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.
Vol.30-4-7 December 2018
Decision Making on Tooth Extraction in Orthodontics
Extraction or non-extraction is an issue that we face in our daily orthodontic practice. Before deciding the
treatment plan, we have to examine the case carefully. Orthodontic tooth extraction involves more than just the
need to create space in the arches but also the concerns of facial esthetics and treatment stability. The report
presented a case of teenage boy with severe external root resorption of tooth 27, 37, 46, 47 which caused
by impaction of third molars and a supernumerary premolar. Patient already had orthodontic treat-ment
before and did not favor a comprehensive orthodontic treatment again. Tooth extraction of 27, 37, 47 and the
supernumerary premolar were conducted. The lingual holding arch with hook was used to upright the mesially
erupted third molar. The opinion and philosophy of the tooth extraction decision making was discussed.
(Taiwanese Journal of Orthodontics. 30(4): 247-255, 2018)
Vol.30-3-1 September 2018
Effect of Home Bleaching Agents on the Surface Corrosion of Stainless Steel Orthodontic Brackets
This in vitro study evaluates the home bleaching treatment effect on the surface corrosion of stainless steel orthodontic brackets.
Cephalometric Analysis of Growth and Treatment with “the Structural Technique: A review of its background and clinical application
Ib Leth Nielsen
The aim of this review is to provide the fundamental basis and scientific evidence for the so-called “Structural Technique.” In this article we will discuss the benefits and challenges this technique presents and compare it to the so-called “best fit” technique. Furthermore, we will introduce the three parts of the analysis, most commonly used for evaluation of growth and treatment changes. The “Structural technique” developed by Professor Arne Björk and his associate Dr. Vibeke Skieller is the result of their longitudinal studies using metallic implants as biological markers.
Vol.30-3-2 September 2018
Orthodontic Correction of Class II Division 2 Malocclusion
Class II division 2 malocclusion has low incidence rate of only 1% in Taiwan. The criteria of diagnosis and treatment consideration is more challenging as compared to other types of malocclusions. The consideration of orthodontic biomechanics could be sophisticated in facing the correction of the molar relationship and the angulation of the anterior teeth. This article discusses the clinical diagnosis and treatment mechanics of Class II division 2 malocclusion.
Surgical Occlusion Setup in Orthognathic Surgery Using Surgery-first Approach for Skeletal Class III Deformity: A Systematic Review
Shu Hsien Lo, DDS, Yu-Fang Liao, DDS, PhD
Surgery-first orthognathic surgery is increasing in popularity because of reduced treatment time, efficient tooth decompensation, and early improvement in facial esthetics. However, it remains difficult due to the surgical occlusion setup. We systematically reviewed the literature in order to determine the guidelines used for surgical occlusion setup in orthognathic-first surgery for skeletal Class III deformity.
Vol.30-3-3 September 2018
An Overview of Digital Intraoral Scanners: Past, Present and Future - From an Orthodontic Perspective
Digital intraoral scanners(IOSs) have become the ongoing trend in contemporary digital orthodontics. This article aims to elaborate the past, present, and future of IOSs from an orthodontist’s perspective. We summarized the comparison between digital and conventional impression in literatures. Also, we discussed about the imaging principles and characteristics of different IOSs. Although unable to recommend the single best option, a checklist of consideration when choosing an IOSs was developed after trailing the mainstream commercial products. With technology revolution, embracing the IOSs may be essential for those interested in future digital orthodontic workflow.
Maxillary Expansion: From Past to Present
Shih-Chieh Chen, Hong-Po Chang, Yu-Chuan Tseng
Maxillary expansion is a common treatment option for upper crowded dentition and posterior lingual crossbite in children and adolescents. As the midpalatal suture is not yet completely interlocked at these ages, the midpalatal suture can be opened via maxillary expansion to increase the length and width of the upper arch. This solves the problems of posterior crossbite and upper crowded dentition. Since the midpalatal suture is stiff in adults, many clinicians believe that adults require surgical intervention to achieve maxillary expansion. However, recent reports indicated that several cases have been treated successfully with the aid of TADs for maxillary expansion. This article discusses the various protocols for performing maxillary expansion from past to present.