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Mutilated overbite case
MUTILATED GEORGE
R.
MOORE,
OVERBITE D.D.S., ANN
CASE” ARBOR,
Mrc~.
H
ISTORY.---The patient, a girl aged nineteen years and six months, was first examined February 9, 1928. In consequence of an early separation from other members of her family, I was unable to get a complete history of her early development. The patient, however, reported having suffered no ,serious illness at any time during her life and was, from all appearances at that time, 1. &Note in an excellent state of health. Casts of her mouth are shown in the normal anteroposterior relation of arches with a deep overbite confined to maxillary central incisor region and mandibular incisor and canine regions only. She was a normal breather with normal lip function. The overbite was not, in this case, symptomatic of deficiency in vertical development of the face. The mandibular right lateral incisor had been extracted at an early age by some dentist who hoped to correct the irregular alignment of mandibular anteriors but who had no knowledge or concern over consequent maloeclusisn which he might produce. Fig. 2 shows radiographs taken several months after treatment was started. The patient had broken several appointments with the resultant tipping of mandibular first molars, and I referred her for this radiographic examination to check for damage to supporting tissues. There was some, as is shown, but mandibular appliances were removed temporarily. Note the amazing number of pulp stones, and yet an analysis of the blood soon after showed normal calcium content. I wanted to show aa a part of this report another radiographic examination, but was unable to get, the patient to come to the o&e again for it. Attributed Etiology.-From the foregoing it will be seen that the deep overbite in this case was contributed to very largely by the premature extraction of mandibular right permanent lateral incisor. Diagnosis.-Mutilated case complicated by retrusion and extrusion of maxillary central incisors, mild protrusion of maxillary lateral incisors, retrusion and extrusion of mandibular anteriors. Treatme&.--From April, 1928, to May, 1930, exeepting for two threemonth summer vacations, treatment was active. This was administered by means of maxillary high labial wire with soldered lingual sections ending at the canine regions and intended to stimulate lateral expansion. With the aid of hook extensions, maxillary central incisors were intruded and tipped labially. At the same time, a mandibular lingual wire with loops in the premolar region was used to elongate the mandibular arch anteroposteriorly and expa.nd it laterally. This accomplished, I proceeded to open up space in the mandibular lateral incisor region by means of a combination of simple and recurved
Fig.
right
*Presented
to
the
American
Board
of
Orthodontia. 449
George R. Moore
450
Fig.
1.
Fig.
2.
Fig.
3,
springs. In May, 1930, there was adequate space for an artificial mandibular lateral incisor, which was supplied as part of a modified Hawley retainer, which is still being worn. Res&ts.---When this patient first appeared in the office, she was concerned over impingement of the mucous membrane lingual to the maxillary incisors, as well as over the repulsive appearance of the exuviated maxillary central incisors. From Fig. 3, which represents casts made in December, 1931, eighteen months after appliances were removed, it, will be seen that both objet!tionable features of this case have been corrected. The patient may not hare iI
Fig.
5.
perfect dentition, but, considering the time spent in treatment and the paFigs. 4 and 5 show phototient’s age, the results have been very satisfactory. graphs made in April, 1932. Prognosis.-In t,he past two years the case has relapsed no more than would be expected along with the settling of the occlusion after removal of appliances. The patient wishes to wear the removable retainer for another year, which may be a fortunate circumstance inasmuch as establishment of rrmndibular incisors in their new positions will thus be more permanently assured. Although a much more satisfactory occlusion might have been assured by the administration of preventive measures early in the patient’s life: I am convinced after having treated this and many other adult cases presenting problems of varying complexity that there is a wide field for t,his kind of treatment.
R.
MOORE,
OVERBITE D.D.S., ANN
CASE” ARBOR,
Mrc~.
H
ISTORY.---The patient, a girl aged nineteen years and six months, was first examined February 9, 1928. In consequence of an early separation from other members of her family, I was unable to get a complete history of her early development. The patient, however, reported having suffered no ,serious illness at any time during her life and was, from all appearances at that time, 1. &Note in an excellent state of health. Casts of her mouth are shown in the normal anteroposterior relation of arches with a deep overbite confined to maxillary central incisor region and mandibular incisor and canine regions only. She was a normal breather with normal lip function. The overbite was not, in this case, symptomatic of deficiency in vertical development of the face. The mandibular right lateral incisor had been extracted at an early age by some dentist who hoped to correct the irregular alignment of mandibular anteriors but who had no knowledge or concern over consequent maloeclusisn which he might produce. Fig. 2 shows radiographs taken several months after treatment was started. The patient had broken several appointments with the resultant tipping of mandibular first molars, and I referred her for this radiographic examination to check for damage to supporting tissues. There was some, as is shown, but mandibular appliances were removed temporarily. Note the amazing number of pulp stones, and yet an analysis of the blood soon after showed normal calcium content. I wanted to show aa a part of this report another radiographic examination, but was unable to get, the patient to come to the o&e again for it. Attributed Etiology.-From the foregoing it will be seen that the deep overbite in this case was contributed to very largely by the premature extraction of mandibular right permanent lateral incisor. Diagnosis.-Mutilated case complicated by retrusion and extrusion of maxillary central incisors, mild protrusion of maxillary lateral incisors, retrusion and extrusion of mandibular anteriors. Treatme&.--From April, 1928, to May, 1930, exeepting for two threemonth summer vacations, treatment was active. This was administered by means of maxillary high labial wire with soldered lingual sections ending at the canine regions and intended to stimulate lateral expansion. With the aid of hook extensions, maxillary central incisors were intruded and tipped labially. At the same time, a mandibular lingual wire with loops in the premolar region was used to elongate the mandibular arch anteroposteriorly and expa.nd it laterally. This accomplished, I proceeded to open up space in the mandibular lateral incisor region by means of a combination of simple and recurved
Fig.
right
*Presented
to
the
American
Board
of
Orthodontia. 449
George R. Moore
450
Fig.
1.
Fig.
2.
Fig.
3,
springs. In May, 1930, there was adequate space for an artificial mandibular lateral incisor, which was supplied as part of a modified Hawley retainer, which is still being worn. Res&ts.---When this patient first appeared in the office, she was concerned over impingement of the mucous membrane lingual to the maxillary incisors, as well as over the repulsive appearance of the exuviated maxillary central incisors. From Fig. 3, which represents casts made in December, 1931, eighteen months after appliances were removed, it, will be seen that both objet!tionable features of this case have been corrected. The patient may not hare iI
Fig.
5.
perfect dentition, but, considering the time spent in treatment and the paFigs. 4 and 5 show phototient’s age, the results have been very satisfactory. graphs made in April, 1932. Prognosis.-In t,he past two years the case has relapsed no more than would be expected along with the settling of the occlusion after removal of appliances. The patient wishes to wear the removable retainer for another year, which may be a fortunate circumstance inasmuch as establishment of rrmndibular incisors in their new positions will thus be more permanently assured. Although a much more satisfactory occlusion might have been assured by the administration of preventive measures early in the patient’s life: I am convinced after having treated this and many other adult cases presenting problems of varying complexity that there is a wide field for t,his kind of treatment.