For many years, orthognathic surgery has been used to level a canted occlusal plane. canted occlusal plane orthodontics case,
canted occlusal plane orthodontics case
However, similar effects might be achieved by intruding the posterior teeth using a miniscrew. canted occlusal plane orthodontics case report describes a patient with a canted occlusal plane orthodontics case, mandibular deviation, shifted dental midlines, and TMD treated with an edgewise appliance using miniscrews as anchorage.canted occlusal plane orthodontics case
Vertical control of posterior teeth with miniscrews enabled flattening of the canted occlusal plane.
Dental midlines coincided with the midfacial line, thereby improving smile symmetry.canted occlusal plane orthodontics case During 4 years of retention, the patient maintained ideal occlusion. Furthermore, TMD symptoms disappeared, and significant improvements in stomatognathic functions were observed compared with those at pretreatment.canted occlusal plane orthodontics case,These results suggest that miniscrews can be used to improve canted occlusal plane and stomatognathic malfunctions
canted occlusal plane orthodontics case
Canted occlusal plane, mandibular deviation, shifted dental midlines, and TMD can be successfully treated using a mandibular fixed orthodontic appliance with miniscrews as anchorage.
Orthognathic surgery was used to level the canted occlusal plane orthodontics case of a 15-year-old girl with mandibular deviation, shifted dental midlines, and temporomandibular disorders (TMD). In addition, miniscrews were used to intrude the posterior teeth using the edgewise appliance to achieve the same clinical results.
canted occlusal plane orthodontics case
When a canted occlusal plane is present, asymmetry between the left and right sides of the face can occur. Midline deviations of the teeth and TMJ problems can also develop. Orthognathic surgery has been used to correct these conditions. However, intruding the posterior teeth with miniscrews may yield similar results. This article reports a patient with a canted occlusal plane, mandibular deviation, midline dental shift, and temporomandibular joint problems treated with an edgewise appliance using miniscrews as anchorage canted occlusal plane orthodontics case.
canted occlusal plane orthodontics case
Generally, a canted occlusal plane orthodontics case results in esthetic problems, such as an asymmetric mandible with midline deviation, and functional problems, such as temporomandibular disorder (TMD). For many years, canted occlusal plane orthodontics case orthognathic surgery has been used to level a canted occlusal plane. However, similar effects might be achieved by intruding the posterior teeth using a miniscrew. This case report describes a patient with a canted occlusal plane, mandibular deviation, shifted dental midlines, and TMD treated with an edgewise appliance using miniscrews as anchorage.
canted occlusal plane orthodontics case factors
Factors canted occlusal plane orthodontics case that is known to cause mandibular deviation include unilateral posterior crossbite, temporomandibular internal derangement, tumor, trauma, in the maxillofacial region, rheumatoid arthritis, and congenital diseases such as hemifacial microsomia.
Patients with mandibular deviation typically have functional problems, such as asymmetric condylar movement. Notably, the condylar path is reportedly steeper on the deviated side than on the non-deviated side during a protrusive excursion and maximum opening and closing movements.
The path length for condylar translation was shorter on the non deviated side than on the deviated side, but no difference was observed between the two sides for non-working condylar translation. The present study showed that the non-working condylar path length was longer on the non-deviated side than on the deviated side during the lateral excursion.canted occlusal plane orthodontics case
In addition, the non-working condylar path length for condylar translation was shorter on the non-deviated side than on the deviated side. This study showed that the path length was shorter on the non-deviated side than on the deviated side for condylar translation during the lateral excursion, suggesting that lateral excursion could be used as a method to evaluate the condyle.canted occlusal plane orthodontics case
canted occlusal plane orthodontics case
Furthermore, the nonworking condylar path length is longer during lateral excursion movement to the non-deviated side than to the deviated side. These asymmetric condylar movements may cause stress imbalance on both sides of the TMJ, resulting in disc displacement.
The signs of TMD are often accompanied by TMJ sounds and pain in the jaw joint. These symptoms are related to the presence of discrepancies in vertical elements, including a canted occlusal plane and an asymmetric ramus height.
Patients with mandibular deviation often exhibit TMJ sounds on the deviated side. However, if you look at the literature, no specific relationship between the direction of mandibular deviation and TMJ sounds has been reported.12 The symptoms of temporomandibular disorder (TMD), including disc displacement and TMJ sounds, are presumably related to the presence of discrepancies in vertical elements, including a canted occlusal plane and an asymmetric ramus height.
In patients with a canted occlusal plane and mandibular deviation, the conventional approach has involved correction via 2-jaw surgery. Miyatake et al described surgical orthodontic therapy with LeFort I osteotomy and intraoral vertical ramus osteotomy to treat a patient with skeletal Class III malocclusion who had TMD, a canted occlusal plane, and mandibular deviation. After the treatment, facial symmetry was achieved.
canted occlusal plane orthodontics case disscussion
To control the anchorage in orthodontic treatment, you have to decide which teeth to remove. This can significantly influence the effectiveness of the anchorage.
