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Case report and clinic
CASE REPORT AND CLINIC*
By
SYDNEY
W.
BRADLEY, lVLD .S. , OTTAWA, CANADA
TIlE
principal object in presenting th e repor t of this case, a bilateral distoclusion with linguover sion of th e maxillary incisors, is to learn if there is some better and easier way to treat this type of malocclusion than I have been using. If I r emember correctl y, we were told at the D ewey school that this type was perhaps not so difficult as some other types we have to treat. I ha ve found them quite difficult, and I fe el very proud of mys elf when 1 get a case of this class finished up nicely, because I find that they a r e difficult to handle and that they take a long time to treat. We really have two types of malocclusion to treat; fir st you mu st tip the maxillary anterior teeth labially, and this changes th e cas e into a bilateral distoclusion with what appears to be a labiover sion of th e maxillary in cisors, but if we tip these t eeth out correctly and elonga t e the premolars whil e doing this we shall find the upper incisors are n ot protruding too much. W e n ext have to carryall th e mandibular te eth mesially to occlude properly with the maxillary. To do t his correctly we must decide if the mental emin ence is prominent and if the t eeth are well back on th e mandible, in which case we shall carry the mandibular teeth forw ard in the alveolar process, carrying the incisors and canines forward first, then the premolars and then the fir st molars; the second molars will usually move mesially with the firs t. And by raising th e mandibular pre molars and first molars while moving these t eeth mesially we cor r ect the distance betw een the nose a nd the chin, whi ch is too shor t, and r emove th e marked d epression in the in cisiv e fo ssa. If ther e is a la ck of development of th e chin, w e mu st somehow elon gat e th e sides of th e mandible, and t o get th e best r esults t his must be done in th e sec on d and third molar areas, that is betw een th e fir st molar and the angle of the ramus. In this particular case that I am going to show the chin is fairly prominent, but I could not get the mandibular te eth to stay in proper occlusion with the maxillary by using intermaxillary elastics. The patient, a boy fourteen years old when th e case was begun in February, 1925, would shove the mandibl e forward into cor re ct occlu sion wh en told to " close, " but just as soon as he un consciously opened his mouth and r elaxed I could see the mandible "flop" di stally , and I decided w e w ere far from a finished r esult. In May, 1927, I decided to put on buccal bite planes as shown me by Dr. George Grieve of Toronto to see if I eould not develop th e bone and muscular tissues in the ma ndible in the areas between the first molars and the angles of the rami. These wer e worn until May of this year when I began to remove my appliances and place retainers. For an upper retainer I used a Hawley Vulcanite plate with planes built in the Vulcanite in the canine are as to remind the patient to close forward all .Read at a m eetinx of th e Alumni Society of the D ewey S chool o f Orthodonti a . August. 1928.
462
Case Report an d Clini«
the time. ]'01' a lower retainer I used a simple bar attached lingually to two Lands cemented to the canines. The patient was a normal healthy boy well developed physically and mentally. His tonsils and adenoids were removed when he was ten or eleven years old. He is now over six feet tall and, as they say at home, "well put together in every way. "
F'ipure 1 shows occlusal views of the upper teeth before and after treatment. Figure 2 shows occlusal views of the mandibular teeth before and after treatment. Figure 3 shows views of the anterior teeth, showing the pronounced supraelusion of the incisors, or rather the infraclusion of the premolars and molars. 'I'he corrected case is shown on the right side. Figure 4 shows right side before and after treatment.
464 F'igurc 5 shows Figure 6 shows after treatment. Figure 7 shows Figure 8 shows
Sydney W. Bradley
left side before and after treatment. anterior views of the occlusion of the teeth before and views of'the full face before and after treatment. profile views of the face before and after treatment.
Figure 9 shows lateral VIews of the buccal bite planes attached to the main alignment wires. Figure 10 shows occlusal views of the planes and also the type of retainers used in this case. Figure 11 shows four pairs of tungsten pointed pliers and a pair of artery forceps used in soldering. The tungsten points are made of 0.030 round gold-plated tungsten wire, soldered to ordinary steel soldering pliers with 22 K. solder. One pair has ordinary fine points; one pair has fine grooves
Case Report and Clinic
465
running the long way of the wire; the other has cross grooves and the third pair takes the place of the angle band soldering pliers. The hemostat (small mosquito forceps) has delicate curved points and is used to hold bands and wires while soldering. When locked it has a positive grip. Fig. 10.
Fig. 9.
-~
I
/ ;
"'I
\
I
,, I'
II
II:!'
-
j
'-t
t l-~1 "
- -"---o-
:I
/ Fig. 12.
Fig. 11.
Figure 12 shows a square tube with looking device which I find much better than the half round tube formerly used on incisor bands. A round pin can be used in it just as well as a square one and works much nicer than when used in the old half round tube; and if you wish to stabilize the tooth, you can use the square pin. The tubes are 0.010 inch long and take a 0.02il round wire or a square wire 0.023 inches to a side 142
LAlllUER AVENUE
W.
