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Non-Surgical Treatment of an Adult Class III Malocclusion Patient with Facial Asymmetry by Unilateral Mandibular Arch Distalization

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Non-Surgical Treatment of an Adult Class III Malocclusion Patient with Facial Asymmetry by Unilateral Mandibular Arch Distalization Volume 29 Issue 2 Article 4 2017 Non-surgical Treatment of an Adult Class III Malocclusion Patient with Facial Asymmetry by Unilateral Mandibular Arch Distalization Chi-Yu Tsai Department of Orthodontics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan Shiu-Shiung Lin Department of Orthodontics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan Yi-Hao Lee Department of Orthodontics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan Li-Tyng Sun Department of Orthodontics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan Yu-Jen Chang Department of Orthodontics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College Fofollow Medicine, this and Kaohsiung, additional T aiwanworks at: https://www.tjo.org.tw/tjo Part of the Orthodontics and Orthodontology Commons See next page for additional authors Recommended Citation Tsai, Chi-Yu; Lin, Shiu-Shiung; Lee, Yi-Hao; Sun, Li-Tyng; Chang, Yu-Jen; and Wu, Te-Ju (2017) "Non-surgical Treatment of an Adult Class III Malocclusion Patient with Facial Asymmetry by Unilateral Mandibular Arch Distalization," Taiwanese Journal of Orthodontics: Vol. 29 : Iss. 2 , Article 4. DOI: 10.30036/TJO.201706_29(2).0004 Available at: https://www.tjo.org.tw/tjo/vol29/iss2/4 This Case Report is brought to you for free and open access by Taiwanese Journal of Orthodontics. It has been accepted for inclusion in Taiwanese Journal of Orthodontics by an authorized editor of Taiwanese Journal of Orthodontics. Non-surgical Treatment of an Adult Class III Malocclusion Patient with Facial Asymmetry by Unilateral Mandibular Arch Distalization Authors Chi-Yu Tsai, Shiu-Shiung Lin, Yi-Hao Lee, Li-Tyng Sun, Yu-Jen Chang, and Te-Ju Wu This case report is available in Taiwanese Journal of Orthodontics: https://www.tjo.org.tw/tjo/vol29/iss2/4 Case Report NON-SURGICAL TREATMENT OF AN ADULT CLASS III MALOCCLUSION PATIENT WITH FACIAL ASYMMETRY BY UNILATERAL MANDIBULAR ARCH DISTALIZATION 1 1 1 1 1 1 Chi-Yu Tsai, Shiu-Shiung Lin, Yi-Hao Lee, Li-Tyng Sun, Yu-Jen Chang, Te-Ju Wu, 1 Department of Orthodontics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan This article reports the treatment of a 22-year-old male with Class III malocclusion and facial asymmetry by non-surgical camouflage orthodontic approach. This patient presented with anterior crossbite and deviated midline, mild protrusive mandible and chin deviation. The Class III malocclusion was marked with anterior functional shift resulted from the premature contact of the incisors. Unilateral mandibular buccal shelf miniscrew was applied for the correction of the skewed mandibular arch. After treatment, the deviated dental midline and Class III molar relation were both corrected. This patient exhibited harmonious profile and occlusion. (Taiwanese Journal of Orthodontics. 29(2): 99-107, 2017) Keywords: Class III malocclusion; orthodontic camouflage; functional shift 1 among Caucasian descent (< 5%). The components of INTRODUCTION Class III deformities included maxillary retrognathism, 2 The skeletal Class III inter-jaw relation describes mandibular prognathism, or a combination of both. craniofacial anomaly involving sagittal jawbone The growth maturity plays a major role in the treatment discrepancies between the maxilla and mandible, and of patients with Class III malocclusion. Orthopedic usually characterized with disharmonious concave facial appliances are commonly used to treat young patients profile. The incidence of Class III malocclusion varies or adolescents with great growth potential, and early by different races, with a higher prevalence among the diagnosis and intervention contribute to improvements of 1,3 Asian population (15% - 23%) and lower prevalence skeletal discrepancies by growth modification. However, Received: April 01, 2017 Revised: June 21, 2017 Accepted: June 23, 2017 Reprints and correspondence to: Dr. Te-Ju Wu, Department of Orthodontics, Kaohsiung Chang Gung Memorial Hospital No.123, Dapi Rd., Niaosong Dist., Kaohsiung City 833, Taiwan (R.O.C.) Tel: 07-7317123 ext. 8291 E-mail: [email protected] Taiwanese Journal of Orthodontics. 