A patient underwent extraction of the right maxillary canine during childhood. After extraction of the canine, there was an increase in the size of the dental midline by 3.0 mm, which was caused by the migration of the dental midline to the right. To correct this deviation, we chose to remove the maxillary left premolar, and not the first premolar because it had undergone root canal treatment.
In this case, we decided to extract the second premolar. We chose to do so because it had undergone root canal treatment, rather than extracting the first premolar, which had undergone the previous extraction of the maxillary right canine during childhood.
However, there was a possibility that anchorage loss would result in reduced space for midline correction by extracting the second premolar. Therefore, we used miniscrews to reinforce the anchorage in posterior molars while correcting the midline deviation.
The miniscrews also provided ideal anchorage in the mandible. Generally, first premolars would be extracted to correct anterior crowding or labial inclination of incisors. However, for this patient, we chose to extract the mandibular second premolars with short roots. By using miniscrews, we were able to control the anchorage, despite extraction of the second premolars.
In this patient, the maxillary right canine was extracted as a child. Therefore, we aligned the maxillary right first premolar in the canine position. Here, interference of the lingual cusp of the maxillary first premolar may occur during lateral movement of the mandible; occasionally, restorative treatment should be considered (eg, grinding of the lingual cusp of the maxillary premolar.
We used a 6-degree-of-freedom jaw movement recording system to monitor the movements of the mandibular incisors during occlusion therapy. We found that the incisors were able to move to both sides in a nearly symmetrical manner after treatment, so we did not perform restorative treatment and closely monitored the tooth after the movement had been completed.
This patient did not exhibit a greater occlusal force and contact area on the deviated right side during pretreatment examinations; they were nearly identical. However, patients with mandibular deviation tend to have a greater occlusal force and contact area on the deviated side.
We presumed this result because there was no contact between maxillary and mandibular teeth caused by the missing maxillary canine. In addition, the crossbite between the maxillary lateral incisor and mandibular canine on the right side was corrected by active treatment.
Conversely, the occlusal force and contact area became greater on the right side than on the left side immediately after debonding; this might have been caused by a temporary reduction of the contact area on the left side because of intrusion of the maxillary left molars.canted occlusal plane orthodontics case
Occlusion stability was improved after the completion of orthodontic treatment. The occlusion finally reached a state where occlusal forces were balanced between both sides. Then, occlusion became more stable than before, and the total occlusal force exceeded the pretreatment value.canted occlusal plane orthodontics case
Occlusal contact was symmetrical at 4 years retention. The deviated condyle showed increased path length at maximum opening and closing compared to the non deviated side during laterotrusion and protrusion.
The same patient showed a greater condylar path length on the deviated side than on the non deviated side, and the condylar path length was significantly shorter than the normal mean value during both pretreatment and posttreatment examinations
However, after 2 years of retention, the condylar paths of the TMJ were shorter than the normal mean values, and both condylar path lengths had increased to the normal mean values. In addition, the TMD symptoms had disappeared.
This patient was referred to our service due to a complaint of facial pain. Her history of trauma to the chin might have affected her mandibular growth; alternatively, she might have experienced unilateral extraction of a maxillary canine leading to asymmetrical lateral guidance of the mandible.
However, because the patient had a skeletal Class I relationship without severe transverse and vertical disharmonies, we decided to perform orthodontic treatment with miniscrews rather than orthognathic surgery.
By using mini screws, we significantly reduced the canted occlusal plane by molar intrusion and opposite molar extrusion, which gradually improved stomatognathic dysfunctions.
After 1 week, immediately after active treatment, an imbalance between the right and left sides’ posterior occlusions was observed, as shown in the results of the occlusal-force recording system. However, as shown in the results of the 6-degrees-of-freedom jaw movement recording system and the occlusal-force recording system at 2 years of retention, the adaptation of stomatognathic function occurred, and the discrepancy of occlusion between both sides disappeared.
A randomized controlled trial showed that the use of a splint appliance improved the position of the maxillary third molars and canted occlusal plane angle in patients with Angle Class I malocclusion.
These adaptive responses might dissolve stress imbalance between both sides of TMJ and induce stomatognathic functional improvement. In addition, we also assumed that the extraction of the supra-erupted maxillary third molars might reduce the restrictions of mandibular movement and lead to the improvement of stomatognathic functions. Further observations are needed to examine relapses of the canted occlusal plane and mandibular deviation while monitoring stomatognathic functions.
The importance of examining stomatognathic functions during orthodontic treatment was emphasized in this case report.
CONCLUSIONS canted occlusal plane orthodontics case
The findings showed that miniscrews were effective for the treatment of vertical disharmony such as a canted occlusal plane and that conventional treatment with orthognathic surgery could be avoided. Furthermore, orthodontic treatment with miniscrews was shown to induce improvement of stomatognathic functions.
for full case report on canted occlusal plane orthodontics case
DOI: 10.1016/j.ajodo.2020.09.028
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