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11/38. A case of Antley-Bixler syndrome with severe skeletal Cl. III malocclusion.

    Antley-Bixler syndrome is a disorder characterized by craniosynostosis, midface hypoplasia, choana blockade, and radiohumeral synostosis. However, the features of occlusion remain unclear. In this paper, we report a case of Antley-Bixler syndrome, a 7-year-old boy, from the viewpoint of orthodontics. From lateral cephalometric head film analysis, remarkable retardation of the anterior subcranial base, infraorbitale, and maxilla were notable, as was vertical growth restriction of the maxilla. The choana blockade tendency was also recognized. Moreover, although reverse occlusion was present, a mandibular retrognathic tendency was also present, and a short ramus mandible, remarkable mandibular vertical growth pattern, and skeletal open bite were present. In the dentition, two of the lower incisors were missing, and the present lower incisors were large. Maxillary and mandibular first molars were delayed in eruption. For treatment, the solutions to such remarkable skeletal problems were limited by the insufficiency of recovery of cranial formation after the operation. We planned a non-surgical treatment to expand the maxilla. It will be necessary to continually consider the treatment of his malocclusion as he continues to grow.
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12/38. Utilization of third molars in the orthodontic treatment of skeletal class III subjects with severe lateral deviation: case report.

    AIM: This clinical report discusses the importance and use of third molars in the adult patient by presenting a case in which their use during orthodontic treatment allowed occlusal improvement. SUBJECT AND TREATMENT PLAN: The patient was a Japanese adolescent boy who had a skeletal Class III malocclusion with severe lateral deviation of the mandible, significant loss of posterior occlusal vertical dimension, due to premature loss of the maxillary and mandibular left first molars, and furthermore, both first molars had advanced carious lesions that had resulted in reduced crown heights and bilateral chewing surfaces. The mandible had shifted to the left, with a bilateral chewing pattern and a lack of posterior vertical alveolar height, which in turn had produced an abnormal occlusal plane and curve of Spee. The maxillary arch was expanded, the maxilla was moved downward and forward, and the mandible was moved slightly backward and rotated open to increase posterior vertical alveolar and crown height. The reconstruction of a functional occlusal plane was achieved by uprighting the posterior teeth to correct asymmetric posterior vertical alveolar and crown height, using a full multibracket system incorporating four third molars and closing the space from the missing first molars and extraction of the questionable first molars. RESULTS: A normal overbite and overjet and adequate posterior support and anterior guidance were established, achieving a better intercuspation of the posterior teeth. A favorable perioral environment was created, with widened tongue space to produce an adequate airway. A well-balanced lip profile and almost symmetric face were achieved using the four wisdom teeth without extraction of the four premolars. Subsequent mandibular growth, with development of posterior vertical alveolar height and temporomandibular joint adaptation, has resulted in an almost symmetric posterior vertical height and joint structure between right and left sides. These factors have contributed to the occlusal stability maintained for more than 5 years. CONCLUSION: In the growing patient, with missing and/or early advanced caries of the first molars, it may be more beneficial to plan occlusal improvement through extraction of the questionable first molar rather than premolar extraction. This method of treatment can equalize posterior vertical dimension and does not restrict tongue space. In addition, this treatment method addresses the clinician's concern about postorthopedic relapse due to tongue habits and eruption of the third molars.
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13/38. Features and treatment of skeletal class III malocclusion with severe lateral mandibular shift and asymmetric vertical dimension.

