The Treatment Of ClassⅢ Anteriors Crossbite With Postoperative Lip Cleft And Alveolar Cleft In Adults

Objective: To discuss the clinical effects of straight arch wire technique in classⅢanteriors crossbite with postoperative lip cleft and alveolar cleft in adults,and the detailsduring orthodontic treatment.Method: One male patient,26years old,was selected in the second hospital affiliatedto dalian medical university in March,2010.The patient was in permanent dentition,withclass Ⅰ relationship in left side molars,and class Ⅲ relationship in right sidemolars,anteriors crossbite.Both side of the canines relationship were class Ⅲ.Thecrowding degree in maxillary was3°,and1°in mandibular.The reverse overjet was3.5mm,overbite was Ⅱ°.There was no obvious compensation in incisors,but13and15were crossbite,14and45,17and47were scissors bite. There were two abnormalteeth in upper right lateral incisor position and23was congential missing,The lowermedline was normal,but upper medline was off to left2mm.The concave in alveolarcould be found in the right side of upper lateral incisor vestibular region.Postoperativescar could be seen from right upper lip to nasal base,and vermilion tubercle shift to rightas secondary deformity.The right side nasal alar collapsed,the shape of nostrils wereasymmetrical.Chin shifted to right,and profile was convex.Straight arch wire techniquewas applied in this case,associated with four first premolars extracted.At early stageNiTi arch wires with rolling chair were used to leveling Spee curve,and eliminate theocclusional force by intruding lower incisors.For reducing the force upon the alveolarcleft zone,strategical bonding brackets was used for upper arch.In middlestage,0.019x0.025stainless steel arch wire associated with functional muscle train wereused to control the torque of upper anteriors,and stainless steel arch wires with rollingchair were used to further eliminate the occlusional force,then increased anchorage ofmolars retrected lower incisors to correct the crossbite and space closure.In the end ofthe treatment,triangle elastic was selected to improve the occlusional relationship and Hawley’s retainer were used for retention.Results: The treatment lasted for33months.The crossbite was corrected,normaloverjet and overbite were obtained,space closed, molars and canines relationship wereclassⅠafter treatment.The medline kept same.From headfilm:SNA did not change,SNBdecreased1°,ANB increased1°,upper incisors axis were controlled,L1/NB decreasedfrom34.5°to17°,FMA was controlled,L1-MP decreased from34mm to31.5mm,L6-MP decreased0.5mm,Wits increased5mm,ULP decreased3°,LLP decreased3.5°,but LsNsLi did not change obviously,Z-angle increased from55°to58°,H-angledecreased from18.5°to16.5°,that indicated both lips did not change in sagittal view,the relationship between lips and chin was corrected,and the soft tissue profile wasimproved.Conclusion: An ideal clinical effects could be obtained by straight arch wiretechnique in adult classⅢ anteriors crossbite with postoperative lip cleft and alveolarcleft.Strategical bonding brackets was chose to reduce the force upon the alveolar cleftregion,and rolling chair was applied to leveling the spee curve,lower incisorsintrusion,eliminate occlusional force,and correct the scissors bite.Then,stainless stellarch wires associated with functional muscle train were added to control upperanteriors torque,and lower incisors retrected to close space and correct crossbite.