BACKGROUND Maxillofacial deformities are skeletal discrepancies that cause occlusal,functional,and esthetic problems,and are managed by multi-disciplinary treatment,including careful orthodontic,surgical,and periodont...BACKGROUND Maxillofacial deformities are skeletal discrepancies that cause occlusal,functional,and esthetic problems,and are managed by multi-disciplinary treatment,including careful orthodontic,surgical,and periodontal evaluations.However,thin periodontal phenotype is often overlooked although it affects the therapeutic outcome.Gingival augmentation and periodontal accelerated osteogenic orthodontics(PAOO)can effectively modify the periodontal phenotype and improve treatment outcome.We describe the multi-disciplinary approaches used to manage a case of skeletal ClassⅢmalocclusion and facial asymmetry,with thin periodontal phenotype limiting the correction of deformity.CASE SUMMARY A patient with facial asymmetry and weakness in chewing had been treated with orthodontic camouflage,but the treatment outcome was not satisfactory.After examination,gingiva augmentation and PAOO were performed to increase the volume of both the gingiva and the alveolar bone to allow further tooth movement.After orthodontic decompensation,double-jaw surgery was performed to reposition the maxilla-mandibular complex.Finally,implant placement and chin molding were performed to restore the dentition and to improve the skeletal profile.The appearance and function were significantly improved,and the periodontal tissue remained healthy and stable.CONCLUSION In patients with dentofacial deformities and a thin periodontal phenotype,multi-disciplinary treatment that includes PAOO could be effective,and could improve both the quality and safety of orthodontic-orthognathic therapy.展开更多
Cleft surgery requires an expert team performing ongoing treatment in order to achieve optimal outcomes. The senior author's(KES) experiences of more than 2000 patients with cleft lip and palate treated by a surgi...Cleft surgery requires an expert team performing ongoing treatment in order to achieve optimal outcomes. The senior author's(KES) experiences of more than 2000 patients with cleft lip and palate treated by a surgical-orthodontic protocol were introduced. The paper here will concentrate on not only correcting the occlusion as others have described,but also on what one surgeon can do to achieve optimal aesthetic balance, harmony and beauty. The results of orthognathic surgery in respect to function, stability, cosmesis, and complications are also audited.展开更多
BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatmen...BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatment plan for a patient initially treated with four-premolar-extraction camouflage, despite indications for orthognathic surgery.CASE SUMMARY A 23-year-old male sought treatment complaining about his unsatisfactory facial appearance. His maxillary first premolars and mandibular second premolars had been extracted, and a fixed appliance had been used to retract his anterior teeth for two years without improvement. He had a convex profile, a gummy smile, lip incompetence, inadequate maxillary incisor inclination, and almost a class I molar relationship. Cephalometric analysis showed severe skeletal class Ⅱ malocclusion(A point-nasion-B point = 11.5°) with a retrognathic mandible(sella-nasion-B point = 75.9°), a protruded maxilla(sella-nasion-A point = 87.4°), and vertical maxillary excess(upper incisor to palatal plane = 33.2 mm). The excessive lingual inclination of the maxillary incisors(upper incisor to nasion-A point line =-5.5°)was due to previous treatment attempts to compensate for the skeletal class Ⅱ malocclusion. The patient was successfully retreated with decompensating orthodontic treatment combined with orthognathic surgery. The maxillary incisors were repositioned and proclined in the alveolar bone, the overjet was increased, and a space was created for orthognathic surgery, including maxillary impaction, anterior maxillary back-setting, and bilateral sagittal split ramus osteotomy to correct his skeletal anteroposterior discrepancy. Gingival display was reduced, and lip competence was restored. In addition, the results remained stable after 2 years. The patient was satisfied with his new profile as well as with the functional malocclusion at the end of treatment.CONCLUSION This case report provides orthodontists a good example of how to treat an adult with severe skeletal class Ⅱ malocclusion with vertical maxillary excess after an unsatisfactory orthodontic camouflage treatment. Orthodontic and orthognathic treatment can significantly correct a patient’s facial appearance.展开更多
