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A case report on the hereditary factor in three cases of mesioclusion
A CASE REPORT
ON THE
HEREDITARY
FACTOR
IN THREE
CASES
OF MESIOCLUSION BROOKSBELL, D.D.S., DALLAS, TEXAS N MANY cases of mesioclusion coming into our oflice we are unable to definitely determine the etiological factor or factors responsible for these malformations. In the cases presented here I would like to bring to your attention not only that these malformations apparently are inherited, but that, in spite of this handicap, it is possible to bring about marked improvement in masticatory function and facial symmetry. I would also ea.11to your attention the fact that, when these malformations are evidenced in one of the parents, restoration of masticatory function and facial symmetry may be accomplished only up to a certain limit-the limit of inherited tendency. Beyond this indiscernible limit our efforts, through mechanical stimulation, to bring about a closer approach to any normal established by the operator are futile.
I
Fig.
L-Case 1. The has inherited this
mother shows slight tendency toward tendency, which has been corrected
mandibular by restoring
protrusion. The normal occlusion.
child
History.-In only one of these three cases was there family history of mandibular malformation beyond the parents, Case 3 in which the maternal grandmother had a protrusive mandible. In all three cases thorough general physical examinations were made which included tests for metabolism, blood cholesterols, and blood calciums, but no In Cases 2 and 3, hand x-rays evidence of endocrine disturbance was present. Read
before
the
American
Association
of Orthodontists,
MO. 1079
April
17 to
20. 1939,
Kansas
City,
Brooks Bell
1080
were made, following Dr. Clint Howard’s findings that acromegaloid conditions are frequently diagnosable through their hand x-rays showing accelerated ossification centers. However, the centers in these cases were diagnosed as normal. Third molars were not considered sticiently formed to be causative factors at these ages.
Mothqr ,,_ “_
Fig.
2.-Occluded
models
Fig.
3.-Occlusal
views
Patient of Case 1.
Mother of Case
Patient 1.
Hereditary
Pa&or
Patient,
Fig.
4.-Case
2.
The mother shows has been completely
a marked corrected
in Mesioclusion
9 gewa
Old
mandibular by restoring
Mother Fig.
5.-Occluded
models
of
1081
Putiare,,cmar 13 nonthsl i@eatment protrusion. normal
Patient Case 2.
This occlusion.
inherited
tendency
1082
Brooks Bell
EtiologzJ.-These malformations were attributed to an inherited tendency toward mandibular protrusion. Dtignosis.-Mesioclusion or Class III, with constriction and lack of anterior development of the maxillary arch. Case 3 may be considered an instance of macrognathia of the mandible. Treatment.-The usual treatment therapy followed in the correction of mesioclusion was employed. A labial arch with intermaxillary hooks in the canine region was placed in the mandible, stabilized through attachment to first
Mother
Fig. ‘id.-Case trusion. In the child under treatment.
Fig.
6.-Occlusal
views
Patient of Case 2.
grandmother and mother 3. The maternal the protrusion has been somewhat reduced
show marked mandibular probut not completely; she is still
Eleredita~y
Factor
in Mesioclusion
1083
deciduous molars by means of bands with .K hooks and with further stabilization furnished through a lingual arch with Ellis posts. A lingual arch with Ellis posts was placed in the maxilla, having recurved springs for lateral development of the deciduous molars and canines and for anterior development of the central and lateral incisors. Added stabilization was furnished by a labial arch attached to the banded first deciduous molars by K hooks. Intermaxillary elastics were worn day and night and changed nightly. Case 3, in addition to intermaxillary elastics, wore a skull-cap chin strap day and night. Appointments were given at three- and four-week intervals.
Fig.
7B.-Case
3.
Anterior
photographs.
l’recdment on Case 1 was begun at 8 years of age and discontinued after 14 months. Treatment on Case 2 was begun at 9 years and discontinued after 13 months. Case 3 began treatment when 4 years old, has continued for 3 years and 3 months, and is still under treatment. Results Achieved-Cases 1 and 2 have attained their normal masticatory function with a considerably improved facial symmetry, though both still show an inherited tendency toward a protrusive mandible. Case 3 has greatly improved in masticatory function and facial symmetry but still must be considered far removed from its normal. Prognosis.-Cases 1 and 2 will continue to develop toward their normals. Case 3 will have to continue under treatment until the tendency toward further mandibular development toward the anterior has ceased. All three cases will be x-rayed at 12 years of age to ascertain whether or not third molar formation might tend to renew mandibular developments toward the anterior.
Brooks Bell Observations and Conclusions.--In this type of malocclusion in which the same malformations are evidenced in one of the parents, one must be most conservative in prognosing restoration of normal masticatory function or facial symmetry to any-established or predetermined normal, for the limitation placed by inheritance surely controls the utmost extent of response to mechanical stimulation.
Mother Fig.
8.-Occluded
models
mother Fig.
S.-Occlusal
views
Patient of Case
3.
