Ectopic Canines
Transcript of Ectopic Canines
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1. Orthognathic cases:Treatment stages
PRE SURGERY (18months-2 years) Relieve crowding Level and align Decompensate Co ordinate arches
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Relieve crowding
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Level and align
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Decompensation(reverse dental compensations)
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Co-ordinate
Width of upper and lower arches need to
match
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Case 1: CT
Class III incisors, class III dental base,
increased vertical proportions
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TCInitialappearance
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SNA = 73SNB = 85.5
ANB = -12.5
UiMx = 103.5
LiMn = 68
MMPA = 34
LFH % = 62
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Treatment plan
Orthodontic maxillary expansion, aiming
for arch co-ordination Decompensation incisors
Bimaxillary osteotomy
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TC: Pre-op orthodontics
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SNA = 72SNB = 79.4
ANB = -7.2
UiMx = 116
LiMn = 94
MMPA = 33
LFH % = 58.5
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Surgical plan
Maxillary adv = 8mm
Impaction 2mm
Mandible set back =
4mm
Adv genioplasty = 5mm
Simuluted prediction
shown on right
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SNA = 78SNB = 74
ANB = 4(5.5)
UiMx = 111.5
LiMn = 87
MMPA = 40
LFH % = 58
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Final facialappearance
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Prediction & actual appearance
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Pre-op & post op
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Case 2: BG
II/I incisors, Class II skeletal base,
increased vertical proportions AOB = -8mm
OJ = 10mm Deep labiomental fold, active mentalis,
retroclination LLS
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Aims of treatment
Align & level arches
Relieve crowding Correct Class II skeletal pattern
Close AOB Reduce OJ
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Treatment plan
Extract lower 2 nd premolars to relieve crowdingand allow some contraction lower arch
Expansion upper arch with quadhelix (arch co-ordination)
Level & align, decompensate using In-ovationbrackets, Roth prescription Bimaxillary osteotomy (maxillary posterior
impaction and advancement, mandibular forward slide)
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Overjet 11.0 mmOverbite -9.5 mmUI/MxP 115.0 LI/MnP 83.5 LI-APo -3.0 mm
SNA 79.5 SNB 75.5
ANB 4.0 MxP/MnP 37.0
LAFH/TAFH 58.5 %
Start
11/09/02: 1 st visit
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Extractions lower 5/5. L014 Sentalloy. Full engagement. SS tubing. Bendbacks ends of wire
11/09/02: 1 visit
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1 st visit
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Upper 014 Sentalloy, Lower 19 25 SS. 7s banded
28/05/03: 6th visit , 8 months into treatment. Upper arch bonded 4 months ago.
23/10/02: 2 nd visit: Lacebacks removed. Retie
h l
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Enough space to align UL2.Piggy back (012 niti)
02/07/03: Visit 7 .Creating more spacefor UR2
Traction ligatures lower arch.Light force to preventproclination of LLS duringlevelling
13/02/04: Visit 10
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13/02/04: Visit 10
UL 1925 SS
Rims taken: orthodonticexpansion insufficient toaddress arch widthdiscrepancyQuad removed to allowuprighting upper molars
OJ = 10mmOB = -7mm
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Surgical procedure
Bimaxillary osteotomy: Posterior maxillary
impaction (3mm), maxillary advancement3mm), mandibular forward slide 11mm 2 part maxilla with midline split (for
surgical expansion) Reduction genioplasty (vertical & horizo
ntal)
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Titanium miniplates
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6 weeks post-op
Seating elastics worn full time
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10 weeks post-opDebond next visitComposite build up
UL2
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4 weeks post debondComposite restoration UL2
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Summary
15 visits pre-surgery
4 visits post-surgery Time in fixed appliances = 30 months
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Case 3: SA
II/II incisors on skeletal II base with
reduced vertical proportions Gingival trauma LLS
Full unit Class II buccal segments
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Start Study models: Note gingival stripping (LR1, LL1)
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Sta t Study ode s: ote g g va st pp g ( , )
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Pre-op OPT: Note extensive caries LR6
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Visit 1Upper arch bondedU 016 Sentalloy
Owing to recession 1/1, LLS left off archwire, protection with bumpa sleeve
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Upper 1925 SS, lower 018SS. Retraction of buccal segments
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Upper 1925 SS, lower 018SS. Retraction of buccal segmentsbefore engagement of 2/2 to avoid proclination of lower incisors
Pre-op lateralcephalogramPre-op profile
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p g
OPAL tracing pre-op
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g p p
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OPAL prediction: Mandibular advancement = 7mm
Post-op profile Post-op lateral ceph
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Post op OPT
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Post-op OPT
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Final photos
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3 months postdebond
Note healthylabial gingiva
Case 4: KB
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Case 4: KB
Class III incisors on skeletal I base,
average vertical proportions
KB
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KB
Age 16
Previous loss
4/4
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SNA = 80
SNB = 76.5
ANB = 3.5UiMx = 108.5
LiMn = 101.5MMPA = 32
LFH % = 56
Aetiology
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Aims of treatment
Align upper arch
Segmental mandibular surgery
Extract lower 1 st p/molars
intra-operatively
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SNA 80 5
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SNA = 80.5
SNB = 76
ANB = 5
UiMx = 110
LiMn = 97.5
MMPA = 38.5
LFH % = 59.5
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Surgery: Hofer type procedure
4/4 extracted at the time of surgery
Anterior segment set back and fixed with plates
Continous archwire placed at the time of surgery
10 weekspost surgery
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post surgery
SNA = 78 5
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SNA = 78.5
SNB = 75
ANB = 3.5
UiMx = 112.5
LiMn = 86.5
MMPA = 35
LFH % = 55.5%
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Case 5
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II/I incisors on class II skeletal base,average vertical proportions
R.M.
Severe
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crowdingMandibular retrognathia
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Start Ceph: 06/07/2000
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SNA = 78SNB = 71.5
ANB = 6.5
UiMxP = 120/93.9Li MnP = 96.5MxMn = 23.5
Treatment plan
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Lip Bumpa Palatal arch Extraction all first premolars U & L standard width system-r brackets.
Roth prescription Alignment, levelling, correction centre line,
space closure Mandibular advancement
1st visit:
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PA to de-rotate 6/6Lip bumpa
Extraction 4/44/4
3 rd visit
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4 th visit
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5th visit: 1/ engaged
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Visit 9: U&L 1925 SS12 months into treatment
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Pre-op U&L 2125 SS with ball hooks
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SNA = 77.4SNB = 71ANB = 6.4
UiMx = 118LiMn = 93
MxMn = 23.7
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Pre-op Post-op
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