Vol.31-1-1 March 2019
Diagnosis and Management of Impacted Maxillary Canines
Yu-Cheng Hsu, Chia-Tze Kao, Chih-Chen Chou, Wen-Ken Tai, Po-Yu Yang
Maxillary canines play an important role in facial esthetics, since the canine eminence can support the alar and the upper lip. Impacted maxillary canines is a common problem which requires multidisciplinary diagnosis and treatment in dental clinic. The aim of this review is to integrate the studies that include clinical diagnosis and guidelines for management of canine impaction.
Vol.31-1-2 March 2019
Accuracy of Different Sequencing in Bimaxillary Orthognathic Surgery: A Systematic Review and Meta-analysis
Thatchawee Borikanphanitphaisan, Ellen Wen-Ching Ko
Introduction: Compared to the classic maxilla-first sequence in bimaxillary orthognathic surgery,
inverted mandible-sequence has been encouraged for potentially higher accuracy. However, evidence regarding
this topic is lacking. Methods: A systematic review of the literature on different sequencing of bimaxillary
surgery was conducted, gathering from following databases: Cochrane, Pubmed, Scopus, Medline (Ovid),
Web of Science, ScienceDirect. Articles mentioning “sequencing”, “mandible-first”, “orthognathic surgery”
of at least case-report level of evidence were included without restriction. Relevant articles were included
for quality assessment and extracted data for indications of mandible-first sequence from all studies. Metaanalysis of surgical accuracy at upper central incisors in horizontal and vertical dimension was performed from
included experimental studies. Results: The search of initially 619 articles resulted in 9 final articles: 6 case
reports and 3 experimental studies. The four most commonly listed indications for mandible-first approach
included instability of condylar centric relation (CR) position, posterior maxillary downgrafting, when rigid
fixation of maxilla cannot be ascertained, and large maxillomandibular advancements. The pooled analysis of
experimental studies composed of 188 patients (122 females, 66 males). Quality assessment of these studies
resulted as moderate. Meta-analysis revealed no difference of surgical accuracy between both sequencing,
with considerable heterogeneity. Conclusion: Mandible-first approach has been advocated under certain
indications, in order to reduce potential jaw repositioning error and ease of surgical manipulation. Differences
were not found in maxilla repositioning at central incisors, horizontally and vertically between both approaches.
However, the results should be taken with caution because of heterogeneity in study design and outcome
measurements. (Taiwanese Journal of Orthodontics. 31(1): 12-23, 2019)
Vol.31-1-3 March 2019
Use the Lip Bumper Appliance to Control the Lower Lip Biting Habit
Chun-Yu Chen,1,2 Chia-Tze Kao,1,2 Yu-Tin Wu,1,2 Chih-Chen Chou,1,2 Jui-Hsien Yang3
This is a 9 years old boy in mixed dentition stage, with Angle Class I malocclusion, anterior teeth crowding and proclined upper incisors. He was diagnosed with lower lip biting habit. The treatment plan was delivered with two stages treatment, stage 1 was to correct the lip biting habit by using the lip bumper. After four-month observation and lip training, the habit was corrected and the irregularity of lower dentition was decreased. Continued with stage 2 treatment, patient had upper and lower 2x4 fixed appliances to align and level the anterior teeth. The result showed the previous proclined upper incisors were moved palatally, and the lower incisors were moved labially after 3 months of treatment. The total treatment duration was 8 months.
Vol.31-1-4 March 2019
Management of Congenital Missing in Bilateral Mandibular Incisors
Yun-Ting Huang, Chien-Wei Chao, Po-Yu Yang, Chia-Tze Kao
This case report described the management of congenital missing bilateral mandibular central incisors in a 16 years-old female patient who was diagnosed as Angle’s Class I molar malocclusion, canine Class II relationship by a treatment plan of orthodontic space regain. The options of fixed bridge, removable partial denture or dental implants to replace the missing teeth were well explained to the patient by prosthodontic consultation. After the orthodontic alignment, the treatment results demonstrated that the initial profile of the patient was maintained, the missing teeth was later replaced by removable partial denture. The interdisciplinary therapy between orthodontics and prosthodontics should be addressed in cases with hypodontia.
