Grassia Vincenzo, Nucci Ludovica, Marra Paola Martina, Isola Gaetano, Itro Angelo, Perillo Letizia
Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy.
Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Italy.
Case Rep Dent. 2020 Aug 11;2020:1376472. doi: 10.1155/2020/1376472. eCollection 2020.
To describe a clinical case with a severe mandibular crowding treated without extraction and showing a long-term outcome.
A 14-year-old boy in permanent dentition showed a class I molar and cuspid relationship, a severe deep bite of 8 mm, a constricted V-shaped upper arch with moderate crowding, and a severe crowding of about 12 mm in the lower arch. The panoramic X-ray showed an impacted upper right canine. The treatment started with the placement of a transpalatal bar and 0.022 × 0.028 in standard edgewise appliances in the upper arch and a lip bumper bonded on the second lower molars. Initial leveling of the teeth was accomplished with light Australian round wires. Finishing was then performed with rectangular wires. The phase with fixed appliances lasted 2 years and 9 months, and the patient was motivated and cooperative throughout the treatment, although with poor oral hygiene. The patient was treated without extractions.
The space was gained with the first and second upper molar derotations using the transpalatal bar and the gingival lip bumper in the lower arch. The upper right canine was well positioned, and the maxillary arch form was improved. The severe lower crowding was completely corrected, and a good overbite was achieved.
A conservative, nonextraction treatment approach for this patient with class I malocclusion with severe mandibular crowding was effective, and the results have remained stable after a long-term follow-up (10 years).
描述一例严重下颌牙列拥挤未拔牙治疗并展示长期治疗效果的临床病例。
一名处于恒牙列期的14岁男孩，磨牙及尖牙关系为I类，深覆合8mm，上颌牙弓呈狭窄V形且有中度拥挤，下颌牙弓严重拥挤约12mm。全景X线片显示右上颌尖牙阻生。治疗开始时在上颌放置横腭杆及0.022×0.028英寸标准方丝弓矫治器，在下颌第二磨牙粘结唇挡。用细澳大利亚圆丝初步排齐牙齿，然后用方丝完成矫治。固定矫治器治疗阶段持续2年9个月，患者在整个治疗过程中积极性高且配合，但口腔卫生较差。该患者未拔牙进行治疗。
通过使用横腭杆使上颌第一和第二磨牙扭转以及下颌牙弓的牙龈唇挡获得了间隙。右上颌尖牙位置良好，上颌牙弓形态得到改善。严重的下颌拥挤完全得到纠正，覆合良好。
对于该患有I类错合畸形伴严重下颌拥挤的患者，保守的非拔牙治疗方法是有效的，长期随访（10年）后结果保持稳定。
