have difficulty distinguishing between growth and displacement when it comes to the mandible and often the two are merged into one and referred to as just mandibular growth. It is clinically important to distinguish between the two as it can greatly affect the choice of treatment protocol and mechanics. In this review we shall attempt to clarify the issue with clinical examples in the hope of bringing more understanding to the problem. Controlling the factors that are involved in determining the outcome of orthodontic treatment in a growing patient can often be a difficult task and is affected …

A New Cephalometric Innovation For Assessing Vertical Skeletal Discrepancy: The Msg Angle, Mahamad Irfanulla Khan, Praveen Kumar Neela

Taiwanese Journal of Orthodontics

Purpose: The aim of the study was to introduce a new cephalometric parameter, the MSG angle; and to assess the effectiveness of the MSG angle to diagnose the vertical skeletal discrepancy of the face.

Methods: One hundred and fifty pretreatment Lateral Cephalometric Radiographs (LCRs) of patients between 14 to 35years (Mean ± SD: 19.6 ± 4.93) were included. Based on the FMA, Sn-Go-Gn, and R - angle, all the LCRs were subdivided into three groups: low angle (28 female and 22 male); average angle (29 female and 21 male); and high angle (27 female and 23 male), with 50 …

Camouflage Orthodontic Correction In An Adult Patient With Skeletal Class Iii Malocclusion – A Case Report, Yun-Fang Chen, Yuh-Jia Hsieh, Yu-Fang Liao

Taiwanese Journal of Orthodontics

The case report described the camouflage treatment of an adult patient with skeletal Class III, anterior cross bite, open bite tendency and dental crowding. A 19-year-old male patient presented with chief complaint of anterior crooked teeth. The clinical examination showed a straight to concave profile, midface retrusion, mandibular protrusion, slightly high mandibular plane angle, upper and lower lip protrusion, lip incompetence, Class III molar and canine relationships. Because the patient refused to receive orthognathic surgery, the camouflage orthodontic treatment was planned along with extraction of bilateral upper second premolars and lower first premolars and modest backward-rotation of the mandible to …

Intraosseous Movement Of Multiple Impacted Teeth Occurred In Unilateral Maxilla During Orthodontic Treatment – A Case Report, Chun-Hsiu Yang, Chun-Liang Kuo

Taiwanese Journal of Orthodontics

The orthodontic treatment of unilateral multiple impacted teeth is challenging. It is often accompanied with a wide range of surgical exposure for impacted teeth. We reported a 14-year-old male patient who had a retained primary canine, first and second molars in left maxilla, complicated with proximal caries and gingival abscess over the primary first molar. The panoramic radiography revealed with a horizontally impacted canine, first premolar and vertically impacted second premolar in left maxilla. After relive the underlined pathogenesis of the tooth impaction by removing the primary teeth and abscess, the second premolar erupted subsequently. During traction of the inferiorly …

Corticotomy Assisted Lower Molar Protraction Treatment For A Periodontally Compromised Patient – A Case Report, Cheng-Hsun Shih, Ming-Chu Huang, Yuen-Yung Tsang

Taiwanese Journal of Orthodontics

This is a case of a 51 years old female with skeletal Class I malocclusion, suffered from root fracture of #46 & moderate generalized periodontitis. She asked for molar protraction of #47 #48 to close the extraction space of #46 without any prosthesis or dramatic change of profile. Treatment planning was removal of #46 & protraction of #47 #48 with mini screw. It became difficult to close the residual space of #46 after 17 months of treatment due to narrow edentulous ridge. Therefore corticotomy plus bone grafting was performed. After treatment, her occlusion was stable and profile was satisfied. Selective …

Orthopedic-Orthodontic Intervention For A Skeletal Class Iii Malocclusion With An Inverted Maxillary Central Incisor Impaction – A Case Report, Hsin-Ho Chen, Sheng-Chin Lin, Shin-Huei Wang, Yuan-Yi Tung, Hsuan-Yi Hsiao, Yi-Jane Chen

