Case Reports Of Orthodontic Treatment Of Different Skeletal Facial Patterns

Objective: To evaluate the clinical efficacy of orthodontic treatment in patients with different skeletal facial patterns of malocclusion.Materials and Methods: Three patients with Class I average-angle skeletal facial pattern of malocclusion,Class II high-angle skeletal facial pattern of malocclusion and Class III high-angle skeletal facial pattern of malocclusion were selected.Case 1: ZZ,a 15-year-old boy with a chief complain of maxillary incisal protrusion and malposed teeth.He was Class I average-angle skeletal facial pattern.He had incompetent lips and his lip muscle relaxation.He had convex profile and gummy smile.He was in the permanent dentition stage with Class I molar relationships,Class II canine relationships,a deep anterior overjet and a anterior open bite.The upper and lower dentitions were severe crowding.The X-ray films showed that his right mandibular second molar was buccoangular impaction.Extracting 4 first premolars to relieve crowding and moving distaly anterior teeth to relieve open bite and improve the convex profile.Extracting the right mandibular third molar to remove the eruption resistance of the right mandibular second molar.Using high position traction with j-hook headgear for treatment of gummy smile.The patient was instructed to exercise lip muscle function to strengthen the tension of lip muscle and promote the closure of upper and lower lip.Case2: LHX,a 11-year-old girl with a chief complain of protrusive lips and a hereditary factor.She was Class II high-angle skeletal facial pattern,she had convex profile with chin retraction.She was in the permanent dentition stage with Class I molar relationships,Class II canine relationships and a deep anterior overjet.The upper and lower dentitions were slight crowding.Extracting 4 premolars to relieve crowding and using MIA(micro implane anchorage)to distaly move anterior teeth to improve the convex profile.TPA,Nance arch and lingual arch were used to control the molar in vertical direction to prevent further deterioration of the face pattern.Case3: ZZY,a 11-year-old pubertal girl with a chief complain of crossbite.She had chronic rhinitis and her adenoid and palatine tonsillar enlargement.She had habit of mouth breathing and protrusion habit of tongue.She was Class III high-angle skeletal facial pattern,she had concave profile,her mandible can be retreated.The patient was in the permanent dentition stage with Class III molar relationships and Class III canine relationships,her anterior crossbite,and her lower anterior tooth area had gaps.Two-phrase Treatment was adopted.The first phrase used a maxillary protraction to promote maxillary growth so that the sagittal incongruity of the jaws was improved.The second phrase used SWA(Straight Wire Appliance)to align and level dentitions,establish a good occlusal relationship and obtain normal overjet,overbite and molar relationship.Treating actively in ENT department and correcting the habit of mouth breathing and protrusion habit of tongue.Results: After the treatment,the teeth of these patients were aligned without gaps.The overbite and overjet of anterior tooth was well.The middle line of the upper and lower dentitions was consistent with the midline of face.The relationships of canine and molar achieved Class I.The occlusion relationships were well.And the profile improved significantly.Conclusion: The patients with different skeletal facial patterns of malocclusion can reach a satisfactory therapeutic effect by orthodontic treatment,but the premise must be accurate and meticulous pre-treatment examination and data analysis,rational treatment plan,adept and effective treatment technology,and the patient's good cooperation.