Cases reported "Open Bite"

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1/11. A less-invasive approach with orthodontic treatment in Beckwith-Wiedemann patients.

    The beckwith-wiedemann syndrome (BWS) is a rare genetic disorder, linked to an alteration on the short arm of chromosome 11 that comprises multiple congenital anomalies. macroglossia is the predominant finding, with subsequent protrusion of dentoalveolar structures, which results in a protruding mandible, anterior open bite, abnormally obtuse gonial angle and increased mandibular length. A less-invasive treatment with orthopaedic appliances in a patient with early tongue reduction is presented. This work summarizes the oral signs linked to macroglossia, and highlights the influence of macroglossia on mandibular growth structures. In our opinion, glossotomy could be carried out in the paediatric patient as a preventive measure in that it curbs the tongue's influence on skeletal growth and dramatically reduces the duration and extensiveness of subsequent treatment.
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2/11. Bilateral open bite in dicygotic twins. A combined orthodontic-prosthetic approach.

    CASE REPORT: Dizygotic twins, male, 25 years of age, required treatment for an identical orthodontic diagnosis. diagnosis: Class III malocclusion with mesial molar relation and frontal edge-to-edge bite, lyrate upper dental arch, grouped cross-bite and bilateral open bite in the molar and bicuspid region, retention and lingual inclination respectively of the lower left second bicuspid, mesial inclination of both lower first molars. The severity of the malocclusion differed in the two brothers. THERAPY: Orthodontic treatment was successful concerning the transversal expansion and alignment of the maxillary dental arch, the functional relation of the anterior teeth, the transversally correct relation of the upper and lower dental arches and, following surgical removal of the lower second bicuspids, the reduction of crowding in the lower arch. An attempt was made to upright the molars in the mandibular arch and to close the lateral open bite by means of vertical elastics. However, the 10-month period of resistance to the therapy suggested, after a tongue protrusion habit had been ruled out, a diagnosis of ankylosis. Further orthodontic treatment was renounced and a prosthetic solution was pursued instead: the teeth in infraocclusion were treated with full ceramic overlays and, in the regions with residual gaps, with pontics (Empress II, Ivoclar, Schaan, liechtenstein), after minimally invasive preparation (confined to removal of existing fillings). CONCLUSION: This case is particularly interesting because the infrapositioned molars in both brothers were very likely due to ankylosis, suggesting a genetic cause.
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3/11. nickel allergy associated with a transpalatal arch appliance.

    AIM: The purpose of this article was to present a case in which nickel sensitivity of the oral mucosa was demonstrated during the use of a transpalatal arch appliance (TPA). CASE REPORT: An 11-year 8-month old post-menarchal female presented for orthodontic treatment with Class III buccal segments and bilateral open bite. The treatment plan consisted of placing a rapid palatal expansion appliance (RPE) and a TPA with soldered lateral tongue cribs, in order to eliminate her tongue thrusting habit. 8 months into treatment, the gingiva of the right posterior segment began to hypertrophy, particularly around the bands of the right first molar and premolar. A patch test of 5% nickel sulfate indicated a positive reaction to nickel. The treatment was finished without the use of nickel titanium wires and the mucosa reaction resolved. The patient had had her ear pierced at age 2 days old, which was 11 years before orthodontic treatment was initiated. The literature shows that this exposure may have been the sensitizing event. CONCLUSIONS: While the nickel sensitive patient may not present an extreme medical risk, the orthodontist must be aware of the problem and the likelihood of treating patients with this condition. It appears that the reaction may vary from patient to patient. The practitioner should possess a basic understanding of the occurrence rate, sex predilection, and signs and symptoms of allergy to nickel, and should be familiar with the best possible alternative modes of treatment, to provide the safest, most effective care possible in these cases. Practitioners should be aware that symptoms of nickel allergy may closely mimic those of typical gingival changes during orthodontic treatment of circumpubertal children.
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4/11. Case report: orofacial characteristics of Hallermann-Streiff Syndrome.

    BACKGROUND: Hallermann in 1948 and Streiff in 1950 described patients characterised by "bird face", congenital cataract, mandibular hypoplasia, and dental abnormalities. The new syndrome was later defined as Hallermann-Streiff Syndrome (HSS), underlining the differences with regard to Franceschetti's mandibulofacial dysostosis. CASE REPORT: Examination of a white male affected by Hallermann-Streiff Syndrome revealed facial characteristics typical of the "bird face" in HSS. The nose appeared thin, sharp and hooked; the prominence of the chin was absent in the lateral view; a marked microstomia was evident as well. Radiographic records showed aplasia of teeth 14, 13, 12, 22, 24, 35, 34, 33, 32, 31, 41, 42, and 43. As for orthodontic diagnosis, the following dentoskeletal features were assessed: skeletal Class II malocclusion, narrow upper arch, bilateral posterior crossbite, and anterior open bite. Lateral cephalogram showed hypoplasia of the mandible, a typical sign of HSS. The mandible revealed a clockwise rotation growth pattern with an opening of the gonial angle, skeletal anterior open bite, and an excessive vertical dimension of the lower third of the face. Radiographs at the age of 13 years showed an anomaly in shape of the lower right first bicuspid, which appeared with a double crown. TREATMENT: Orthodontic treatment started at 10 years of age with rapid maxillary expansion in the early stages of the mixed dentition, in order to correct the posterior crossbite due to the narrow maxillary arch. A subsequent phase of the orthodontic therapy consisted of a functional appliance with the goal of maintaining the transverse dimension of the dental arches and of controlling the tongue thrust in the anterior open bite. Surgical and prosthetic interventions were scheduled at completion of growth to solve the skeletal discrepancy and for occlusal rehabilitation. FOLLOW-UP: The therapeutic protocol used in the patient presented here was able to reach the orthodontic goals during the developmental ages. Further treatment is planned as there are multiple missing permanent teeth and prosthetic/restorative care is needed until the patient reaches full adulthood.
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5/11. lip sucking and lip biting in the primary dentition: two cases treated with a morphological approach combined with lip exercises and habituation.