Taiwanese Journal of Orthodontics

The etiologies of Class III malocclusions may result from mandibular prognathism, maxilla deficiency, or both. For growing children with Class III malocclusions characterized with deficient maxilla, the treatment of choice would be protraction of the maxilla. Successful orthopedic treatment through growth modification has increased the possibility to correct developing Class III malocclusion with non-surgical method. In addition, maxillary expansion is frequently required in treatment of Class III malocclusions by increase the transverse width of the maxilla, and possibly enhance the protraction effect of the facemask through disrupting the maxillary suture system. Herein we report a case of 8-year-old boy presenting …

Long-Term Evaluation And Treatment For A Patient With Costochondral Graft Reconstruction In Hemifacial Microsomia – A Case Report, Shih-Wen Fan, Wen-Ching Ko, Kuo-Ting Chen

Taiwanese Journal of Orthodontics

A 17-year-old girl who was diagnosed as Pruzansky Grade III hemifacial microsomia (HFM) at right side, came with chief complaint of face asymmetry and occlusal deviation. The patient was regularly followed up in the Chang Gung Craniofacial Center. She had her affected right side ramus and condyle reconstructed with costochondral graft (CCG) around 6 years of age. The extraoral examinations indicated severe facial asymmetry with longer right face and prominent left face; the lower jaw was severely deviated to the left side due to overgrowth of the CCG at right mandible; besides, the right reconstructed condyle was ankylosed. The presurgical …

Orthodontic Treatment To Improve Periodontal Defect In A Patient With Lower First Molar Extraction– A Case Report, Yu-Ling Cheng, Yuen-Yung Tsang, Chia-Yi Pan, Ming-Juean Su

Taiwanese Journal of Orthodontics

A 23 year-old male came with chief complaint of lower anterior crowding and protrusive lower lip. Dental examination revealed missing teeth 14, 24 and 34 and horizontally impacted 38 and 48. Poor prognosis of tooth 36 was found after evaluation. Anterior cross bite and open bite at his left side occlusion were also seen. In this case, removal of teeth 36 and 38 were selected instead of 44 extraction. Thus the timing and proper sequence of tooth extraction become critical. The biomechanics of tooth movement was designed to ensure that all teeth are in functional occlusion and the lower left …

Methods Of Gaining Dental Space – A Literature Review, Wei-Ting Chang, Hsuan-Yi Hsiao, Chi-Ying Huang, Yi-Jane Chen

Taiwanese Journal of Orthodontics

When treating patients with teeth mal-alignment and crowding, orthodontists have many strategies to gain the space. This article reviews the conventional methods which focus on molar distalization and arch expansion, rather than tooth extraction and temporary anchorage devices. The outcome of treatment with pendulum, distal jet, rapid maxillary expansion, and lip bumper were evaluated from various aspects. The aims of the literature review are to help orthodontists formulate an optimized treatment plan and predict treatment outcome and limitation in acquiring space by molar distalization and arch expansion.

Relationship Between Orthodontic Treatment And Root Resorption – A Literature Review, Yu-Tnig Wu, Wen-Ken Tai, Hoi-Shing Luk, Chih-Chen Chou, Heng-Ming Mark Chang, Chia-Tze Kao

Taiwanese Journal of Orthodontics

Shorting of tooth or external root resorption that happen during or after completion of orthodontic treatment are troublesome. The root resorption could affect treatment outcome, unstable orthodontic tooth movement and even cause medical dispute. The etiologies of external root resorption could be systemic problems or local factors. The mechanism of external root resorption is still unclear and under investigation. This article reviewed the factors and possible causes on the orthodontic root resorption and discussed the possible role of light emitted diode (LED) biophotostimualtion effects to inhibit the root resorption. The information was provided for orthodontists in daily practice.