2017, Vol. 29. No. 2 99 Tsai CY, Lin SS, Lee YH, Sun LT, Chang YJ, Wu TJ for those adult patients, the treatment strategies restrict normal developed maxilla. The patient also exhibited the to either orthodontic teeth movement alone, or combine mandibular deviation toward right side for 2 mm, no lip 4-8 surgical orthodontic treatment. incompetence, gummy smile or canting occlusal plane The dento-alveolar compensations of specific were observed (Figure 1, 3). patients characterized with skeletal Class III jaw relation The intraoral examination revealed dental Class III but acceptable profiles have been extensively utilized in malocclusion with both anterior and posterior crossbite, treating those patients don’t accept orthognathic surgery. the original overjet was -2.5 mm, and overbite was 3 mm, The camouflage treatment usually includes compensated patient had 2 mm and 0.5 mm space distal to the lower left incisor movements within the boundary limitations of and right canines, respectively, the lower dental midline underlying jawbones to improve the dental occlusion. deviated to the right by 2 mm relative to facial midline at The extraction of mandibular teeth to provide space for patient’s centric occlusal position (Figure 2). retraction of lower anterior teeth is a common treatment During the functional examination, patient 7 strategy. On the contrary, the alternative involves demonstrated anterior functional shift of the mandible whole mandibular dental arch distalization without resulted from the premature contact of the incisors (Figure 8 sacrificing any natural teeth. Clinicians should consider 2), the edge-to-edge incisor relationship could be achieved these treatment options based on meticulous clinical and mentioned. Despites the improvement of the sagittal examination, and evaluate the adverse effects during the jaw discrepancies, the mandibular right side deviation still orthodontic treatment. presented in the centric relation (CR) position. DIAGNOSIS AND ETIOLOGY TREATMENT OBJECTIVE One 22-year-old healthy male patient presented Clinician’s treatment objectives were to establish with a chief complaint of “reversed occlusion and chin proper overjet and overbite, to eliminate the mandibular prominence”, an extra-oral examination revealed skeletal functional shift, to correct dental midline discrepancies, to Class III jaw relationship with prognathic mandible and achieve bilateral Class I molar and canine relationship. Figure 1. Initial extraoral photographs. 100 Taiwanese Journal of Orthodontics. 2017, Vol. 29. No. 2 Non-surgical Treatment of Class III Asymmetry Figure 2. Initial intraoral photographs and functional examination. (edge-to- edge incisal relationship). Figure 3. Pretreatment panoramic and cephalometric radiographs. Taiwanese Journal of Orthodontics. 2017, Vol. 29. No. 2 101 Tsai CY, Lin SS, Lee YH, Sun LT, Chang YJ, Wu TJ ® (0.022 slot Damon system) were used for treatment. The TREATMENT PLAN initial leveling was performed with 0.014-inch nitinol After discussion of all possible treatment alternatives, wires, followed by 0.014x0.025-inch CuNiTi wire, and the camouflage treatment plan set up as: 0.018-inch nitinol wires for alignment. After 4 months, 1. Full mouth orthodontic treatment without orthognathic the miniscrew (2.0 mm in diameter; Bio-Ray, Syntec surgery Scientific Corp., Taipei, Taiwan) was placed in the left 2. Extraction bilateral lower third molars mandibular buccal shelf. The unilateral mandibular arch 3. Unilateral miniscrew inserted over left mandibular distalization were performed over a 0.018x0.025-inch buccal shelf 4. Close all the remaining space stainless-steel archwire. The miniscrew initially provided 5. Retention with fixed retainer and bimaxillary Hawley indirect anchorage to close the excessive space mesial retainer to mandibular left first premolar. Positive overjet was rd achieved at the 3 month after initiation of miniscrew- TREATMENT ALTERNATIVES facilitated mechanism. The long power arm was then used for the succeeding unilateral distalization (Figure 4) 1. Orthodontic camouflage treatment by extraction of mandibular first premolars and maxillary second and protraction of right side mandibular dentition. In the th premolars for anterior retraction. 26 month, all the residual space was closed and dental 2. Orthodontic treatment combined with two-jaw midline became coincident. The bilateral Class III elastics orthognathic surgery for correction of mandibular were used for improvement of molar relationship followed prognathism and facial asymmetry. by finshing procedures. After 32 months of orthodontic treatment, the bands and braces were removed. The TREATMENT PROGRESS 0.0175-inch tripleflex wire were bonded from canine to The orthodontic treatment initiated after extraction canine in the upper jaw, meanwhile the fixed bonded wire of bilateral lower third molars. The self-ligating brackets extended between the first premolars in the lower arch. Figure 4. Miniscrew facilitated correction of skewed mandibular dental arch. 102 Taiwanese Journal of Orthodontics. 2017, Vol. 29. No. 2 Non-surgical Treatment of Class III Asymmetry TREATMENT RESULT skeletal relationship. The proclination of upper
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