By
SYDNEY
W.
BRADLEY, lVLD .S. , OTTAWA, CANADA
TIlE
principal object in presenting th e repor t of this case, a bilateral distoclusion with linguover sion of th e maxillary incisors, is to learn if there is some better and easier way to treat this type of malocclusion than I have been using. If I r emember correctl y, we were told at the D ewey school that this type was perhaps not so difficult as some other types we have to treat. I ha ve found them quite difficult, and I fe el very proud of mys elf when 1 get a case of this class finished up nicely, because I find that they a r e difficult to handle and that they take a long time to treat. We really have two types of malocclusion to treat; fir st you mu st tip the maxillary anterior teeth labially, and this changes th e cas e into a bilateral distoclusion with what appears to be a labiover sion of th e maxillary in cisors, but if we tip these t eeth out correctly and elonga t e the premolars whil e doing this we shall find the upper incisors are n ot protruding too much. W e n ext have to carryall th e mandibular te eth mesially to occlude properly with the maxillary. To do t his correctly we must decide if the mental emin ence is prominent and if the t eeth are well back on th e mandible, in which case we shall carry the mandibular teeth forw ard in the alveolar process, carrying the incisors and canines forward first, then the premolars and then the fir st molars; the second molars will usually move mesially with the firs t. And by raising th e mandibular pre molars and first molars while moving these t eeth mesially we cor r ect the distance betw een the nose a nd the chin, whi ch is too shor t, and r emove th e marked d epression in the in cisiv e fo ssa. If ther e is a la ck of development of th e chin, w e mu st somehow elon gat e th e sides of th e mandible, and t o get th e best r esults t his must be done in th e sec on d and third molar areas, that is betw een th e fir st molar and the angle of the ramus. In this particular case that I am going to show the chin is fairly prominent, but I could not get the mandibular te eth to stay in proper occlusion with the maxillary by using intermaxillary elastics. The patient, a boy fourteen years old when th e case was begun in February, 1925, would shove the mandibl e forward into cor re ct occlu sion wh en told to " close, " but just as soon as he un consciously opened his mouth and r elaxed I could see the mandible "flop" di stally , and I decided w e w ere far from a finished r esult. In May, 1927, I decided to put on buccal bite planes as shown me by Dr. George Grieve of Toronto to see if I eould not develop th e bone and muscular tissues in the ma ndible in the areas between the first molars and the angles of the rami. These wer e worn until May of this year when I began to remove my appliances and place retainers. For an upper retainer I used a Hawley Vulcanite plate with planes built in the Vulcanite in the canine are as to remind the patient to close forward all .Read at a m eetinx of th e Alumni Society of the D ewey S chool o f Orthodonti a . August. 1928.
462
Case Report an d Clini«
the time. ]'01' a lower retainer I used a simple bar attached lingually to two Lands cemented to the canines. The patient was a normal healthy boy well developed physically and mentally. His tonsils and adenoids were removed when he was ten or eleven years old. He is now over six feet tall and, as they say at home, "well put together in every way. "
F'ipure 1 shows occlusal views of the upper teeth before and after treatment. Figure 2 shows occlusal views of the mandibular teeth before and after treatment. Figure 3 shows views of the anterior teeth, showing the pronounced supraelusion of the incisors, or rather the infraclusion of the premolars and molars. 'I'he corrected case is shown on the right side. Figure 4 shows right side before and after treatment.
464 F'igurc 5 shows Figure 6 shows after treatment. Figure 7 shows Figure 8 shows
Sydney W. Bradley
left side before and after treatment. anterior views of the occlusion of the teeth before and views of'the full face before and after treatment. profile views of the face before and after treatment.
Figure 9 shows lateral VIews of the buccal bite planes attached to the main alignment wires. Figure 10 shows occlusal views of the planes and also the type of retainers used in this case. Figure 11 shows four pairs of tungsten pointed pliers and a pair of artery forceps used in soldering. The tungsten points are made of 0.030 round gold-plated tungsten wire, soldered to ordinary steel soldering pliers with 22 K. solder. One pair has ordinary fine points; one pair has fine grooves
Case Report and Clinic
465
running the long way of the wire; the other has cross grooves and the third pair takes the place of the angle band soldering pliers. The hemostat (small mosquito forceps) has delicate curved points and is used to hold bands and wires while soldering. When locked it has a positive grip. Fig. 10.
Fig. 9.
-~
I
/ ;
"'I
\
I
,, I'
II
II:!'
-
j
'-t
t l-~1 "
- -"---o-
:I
/ Fig. 12.
Fig. 11.
Figure 12 shows a square tube with looking device which I find much better than the half round tube formerly used on incisor bands. A round pin can be used in it just as well as a square one and works much nicer than when used in the old half round tube; and if you wish to stabilize the tooth, you can use the square pin. The tubes are 0.010 inch long and take a 0.02il round wire or a square wire 0.023 inches to a side 142
LAlllUER AVENUE
W.