基金Supported by Nanjing Clinical Research Center for Oral Diseases,No.2019060009the Nanjing Medical Science and Technology Development Program,No.YKK17139。
文摘BACKGROUND Maxillofacial deformities are skeletal discrepancies that cause occlusal,functional,and esthetic problems,and are managed by multi-disciplinary treatment,including careful orthodontic,surgical,and periodontal evaluations.However,thin periodontal phenotype is often overlooked although it affects the therapeutic outcome.Gingival augmentation and periodontal accelerated osteogenic orthodontics(PAOO)can effectively modify the periodontal phenotype and improve treatment outcome.We describe the multi-disciplinary approaches used to manage a case of skeletal ClassⅢmalocclusion and facial asymmetry,with thin periodontal phenotype limiting the correction of deformity.CASE SUMMARY A patient with facial asymmetry and weakness in chewing had been treated with orthodontic camouflage,but the treatment outcome was not satisfactory.After examination,gingiva augmentation and PAOO were performed to increase the volume of both the gingiva and the alveolar bone to allow further tooth movement.After orthodontic decompensation,double-jaw surgery was performed to reposition the maxilla-mandibular complex.Finally,implant placement and chin molding were performed to restore the dentition and to improve the skeletal profile.The appearance and function were significantly improved,and the periodontal tissue remained healthy and stable.CONCLUSION In patients with dentofacial deformities and a thin periodontal phenotype,multi-disciplinary treatment that includes PAOO could be effective,and could improve both the quality and safety of orthodontic-orthognathic therapy.
文摘Cleft surgery requires an expert team performing ongoing treatment in order to achieve optimal outcomes. The senior author's(KES) experiences of more than 2000 patients with cleft lip and palate treated by a surgical-orthodontic protocol were introduced. The paper here will concentrate on not only correcting the occlusion as others have described,but also on what one surgeon can do to achieve optimal aesthetic balance, harmony and beauty. The results of orthognathic surgery in respect to function, stability, cosmesis, and complications are also audited.
文摘BACKGROUND Patient satisfaction with facial appearance at the end of orthodontic camouflage treatment is very important, especially for skeletal malocclusion. This case report highlights the importance of the treatment plan for a patient initially treated with four-premolar-extraction camouflage, despite indications for orthognathic surgery.CASE SUMMARY A 23-year-old male sought treatment complaining about his unsatisfactory facial appearance. His maxillary first premolars and mandibular second premolars had been extracted, and a fixed appliance had been used to retract his anterior teeth for two years without improvement. He had a convex profile, a gummy smile, lip incompetence, inadequate maxillary incisor inclination, and almost a class I molar relationship. Cephalometric analysis showed severe skeletal class Ⅱ malocclusion(A point-nasion-B point = 11.5°) with a retrognathic mandible(sella-nasion-B point = 75.9°), a protruded maxilla(sella-nasion-A point = 87.4°), and vertical maxillary excess(upper incisor to palatal plane = 33.2 mm). The excessive lingual inclination of the maxillary incisors(upper incisor to nasion-A point line =-5.5°)was due to previous treatment attempts to compensate for the skeletal class Ⅱ malocclusion. The patient was successfully retreated with decompensating orthodontic treatment combined with orthognathic surgery. The maxillary incisors were repositioned and proclined in the alveolar bone, the overjet was increased, and a space was created for orthognathic surgery, including maxillary impaction, anterior maxillary back-setting, and bilateral sagittal split ramus osteotomy to correct his skeletal anteroposterior discrepancy. Gingival display was reduced, and lip competence was restored. In addition, the results remained stable after 2 years. The patient was satisfied with his new profile as well as with the functional malocclusion at the end of treatment.CONCLUSION This case report provides orthodontists a good example of how to treat an adult with severe skeletal class Ⅱ malocclusion with vertical maxillary excess after an unsatisfactory orthodontic camouflage treatment. Orthodontic and orthognathic treatment can significantly correct a patient’s facial appearance.
