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Case report Extreme case of bilateral distoclusion with labioversion of maxillary incisors
CASE REPORT”
EXTREME CASE OF BILATERAL
DISTOCLIJSION
WITH
IJAHIOVERSION
OF
MAXILLXRY
INCISOltS
BY
T.
WALLACE
SORRELS,
D.D.S.,
OKLAHOMA
CITP,
OKLA
AM prompted to offer this case report for your consideration by reason of the many interesting factors it presents for serious thought. For conven.ence of study we will discuss it under the salient points of etiology, diaglosis, prognosis, and treatment. The primary causative factors from both a theoretical and clinical aspect rvere evidently the combined influence of nasal obstructions and an abnorcaused bp nally large tongue. Theoretically the enlarged tongue js usualfy ocal inflammation, and enlargement. of the lymph vessels called lymph-
Fig.
Fig.
1.
2.
The abnoringiectasia or from muscular hypertrophy called megaloglossia. mally large tongue is known as macroglossia whether or not it be the result If either one or both of these causative factors, it being only reasonable to assume that these conditions may be the result of excessive exercise and Abnormal use of the tongue during prolonged irritations of mild degree. Infancy and its growing period should therefore be carefully watched and :he habits be prohibited if the abnormally large dent,al arches and interrupted contacts of the teeth are to be prevented. A study of the malocclusion and associated facial deformity as illustrated by Figs. 1, 2, 3, 4, and 5, has, as will be noted, all the characteristics of a severe and extre-ma cttse of bilateral distoclusion wit,h labioversion of the maxillary anterior teeth. wld
at
*Read before the Twenty-fifth Atlanta, Ga., April 14-17.
Annual 1925.
Meeting
748
of
th(‘
Xmcaricarr
Sorirty
of
c)rthadontists
Case Report Any attempt extraction of the the six maxillary ticed by many in occlusion, would dental arches is tongue.
to establish harmony in first maxillary right and anterior teeth distally as treating cases of advanced be sure to result in failure. made prohibitive by the
Fig.
Fig.
4.
749 the mesiodistal relationship by left first premolars and moving frequently advocated and praeyears with similar types of malAny reduction in size of the action of the abnormally large
3.
Fig.
5.
The usual plan of treatment for cases of this class, such as retracting the maxillary incisors and moving all the maxillary teeth distally and all the mandibular teeth mesially, would be impractical. Clinical experience has demonstrated that the prognosis under this plan of treatment would be too unfavorable. This plan of treat,ment would require several years of watchful care and then probably result in failure as is almost invariably the rule is with cases of this class and type at this age. Such a plan of treatment
Fix,
(i.
Fig. 7.
ads. Hooks were soldered IO the arch jusi. distal to thr laterals to receive intermaxillary elastics. Spring loops of .02H hard tlrawn wire were soldered to the arch just anterior to the buccal tubes with space allowed between them to permit the arch to travel distally in retracting the maxillary incisors. Wire ligatnres were used about buccal tubes and sprin g loops to stabalize the arch *ml assist in moving the incisors distally. Long hooks were soldered to -I&i in the cuspid region t 0 receive intermaxillar~ elastics. Plain bands with ribbon arch slleath tubes were &wed on the mandibular left first molar and mandibular right second molar. Ribbon arch bracket bands were plsced on the sccontl premolars. Depressor hooks for mandibular sec*Oll(l prenioliws. were
used after sufficient space had been made between second premolar and first molar to receive the wire. Finger springs were used at the beginning of treatment on the right side where the first molar is now absent. This prevented a rotation of second premolars and more equally distributed the applied force on these teeth. Nuts on the arch were used to move all the The mandibular molars served incisors, canines, and premolars mesially.
Fig.
Fig.
9.
8.
Fig.
10.
as a fulcrum for moving the ten teeth mesially and were reinforced by the use of the intermaxillary elastics which also moved the maxillary incisors distally. Wire ligatures were used about lower incisors in combination with ribbon arch bracket bands which were used alternately. A plain lingual alignment wire of .038 gauge soldered to molar bands with finger springs extending bucally and located distal to right and left second premolars was used to retain the mandibular teeth. A plain labial
752
T. Wallace Sorrels
alignment wire of .038 gaugt: soldered lo molar bantls with iuci;-al hooks over central served as retention for the maxillary twth. Ilridge work ~vill be inserted to fill space created by the nresial movement and loss of llle 6~1. permanent. molar which will act as a permanent form of retention. Massage and a special exercise of attempting to clra\v the maxillary lil) downward and suck it in bct.ween t hc masillary aud mandibular teeth has greatly increased the size of the upper lip which \vas much below normal in size. This young man, who is a premedical student, is now a. normal breather and proportionately has a better lease on health and life as well as the pleasure and benefits to be derived from his improved appearance. Figs. 1: 3> 3, 4, and 5 illustrate the case before treatment, while Figs. 6, 7, 8, 9, and 10 The elapsed time betwee the motlels and illustrate Ihe case after treatment. pictlrres of befort: alrd after treatment is two years and three mont,lls, but the pat,icnt is still under retention.