    AIM: To highlight the effectiveness of orthodontic treatment and bilateral equalization of the vertical occlusal dimension, along with the correction of asymmetric cervical and masticatory muscle activities in patients with Class III malocclusion with lateral deviation of the mandible and severely asymmetric condyle and ramus. methods: Two normally growing and one nongrowing Japanese patients with severe lateral deviation of the mandible, asymmetric vertical occlusal dimension, and severely asymmetric temporomandibular joints are discussed. In addition to orthodontic treatment, all patients received physiotherapy of the cervical muscles and gum-chewing training for elimination of the masticatory muscular imbalance. patients also had postural training during treatment. All patients were treated with a bite plate to equalize the bilateral posterior vertical dimension, followed by full multi-bracketed treatment to establish a stable form of occlusion and to improve facial esthetics. RESULTS: This interdisciplinary treatment approach resulted in normalization of stomatognathic function, elimination of temporomandibular joint dysfunction symptoms, and improvement of facial appearance and posture. In growing patients, the significant response of the fossa, condyle, and ramus on the affected side during and after occlusal correction contributed to the improvement of cervical muscle activity. In contrast, less improvement was observed in the growing patient who did not receive physiotherapy of the neck muscles, postural training, or masticatory habit training during the posttreatment period. The nongrowing patient showed little morphologic improvement of the cervical spine, condyle, and fossa during treatment and after retention, even with physiotherapy of the neck muscles and attention to posture and masticatory habits. CONCLUSION: Based on these results, early occlusal improvement, combined with physiotherapy to achieve muscular balance of the neck and masticatory muscles, was found to be effective. It is important to assess the morphology and function of the neck muscles and cervical spine prior to occlusal therapy in patients with an asymmetric vertical dimension, lateral deviation of the mandible, and asymmetric temporomandibular joint structures. Therapy should correlate orthopedic and surgical patient management as needed.
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14/38. Maxillofacial intraoral distraction osteogenesis followed by elastic traction in cleft maxillary deformity.

    We present a case of severe maxillary hypoplasia in a 16 years old cleft patient treated by distraction osteogenesis maxillary advancement. Initial evaluation showed vertical and antero-posterior maxillary deficiencies, and a Class III malocclusion. Two intraoral distractors (Zurich Pediatric Maxillary Distractor, KLS Martin, Tuttlingen, germany) were placed in a high Le Fort I osteotomy. An initial advancement of 11 mm was obtained, but the resulting occlusion was unsatisfactory (end-to-end occlusion). The consolidation period was reduced to 3 weeks to allow the mechanical manipulation of the newly formed bone with Class III elastics. An additional advancement of 3 mm, caused by elastic orthodontic traction produced both normal skeletal relationship and satisfactory occlusion. This observation shows that it is possible to carry on a skeletal maxillary displacement by interdental elastics before the complete fusion of the callus. After 12 months of postoperative follow-up no osseous relapse could be detected and the occlusal result was stable.
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15/38. Italian Board of orthodontics: case N. 2 adult malocclusion.

    OBJECTIVES: this 20,2 year-old girl presented with a class III malocclusion with severe crowding. MATERIALS AND methods: she was at the end of her growth with a severe skeletal and dental class III malocclusion with lower midline deviation and severe crowding. A concave profile, due to chin's prominence, was present. Lower vertical third of the face increased. No signs or symptoms of TMJ problems were present: lingual position of 12 and 22 is a potential problem for TMJ's health. The state of oral mucosa and gingiva was good. But oral hygiene was not good. Lower midline deviated 3 mm to the left side; canine and molar class I on the right side and class III on the left side. The sequence of her treatment was as follows: a) extraction of 15, 25, 35, 44; b) upper and lower arch fixed appliance for alignment, leveling, correction of lower midline and occlusal relationship; c) post-treatment retention.
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16/38. Skeletal Class III oligodontia patient treated with titanium screw anchorage and orthognathic surgery.

    This article reports the successful treatment of a patient, aged 15 years 8 months, with a Class III malocclusion and oligodontia; a titanium screw was used for absolute anchorage during treatment. The patient had a concave profile because of mandibular excess and asymmetric spaces in both arches. titanium screws were implanted in the retromolar area during intraoral vertical ramus osteotomy combined with LeFort I osteotomy. Absolute anchorage was provided with anchorage wires extending from the screws to the left canine and the right lateral incisor. After orthodontic space closure, the mandibular molars were moved mesially without lingual tipping of the mandibular incisors. A good interincisal relationship was achieved. Our results suggest that titanium screws and anchorage wires in the retromolar area are useful for the mesial movement of mandibular molars.
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17/38. Nonsurgical and nonextraction treatment of a skeletal class III adult patient with severe prognathic mandible.

