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Bimaxillary protrusion adult case -Consultation
Wasserstein A., D.M.D., Israel
www.lingualnews.com Vol. 1 No. 4, November 2003 |
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Consultation.
A 23 years old female presented for an orthodontic consultation with a complaint of “protruding jaws”. About a month earlier she addressed her complaint to an oral and maxillofacial surgeon asking for jaws surgery. The surgeon’s advice was not to perform any surgery but to seek orthodontic treatment.
Diagnosis
Frontal view (Fig.1) reveals slight asymmetry of the face with protrusion of the oral region (the orbicularis oris region). At rest the lips are 3 millimeters apart and there is 5mm incisal edge exposure at rest with greater exposure of the right quadrant on smiling (Fig.2). The profile (Fig.3) is convex and the nasolabial angle is acute.
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Fig.1: Pretreatment facial photographs |
Fig. 2: Pretreatment intraoral photographs |
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Fig. 3: Pretreatment cephalometric x-rays |
Fig. 4: Partial space closure |
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Intraoral examination shows very mild malalignment, Class I dental relationships, missing lower left first molar and extensive loss of crown material of the lower right second premolar.
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Fig. 5: Partial closure of spaces had a positivel effect on the profile but not on the frontal view, which remained unchanged |
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Treatment Plan
An extraction-based therapeutic modality with extraction of an upper premolar on each side of the maxillary arch, and the lower right second premolar was utilized. The second premolars were chosen for extractions in the upper arch due to esthetic considerations. Maximum anchorage was planned while retracting the front teeth.
Treatment Progress
Lingual brackets were bonded to the upper arch and labial brackets to the lower from second molar to second molar. Headgear for nighttime wear, and class III elastics were used to preserve anchorage.
The problem
Partial closure of the spaces (Fig. 4) had a positive effect on the profile but not on the frontal view of the face, which remained unchanged. The upper oral area remained prominent (Fig 5). Consultation with a plastic surgeon provided no solution.
www.lingualnews.com
Adult and Lingual Orthodontics
EDITORS:
Dr. Silvia Geron D.M.D., M.Sc
Dr. Rafi Romano D.M.D., M.Sc
Dr. Pablo Echarri D.M.D., M.Sc
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