    lip sucking and lip biting in the primary-dentition period can cause the upper incisors to tip labially and the lower incisors to collapse lingually with the lower lip wedged between the upper and lower anterior teeth. The resulting lip incompetence further aggravates maxillary protrusion. Thus, there is a causal relationship between lip sucking/lip biting and maxillary protrusion. Orofacial myologists provide lip training to activate the flaccid upper lip and raise the child's awareness to help stop the sucking or biting of the lower lip, sometimes using an oral screen. Two primary-dentition cases with lip sucking and lip biting were treated with a functional appliance (F.A.), resulting in the elimination of the habits in 5 to 6 months along with the improvement of the overjet, overbite and facial profile. The authors prioritize myofunctional therapy (MFT) when treating open bite cases with tongue thrust in the primary dentition. However, the treatment of maxillary protrusion due to lip sucking and lip biting is approached differently with priority given to morphological improvement to create an oral environment that makes lip sucking and lip biting difficult, which is complimented with lip exercises and habituation. This combined approach was found to be effective in breaking the lip-sucking and lip-biting habits.
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6/11. cleft palate and beckwith-wiedemann syndrome.

    OBJECTIVE: patients with beckwith-wiedemann syndrome suffer numerous anomalies, which vary somewhat from case to case. cleft palate in combination with this syndrome has rarely been reported in the literature. Through two cases, this report examines the staging of the surgical repairs and the role of macroglossia in cleft palate and the consequences of the scarred palate on mandibular development. RESULTS: Of four patients with beckwith-wiedemann syndrome, only two had a cleft palate. The timing of the repair in these two children was different. speech development was satisfactory in the first case but mediocre in the second. This result seemed to be related to a poor social environment. Mandibular prognathism persisted in both cases. CONCLUSION: The treatment of patients with cleft palate and beckwith-wiedemann syndrome remains complex. It is preferable not to operate on a cleft palate before performing a tongue reduction plasty, but rather to combine these two surgical interventions. This would reduce the risks of anesthesia and enable the palate to heal more efficiently. Surgical treatment should be performed after the age of 6 months and before problems in speech development occur. An orthognathic surgery at adolescence could be performed if prognathism persists. While the origin of the cleft palate is still being discussed, we cannot claim that macroglossia is related to the development of cleft palate, nor that the scarred palate has an impact on the mandibular development.
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7/11. 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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8/11. An application of a splint purposeful resin-bonded fixed partial denture after orthodontic treatment: a case report.

    An adult male patient who had lost his maxillary left central incisor seven years ago in a traffic accident presented with a chief complaint about his unaesthetic appearance associated with the loss of his maxillary left central incisor space, a Class III molar occlusion, and an anterior open bite malocclusion due to tongue-thrust swallowing. Fixed orthodontic treatment was rendered following fan-type expansion of the maxilla. A maryland bridge as a minimally invasive dentistry approach was used as a retention appliance and the patient's aesthetic appearance was restored.
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9/11. The oral manifestations of Maroteaux-Lamy syndrome (mucopolysaccharidosis vi): a case report.

    Maroteaux-Lamy syndrome is one of the genetic disorders involving disturbances in mucopolysaccharide metabolism resulting in increased storage of acid mucopolysaccharide in various tissues. The basic defect in Maroteaux-Lamy syndrome is a deficiency of arylsulfatase B, which leads to accumulation of dermatan sulfate in tissues and their urinary excretion. The deposition of mucopolysaccharides leads to a progressive disorder involving multiple organs that often results in death in the second decade of life. This disease, which has several oral and dental manifestations, is first diagnosed on the basis of clinical findings. A large head, short neck, corneal opacity, open mouth associated with an enlarged tongue, enlargement of skull, and a long antero-posterior dimension are the main characteristic features. Dental complications can be severe and include unerupted dentition, dentigerous cystlike follicles, malocclusions, condylar defects, and gingival hyperplasia. An 11-year-old boy with Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI) is described in this article, with special emphasis on the oral manifestations.
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10/11. Dynamic MRI evaluation of tongue posture and deglutitive movements in a surgically corrected open bite.

    tongue thrust usually develops in the presence of anterior open bite in order to achieve anterior valve function. In the literature, tongue thrust is described both as the result and the cause of open bite. If it is an adaptation to malocclusion, then tongue posture and deglutitive tongue movements should change after treatment. In this case report, an adult who had skeletal open bite and Class II malocclusion caused by mandibular retrusion was treated surgically. The mandible was advanced in a forward and upward direction with a sagittal split osteotomy. The open bite and Class II malocclusion were corrected and an increase in the posterior airway space (PAS) was observed. Pretreatment and posttreatment dynamic magnetic resonance imaging (MRI) revealed that tongue tip was retruded behind the incisors and contact of the tongue with the palate increased. It was also determined that the anterior and middle portions descended, whereas the posterior portion was elevated at all stages. Advancement of the mandible, correction of open bite, and an increase in PAS affected not only the tongue posture and deglutitive movements, but also the breathing pattern of the patient.
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