Scribd Logo
Upload

Welcome to Scribd!

  • 6 views

    Correction of Class II Division 2 Deepbite Malocclusion With Non-Extraction Therapy

    Uploaded by

    Đỗ Khưu Thịnh

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Correction of Class II Division 2 Deepbite Malocclusion With Non-Extraction Therapy

    Uploaded by

    Đỗ Khưu Thịnh
    6 views3 pages

    Original Title

    7590

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    6 views3 pages

    Correction of Class II Division 2 Deepbite Malocclusion With Non-Extraction Therapy

    Uploaded by

    Đỗ Khưu Thịnh

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Case Report

    Correction of Class II Division 2 Deepbite Malocclusion


    with Non-extraction Therapy

    Dr Situ L Shrestha,1 Dr Supreeth S Manipal,2 Dr Bikash V Shrestha,3 Dr Alok K Jaiswal4


    1
    Professor, Asst Professor, Dept of Orthodontics, Peoples Dental College, Kathmandu, Nepal
    2,3

    Asst Professor, Kedia Dental College, Birgunj, Nepal


    4

    Correspondence: [email protected]

    ABSTRACT
    The article presents a case report of a teen age girl with Class II Division 2 malocclusion with deep over bite. The
    case was treated on non-extraction basis using 0.018 pre-adjusted edgewise appliance with anterior bite plate
    (monobloc) to correct deep bite and forward placement of the mandible. Use of Class II elastics helped to achieve
    Class I canine and molar retention. Treatment was completed in 22 months with good occlusion and facial esthetics.

    INTRODUCTION Temporomandibular joint examinations confirmed


    normal joints and maximum inter-incisal opening was
    Class II malocclusion is among the common acceptable with no deviation. No joint noises were
    malocclusions that is faced in orthodontic practice. perceptible in excursive movements of the mandible.
    Early diagnosis and proper management can avoid
    the unnecessary extractions and even orthognathic Orthodontically the patient presented with Angle’s
    surgeries that might be needed in some cases. Class II Division 2 malocclusion. Complete traumatic
    Monobloc (anterior bite plane) appliance can be used deep bite with 2 mm overjet and flared upper
    in such case to treat the growing skeletal malocclusion. lateral incisors was noted. There was mild lower
    Further treatment refinement is done using Class II anterior crowding (2 mm) and mild upper anterior
    elastics, which shows desirable mandibular growth crowding (1.5 mm); and a moderate curve of Spee
    leading to non-extraction correction of skeletal and in both arches. The soft tissue was within normal limits
    dental Class II malocclusion. (Figure 1).

    CASE HISTORY CEPHALOMETRIC EVALUATION


    A 13 years and 7 months old female patient whose chief Cephalometric analysis (Figure 2) revealed
    complaint in her own words was “I don’t like the way normognathic maxilla (SNA 82o), rethrognathic
    my upper teeth are” was presented to the Department mandible (SNB 73o); skeletal Class II relationship (ANB
    of Orthodontics, Peoples Dental College and Hospital.
    9o) with a horizontal growth pattern (Y-axis growth 54o).
    The patient’s medical history was noncontributory and
    The upper and lower central incisors were retroclined
    her dental history included routine dental check-ups.
    (UI to NA angle 6o, LI to NB angle 8o), and the chin was
    Other findings and history were unremarkable and
    prominent (Table I). Panoramic evaluation revealed
    perverse habits were not present.
    permanent dentition with all permanent teeth present.
    CLINICAL EXAMINATION The periodontal condition was within normal limits
    (Figure 3).
    Extra-oral examination of the patient showed
    symmetric and leptoprosopic facial type on frontal
    view. The profile view revealed prominent chin, TREATMENT
    convex profile, prominent upper lip, deep labio-mental
    After reviewing the diagnostic records and patient
    sulcus, average nasolabial angle, and competent lip.
    history; non-extraction orthodontic correction with

    Orthodontic Journal of Nepal, Vol. 3, No. 1, June 2013


    73
    Shrestha SL, Manipal SS, Shrestha BV, Jaiswal AK : Correction of Class II Division 2 Deepbite Malocclusion with Non-extraction Therapy

    Table 1: Comparative cephalometric analysis

    Parameters Pre treatment Post treatment Mean value

    SNA 78 83 83.2

    SNB 73 78 79.8

    ANB 5 5 3.4

    UI to NA 6 21 21.3

    LI to NB 8 30 26.3

    Facial Angle 90 87 89.8

    Angle of Convexity 4 4 3,1

    Cant of OP 4 4 7.1

    MP angle 16 20 23.2

    Y-axis 54 57 58.6

    preadjusted edgewise appliance technique was The overbite and overjet were corrected; and maxillary
    initiated, expecting that growth of the mandible would and mandibular crowding was eliminated. The final
    contribute to achieve a Class I molar and canine cephalometric radiograph is shown in Figure 5. The
    relationship. posterior intercuspation was excellent with occlusal
    settlement and the panoramic radiograph (Figure 6)
    The upper arch was initially banded on the first molars
    showed near parallel root position. The maxilla showed
    and bonded from second premolar to second premolar
    a slight forward movement, most likely because of the
    with standard Roth prescribed 0.018 pre-adjusted
    edgewise brackets, with arch wire progression starting residual growth. The mandible moved in a favorable
    from 0.012 NiTi. Mono-block (anterior bite plane) was forward and downward direction. The upper and lower
    fabricated and inserted which helped in advancement incisors showed excellent inter-arch relationship. Slight
    of mandible. It also acted as anterior bite plate for extrusion and significant protraction of the lower molars
    correction of deep bite. After 1 month lower arch was were observed (Figure 4). This can be attributed to
    also bonded and banded. Class II mechanics that opened the bite. The following
    esthetic changes were achieved: a decrease in facial
    Class II elastics were used during the treatment and convexity, increase in anterior facial height, and flatter
    Class I molar and canine relationships were achieved
    labiomental sulcus. The profile was well balanced.
    with excellent patient cooperation. After 22 months of
    active therapy followed by 6 months of active retention
    period, debonding was done and impressions were
    DISCUSSION
    made for retainers. The treatment attempted to potentiate more forward
    growth and development of the mandible. Use of
    RETENTION mono-block (anterior bite plane) worked for anterior
    Clear retainer was placed in maxillary arch and fixed placement of mandible as well as for correction
    lingual retainer was placed in the mandibular arch. The of deep bite; also to eliminate crowding, correct
    patient was instructed to wear them full time for 1 year, midline discrepancy, obtain good torque and root
    at night for an additional year, and to return for periodic axial inclination. Obtaining Class I molar and canine
    evaluation until completion of growth. relationship; obtaining an acceptable overjet and
    overbite; achieve proper intercuspation; improve facial
    RESULTS ACHIEVED profile by reducing facial convexity and increasing
    anterior lower facial height were other treatment goals
    Post-treatment facial photographs are shown in Figure 4.
    achieved.
    A Class I molar and canine relationship were obtained. OJN

    74 Orthodontic Journal of Nepal, Vol. 3, No. 1, June 2013


    Shrestha SL, Manipal SS, Shrestha BV, Jaiswal AK : Correction of Class II Division 2 Deepbite Malocclusion with Non-extraction Therapy

    Figure 2: Pretreatment Lateral Cephalogram

    Figure 1: Pretreatment facial and intra-oral photographs Figure 3: Pretreatment OPG

    Figure 5: Post treatment Lateral Cephalogram

    Figure 4: Post treatment facial and intra oral photograph Figure 6: Post treatment OPG

    Orthodontic Journal of Nepal, Vol. 3, No. 1, June 2013


    75

    You might also like