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Authors: Dr. Suraj Prasad Sinha, Dr. Arjun Nayak, Dr. U S Krishna Nayak

Abstract

Whenever a jaw discrepancy exists, the ideal solution is to correct it by modifying the child’s facial growth, so that the skeletal problem is corrected by more or less growth of one jaw than the other. Both anteroposterior and vertical maxillary deficiency can contribute to Class III malocclusion. The facemask obtains anchorage from the forehead and chin. The forward force on the maxilla is generated via elastics that attach to a maxillary appliance. In this case report, we will see how a concave profile of a nine year old girl improved with RME and FACE MASK therapy. Once the orthopedic phase was completed, she was put on the CHIN CUP therapy during the observational phase for about 8 – 10 months. Once all the premolars erupt, the case would be finished with fixed mechanotherapy.



INTRODUCTION

Interceptive orthodontics includes procedures that are undertaken at an early stage of a malocclusion to eliminate or reduce the severity of the same. Whenever a jaw discrepancy exists, the ideal solution is to correct it by modifying the child’s facial growth, so that the skeletal problem is corrected by more or less growth of one jaw than the other. Whatever the type of appliance that is used or the kind of growth effect that is desired, if growth is to be modified, the patient has to be growing. The clearest indications for treatment of skeletal problems prior to adolescence are maxillary deficiency in any plane of space, and a progressive deformity (which almost always produces a worsening facial asymmetry). For all practical purposes, early orthodontic treatment for skeletal problems is mixed dentition treatment, and a second phase of treatment during adolescence will be required. Both anteroposterior and vertical maxillary deficiency can contribute to Class III malocclusion. Skeletal maxillary constriction is distinguished by a narrow palatal vault. It can be corrected by opening the midpalatal suture, which widens the roof of the mouth and the floor of the nose. This transverse expansion corrects the posterior crossbite, sometimes moves the maxilla forward, increases space in the arch, and repositions underlying permanent tooth buds. The facemask obtains anchorage from the forehead and chin. The forward force on the maxilla is generated via elastics that attach to a maxillary appliance. To resist tooth movement as much as possible, the maxillary teeth should be splinted together as a single unit. Approximately 350 – 450 grams of force per side is applied for 12 – 14 hours per day. A downward pull will be contraindicated if lower face height were already large. In this case report, we will see how a concave profile of a nine year old girl improved with RME and FACE MASK therapy. Once the orthopedic phase was completed, she was put on the CHIN CUP therapy during the observational Department of Orthodontics and Dentofacial Orthopedics A B Shetty Memorial Institute of Dental Sciences, Mangalore A Case Report phase for about 8 – 10 months. Once all the premolars erupt, the case would be finished with fixed mechanotherapy.

CASE REPORT

A nine year old female reported to the department with the chief complaint of forward placement of her lower jaw and flat nose. On extra oral examination, the patient was brachycephalic, concave facial profile with prognathic mandible, steep mandibular plane angle, anterior divergence and positive lip step. On intra oral examination, the patient had mixed dentition with primary and permanent teeth. The molar relationship was Angle’s Class III bilaterally with reverse overjet of -4.5 mm.

DIAGNOSIS

Skeletal Class III apical bases with severly Retrusive maxilla and slightly Prognathic mandible.

TREATMENT OBJECTIVES
  • XXCorrection of Class III Skeletal relationship
  • XXCorrection of overjet and overbite
  • XXObtain Class I molar and canine relationship.
  • XXAchieve optimal facial balance and esthetics.
TREATMENT PLAN

The treatment plan was finalized with the Growth Modification using RME and FACE MASK followed by fixed mechanotherapy. The treatment started with RME which was attached to the FACEMASK with the extra oral elastics for six months.

GROWTH MODULATION THERAPY OUTCOME

The extraoral and the intra oral pictures shows that the profile improved to a large extent. Since the patient was just about 10 years of age with some premolars yet to erupt, she was put on the CHIN CUP therapy during this observational phase for about 8 – 10 months. Once all the premolars erupt, the case would be finished with fixed mechanotherapy.

REFERENCES
  • Proffit, Field, Sarver. Contemporary Orthodontics. 4th ed. St. louis : Mosby; 2007.
  • Graber, Vanarsdall, Vig. Orthodontics: Current Principles and techniques. 4th ed. St. louis : Mosby;2005.
  • Moss, ML. The primacy of functional matrices in profacial growth, Dent Pract, 1968, 19: 65-73.

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