The Orthodontic ?Surgical And Prosthodontic Treatment On Skeletal ? With Mandibular Asymmetry

Objective: to assess the clinical effects of orthodontic?surgical and Prosthodontic treatment on skeletal III with mandibular asymmetry and dentition defect.Materials and methods: one skeletal III with mandibular asymmetry patient was selected in Orthodontics Department of The First Affiliated Hospital of Dalian Medical University.The patient had a concave profile,its face was not symmetrical,its jaw tilted to right,its face tilted to right,its underjaw stuck out and was high-angle,its anterior teeth had malocclusion with open bite and its right teeth cross bit;left molar relationship was fully mesial and right molar relationship was mesial and canine-to-canine.The upper dental arch was too narrow to match with the lower dental arch.The lower middle line tilted rightwards about 7mm.16 had residual root,11,12 and 13 had treatment history and porcelain-fused-to-metal bridge,24 and 26 were lost,23/24/25/26 had porcelain-fused-to-metal bridge,36 was lost,35/36/37 had porcelain-fused-to-metal bridge,and 46 was deep cries.Alveolar bone was absorbed slightly.Mandibular body on both sides and mandibular ramus were not symmetrical and the shape of condyle process was not symmetrical.One week before the treatment,a lateral X-ray photograph and a posterior-anterior photograph for head was taken to specifically measure the 35 soft and hard tissue indexes of lateral head and the 12 indexes of the anterior and posterior sections of head.Then,the sagittalis and vertical direction of soft and hard tissues and the symmetrical changes of face of the patient before and after correction were observed and analyzed;orthodontic and surgicaltreatment was adopted to correct skeletal III with mandibular asymmetry,including preoperative orthodontic and decompensation treatment,postoperative orthodontic and intense adjustment treatment and the prosthetic treatment after orthodontic treatment.Results: after 22 months of correction,the widths of dental arches of upper and lower jaws matched with each other,the good occlusal relation was achieved,the molar relation is neutralizing,the overbite and coverage of anterior teeth was basically normal and mandibular asymmetry was improved greatly.The analysis of soft tissues before and after treatment: SNB decreased by 4.5°,ANB increased by 3°,Wits value decreased by 9mm,the upper and lower dental axes were vertical,and after operation the proportion that lower dental axes were higher than lower dental axes was basically normal.The analysis of soft tissues before and after treatment: the lateral profile of preumbonal soft tissues of underjaw was improved and approximately vertical.The posterior-anterior photographs of head before and after treatment: the asymmetry ratio of the symmetrical structures on the both sides of face decreased obviously.Seeing from the front,the patient's jaw was basically in the middle.The patient was satisfied with its face.The adjustment after orthodontic treatment eliminated those symptoms including uncomfortable occlusion and muscular soreness,the later prosthodontic treatment built the wide occlusion of cannies and fossea and recovered the shape and functions of lost teeth.Conclusion: the patient had skeletal III with mandibular asymmetry,serious losses of tooth and unreasonable distribution of edentulous space.The patient had serious skeletal deformity but had high requirements for beauty,so orthodontic and surgical treatment was adopted to the patients.8 months of orthodontic and decompensation treatment was conducted before operation,including the matching of tooth enamel of vertical upper and lower anterior teeth and the shape of dental arch.The one-jaw operation plan of sagittal split ramus osteotomy was adopted producing matching and beautiful front and lateral profile.After operation,9 months of orthodontic treatment was conducted including the intense adjustment of occlusion and the maintenance of operation effects.After orthodontic treatment,occlusal interferences were adjusted andprosthodontic treatment was conducted.The purposes of prosthodontic treatment were to repair the shape and functions of the lost teeth as well as to build the stable occlusion of canines and fossea to maintain correction effects.At last,the normal overbite and coverage of anterior teeth,the alignment of middle line and the neutralizing molar relation were achieved.The patient was satisfied with the curative effects.Orthodontic and surgical treatment has good effects on skeletal III with mandibular asymmetry.