Vol.31-1-5 March 2019
Orthodontic Correction of Transposed Maxillary Canine and First Premolar in Mixed Dentition
Lan-Tien Lin, Yi-Min Liu, Yuen-Yung Tsang
Transposition is rare and occurred commonly on maxillary canine and premolar. To extract or not to
extract, to correct or not to correct the dental transposition teeth, it’s a tough decision. A 12-year-old boy was
referred for orthodontic correction because of bad alignment at upper dentition. His dental age was in late
mixed dentition. Both upper deciduous canines were still retained. Left canine was buccally blocked-out, and
first premolar was in palatal crossbite with the lower premolars. Panoramic film showed impacted upper right
canine and transposed left canine and first premolar. The treatment duration took 3.5 years. The upper left
canine and the first premolar were aligned in correction of tooth position. In addition, the impacted upper
right canine was successfully exposed and aligned. The consideration of treatment plan should include factors
like positions of the crowns and roots, gingival line, smile esthetics, occlusal interferences and treatment
duration. It is important to avoid root interference and root resorption during tooth movement. Bucco-lingual
root inclination and soft tissue management should be addressed during correction of the dental transposition.
Vol.31-1-6 March 2019
The Orthodontic Treatment of Class III Malocclusion with Anterior Cross bite and Severe deep bite
Chieh Yang, Yu-Chuan Tseng
This 22-year-old female presents with skeletal Class III malocclusion, complicated by anterior cross bite, deep bite, and congenital missing of bilateral mandibular second premolars. The treatment modality was full-mouth fixed edgewise appliances. A favorable result of ideal overbite and overjet and closure of bilateral spaces of missing teeth were achieved. The patient was satisfied the improvement of function and esthetics after treatment.
Vol.30-4-1 December 2018
Orthodontic Treatment Management for Congenitally Missing Maxillary Lateral Incisors
Congenitally missing of maxillary lateral incisor is one of the most common agenesis anomalies. The purpose of this review was to present the orthodontic treatment of choice for a malocclusion with missing maxillary lateral incisors. Treatment plans consist of three categories: canine substitution, single-tooth implant and tooth supported restorations. Among which the least invasive option to achieve satisfying function and aesthetics is canine substitution.
Factors such as the profile of the patient, the space analysis of dentition, and the color and shape of canine should be taken into consideration for treatment choice.
Vol.30-4-2 December 2018
Rapid Maxillary Alveolar Expansion in Maxillary Severe Space Deficiency
Although maxillary skeletal palatal expansion was efficient to correct the transverse dental deficiency, the conventional maxillary palatal expansion is still effective in some cases. This case report describes the orthodontic treatment procedure of a 15-year-old female patient who was diagnosed as Angle’s Class I malocclusion with severe space deficiency. The space deficiency of 11 mm was noted in maxillary arch in conjunction with severe overjet, blocked-in lateral incisors, high maxillary vault, posterior crossbite and V shape arch-form. The treatment plan presented non-extraction with rapid maxillary alveolar expansion in
upper arch. The Hyrax expander was used in a rhythm of 2 turns/day. The treatment outcome demonstrated 5 mm transverse expansion after 3 weeks of activation. The fixed orthodontic therapy followed the maxillary expansion. The treatment result indicated harmonious facial profile with a normal overjet and overbite occlusion. It is suggested that correct diagnosis in transverse problems and proper selection of appliance contribute to the good treatment outcome.
