Journal of Orthodontics, Vol. 40, 2013, 345–351
CLINICAL SECTION
Early interceptive treatment in the primary dentition – a case report Mauro Cozzani1, Laura Mazzotta2 and Paolo Cozzani1 1
Private Practice, La Spezia, Italy; 2Orthodontic Department, Cagliari University, Cagliari, Italy
This article describes treatment of a patient presenting with a class II malocclusion, maxillary and mandibular crowding, posterior crossbite and an increased deep bite, where the specific treatment goals were achieved in the early mixed dentition by only working on the primary teeth. A Haas-type rapid maxillary expansion (RME) appliance was modified to be anchored on the primary second molars and canines and activated once a day, with each activation equal to 0.20 mm. The appliance was blocked after 30 days and left as a retainer. After 6 months, the RME appliance was removed and bands were cemented to the primary second molars in order to apply traction with headgear. After complete eruption of the mandibular central and lateral incisors, sequential slicing of the lower primary teeth was performed to transfer the leeway space from the distal to the mesial part of the arch. When the patient had entered the permanent dentition, a dental class I relationship was achieved, the crossbite corrected and the crowding improved. The overjet and overbite were also improved. No permanent teeth were involved during this phase of treatment. The outcome of this case report shows that it is possible to work only on primary teeth in the mixed dentition and this can be an effective way to correct a class II malocclusion with deep bite, posterior crossbite and maxillary and mandibular crowding. Key words: Deciduous teeth, early treatment, crowding, RME, sequential slicing Received 11 March 2013; accepted 11 May 2013
Introduction The most appropriate timing for the treatment of class II malocclusion is controversial. Some clinicians advocate starting a first phase in the mixed dentition followed by a second phase in the permanent dentition, because in the early mixed dentition, the skeletal growth pattern can be modified.1,2 Others, see no clear advantage in this approach and recommend treatment in the late mixed or early permanent dentition.3–6 The literature indicates that very early treatment should not be thought of as the most efficient way to treat most class II children,7–9 therefore any decision to undertake early intervention should be based on specific indications for each child: early treatment as a standard of care can only be justified if it provides additional benefits to the patient.7 For treatment such as rapid maxillary expansion (RME), which is often undertaken in the early permanent dentition, there may be a number of undesirable effects, such as a buccal tipping,10,11 root resorption12,13 and periodontal damage, such as gingival recession of anchoring teeth.14 These undesirable effects can potentially be prevented by undertaking RME in the mixed dentition: the RME appliance can be anchored to the primary second molars and canines, teeth that will be Address for correspondence: L. Mazzotta, Private Practice, Via Fontevivo 21N, 19125 La Spezia, Italy. Email: [email protected] # 2013 British Orthodontic Society
replaced; and by doing so, the permanent molars do not undergo a direct force.15 Here, we report the case of a patient that presented with a class II malocclusion, maxillary and mandibular crowding, posterior crossbite and an increased deep bite, where specific treatment goals were achieved following treatment in the early mixed dentition, with the appliances only applied to the primary teeth.
Case report AB presented as an 8-year-old Caucasian in the early mixed dentition with a class II division I incisor relationship, bilateral crossbite on the permanent first molars, 9 mm overjet and 5 mm overbite. He also showed crowding in both arches, with an 8 mm Little’s irregularity index in the mandibular arch and 13 mm in the maxillary arch. The panoramic radiograph showed the presence of all permanent teeth besides the maxillary third molar tooth germs. The lateral cephalometric radiograph showed an SNA angle of 81u, a SNPg angle of 76u and an ANPg angle of 5u determining a skeletal class II relationship. His health history and family history were non-contributory (Figures 1–3).
DOI 10.1179/1465313313Y.0000000068
346
Cozzani et al.
Figure 1
Clinical Section
(A, B) Pre-treatment records — facial photos
Figure 3
JO December 2013
Pre-treatment cephalometric radiograph
Treatment plan
Maxillary arch
The treatment plan was divided into two phases: a first phase of early treatment to be undertaken only on the primary teeth and a second phase of treatment with fixed appliances in the permanent dentition. The first phase of treatment aimed to alleviate the crowding, achieve a class I incisor relationship, resolve the posterior crossbite and improve the deep bite. The second phase had the goals of leveling and aligning the dental arches, controlling tip and torque and finishing in the permanent dentition.
