ectopic canines

8/12/2019 Ectopic Canines

1/92

1. Orthognathic cases:Treatment stages

PRE SURGERY (18months-2 years) Relieve crowding Level and align Decompensate Co ordinate arches


2/92

Relieve crowding


3/92

Level and align


4/92

Decompensation(reverse dental compensations)


5/92

Co-ordinate

Width of upper and lower arches need to

match


6/92

Case 1: CT

Class III incisors, class III dental base,

increased vertical proportions


7/92

TCInitialappearance


8/92


9/92

SNA = 73SNB = 85.5

ANB = -12.5

UiMx = 103.5

LiMn = 68

MMPA = 34

LFH % = 62


10/92

Treatment plan

Orthodontic maxillary expansion, aiming

for arch co-ordination Decompensation incisors

Bimaxillary osteotomy


11/92

TC: Pre-op orthodontics


12/92


13/92

SNA = 72SNB = 79.4

ANB = -7.2

UiMx = 116

LiMn = 94

MMPA = 33

LFH % = 58.5


14/92

Surgical plan

Maxillary adv = 8mm

Impaction 2mm

Mandible set back =

4mm

Adv genioplasty = 5mm

Simuluted prediction

shown on right


15/92

SNA = 78SNB = 74

ANB = 4(5.5)

UiMx = 111.5

LiMn = 87

MMPA = 40

LFH % = 58


16/92


17/92


18/92

Final facialappearance


19/92

Prediction & actual appearance


20/92

Pre-op & post op


21/92

Case 2: BG

II/I incisors, Class II skeletal base,

increased vertical proportions AOB = -8mm

OJ = 10mm Deep labiomental fold, active mentalis,

retroclination LLS


22/92


23/92

Aims of treatment

Align & level arches

Relieve crowding Correct Class II skeletal pattern

Close AOB Reduce OJ


24/92

Treatment plan

Extract lower 2 nd premolars to relieve crowdingand allow some contraction lower arch

Expansion upper arch with quadhelix (arch co-ordination)

Level & align, decompensate using In-ovationbrackets, Roth prescription Bimaxillary osteotomy (maxillary posterior

impaction and advancement, mandibular forward slide)


25/92

Overjet 11.0 mmOverbite -9.5 mmUI/MxP 115.0 LI/MnP 83.5 LI-APo -3.0 mm

SNA 79.5 SNB 75.5

ANB 4.0 MxP/MnP 37.0

LAFH/TAFH 58.5 %

Start

11/09/02: 1 st visit


26/92

Extractions lower 5/5. L014 Sentalloy. Full engagement. SS tubing. Bendbacks ends of wire

11/09/02: 1 visit


27/92

1 st visit


28/92

Upper 014 Sentalloy, Lower 19 25 SS. 7s banded

28/05/03: 6th visit , 8 months into treatment. Upper arch bonded 4 months ago.

23/10/02: 2 nd visit: Lacebacks removed. Retie

h l


29/92

Enough space to align UL2.Piggy back (012 niti)

02/07/03: Visit 7 .Creating more spacefor UR2

Traction ligatures lower arch.Light force to preventproclination of LLS duringlevelling

13/02/04: Visit 10


30/92

13/02/04: Visit 10

UL 1925 SS

Rims taken: orthodonticexpansion insufficient toaddress arch widthdiscrepancyQuad removed to allowuprighting upper molars

OJ = 10mmOB = -7mm


31/92

Surgical procedure

Bimaxillary osteotomy: Posterior maxillary

impaction (3mm), maxillary advancement3mm), mandibular forward slide 11mm 2 part maxilla with midline split (for

surgical expansion) Reduction genioplasty (vertical & horizo

ntal)


32/92

Titanium miniplates


33/92


34/92

6 weeks post-op

Seating elastics worn full time


35/92

10 weeks post-opDebond next visitComposite build up

UL2


36/92

4 weeks post debondComposite restoration UL2


37/92


38/92


39/92


40/92

Summary

15 visits pre-surgery

4 visits post-surgery Time in fixed appliances = 30 months


41/92

Case 3: SA

II/II incisors on skeletal II base with

reduced vertical proportions Gingival trauma LLS

Full unit Class II buccal segments


42/92

Start Study models: Note gingival stripping (LR1, LL1)


43/92

Sta t Study ode s: ote g g va st pp g ( , )


44/92

Pre-op OPT: Note extensive caries LR6


45/92


46/92


47/92


48/92

Visit 1Upper arch bondedU 016 Sentalloy

Owing to recession 1/1, LLS left off archwire, protection with bumpa sleeve


49/92

Upper 1925 SS, lower 018SS. Retraction of buccal segments


50/92

Upper 1925 SS, lower 018SS. Retraction of buccal segmentsbefore engagement of 2/2 to avoid proclination of lower incisors

Pre-op lateralcephalogramPre-op profile


51/92

p g

OPAL tracing pre-op


52/92

g p p


53/92

OPAL prediction: Mandibular advancement = 7mm

Post-op profile Post-op lateral ceph


54/92

Post op OPT


55/92

Post-op OPT


56/92

Final photos


57/92

3 months postdebond

Note healthylabial gingiva

Case 4: KB


58/92

Case 4: KB

Class III incisors on skeletal I base,

average vertical proportions

KB


59/92

KB

Age 16

Previous loss

4/4


60/92

SNA = 80

SNB = 76.5

ANB = 3.5UiMx = 108.5

LiMn = 101.5MMPA = 32

LFH % = 56

Aetiology


61/92

Aims of treatment

Align upper arch

Segmental mandibular surgery

Extract lower 1 st p/molars

intra-operatively


62/92

SNA 80 5


63/92

SNA = 80.5

SNB = 76

ANB = 5

UiMx = 110

LiMn = 97.5

MMPA = 38.5

LFH % = 59.5


64/92


65/92

Surgery: Hofer type procedure

4/4 extracted at the time of surgery

Anterior segment set back and fixed with plates

Continous archwire placed at the time of surgery

10 weekspost surgery


66/92

post surgery

SNA = 78 5


67/92

SNA = 78.5

SNB = 75

ANB = 3.5

UiMx = 112.5

LiMn = 86.5

MMPA = 35

LFH % = 55.5%


68/92


69/92


70/92


71/92


72/92

Case 5


73/92

II/I incisors on class II skeletal base,average vertical proportions

R.M.

Severe


74/92

crowdingMandibular retrognathia


75/92

Start Ceph: 06/07/2000


76/92

SNA = 78SNB = 71.5

ANB = 6.5

UiMxP = 120/93.9Li MnP = 96.5MxMn = 23.5

Treatment plan


77/92

Lip Bumpa Palatal arch Extraction all first premolars U & L standard width system-r brackets.

Roth prescription Alignment, levelling, correction centre line,

space closure Mandibular advancement

1st visit:


78/92

PA to de-rotate 6/6Lip bumpa

Extraction 4/44/4

3 rd visit


79/92

4 th visit


80/92

5th visit: 1/ engaged


81/92


82/92

Visit 9: U&L 1925 SS12 months into treatment


83/92

Pre-op U&L 2125 SS with ball hooks


84/92


85/92

SNA = 77.4SNB = 71ANB = 6.4

UiMx = 118LiMn = 93

MxMn = 23.7


86/92


87/92


88/92


89/92


90/92


91/92

Pre-op Post-op


92/92

ectopic canines

Documents