Section of Orthodontics, School of Dentistry, Center for Health Science, University of California Los Angeles, Los Angeles, Calif.
Section of Orthodontics, School of Dentistry, Center for Health Science, University of California Los Angeles, Los Angeles, Calif.
Am J Orthod Dentofacial Orthop. 2022 Aug;162(2):264-278. doi: 10.1016/j.ajodo.2021.02.027. Epub 2022 May 6.
Optimal treatment for an adult patient with hyperdivergent facial morphology, Class III malocclusion, bilateral posterior crossbite, and skeletal disharmony usually requires comprehensive orthodontics combined with extractions, orthognathic surgery, or both. However, treatment becomes more challenging when the patient rejects surgery because of fear or cost. This case report presents the orthodontic treatment of a 24-year-old woman with a Class III malocclusion and bilateral posterior crossbite without surgery using orthopedic and comprehensive orthodontic approaches. The extraoral evaluation showed a hyperdivervent pattern, paranasal deficiency, a slightly protrusive lower lip, and an obtuse labiomental angle with a chin deviated to the left. Intraorally, she exhibited a severe Angle Class III malocclusion bilaterally with edge-to-edge to -1 mm overjet, canting of the occlusal plane up to the left with mandibular midline 5.3 mm to the left of the maxillary and facial midlines, and bilateral posterior crossbite with 5.7 mm of arch width discrepancy. Therefore, the patient was diagnosed with skeletal and dental Class III relationship, hyperdivergent pattern, a deviation of the mandible to the left, bilateral posterior crossbite, mild to moderate maxillary and mandibular crowding, slightly proclined maxillary incisors and upright mandibular incisors. After 15 months of treatment, all treatment objectives were achieved, and the appliances were removed. Teeth were well leveled and aligned, ideal overbite and overjet were established with premolars and canines in a Class I relationship, bilateral posterior crossbite was corrected, vertical dimension was controlled, and the smile was improved with a slight improvement in the profile; however, bilaterally, the molar occlusion was not completely settled and remained in a Class III relationship. This case report demonstrates the successful nonsurgical treatment of an adult with Class III malocclusion, hyperdivergent facial morphology, and bilateral posterior crossbite using a midfacial skeletal expander and facemask for orthopedic correction. With reduced costs and fewer risks than surgical treatment options, this treatment protocol offers an alternative to adult patients.
对于成人患者，以下面高角型面型、III 类错颌、双侧后牙反颌、骨骼不协调为特征的患者，通常需要综合正畸治疗联合拔牙、正颌手术或两者联合治疗。但是，如果患者因为害怕或费用问题而拒绝手术，那么治疗就会变得更加具有挑战性。本病例报告介绍了一位 24 岁女性患者的正畸治疗过程，她存在 III 类错颌和双侧后牙反颌，但未接受手术，而是采用了矫形和综合正畸方法。口外评估显示患者呈高角型面型、鼻旁凹陷、轻度前突下唇和钝角唇颏角，下巴偏向左侧。口内检查显示，患者双侧存在严重的安氏 III 类错颌，覆颌覆盖 1mm 以内，咬合平面倾斜至左侧，下颌中线相对于上颌和面部中线偏左 5.3mm，双侧存在后牙反颌，牙弓宽度相差 5.7mm。因此，患者被诊断为骨骼和牙齿的 III 类关系、高角型面型、下颌偏左、双侧后牙反颌、轻度至中度上颌和下颌拥挤、上颌切牙轻度前倾、下颌切牙直立。经过 15 个月的治疗，所有治疗目标均达成，矫治器被拆除。牙齿排列整齐，前磨牙和尖牙建立了理想的覆盖和覆颌关系，双侧后牙反颌得到纠正，垂直向控制良好，微笑得到改善，侧貌有轻微改善；然而，双侧磨牙关系仍未完全解决，保持 III 类关系。本病例报告介绍了一位成人患者采用中面部骨骼扩张器和面具进行矫形治疗，成功地非手术治疗了 III 类错颌、高角型面型和双侧后牙反颌。与手术治疗方案相比，该治疗方案成本更低、风险更小，为成年患者提供了一种替代方案。
