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х ү э э Skeletal CIII, Openbite tendency and Dental CIII malocclusion with upper anterior severe crowding
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Enkhjin.Ch1, Tserenlham.Ts1 State Dental Clinic1, chinbatenkhjin@yahoo.com
1. Abstract A 16 years old client with Skeletal CIII and openbite tendency, Dental CIII malocclusion with upper severe crowding. The chief concerns were about tooth crowding. He had CIII molar relationship on both sides, -0.82 mm overjet. The clinical examination showed a symmetrical face, competent lips, slight convex lateral profile. Follow up examination revealed an improved facial profile, normal overjet, and overbite, and good intercuspation. The patient was satisfied with his occlusion, smile, and facial appearance. The result suggest that orthodontic camouflage by using the Standart technique could be an effective option for correcting occlusal plane. 2. Case summary The treatment with the extraction of 15,24,34,44 is proceeding 1.6 years. In the treatment of case with premolars extraction, it was important to control the torque of anterior teeth. 3. Initial records Initial extraoral photographs
Initial oral photograph
Severe crowding of upper anterior teeth Overbite 0mm Overjet -0.82mm
Model analysis Upper arch discrepancy 9.3mm Lower arch discrepancy 2.83mm Curve of Spee 0.55mm

Bolton index: anterior ratio 76.2%, over all ratio 90.4%
o Initial laterial cephalometric and measurement Normal
Pre Tx.
FMIA
67.0
58.5
FMA
25.0
28
IMPA
88.0
93.5
SNA
82.0
76
SNB
80.0
76
ANB
2.0
0
AO-BO
2mm
7.5
OCC.Plane
10.0
13
Z Angle
75.0
69.5
Upper lip
=
15
Total chin
=
14
Post.facial Ht
45mm
51
Ant.facial Ht
65mm
69
Index Post/Ant
.69
73.9
Post - Tx
o Initial panoramic radiograph o No abnormalities in the number and morphology of the dentition o Impacted third molars 4. Diagnosis and treatment plan
Problem list Skeletal Class III skeletal tendency Open bite tendency Slightly convex profile Retrusive maxilla
Dental: Molar and Canine relationship CIII Anterior crossbite Severe crowding in the upper arch Asymmetrical arch shape Impacted third molar
Diagnosis
Skeletal CIII, openbite tendency and dental CIII malocclusion with upper anterior severe crowding
Treatment plan o Scaling, OHI, guidelines to follow o Refer for speech specialist for consultation o Extraction (15, 24, 34, 44) o Metal, Standard edgewise 0.22 DBS o Extraction o Retention Treatment procedures
First six months of treatment: 0.12-0.18 Niti wires and 0.016x0.022 SS arch wires inserted for leveling and aligned.
0.017x0.25 SS arch wire + 0.18 Niti arch wire (double arch) for high canine. Now U/L – 0.018x0.025 SS arch wires inserted and up down elastics 3/16 1. Last records
Normal
Pre - Tx.
Post - Tx
FMIA
67.0
58.5
69
FMA
25.0
28
30
IMPA
88.0
93.5
81
SNA
82.0
76
76
SNB
80.0
76
74
ANB
2.0
0
2
AO-BO
2mm
7.5
4.5
OCC.Plane
10.0
13
11
Z Angle
75.0
69.5
74
Upper lip
=
15
14.5
Total chin
=
14
12.5
Post.facial Ht
45mm
51
55
Ant.facial Ht
65mm
69
72
Index Post/Ant
.69
73.9
76.3
Initial position last position
Conclusion Rare and severe tooth crowding and positional anomalies that create many orthodontic problems from esthetic and functional point of view. In this report we describe a case of orthodontic management of the torque of the upper and lower incisors, anteroposterior and transverse skeletal changes. The client was treated with a standard edgewise appliance and the extraction of premolars. This procedure allowed a more harmonious occlusal relationship at the canine level and provided better occlusal stability of the final result.
