Cases Analysis Of Three Different Skeletal Malocclusion Treated By Different Approaches

Objective: To investigate the treatment planning,process and effect based on the three cases with skeletal Class ?,? and ? malocclusion treated with Physiologic Anchorage Spee's wire system,two-stage treatment as well as combined treatment with orthodontic-orthognathic surgery.Materials and Methods: Three cases with different skeletal malocclusion were selected during my postgraduate study.Case 1: CM,18-year-old male with chief complaint of crossbite.He had mandibular prognathism and skeletal Class ? malocclusion with high mandibular plane angle.Molars relationship were Angle Class ?,negative overjet 6.5 mm,with slightly posterior crossbite on both sides.Minor crowding was noted in both upper and lower arch with increased Bolton index of the dentition and anterior teeth.Combined treatment with orthodontic-orthognathic surgery was used.Due to the less compensation of anterior teeth,the goal of pre-surgery orthodontics treatment was to align teeth,eliminate occlusal interference,and correct the upper midline.In addition,the horizontal problems should be corrected.The surgery included mandibular sagittal split ramus osteotomy and genioplasty.The goal of post-surgery orthodontic treatment was to refine and finalize upper and lower occlusion.Case 2:YZC,19-year-old male with chief complaint of prominent anterior teeth.He had convex profile and skeletal Class ? malocclusion with average mandibular plane angle.Molars and canine relationships were Angle Class ? on both sides.The bolton index of anterior teeth was 83.3%,which was greater than the norm,Proclination of upper and lower incisor with increased Bolton index on anterior teeth were noted.After extraction(?),Physiologic Anchorage Spee's wire System was used for anchorage preparation,and anchorage was reinforced during the treatment,.Additionally,the attention should be paid to control the torque of the anterior teeth.Case 3: HDH,12-year-old male with chief complaint of prominent anterior tooth.He had convex profile and skeletal Class ? malocclusion with decreased mandibular plane angle.The lower midline was shift 1.0 mm to the right.Canines and molars relationship were Angle Class ? on both sides.Increased overbite(?)and overjet(12.0 mm)were observed.Upper incisors were proclined and lower incisor was slightly retroclined with the oral habit of biting the lower lip.Based on CVM,the patient was at the growth peak.Activator appliance was used at the Stage one treatment to correct sagittal discrepancy and at the second stage the occlusal relationship was refined by fixed orthodontic appliance.During the treatment,special attention should be paid to give up the bad habit and the reinforce function exercise on lingual and labial muscles.Results: After treatment,three patients presented with skeletal Class ? facial profile,with normalized overbite and overjet and Class ? canine and molar relationships.The roots are parallel and the shape of the condyles are normal with continuous cortical bones.Alveolar bones are not absorbed.Conclusion: Before treatment,adequate analysis of the mechanism and severity of malocclusion,together with careful evaluation of the growth potential of the patient is necessary for reasonable treatment planning.Patients with different skeletal malocclusion would obtain good occlusion and harmonious facial profile after treatment.