A Haas-type RME appliance16 modified for anchorage on the primary second molars and canines was used initially;11,15,17,18 this was activated once a day, with each activation equal to 0.20 mm of expansion. The appliance was blocked after 30 days and was left as a retainer. A cervical headgear was also applied to the primary molar bands of the RME appliance. After 6 months, the RME appliance was removed and bands were cemented onto the second primary molars in order to support the provision of headgear. A class I molar
Figure 2
(A–E) Pre-treatment records — intraoral photos
JO December 2013
Clinical Section
Treatment of malocclusions on primary teeth
347
Figure 4 Maxillary arch during first phase treatment. (A) RME inserted; (B) RME blocked; (C) effects of the headgear; (D) reduction of overjet and overbite
relationship was achieved within 6 months and the headgear was suspended (Figure 4).
Mandibular arch After complete eruption of the permanent central and lateral incisors, sequential slicing of the lower primary teeth was performed as described by Rosa,19 to transfer the leeway space from the distal to the mesial part of the arch and therefore resolve the crowding (Figure 5). After completion of the first phase of treatment, the patient was monitored every 4 months until they entered the permanent dentition. At the beginning of the second phase of treatment, the patient was in the permanent dentition with a class I molar relationship, the molar crossbite had been resolved and the upper and lower crowding improved. Little’s irregularity index had gone from 8 to 4 mm in the mandibular arch and from 13 to 5 mm in the maxillary arch. Overjet and overbite were also improved (Figures 6). No permanent tooth was involved during this early treatment. However, the patient still presented with inferior crowding, rotations on the mandibular incisors and an increased overbite; therefore, he was bonded with fixed appliances in both arches at this point.
with well aligned arches, along with a centered midline. A class I canine and molar relationship was also achieved together with an ideal overjet and overbite and a mutually protected occlusion (Figures 7 and 8). The lateral cephalometric radiograph showed an SNA angle of 81u, a SNPg angle of 79u and an ANPg angle of
Treatment outcome On removal of the fixed appliances, the crowding had been completely corrected and the patient presented
Figure 5 (A, B) Mandibular arch during the first phase treatment
348
Cozzani et al.
Figure 6
Clinical Section
JO December 2013
(A–E) Intraoral photos at starting of phase 2 of treatment
2u, indicating a skeletal class I pattern as a result of favourable mandibular growth (Fig. 9). The patient was seen 4 years later and his occlusion had remained stable, a dental class I relation on the right and on the left were maintained and he still presented with an ideal overjet and overbite (Figure 10). The lateral cephalometric radiograph (Figures 11 and 12) (Table 1) showed an SNA angle of 84u, a SNPg angle of 84.5u and an ANPg angle of 20.5u, indicating a skeletal class I.
Discussion
Figure 7 (A, B) Post-treatment records — facial photos at end of phase 2 of treatment
Figure 8 (A–E) Post-treatment records — intraoral photos at end of phase 2 of treatment
Early mechanotherapy in the mixed dentition, with specific treatment goals may be beneficial for selected patients.8 The patient analysed in this case report presented at the age of 8 years with a dental and skeletal class II relationship, maxillary and mandibular crowding, posterior crossbite and deep bite. What is known from the literature is that posterior crossbite on the first
JO December 2013
Clinical Section
Treatment of malocclusions on primary teeth
349
Figure 9 Post-treatment cephalometric radiograph
Figure 10 (A–C) Post-retention intra-oral photos: 4-year follow-up
permanent molars does not generally self-correct and that a good time for crossbite correction is the early mixed dentition.20 Also, 4–5 mm of lower incisor crowding in the mixed dentition stage of development can usually be treated with non-extraction procedures, if the leeway space is maintained and if treatment is started early enough.21 Moreover, both dental class II22 and deep bite are malocclusions that do not self-correct; in this case, if an early treatment had not been carried out, the alternative would have been a one phase treatment to correct the malocclusion in the permanent dentition, with a likelihood of extractions and potential undesired effects on the dentition. Some studies have also shown that the trans-septal fibres are not determined by tooth anatomy, but by tooth position and orientation within the dental arch during their development, which happens after the teeth erupt.23 There has been some suggestion that these fibres have more
Figure 11 Post-retention cephalometric radiograph
difficulty in adapting to tooth derotation once they have developed.24 This is one of reason why it may be advisable to expand before eruption of the permanent lateral incisors;18 by doing so, trans-septal fibres will develop after the lateral incisors have erupted into the correct position, potentially reducing relapse. Early treatment can be justified only if it provides additional benefits to the patient;7 in this case, the patient had resolution of all skeletal and dental discrepancies working on the primary teeth and then only 11 months of fixed therapy was required in the permanent dentition. We believe that this early intervention was therefore a benefit.