The Proper Timing And Strategies To Initiate Orthodontic Treatment For Patients With Class Iii Malocclusion– A Literature Review, I-Hsuan Su, Ar-Ting Wang, Feng-Lan Chan, Jenny Zwei-Chieng Chang

Taiwanese Journal of Orthodontics

Treatment for Class III malocclusion has been a controversial issue due to the unpredictable growth pattern. According to the literatures, various early interventions have been proposed to modify the skeletal relationship in order to reduce the need for the future complex orthognathic surgery. The influences of the age and the growth potential of patients at the time of treatment were also commonly discussed. Systematic review of the literatures showed that the amount of orthopedic effect was related to the age of patients; however, for those that start treatment before puberty, the stage of the mixed dentition at time of treatment …

Non-Extraction Treatment For Class Ii Malocclusion With Dentition Crowding – A Case Report, Hung-Hsiang Liao, Shao-Chun Lu, Ya-Ting Wang, Joung-Lin Liaw, Fong-Lan Chan, Chung-Chen Jane Yao

Taiwanese Journal of Orthodontics

To coordinate the dental midlines with facial midline is one of the orthodontic treatment goals. This case report presented a case with Class II dentition crowding and asymmetry by non-extraction therapy with the aids of TADs. Transpalatal arch with extension arm was used to correct buccal version of upper second molar which contributed the mandibular deviation. Molar distalization and arch widening were achieved by using TADs. Midline and Class II elastics resulted more correction of dental midlines to facial midlines. At the end of treatment, Class I canine and molar relationships and centered midlines were obtained. Better facial symmetry was …

Correction Of Angle Class Ii Malocclusion And Buccal Crossbite Assisted By Tads – A Case Report, Huei-Ying Mu, Yuen-Yung Tsang, Yu-Ling Cheng, Chia-Yi Pan, Ming-Jeaun Su, Yi-Min Liu

Taiwanese Journal of Orthodontics

Complete buccal crossbite is rare and difficult to be treated either orthodontically or surgically. This article presents an adult patient with bilateral Class II molar relationship and complete buccal crossbite at the right premolars region. She was treated with four bicuspids extraction along with upper buccal and palatal TADs as well as cross elastics in order to achieve well-aligned dentition. The buccal crossbite was corrected and and good profile was achieved.

Consideration Of Therapy In Angle Class I Malocclusion With Anterior Open Bite, Yu-Hsiang Lin, Yi-Sheng Lee, Chih-Peng Su, Hsin-Kuang Chen, Ming-Shi Tsai, Sheng-Yang Lee

Taiwanese Journal of Orthodontics

Anterior open bite is a common and challengeable malocclusion. To manage Angle Class I molar relationship in adult cases with several problems, such as high mandibular plane angle, maxillary canting, anterior open bite, discrepancy of anterior Bolton ratio and bilateral posterior crossbite, we should choose therapeutic method carefully. It is not necessary to improve occlusion and profile with orthognathic surgery. A case of an adult woman with tongue thrust had the chief complaint of anterior open bite. The principle of orthodontic treatment without orthognathic surgery is the occlusal plane change and vertical control to achieve the forward rotation of mandible …

Correction Of Class Ii Malocclusion And Lower Premolar Impaction Of An Adult Patient With Tads – A Case Report, Chien-Cheng Chen, Shih-Syun Syu, Yi-Horng Chen

Taiwanese Journal of Orthodontics

Dentoalveolar ankyloses of primary tooth sometimes cause impaction of its successor tooth. In this condition, extraction of the ankylosed primary tooth and orthodontic forced eruption of the impacted permanent tooth may be a choice of treatment. In this case report, we present a 23-year-old female with Angle Class II malocclusion, whose mandibular left 2nd premolar impacted due to ankyloses of its primary tooth. She also had dental arch crowding and gummy smile problems. The patient received full-mouth orthodontic non-extraction treatment combine using TADs. As a result, her problems of malocclusion and gummy smile improved.