American Journal of ORTHODONTICS and DENTOFACIAL ORTHOPEDICS Founded in 1915
Volume 101 Number 3
March 1992
Copyright © 1992 by the American Association of Orthodontists
CASE REPORT
Clinical application of the ACCO appliance. Part II David W. Warren, DDS Miami, Fla.
EDITOR'S NOTE: The first part of this series of ACCO case reports by Dr. Warren was published in the February issue of the AJO-DO, vol 101--pages 101-11, 1992. A brief description of the appliance and its advantages and disadvantages is given. The ACCO acronym was suggested by Herbert Margolis, for combination extraoral force and maxillary removable appliance therapy. The "J" hooks from the cervical extraoral appliance insert in the loops bent into the labial wire of the modified Hawley-type appliance. Appropriate finger springs are incorporated for individual tooth movement--usually the maxillary molars. (TMG)
CASE 3 An 11 V2-year-old girl was referred for treatment of a Class II Division 1 malocclusion. Her mother's chief complaint was "her teeth stick out." The patient had a symmetrical face from the front. Her profile was moderately full with a recessive chin, mentalis muscle strain, and the lower lip cushioned the lingual aspect of the maxillary incisors during function (Fig. 1). The casts and photographs showed a severe Class II, Division 1 malocclusion with severe overbite, severe overjet, and a large maxillary diastema. The molars and canines were
8/1/25572
in full Class II relationship. The periodontium and the temporomandihular joints were healthy, and the Bolton analysis was within normal limits (Fig. 2). The cephalogram revealed a Class II malocclusion, with the maxillary and mandibular incisors well related to the NA and NB lines. The skeletal pattern was good (Fig. 3). The treatment plan called for no tooth extraction since the patient was entering her growth spurt and had a good mandibular dental arch (Fig. 4). The nonextraction treatment plan had three continuous phases of treatment, a maxillary anterior alignment and lip bumper wear phase, an ACCO and lip bumper phase, and a full banded phase (Figs. 5 and 6). Treatment time for this case was 33 months. The patient
Fig. 1. Pretreatment facial photographs. 199
200
Warren
Am. J. Orthod. Dentofac. Orthop. March 1992
Fig. 2. Pretreatment intraoral photographs.
Fig. 3. Initial cephalometric tracing.
Fig. 4. Pretreatment panoral radiograph.
Volume lOl Number 3
Case report
Fig. 5. Progress intraoral views in the initial partly banded stage.
Fig, 6, ACCO phase of treatment.
201
202
Warren
Am. J.
Orthod. Dentofac. Orthop. March 1992
Fig. 7. Posttreatment facial views.
Fig, 8. Posttreatment intraoral photographs.
achieved good facial balance and an attractive smile. The occlusion was Class I, and the cephalometric analysis revealed that the maxilla and the mandible were coordinated (Figs. 7 to 10).
CASE 4 A 10~A-year-old boy was referred for treatment of a Class If, Division 1 malocclusion. His mother's chief complaint was "cosmetics."
Volume 101 Number 3
Case report
Fig. 8 (cont'd). Posttreatment intraoral photographs.
Fig. 9. Posttreatment panoral radiograph.
I
B
,a
.._o.
A
C Fig. 10. Posttreatment cephalometric superimpositions.
903
204
Warren
Am. J. Orthod. Dentofac. Orthop. March 1992
~,,~E ~
Fig. 11. Pretreatment facial photographs.
Fig. 12. Pretreatment intraoral photographs.
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Number 3
Fig. 13. Pretreatment panoral radiograph.
Fig. 14. Pretreatment cephalometric tracing.