Figure 12 Superimposition of lateral cephalograms: end of treatment and post-retention
350
Cozzani et al.
Table 1
Clinical Section
JO December 2013
Pre-treatment, post-treatment and post-retention cephalometric values. Initial (Jan 1993)
Sagittal skeletal relations Maxillary position: S–N–A Mandibular position: S–-N–Pg Sagittal jaw relation: A–N–Pg Vertical skeletal relations Maxillary inclination: S–N/ANS–PNS Mandibular inclination: S–N/Go–Gn Vertical jaw relation: ANS–PNS/Go–Gn Dento-basal relations Maxillary Incisor Inclination: 1 — ANS-PNS Mandibular incisor inclination: 1 — Go–Gn Mandibular incisor compensation: 1 — A–Pg (mm) Dental relations Overjet (mm) Overbite (mm) Interincisal angle: 1/1
Final (Feb 1997)
Post-retention (Aug 2001)
Mean
81u 76u 5u
81u 79u 2u
84u 84.5u 20.5u
82¡3.5u 82u¡3.5u 2¡2.5u
5u 31u 26u
6u 31u 25u
5u 23u 18u
8¡3u 33¡2.5u 25¡6u
111u 93u 3
112u 101u 5
113u 107u 2
110¡6u 94¡7u 2¡2
9 5 130u
2 2,5 122u
2 2,5 121u
3.5¡2.5 2¡2.5 132¡6u
Conclusion This case report has demonstrated that it is possible to carry out early interceptive treatment on the primary teeth in the early mixed dentition and this can be an effective way to correct a class II malocclusion with deep bite, posterior crossbite and crowding.
References 1. Tulloch JF, Phillips C, Koch G, Proffit WR. The effect of early intervention on skeletal pattern in Class II malocclusion: a randomized clinical trial. Am J Orthod Dentofac Orthop 1997; 111: 391–400. 2. Keeling SD, Wheeler TT, King GJ, et al. Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear. Am J Orthod Dentofac Orthop 1998; 113: 40–50. 3. King GJ, McGorray SP, Wheeler TT, Dolce C, Taylor M. Comparison of peer assessment ratings (PAR) from 1phase and 2-phase treatment protocols for Class II malocclusions. Am J Orthod Dentofacial Orthop 2003; 123: 489–96. 4. Wortham JR, Dolce C, McGorray SP, Le H, King GJ, Wheeler TT. Comparison of arch dimension changes in 1phase vs 2-phase treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop 2009; 136: 65–74. 5. Pavlow SS, McGorray SP, Taylor MG, Dolce C, King GJ, Wheeler TT. Effect of early treatment on stability of occlusion in patients with Class II malocclusion. Am J Orthod Dentofacial Orthop 2008, 133, 235–244. 6. Dolce C, Schader RE, McGorray SP, Wheeler TT. Centrographic analysis of 1-phase versus 2-phase treatment
7.
8.
9.
10.
11.
12.
13.
14.
for Class II malocclusion. Am J Orthod Dentofacial Orthop 2005; 128: 195–200. Tulloch JF, Proffit WR, Phillips C. Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Am J Orthod Dentofacial Orthop 2004; 125: 657–67. Rinchuse DJ, Miles PG. Early intervention: the evidence for and against. In Miles PG, Rinchuse DJ, Rinchuse DJ (eds.). Evidence-based clinical orthodontics, 1st Edn. Hanover Park, IL: Quintessence Publishing Co Inc., 2012, 7–16. O’Brien K, Wright J, Conboy F, et al. Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 2: Psychosocial effects. Am J Orthod Dentofacial Orthop 2003; 124: 488–94; discussion 494–95. Haas AJ. Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod 1970; 57: 219– 55. Silva Filho OG, Prado Montes LA, Torelly LF. Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis. Am J Orthod dentofac Orthop 1995; 107: 268–75. Timms DJ, Moss JP. A histological investigation into the effects of rapid maxillary expansion on the teeth and their supporting tissues. Trans Eur Orthod Soc 1971; 47: 263– 71. Vardimon AD, Graber TM, Voss LR, Lenke J. Determinants controlling iatrogenic external root resorption and repair during and after palatal expansion. Angle Orthod 1991; 61: 113–22. Vanarsdall RL. Periodontal/orthodontic interrelationships. In Graber TM, Swain BF (eds.). Orthodontics, Current principles and techniques. St Louis, MO: Mosby, 1994, 715– 21.