Vol.30-4-3 December 2018
Nonsurgical Treatment of an Adult Patient with Bilateral Scissors-bite and Class II Division 2 Malocclusion
This report illustrates a 20 years old female presented a Class II division 2 malocclusion with deep overbite, gummy smile, canted maxillary anterior occlusal plane, low mandibular plane angle and bilateral scissors-bite. Angle's Class II division 2 malocclusion needs to be treated by correcting the inclination of maxillary incisors and lower lip posture. Selective bonding of maxillary anterior teeth and molars were performed to level the occlusal plane and gingival line, thus creating a consonant smile arc. Disocclusion was necessary by using a removable bite plate. Maxillary second premolars and second molars, lower third molars were extracted. The aim was to intrude the elongated maxillary molars and upright the mandibular molars. The treatment of bilateral scissors-bite is more efficient with the help of temporary anchorage devices (TADs). Four titanium bone screws were therefore inserted at maxillary and mandibular posterior regions to intrude and upright the molars even without patient’s compliance. At the end of treatment, a harmonized smile and stable occlusion were accomplished. After one-year retention period, the treatment results still maintained well.
Vol.30-4-4 December 2018
Surgical-Orthodontic Correction in Skeletal Class III Anterior Open Bite with an Ankylosed Maxillary Molar
This case report describes the treatment of a 24-year-old woman with chief complaints of anterior open
bite and long lower jaw. She had a skeletal Class III with concave facial profile, hyperdivergent facial pattern,
long lower facial height, and excessive anterior open bite. Intraoral examination revealed 26 tooth ankyloses
and 32, 42 congenital missing teeth. The 26 was highly-locked, showing root penetrating into the sinus floor.
Treatment was performed with a modified surgery-first approach, which included 5 months of presurgical
alignment phase to upright the 27 mesially-tilted tooth and to correct upper dental midline by 14 extraction.
The surgeries included 3-pieces LeFort I impaction by using 14 and 26 extraction spaces as well as bilateral
sagittal split ramus osteotomies setback with closing rotation and genioplasty. Upper and lower arches
coordinated well soon after surgery. The posterior open bite settled well during postsurgical orthodontic phase.
Appropriate vertical facial proportion and solid interdigitation were achieved after treatment. The treatment had
successfully corrected the anterior open bite and long face problems, concomitantly solved her difficult molar
ankyloses issue during the time of surgery, no further prostheses were required. Pleasing esthetic outcomes
were achieved, contributing to patient’s psychosocial satisfaction.
Vol.30-4-5 December 2018
Orthodontic Treatment Combined with Maxillary Posterior Subapical Osteotomy in Severe Anterior Open Bite
A 29-year-old woman presented with severe anterior open bite (−6 mm). Eight-month presurgical orthodontic treatment involving arch rounding and leveling was performed, with the upper arch treatment from canine to canine only. Bilateral maxillary posterior subapical osteotomy (PSO) for posterior intrusion was performed for 6-week fixation. Postsurgical orthodontic treatment followed, resulting in a total treatment time of 19 months. Cephalometric X-ray superimposition revealed that the anterior overbite was corrected by 9 mm (from -6mm to +3 mm), and the lower mandibular plane angle changed from 38.4° to 35.4°. Therefore, counterclockwise rotation of the mandible improved the facial profile. In conclusion, orthodontic treatment combined with upper posterior intrusion through PSO was useful for correcting severe anterior open bite; it simultaneously achieved a short treatment time and prevented open bite relapse.
Vol.30-4-6 December 2018
Management of Tipped and Impacted Mandibular Second Molars
This is a 12Y11M old girl with mesial tipping of left and right mandibular second molars. The chief compliant was crowding of the teeth. The clinical examination revealed crowding of lower anterior teeth, 13, 23 block out and 47, 37 mesial tipping. The diagnosis was Angle Class I malocclusion with lower anterior crowding and 37, 47 mesial tipping. The treatment plan was four 1st premolars extraction. The treatment goal was to align anterior teeth and upright 37, 47. Two different uprighting spring were applied, one was a hand-bending lever arm appliance on the right second molar, and the other was a prefabricated upright spring on the left second molar. Total treatment duration was 4 months for the 37 and 47 uprighting. Correction of the mesial tipped mandibular molars is important for better oral hygiene care, improving occlusion and chewing function, and facilitating the prosthodontic rehabilitation. The aim of this case report was to interpret etiology of the tipped mandibular molars, and to enumerate the treatment options for uprighting of the mesial tipped mandibular molars.