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A woman was referred to the orthodontic clinic for treatment. She was diagnosed with a skeletal Class II malocclusion, a steep mandibular plane, and an anterior open bite. Conventional orthodontic treatment was considered to correct the maxillary protrusion and anterior open bite, but the patient also requested improvement of
her facial esthetics. We therefore decided that nonsurgical treatment consisting of 4 premolar extractions combined with temporary anchorage devices was indicated. Satisfactory improvement of the overjet and overbite,
and proper functional occlusion were obtained, resulting in a Class I molar relationship. Active treatment was
completed in 2 years 10 months, and the result remained stable at 2 years 6 months after debonding. (Am J
Orthod Dentofacial Orthop 2016;149:889-98)
In this case report, we demonstrate a nonsurgical orthodontic treatment of an adult with a skeletal Class II
anterior open bite and a large Frankfort-mandibular
plane angle (FMA). Since the patient desired improvement of her facial esthetics along with a suitable occlusion by undergoing orthodontic treatment alone,
nonsurgical treatment combined with TADs was applied.
DIAGNOSIS AND ETIOLOGY
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The patient desired improvement of not only her occlusion but also her facial appearance. The main objectives of treatment were to correct the anterior open bite,
achieve a suitable functional occlusion, and improve her
facial esthetics with a competent lip seal.
TREATMENT ALTERNATIVES
Two treatment options were considered for this patient: (1) surgical orthodontic treatment, which could
improve both occlusion and facial appearance, was the
primary treatment plan of choice; or (2) nonsurgical orthodontic treatment with extraction of the maxillary rst
premolars and mandibular second premolars combined
with TADs for the maxilla and mandible was considered
as an alternative to orthognathic surgery.
These alternatives were discussed with the patient.
TADs would be used to intrude the maxillary and
mandibular molars, resulting in a change in facial
appearance. Since the patient refused surgical
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Fig 3. Pretreatment records: lateral cephalogram, cephalometric tracing, and panoramic radiograph.
Fig 4. Intraoral photographs during active treatment: A, After 4 months of treatment. In the maxillary
arch, to distalize the canines and intrude the molars, power chains were placed between the canines
and the TADs with stainless steel round wire with an increased curve of Spee, for inhibition of the
remarkable lingual inclination of the maxillary incisors. In the mandibular arch, to intrude the mandibular
molars, power chains were placed between the archwire of the molar region and the TADs. B, After
18 months of treatment. The 0.018 3 0.025-in rectangular wires with vertical closing loops were placed
to move the maxillary incisors lingually with maintenance of adequate torque under the condition of reinforced anchorage using TADs in the maxillary arch. The 0.017 3 0.025-in rectangular wires with vertical closing loops were used to move the mandibular molar mesially.
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Fig 7. Posttreatment records: lateral cephalogram, cephalometric tracing, and panoramic radiograph.
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Fig 8. Superimposed cephalometric tracings: A, Sella-nasion at sella for overall change with treatment; B, palatal plane at ANS for maxillary change; C, mandibular plane at mention for mandibular
change. Solid line, Pretreatment; dashed line, posttreatment.
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Fig 11. Postretention records: lateral cephalogram, cephalometric tracing, and panoramic radiograph.
Fig 12. Superimposed cephalometric tracings: A, sella-nasion at sella for overall change during retention; B, palatal plane at ANS for maxillary change; C, mandibular plane at menton for
mandibular change. Solid line, Posttreatment; dashed line, postretention.
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CONCLUSIONS