Patient of Case 3.
ON THE
HEREDITARY
FACTOR
IN THREE
CASES
OF MESIOCLUSION BROOKSBELL, D.D.S., DALLAS, TEXAS N MANY cases of mesioclusion coming into our oflice we are unable to definitely determine the etiological factor or factors responsible for these malformations. In the cases presented here I would like to bring to your attention not only that these malformations apparently are inherited, but that, in spite of this handicap, it is possible to bring about marked improvement in masticatory function and facial symmetry. I would also ea.11to your attention the fact that, when these malformations are evidenced in one of the parents, restoration of masticatory function and facial symmetry may be accomplished only up to a certain limit-the limit of inherited tendency. Beyond this indiscernible limit our efforts, through mechanical stimulation, to bring about a closer approach to any normal established by the operator are futile.
I
Fig.
L-Case 1. The has inherited this
mother shows slight tendency toward tendency, which has been corrected
mandibular by restoring
protrusion. The normal occlusion.
child
History.-In only one of these three cases was there family history of mandibular malformation beyond the parents, Case 3 in which the maternal grandmother had a protrusive mandible. In all three cases thorough general physical examinations were made which included tests for metabolism, blood cholesterols, and blood calciums, but no In Cases 2 and 3, hand x-rays evidence of endocrine disturbance was present. Read
before
the
American
Association
of Orthodontists,
MO. 1079
April
17 to
20. 1939,
Kansas
City,
Brooks Bell
1080
were made, following Dr. Clint Howard’s findings that acromegaloid conditions are frequently diagnosable through their hand x-rays showing accelerated ossification centers. However, the centers in these cases were diagnosed as normal. Third molars were not considered sticiently formed to be causative factors at these ages.
Mothqr ,,_ “_
Fig.
2.-Occluded
models
Fig.
3.-Occlusal
views
Patient of Case 1.
Mother of Case
Patient 1.
Hereditary
Pa&or
Patient,
Fig.
4.-Case
2.
The mother shows has been completely
a marked corrected
in Mesioclusion
9 gewa
Old
mandibular by restoring
Mother Fig.
5.-Occluded
models
of
1081
Putiare,,cmar 13 nonthsl i@eatment protrusion. normal
Patient Case 2.
This occlusion.
inherited
tendency
1082
Brooks Bell
EtiologzJ.-These malformations were attributed to an inherited tendency toward mandibular protrusion. Dtignosis.-Mesioclusion or Class III, with constriction and lack of anterior development of the maxillary arch. Case 3 may be considered an instance of macrognathia of the mandible. Treatment.-The usual treatment therapy followed in the correction of mesioclusion was employed. A labial arch with intermaxillary hooks in the canine region was placed in the mandible, stabilized through attachment to first
Mother
Fig. ‘id.-Case trusion. In the child under treatment.
Fig.
6.-Occlusal
views
Patient of Case 2.
grandmother and mother 3. The maternal the protrusion has been somewhat reduced
show marked mandibular probut not completely; she is still
Eleredita~y
Factor
in Mesioclusion
1083
deciduous molars by means of bands with .K hooks and with further stabilization furnished through a lingual arch with Ellis posts. A lingual arch with Ellis posts was placed in the maxilla, having recurved springs for lateral development of the deciduous molars and canines and for anterior development of the central and lateral incisors. Added stabilization was furnished by a labial arch attached to the banded first deciduous molars by K hooks. Intermaxillary elastics were worn day and night and changed nightly. Case 3, in addition to intermaxillary elastics, wore a skull-cap chin strap day and night. Appointments were given at three- and four-week intervals.
Fig.
7B.-Case
3.
Anterior
photographs.
l’recdment on Case 1 was begun at 8 years of age and discontinued after 14 months. Treatment on Case 2 was begun at 9 years and discontinued after 13 months. Case 3 began treatment when 4 years old, has continued for 3 years and 3 months, and is still under treatment. Results Achieved-Cases 1 and 2 have attained their normal masticatory function with a considerably improved facial symmetry, though both still show an inherited tendency toward a protrusive mandible. Case 3 has greatly improved in masticatory function and facial symmetry but still must be considered far removed from its normal. Prognosis.-Cases 1 and 2 will continue to develop toward their normals. Case 3 will have to continue under treatment until the tendency toward further mandibular development toward the anterior has ceased. All three cases will be x-rayed at 12 years of age to ascertain whether or not third molar formation might tend to renew mandibular developments toward the anterior.
Brooks Bell Observations and Conclusions.--In this type of malocclusion in which the same malformations are evidenced in one of the parents, one must be most conservative in prognosing restoration of normal masticatory function or facial symmetry to any-established or predetermined normal, for the limitation placed by inheritance surely controls the utmost extent of response to mechanical stimulation.
Mother Fig.
8.-Occluded
models
mother Fig.
S.-Occlusal
views
Patient of Case
3.
Patient of Case 3.