    AIM: A patient with a skeletal Class III malocclusion, prognathic mandible, anterior open bite, large tongue, and temporomandibular disorders is presented. Treatment objectives included establishing a stable occlusion with normal respiration, eliminating temporomandibular disorder symptoms, and improving facial esthetics through nonextraction and nonsurgical treatment by creating a favorable perioral environment, restoring the harmony to the tongue and perioral environment, improving masticatory muscle function, and creating adequate tongue space for establishment of normal respiration. SUBJECT AND methods: The patient was a Japanese adult male, who had previously been advised to have orthognathic surgery, with tongue-size reduction. An expansion plate was used to expand the maxillary dentoalveolar arch. Distalization of the mandibular arch was achieved by reduced excessive posterior vertical dimension, through uprighting and intruding the mandibular posterior teeth and rotating the mandible slightly counter-clockwise. The height of the maxillary alveolar process and the vertical height of symphysis were increased slightly. The functional occlusal plane was reconstructed by uprighting and intruding the posterior teeth with a full-bracket appliance, combined with a maxillary expansion plate, with short Class III and vertical elastics in the anterior area. myofunctional therapy involved sugarless chewing gum exercises. RESULTS: The excessive posterior vertical occlusal dimension was reduced slightly, creating a small clearance between the posterior maxilla and mandible. At the same time, the interferences in the posterior area were eliminated by the expansion of the maxillary dentoalveolar arch. As a result, the laterally displaced mandible moved to a more favorable jaw relationship, with distalization of the mandibular arch. The functional occlusal plane was reconstructed and an almost-normal overjet and overbite were created. Adequate tongue space for normal respiration was established during the early stage of treatment, by 7 months. A stable occlusion, with adequate posterior support and anterior guidance, was established and maintained at more than 4 years posttreatment.
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18/38. Otodental syndrome: a case report.

    The purpose of this article is to describe the clinical features of otodental syndrome. A 9-year-old boy presented with dental abnormalities that have been described for otodental syndrome. The characteristic findings included large bulbous crowns in canine and molar teeth of both dentitions, deep vertical enamel fissures separating the cusps of affected molars, and hypoplastic yellow areas on the labial surfaces of the canines. Radiographs revealed the abnormal molars to possibly be the product of fusion of multiple tooth buds. The pulp chambers appeared to be duplicated, and possibly a supernumerary tooth or complex odontoma is present.
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19/38. Vertical control by combining a monoblock appliance in adult class III overclosure treatment.

    Monoblock appliances were used in combination with intermaxillary elastics for treatment of adult skeletal Class III patients. The patients showed predisposing upper incisors problems, significant mobility in patient 1 and root resorption in patient 2, which contraindicated direct intrusion of the incisors. Using the monoblock with selective extrusion of the molars, a clockwise rotation was induced to reduce overbite and to achieve a better profile. It was also possible to reduce the excessive force to the upper incisors during and after treatment, which improved incisor mobility to a physiologic extent (patient 1) and prevented further progression of root resorption (patient 2). Stability was high after the 2-year follow-up, which suggests a stable vertical control approach by using the monoblock appliance in combination with a fixed appliance in adults.
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20/38. Nonsurgical treatment of a patient with a Class III malocclusion.

    A patient with a bilateral Class III molar relationship came to the Department of orthodontics clinic at Case Western Reserve University. Our first choice for treatment was a combination of orthodontic therapy and orthognathic surgery. The patient, however, opted for a nonsurgical approach that took 34 months and involved the extraction of 4 first premolars and a remaining deciduous tooth, and Class III vertical elastics. Although orthodontic treatment was considered to be a second-line alternative, the results suggest that, for some surgical patients, orthodontic treatment alone might be a better choice because of the favorable cost/benefit ratio.
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