| Objective: To explore the effects of clinical treatment on soft tissue appearance through the case of an adult skeletal Class Ⅲ high-angle malocclusion and jaw asymmetry deformity patient who has been treated by the straight arch wire technique combined with orthodontic-orthognathic method.Method: A 28-year-old male maxillary retrusion patient with high-angle and jaw asymmetry deformity was selected from the stomatology department of the second affiliated hospital of Dalian Medical University on June 2nd,2015.The patient described that he found himself crossbite and asymmetry when he was young,and the malocclusion had affected masticatory function and appearance,so recently he decided to treat in our hospital.The patient had bad oral habits,such as biased side sleeping,mouth breathing and propping on cheek,We made the diagnosis by checking the patient with clinical examination,model checking and X-ray measurement.Finally,orthodontic treatment combined with orthognathic surgical method was designed for the case after consulting with the patient.After the treatment,we systemically compared the post-treatment clinical examination,model checking and X-ray measurement with pretreatment.We discussed the effects of Orthodontic-orthognathictreatment on soft tissue appearance.Results: The treatment lasted for 20 months.In comparison:(1)Bone tissue: SNA、SNB、NP-FH was normal,Wits changed from-15.2mm to-4mm,APDI changed to 85°,AB-NP decreased by 7°,these meant the sagital relationship of jaws changed from Class Ⅲ to Class Ⅰafter the treatment.Index Post/Ant increased by 8.6°,ANS-Me decreased by 6.4°,FMA decreased by 11.5°,ODI increased by 10°,changed to nearly normal,these indicated anterior face height decreased which made mandibular counterclockwise rotation occurred.Openbite was improved and the vertical relationship of jaws changed from high-angle to nomal-angle.Horizontally,asymmetric rate was generally decreased and recovered to normal degree,and the asymmetry deformity of upper and lower jaws was improved.(2)Teeth: U1-AP decreased by 1.5°,L1-MP increased by 12.5°,L1-OP increased by 11°,these indicated the compensation of the upper and lower incisors was decompensated.After treatment,the molar and canine were both Class Ⅰ on each side,and overjet and overbite were nomal with flat curve of Spee.Teeth arrangement were corrected and width and shape of the upper and lower arch were coordinated with flat curve of Spee and symmetry.The midline of bone、arch and face was the same.(3)Soft tissue: EP-UL increaded by 1.1mm,EP-LL decreaded by 3.3mm,this indicated UL point gets closer to esthetic plane.Upper Lip decreased by 0.3mm,Total Chin increased by 4mm,Total Chin/Upper Lip changed to 0.7,these indicated upper lip changed thinner and total chin changed thicker,which made index of total chin and upper lip was improved.Z-plane increaded by 4°,that indicated lower anterior face appearance was improved but chin thickness was deficient due to the speed of soft tissue rebuild was slow.(4)Others: Clicking of joint 、 masticatory function and cervical vertebrase posture on coronal plane were improved.(5)The effects on soft tissue appearance: From the frontal view,the face was symmetrical and chin was in the midface region.Index of upper、middle and lower face height was coordinated and the ligature of mandibularangle and angulus oris were horizontal.From the lateral view,the profile changed from Class Ⅲ to Class Ⅰ and mentolabial sulcus was normal,but chin soft tissue was thin with a little retrogenia.The masticatory function and appearance of the patient were improved obviously by means of orthodontic-orthognathic treatment.The patient was very satisfied with the result.Conclusion:(1)Adult skeletal Class Ⅲ high-angle malocclusion with jaw asymmetry deformity is a kind of complex case.Jaw exists three-dimensional uncoordination,so the treatment is very difficult.Ideal profile、occlusion and function could be achieved with orthodontic-orthognathic treatment,which cannot be obtained by surgery or orthodontic treatment individually.(2)For the adult skeletal Class Ⅲhigh-angle malocclusion patient who has jaw asymmetry deformity,the orthodontic-orthognathic treatment can effect function and organization struction of stomatognathic system.It could cause temporomandibular joint position changes,oral functional space decreases,upper airway stenosis and surrounding structures changes.Early postoperative occlusal force and masticatory function are effected,then return to nomal level gradually.The temporomandibular joint and mandibular movement limiatation and the pre-treatment temporomandibular joint disorders are restored after treatment. |
PDF Full Text Request