The patient had a symmetrical face from the front. There was a full profile with mentalis muscle strain, and the lower lip cushioned the lingual aspect of the maxillary incisors during function (Fig. 11). The casts and photographs showed a severe Class II,
Division 1 malocclusion with severe overbite, severe overjet, and maxillary anterior spacing. The molars and canines were in Class II relationship (Fig. 12). The panoramic radiograph revealed that the mandibular left second premolar was congenitally missing (Fig. 13). The periodontium and the tem-
206
Warren
Am. J. Orthod. Dentofac. Orthop. March 1992
Fig. 15. Progress ACCO phase of treatment.
poromandibular joints were healthy, and the Bolton analysis showed an anterior tooth-size discrepancy. The cephalogram revealed a Class II malocclusion with the maxillary incisors forward of the NA line, and the mandibular incisors well related to the NB line. The skeletal pattern was fair (Fig. 14). The treatment plan called for no tooth extraction since the patient was entering his growth spurt and had a good
mandibular dental arch. It was decided to close the space of the missing mandibular left second premolar rather than commit the patient to a lifetime of permanent bridgework. The nonextraction treatment plan used five continuous phases of treatment: an initial maxillary partially banded phase, an ACCO phase, a fully banded phase, a second ACCO phase with mandibular banding, and a second fully banded phase. The second ACCO period was begun because after
Volume 101 Number 3
Case report
Fig. 16. Banding and ACCO combination.
Fig. 17, Posttreatment facial photographs.
207
2(18
Warren
Am. J. Orthod. Dentofac. Orthop. March 1992
Fig. 18. Posttreatment intraoral photographs.
Fig. 19. Posttreatment panoral radiograph.
Volume 101 Number 3
Case report
209
B
I / J
, - - - _-_
~.
',
/eo# \
,
'
*J
w
! I ! I
% I P
A
C Fig. 20, Posttreatment cephalometric superimpositions.
orthodontic appliances were placed in the maxillary arch, headgear cooperation ended, with a resultant loss of the Class I relationship of the posterior teeth. Therefore maxillary anterior appliances were removed and a second ACCO phase was used to reestablish a Class I occlusion of the posterior teeth (Figs. 15 and 16). Treatment time for this case was 39 months. The patient achieved good facial balance and an attractive smile (Fig. 17). The canine and right molar occlusion is Class I, and the
left molar occlusion (where the premolar is missing) is Class II (Fig. 18). The cephalometric analysis indicates that the maxilla and the mandible are well coordinated (Figs. 19 and 20). Reprint requests to:
Dr. David Warren 8821 S.W. 69th Ct. Miami, FL 33156
Volume 101 Number 3
March 1992
Copyright © 1992 by the American Association of Orthodontists
CASE REPORT
Clinical application of the ACCO appliance. Part II David W. Warren, DDS Miami, Fla.
EDITOR'S NOTE: The first part of this series of ACCO case reports by Dr. Warren was published in the February issue of the AJO-DO, vol 101--pages 101-11, 1992. A brief description of the appliance and its advantages and disadvantages is given. The ACCO acronym was suggested by Herbert Margolis, for combination extraoral force and maxillary removable appliance therapy. The "J" hooks from the cervical extraoral appliance insert in the loops bent into the labial wire of the modified Hawley-type appliance. Appropriate finger springs are incorporated for individual tooth movement--usually the maxillary molars. (TMG)
CASE 3 An 11 V2-year-old girl was referred for treatment of a Class II Division 1 malocclusion. Her mother's chief complaint was "her teeth stick out." The patient had a symmetrical face from the front. Her profile was moderately full with a recessive chin, mentalis muscle strain, and the lower lip cushioned the lingual aspect of the maxillary incisors during function (Fig. 1). The casts and photographs showed a severe Class II, Division 1 malocclusion with severe overbite, severe overjet, and a large maxillary diastema. The molars and canines were
8/1/25572
in full Class II relationship. The periodontium and the temporomandihular joints were healthy, and the Bolton analysis was within normal limits (Fig. 2). The cephalogram revealed a Class II malocclusion, with the maxillary and mandibular incisors well related to the NA and NB lines. The skeletal pattern was good (Fig. 3). The treatment plan called for no tooth extraction since the patient was entering her growth spurt and had a good mandibular dental arch (Fig. 4). The nonextraction treatment plan had three continuous phases of treatment, a maxillary anterior alignment and lip bumper wear phase, an ACCO and lip bumper phase, and a full banded phase (Figs. 5 and 6). Treatment time for this case was 33 months. The patient
Fig. 1. Pretreatment facial photographs. 199
200
Warren
Am. J. Orthod. Dentofac. Orthop. March 1992
Fig. 2. Pretreatment intraoral photographs.
