Zhou Yi-Wen, Wang Yan-Yi, He Zhi-Feng, Lu Ming-Xing, Li Gui-Feng, Li Huang
Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China.
World J Clin Cases. 2023 Feb 16;11(5):1106-1114. doi: 10.12998/wjcc.v11.i5.1106.
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.
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.
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.
正畸掩饰治疗结束时患者对面部外观的满意度非常重要，尤其是对于骨性错 畸形。本病例报告强调了治疗计划对于一名最初接受四颗前磨牙拔除掩饰治疗患者的重要性，尽管该患者有正颌手术指征。
一名23岁男性因对自己不满意的面部外观前来寻求治疗。他的上颌第一前磨牙和下颌第二前磨牙已被拔除，并且使用固定矫治器内收前牙两年但没有改善。他有凸面型、露龈笑、唇闭合不全、上颌切牙倾斜度不足，磨牙关系几乎为I类。头影测量分析显示严重的骨性II类错 （A点-鼻根点-B点=11.5°），下颌后缩（蝶鞍-鼻根点-B点=75.9°），上颌前突（蝶鞍-鼻根点-A点=87.4°），以及上颌垂直向过度发育（上切牙至腭平面=33.2mm）。上颌切牙过度舌倾（上切牙至鼻根点-A点连线=-5.5°）是由于之前试图代偿骨性II类错 的治疗尝试。该患者通过去代偿正畸治疗联合正颌手术成功进行了再治疗。上颌切牙在牙槽骨中重新定位并唇倾，覆盖增加，为正颌手术创造了空间，包括上颌骨上移、上颌前部后退以及双侧矢状劈开下颌升支截骨术以纠正其骨性前后向不调。露龈笑减少，唇闭合功能恢复。此外，两年后结果保持稳定。患者对治疗结束时的新面型以及功能错 都很满意。
本病例报告为正畸医生提供了一个很好的范例，展示了如何在正畸掩饰治疗效果不佳后治疗一名患有严重骨性II类错 伴上颌垂直向过度发育的成年人。正畸和正颌治疗可以显著改善患者的面部外观。