JO December 2013
Clinical Section
15. Cozzani M, Rosa M, Cozzani P, Siciliani G. Primary dentition-anchored rapid maxillary expansion in cross-bite and non-cross-bite mixed dentition patients: reaction of the permanent first molar. Prog Orthod 2003; 4: 15–22. 16. Haas AJ. The treatment of the maxillary deficiency by opening the mid-palatal suture. Angle Orthod 1965; 35: 200– 17. 17. Cozzani M, Guiducci A, Mireghi S, Mutinelli S, Siciliani G. Arch width changes with a rapid maxillary expansion appliance anchored to the primary teeth. Angle Orthod 2007; 77: 296–302. 18. Mutinelli S, Cozzani M, Manfredi M, Bee M, Siciliani G. Dental arch changes following rapid maxillary expansion. Eur J Orthod 2008; 30: 469–76. 19. Rosa M, Cozzani M, Cozzani G. Sequential slicing of lower deciduous teeth to resolve incisor crowding. J Clin Orthod 1994; 28: 596–99.
Treatment of malocclusions on primary teeth
351
20. Thilander B, Wahlund S, Lennartsson B. The effect of early interceptive treatment in children with posterior cross-bite. Eur J Orthod 1984; 6: 25–34. 21. Gianelly AA. Leeway space and the resolution of crowding in the mixed dentition. Semin Orthod 1995; 1: 188–94. 22. Stahl F, Baccetti T, Franchi L, McNamara JA, Jr. Longitudinal growth changes in untreated subjects with Class II Division 1 malocclusion. Am J Orthod Dentofacial Orthop 2008; 134: 125–37. 23. Kusters ST, Kuijpers-Jagtman AM, Maltha JC. An experimental study in dogs of transseptal fiber arrangement between teeth, which have emerged in rotated or nonrotated positions. J Dent Res 1991; 70: 192–97. 24. Edwards JG. A long-term prospective evaluation of the circumferential supercrestal fiberotomy in alleviating orthodontic relapse. Am J Orthod Dentofac Orthop 1988; 93: 380– 87.
CLINICAL SECTION
Early interceptive treatment in the primary dentition – a case report Mauro Cozzani1, Laura Mazzotta2 and Paolo Cozzani1 1
Private Practice, La Spezia, Italy; 2Orthodontic Department, Cagliari University, Cagliari, Italy
This article describes treatment of a patient presenting with a class II malocclusion, maxillary and mandibular crowding, posterior crossbite and an increased deep bite, where the specific treatment goals were achieved in the early mixed dentition by only working on the primary teeth. A Haas-type rapid maxillary expansion (RME) appliance was modified to be anchored on the primary second molars and canines and activated once a day, with each activation equal to 0.20 mm. The appliance was blocked after 30 days and left as a retainer. After 6 months, the RME appliance was removed and bands were cemented to the primary second molars in order to apply traction with headgear. After complete eruption of the mandibular central and lateral incisors, sequential slicing of the lower primary teeth was performed to transfer the leeway space from the distal to the mesial part of the arch. When the patient had entered the permanent dentition, a dental class I relationship was achieved, the crossbite corrected and the crowding improved. The overjet and overbite were also improved. No permanent teeth were involved during this phase of treatment. The outcome of this case report shows that it is possible to work only on primary teeth in the mixed dentition and this can be an effective way to correct a class II malocclusion with deep bite, posterior crossbite and maxillary and mandibular crowding. Key words: Deciduous teeth, early treatment, crowding, RME, sequential slicing Received 11 March 2013; accepted 11 May 2013
Introduction The most appropriate timing for the treatment of class II malocclusion is controversial. Some clinicians advocate starting a first phase in the mixed dentition followed by a second phase in the permanent dentition, because in the early mixed dentition, the skeletal growth pattern can be modified.1,2 Others, see no clear advantage in this approach and recommend treatment in the late mixed or early permanent dentition.3–6 The literature indicates that very early treatment should not be thought of as the most efficient way to treat most class II children,7–9 therefore any decision to undertake early intervention should be based on specific indications for each child: early treatment as a standard of care can only be justified if it provides additional benefits to the patient.7 For treatment such as rapid maxillary expansion (RME), which is often undertaken in the early permanent dentition, there may be a number of undesirable effects, such as a buccal tipping,10,11 root resorption12,13 and periodontal damage, such as gingival recession of anchoring teeth.14 These undesirable effects can potentially be prevented by undertaking RME in the mixed dentition: the RME appliance can be anchored to the primary second molars and canines, teeth that will be Address for correspondence: L. Mazzotta, Private Practice, Via Fontevivo 21N, 19125 La Spezia, Italy. Email: [email protected] # 2013 British Orthodontic Society