EXTREME CASE OF BILATERAL
DISTOCLIJSION
WITH
IJAHIOVERSION
OF
MAXILLXRY
INCISOltS
BY
T.
WALLACE
SORRELS,
D.D.S.,
OKLAHOMA
CITP,
OKLA
AM prompted to offer this case report for your consideration by reason of the many interesting factors it presents for serious thought. For conven.ence of study we will discuss it under the salient points of etiology, diaglosis, prognosis, and treatment. The primary causative factors from both a theoretical and clinical aspect rvere evidently the combined influence of nasal obstructions and an abnorcaused bp nally large tongue. Theoretically the enlarged tongue js usualfy ocal inflammation, and enlargement. of the lymph vessels called lymph-
Fig.
Fig.
1.
2.
The abnoringiectasia or from muscular hypertrophy called megaloglossia. mally large tongue is known as macroglossia whether or not it be the result If either one or both of these causative factors, it being only reasonable to assume that these conditions may be the result of excessive exercise and Abnormal use of the tongue during prolonged irritations of mild degree. Infancy and its growing period should therefore be carefully watched and :he habits be prohibited if the abnormally large dent,al arches and interrupted contacts of the teeth are to be prevented. A study of the malocclusion and associated facial deformity as illustrated by Figs. 1, 2, 3, 4, and 5, has, as will be noted, all the characteristics of a severe and extre-ma cttse of bilateral distoclusion wit,h labioversion of the maxillary anterior teeth. wld
at
*Read before the Twenty-fifth Atlanta, Ga., April 14-17.
Annual 1925.
Meeting
748
of
th(‘
Xmcaricarr
Sorirty
of
c)rthadontists
Case Report Any attempt extraction of the the six maxillary ticed by many in occlusion, would dental arches is tongue.
to establish harmony in first maxillary right and anterior teeth distally as treating cases of advanced be sure to result in failure. made prohibitive by the
Fig.
Fig.
4.
749 the mesiodistal relationship by left first premolars and moving frequently advocated and praeyears with similar types of malAny reduction in size of the action of the abnormally large
3.
Fig.
5.
The usual plan of treatment for cases of this class, such as retracting the maxillary incisors and moving all the maxillary teeth distally and all the mandibular teeth mesially, would be impractical. Clinical experience has demonstrated that the prognosis under this plan of treatment would be too unfavorable. This plan of treat,ment would require several years of watchful care and then probably result in failure as is almost invariably the rule is with cases of this class and type at this age. Such a plan of treatment
Fix,
(i.
Fig. 7.
ads. Hooks were soldered IO the arch jusi. distal to thr laterals to receive intermaxillary elastics. Spring loops of .02H hard tlrawn wire were soldered to the arch just anterior to the buccal tubes with space allowed between them to permit the arch to travel distally in retracting the maxillary incisors. Wire ligatnres were used about buccal tubes and sprin g loops to stabalize the arch *ml assist in moving the incisors distally. Long hooks were soldered to -I&i in the cuspid region t 0 receive intermaxillar~ elastics. Plain bands with ribbon arch slleath tubes were &wed on the mandibular left first molar and mandibular right second molar. Ribbon arch bracket bands were plsced on the sccontl premolars. Depressor hooks for mandibular
used after sufficient space had been made between second premolar and first molar to receive the wire. Finger springs were used at the beginning of treatment on the right side where the first molar is now absent. This prevented a rotation of second premolars and more equally distributed the applied force on these teeth. Nuts on the arch were used to move all the The mandibular molars served incisors, canines, and premolars mesially.
Fig.
Fig.
9.
8.
Fig.
10.
as a fulcrum for moving the ten teeth mesially and were reinforced by the use of the intermaxillary elastics which also moved the maxillary incisors distally. Wire ligatures were used about lower incisors in combination with ribbon arch bracket bands which were used alternately. A plain lingual alignment wire of .038 gauge soldered to molar bands with finger springs extending bucally and located distal to right and left second premolars was used to retain the mandibular teeth. A plain labial
752
T. Wallace Sorrels
alignment wire of .038 gaugt: soldered lo molar bantls with iuci;-al hooks over central served as retention for the maxillary twth. Ilridge work ~vill be inserted to fill space created by the nresial movement and loss of llle 6~1. permanent. molar which will act as a permanent form of retention. Massage and a special exercise of attempting to clra\v the maxillary lil) downward and suck it in bct.ween t hc masillary aud mandibular teeth has greatly increased the size of the upper lip which \vas much below normal in size. This young man, who is a premedical student, is now a. normal breather and proportionately has a better lease on health and life as well as the pleasure and benefits to be derived from his improved appearance. Figs. 1: 3> 3, 4, and 5 illustrate the case before treatment, while Figs. 6, 7, 8, 9, and 10 The elapsed time betwee the motlels and illustrate Ihe case after treatment. pictlrres of befort: alrd after treatment is two years and three mont,lls, but the pat,icnt is still under retention.