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Authors: Dr. Akhil Shetty, Dr. Suraj Prasad Sinha, Dr. Krishna Nayak US

ABSTRACT

A 11 year old growing male reported with the Chief Complaint of forwardly placed upper front teeth. The case was diagnosed to be Skeletal Class II due to Retrognathic Mandible and slightly Prognathic Maxilla. Since the patient was in the growing phase, two phase treatment was planned. The First phase comprised of mandibular advancement using TWIN BLOCK Appliance and HEADGEAR to restrain the growth of maxilla. The final finishing and detailing was achieved in the Second phase of treatment using 0.022 MBT Prescription.

INTRODUCTION

Twin block appliances are simple bite blocks that are designed for full-time wear. They achieve rapid functional correction of malocclusion by the transmission of favorable occlusal forces to occlusal inclined planes that cover the posterior teeth. The proprioceptive sensory feedback mechanism control muscular activity and provides a functional stimulus or deterrent to the full expression of mandibular bone growth.1 There is a consensus that headgear inhibits anterior growth of the maxilla, which contributes to the correction of the anteroposterior discrepancy between the maxillary and the mandibular dentitions.2 Compared with other techniques used to distalize molars such as intra-oral appliances and mini-implants, headgear is the appliance of choice when restraint of maxillary growth and dental movement are required.3

 
PRETREATMENT EXTRA ORAL AND INTRA ORAL PHOTOGRAPHS
CASE REPORT

A 11 year old growing male reported to our department with the chief complaint of forwardly placed upper front teeth. On Extra Oral Examination, patient was having convex profile, leptoprosopic facial index with incompetent lips, recessive chin and deep mentolabial sulcus. On Intra Oral Examination, the Molar relationship was Angle’s Class II and the Incisor relationship was Class II Div 1 with overjet of 12 mm and over 4 mm overbite. The maxillary canines were partially erupted and the primary second molars were also present.

DIAGNOSIS:

Growing male patient having Skeletal Class II malocclusion due to Retrognathic Mandible and Prognathic Maxilla, average growth pattern and everted lower lip.

TREATMENT OBJECTIVES:
  • Correction of Skeletal Class II malocclusion
  • Correction of overjet and overbite.
  • Achieve Class I molar and canine relationship.
  • Achieve optimal facial balance and esthetics.
TREATMENT PLAN:

The patient was in the growing phase and hence it was planned to use a growth modulation appliance to advance the severely retruded mandible and to restrain the maxillary growth at the same time incorporating an headgear along with a twin block. The VTO (Visual Treatment Objective) was positive which is evident from the photograph.

VTO (Positive)
FIRST Phase:

GROWTH MODIFICATION using TWIN BLOCK and HEADGEAR.

SECOND Phase:

PEA – 0.022 MBT Prescription Brackets.

FIRST PHASE:

Twin block are designed to be worn 24 hours per day to take full advantage of all functional forces applied to the dentition, including the forces of mastication. Upper and lower bite blocks interlock at a 70̇®angle when engaged in full closure. This causes a forward mandibular posture to an edge to edge position with the upper anteriors, provided the patient can comfortably maintain full occlusion on the appliances in that position.1 Headgear is a common option for the treatment of class II malocclusion.2

INTRAORAL PHOTOGRAPHS WITH TWIN BLOCK
EXTRA ORAL PHOTOGRAPHS WITH HEADGEAR
POST TWIN BLOCK PHASE OUTCOME:

The post growth modulation phase is marked with sagittal correction from skeletal class II to skeletal class I which is evident from the profile photographs. The intraoral photographs show the dental malocclusion which gets corrected in the second phase of the treatment.

EXTRA ORAL AND INTRA ORAL PHOTOGRAPHS (POST GROWTH MODULATION PHASE
SECOND PHASE

NON EXTRACTION treatment was undertaken with fixed mechanotherapy using 0.022 slot MBT bracket system.

MID TREATMENT PHOTOGRAPHS
POST TREATMENT OUTCOME:

The post treatment intra oral photographs show the proper alignment of the upper and lower arch with proper intercuspation and the extra oral photographs show the harmonious profile of the patient. The treatment results showed significant improvement in the patients’ stomatognathic system with best possible aesthetics and function.

REFERENCES:
  • Clark WJ. Twin Block Functional Therapy. 2nd ed. Mosby; 2002.
  • Ashmore JL, Kurland BF, King GJ, Wheeler TT, Ghafari J, Ramsay DS. A 3-dimensional analysis of molar movement during headgear treatment. Am J Orthod Dentofacial Orthop 2002; 121: 18–29.
  • Luciana Rougemont Squeff et al. Asymmetric headgear for differential molar movement: a study using finite element analysis. Journal of Orthodontics, Vol. 36, 2009, 145–151.

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