replaced; and by doing so, the permanent molars do not undergo a direct force.15 Here, we report the case of a patient that presented with a class II malocclusion, maxillary and mandibular crowding, posterior crossbite and an increased deep bite, where specific treatment goals were achieved following treatment in the early mixed dentition, with the appliances only applied to the primary teeth.
Case report AB presented as an 8-year-old Caucasian in the early mixed dentition with a class II division I incisor relationship, bilateral crossbite on the permanent first molars, 9 mm overjet and 5 mm overbite. He also showed crowding in both arches, with an 8 mm Little’s irregularity index in the mandibular arch and 13 mm in the maxillary arch. The panoramic radiograph showed the presence of all permanent teeth besides the maxillary third molar tooth germs. The lateral cephalometric radiograph showed an SNA angle of 81u, a SNPg angle of 76u and an ANPg angle of 5u determining a skeletal class II relationship. His health history and family history were non-contributory (Figures 1–3).
DOI 10.1179/1465313313Y.0000000068
346
Cozzani et al.
Figure 1
Clinical Section
(A, B) Pre-treatment records — facial photos
Figure 3
JO December 2013
Pre-treatment cephalometric radiograph
Treatment plan
Maxillary arch
The treatment plan was divided into two phases: a first phase of early treatment to be undertaken only on the primary teeth and a second phase of treatment with fixed appliances in the permanent dentition. The first phase of treatment aimed to alleviate the crowding, achieve a class I incisor relationship, resolve the posterior crossbite and improve the deep bite. The second phase had the goals of leveling and aligning the dental arches, controlling tip and torque and finishing in the permanent dentition.
A Haas-type RME appliance16 modified for anchorage on the primary second molars and canines was used initially;11,15,17,18 this was activated once a day, with each activation equal to 0.20 mm of expansion. The appliance was blocked after 30 days and was left as a retainer. A cervical headgear was also applied to the primary molar bands of the RME appliance. After 6 months, the RME appliance was removed and bands were cemented onto the second primary molars in order to support the provision of headgear. A class I molar
Figure 2
(A–E) Pre-treatment records — intraoral photos
JO December 2013
Clinical Section
Treatment of malocclusions on primary teeth
347
Figure 4 Maxillary arch during first phase treatment. (A) RME inserted; (B) RME blocked; (C) effects of the headgear; (D) reduction of overjet and overbite
relationship was achieved within 6 months and the headgear was suspended (Figure 4).
Mandibular arch After complete eruption of the permanent central and lateral incisors, sequential slicing of the lower primary teeth was performed as described by Rosa,19 to transfer the leeway space from the distal to the mesial part of the arch and therefore resolve the crowding (Figure 5). After completion of the first phase of treatment, the patient was monitored every 4 months until they entered the permanent dentition. At the beginning of the second phase of treatment, the patient was in the permanent dentition with a class I molar relationship, the molar crossbite had been resolved and the upper and lower crowding improved. Little’s irregularity index had gone from 8 to 4 mm in the mandibular arch and from 13 to 5 mm in the maxillary arch. Overjet and overbite were also improved (Figures 6). No permanent tooth was involved during this early treatment. However, the patient still presented with inferior crowding, rotations on the mandibular incisors and an increased overbite; therefore, he was bonded with fixed appliances in both arches at this point.
with well aligned arches, along with a centered midline. A class I canine and molar relationship was also achieved together with an ideal overjet and overbite and a mutually protected occlusion (Figures 7 and 8). The lateral cephalometric radiograph showed an SNA angle of 81u, a SNPg angle of 79u and an ANPg angle of
Treatment outcome On removal of the fixed appliances, the crowding had been completely corrected and the patient presented
Figure 5 (A, B) Mandibular arch during the first phase treatment
348
Cozzani et al.