Fig. 3. Initial cephalometric tracing.
Fig. 4. Pretreatment panoral radiograph.
Volume lOl Number 3
Case report
Fig. 5. Progress intraoral views in the initial partly banded stage.
Fig, 6, ACCO phase of treatment.
201
202
Warren
Am. J.
Orthod. Dentofac. Orthop. March 1992
Fig. 7. Posttreatment facial views.
Fig, 8. Posttreatment intraoral photographs.
achieved good facial balance and an attractive smile. The occlusion was Class I, and the cephalometric analysis revealed that the maxilla and the mandible were coordinated (Figs. 7 to 10).
CASE 4 A 10~A-year-old boy was referred for treatment of a Class If, Division 1 malocclusion. His mother's chief complaint was "cosmetics."
Volume 101 Number 3
Case report
Fig. 8 (cont'd). Posttreatment intraoral photographs.
Fig. 9. Posttreatment panoral radiograph.
I
B
,a
.._o.
A
C Fig. 10. Posttreatment cephalometric superimpositions.
903
204
Warren
Am. J. Orthod. Dentofac. Orthop. March 1992
~,,~E ~
Fig. 11. Pretreatment facial photographs.
Fig. 12. Pretreatment intraoral photographs.
Volume 101
Case report
205
Number 3
Fig. 13. Pretreatment panoral radiograph.
Fig. 14. Pretreatment cephalometric tracing.
The patient had a symmetrical face from the front. There was a full profile with mentalis muscle strain, and the lower lip cushioned the lingual aspect of the maxillary incisors during function (Fig. 11). The casts and photographs showed a severe Class II,
Division 1 malocclusion with severe overbite, severe overjet, and maxillary anterior spacing. The molars and canines were in Class II relationship (Fig. 12). The panoramic radiograph revealed that the mandibular left second premolar was congenitally missing (Fig. 13). The periodontium and the tem-
206
Warren
Am. J. Orthod. Dentofac. Orthop. March 1992
Fig. 15. Progress ACCO phase of treatment.
poromandibular joints were healthy, and the Bolton analysis showed an anterior tooth-size discrepancy. The cephalogram revealed a Class II malocclusion with the maxillary incisors forward of the NA line, and the mandibular incisors well related to the NB line. The skeletal pattern was fair (Fig. 14). The treatment plan called for no tooth extraction since the patient was entering his growth spurt and had a good
mandibular dental arch. It was decided to close the space of the missing mandibular left second premolar rather than commit the patient to a lifetime of permanent bridgework. The nonextraction treatment plan used five continuous phases of treatment: an initial maxillary partially banded phase, an ACCO phase, a fully banded phase, a second ACCO phase with mandibular banding, and a second fully banded phase. The second ACCO period was begun because after
Volume 101 Number 3
Case report
Fig. 16. Banding and ACCO combination.
Fig. 17, Posttreatment facial photographs.
207
2(18
Warren
Am. J. Orthod. Dentofac. Orthop. March 1992
Fig. 18. Posttreatment intraoral photographs.
Fig. 19. Posttreatment panoral radiograph.
Volume 101 Number 3
Case report
209
B
I / J
, - - - _-_
~.
',
/eo# \
,
'
*J
w
! I ! I
% I P
A
C Fig. 20, Posttreatment cephalometric superimpositions.
orthodontic appliances were placed in the maxillary arch, headgear cooperation ended, with a resultant loss of the Class I relationship of the posterior teeth. Therefore maxillary anterior appliances were removed and a second ACCO phase was used to reestablish a Class I occlusion of the posterior teeth (Figs. 15 and 16). Treatment time for this case was 39 months. The patient achieved good facial balance and an attractive smile (Fig. 17). The canine and right molar occlusion is Class I, and the
left molar occlusion (where the premolar is missing) is Class II (Fig. 18). The cephalometric analysis indicates that the maxilla and the mandible are well coordinated (Figs. 19 and 20). Reprint requests to:
Dr. David Warren 8821 S.W. 69th Ct. Miami, FL 33156