Figure 6
Clinical Section
JO December 2013
(A–E) Intraoral photos at starting of phase 2 of treatment
2u, indicating a skeletal class I pattern as a result of favourable mandibular growth (Fig. 9). The patient was seen 4 years later and his occlusion had remained stable, a dental class I relation on the right and on the left were maintained and he still presented with an ideal overjet and overbite (Figure 10). The lateral cephalometric radiograph (Figures 11 and 12) (Table 1) showed an SNA angle of 84u, a SNPg angle of 84.5u and an ANPg angle of 20.5u, indicating a skeletal class I.
Discussion
Figure 7 (A, B) Post-treatment records — facial photos at end of phase 2 of treatment
Figure 8 (A–E) Post-treatment records — intraoral photos at end of phase 2 of treatment
Early mechanotherapy in the mixed dentition, with specific treatment goals may be beneficial for selected patients.8 The patient analysed in this case report presented at the age of 8 years with a dental and skeletal class II relationship, maxillary and mandibular crowding, posterior crossbite and deep bite. What is known from the literature is that posterior crossbite on the first
JO December 2013
Clinical Section
Treatment of malocclusions on primary teeth
349
Figure 9 Post-treatment cephalometric radiograph
Figure 10 (A–C) Post-retention intra-oral photos: 4-year follow-up
permanent molars does not generally self-correct and that a good time for crossbite correction is the early mixed dentition.20 Also, 4–5 mm of lower incisor crowding in the mixed dentition stage of development can usually be treated with non-extraction procedures, if the leeway space is maintained and if treatment is started early enough.21 Moreover, both dental class II22 and deep bite are malocclusions that do not self-correct; in this case, if an early treatment had not been carried out, the alternative would have been a one phase treatment to correct the malocclusion in the permanent dentition, with a likelihood of extractions and potential undesired effects on the dentition. Some studies have also shown that the trans-septal fibres are not determined by tooth anatomy, but by tooth position and orientation within the dental arch during their development, which happens after the teeth erupt.23 There has been some suggestion that these fibres have more
Figure 11 Post-retention cephalometric radiograph
difficulty in adapting to tooth derotation once they have developed.24 This is one of reason why it may be advisable to expand before eruption of the permanent lateral incisors;18 by doing so, trans-septal fibres will develop after the lateral incisors have erupted into the correct position, potentially reducing relapse. Early treatment can be justified only if it provides additional benefits to the patient;7 in this case, the patient had resolution of all skeletal and dental discrepancies working on the primary teeth and then only 11 months of fixed therapy was required in the permanent dentition. We believe that this early intervention was therefore a benefit.
Figure 12 Superimposition of lateral cephalograms: end of treatment and post-retention
350
Cozzani et al.
Table 1
Clinical Section
JO December 2013
Pre-treatment, post-treatment and post-retention cephalometric values. Initial (Jan 1993)
Sagittal skeletal relations Maxillary position: S–N–A Mandibular position: S–-N–Pg Sagittal jaw relation: A–N–Pg Vertical skeletal relations Maxillary inclination: S–N/ANS–PNS Mandibular inclination: S–N/Go–Gn Vertical jaw relation: ANS–PNS/Go–Gn Dento-basal relations Maxillary Incisor Inclination: 1 — ANS-PNS Mandibular incisor inclination: 1 — Go–Gn Mandibular incisor compensation: 1 — A–Pg (mm) Dental relations Overjet (mm) Overbite (mm) Interincisal angle: 1/1
Final (Feb 1997)
Post-retention (Aug 2001)
Mean
81u 76u 5u
81u 79u 2u
84u 84.5u 20.5u
82¡3.5u 82u¡3.5u 2¡2.5u
5u 31u 26u
6u 31u 25u
5u 23u 18u
8¡3u 33¡2.5u 25¡6u
111u 93u 3
112u 101u 5
113u 107u 2
110¡6u 94¡7u 2¡2
9 5 130u
2 2,5 122u
2 2,5 121u
3.5¡2.5 2¡2.5 132¡6u
Conclusion This case report has demonstrated that it is possible to carry out early interceptive treatment on the primary teeth in the early mixed dentition and this can be an effective way to correct a class II malocclusion with deep bite, posterior crossbite and crowding.
References 1. Tulloch JF, Phillips C, Koch G, Proffit WR. The effect of early intervention on skeletal pattern in Class II malocclusion: a randomized clinical trial. Am J Orthod Dentofac Orthop 1997; 111: 391–400. 2. Keeling SD, Wheeler TT, King GJ, et al. Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear. Am J Orthod Dentofac Orthop 1998; 113: 40–50. 3. King GJ, McGorray SP, Wheeler TT, Dolce C, Taylor M. Comparison of peer assessment ratings (PAR) from 1phase and 2-phase treatment protocols for Class II malocclusions. Am J Orthod Dentofacial Orthop 2003; 123: 489–96. 4. Wortham JR, Dolce C, McGorray SP, Le H, King GJ, Wheeler TT. Comparison of arch dimension changes in 1phase vs 2-phase treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop 2009; 136: 65–74. 5. Pavlow SS, McGorray SP, Taylor MG, Dolce C, King GJ, Wheeler TT. Effect of early treatment on stability of occlusion in patients with Class II malocclusion. Am J Orthod Dentofacial Orthop 2008, 133, 235–244. 6. Dolce C, Schader RE, McGorray SP, Wheeler TT. Centrographic analysis of 1-phase versus 2-phase treatment
7.
8.
9.
10.
11.
12.
13.
14.
for Class II malocclusion. Am J Orthod Dentofacial Orthop 2005; 128: 195–200. Tulloch JF, Proffit WR, Phillips C. Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Am J Orthod Dentofacial Orthop 2004; 125: 657–67. Rinchuse DJ, Miles PG. Early intervention: the evidence for and against. In Miles PG, Rinchuse DJ, Rinchuse DJ (eds.). Evidence-based clinical orthodontics, 1st Edn. Hanover Park, IL: Quintessence Publishing Co Inc., 2012, 7–16. O’Brien K, Wright J, Conboy F, et al. Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 2: Psychosocial effects. Am J Orthod Dentofacial Orthop 2003; 124: 488–94; discussion 494–95. Haas AJ. Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod 1970; 57: 219– 55. Silva Filho OG, Prado Montes LA, Torelly LF. Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis. Am J Orthod dentofac Orthop 1995; 107: 268–75. Timms DJ, Moss JP. A histological investigation into the effects of rapid maxillary expansion on the teeth and their supporting tissues. Trans Eur Orthod Soc 1971; 47: 263– 71. Vardimon AD, Graber TM, Voss LR, Lenke J. Determinants controlling iatrogenic external root resorption and repair during and after palatal expansion. Angle Orthod 1991; 61: 113–22. Vanarsdall RL. Periodontal/orthodontic interrelationships. In Graber TM, Swain BF (eds.). Orthodontics, Current principles and techniques. St Louis, MO: Mosby, 1994, 715– 21.
JO December 2013
Clinical Section
15. Cozzani M, Rosa M, Cozzani P, Siciliani G. Primary dentition-anchored rapid maxillary expansion in cross-bite and non-cross-bite mixed dentition patients: reaction of the permanent first molar. Prog Orthod 2003; 4: 15–22. 16. Haas AJ. The treatment of the maxillary deficiency by opening the mid-palatal suture. Angle Orthod 1965; 35: 200– 17. 17. Cozzani M, Guiducci A, Mireghi S, Mutinelli S, Siciliani G. Arch width changes with a rapid maxillary expansion appliance anchored to the primary teeth. Angle Orthod 2007; 77: 296–302. 18. Mutinelli S, Cozzani M, Manfredi M, Bee M, Siciliani G. Dental arch changes following rapid maxillary expansion. Eur J Orthod 2008; 30: 469–76. 19. Rosa M, Cozzani M, Cozzani G. Sequential slicing of lower deciduous teeth to resolve incisor crowding. J Clin Orthod 1994; 28: 596–99.
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