- Email: [email protected]
Correction of an open-bite case complicated by an extreme narrowness of the maxillary arch
CORRECTION EXTREME
OF AN OPEN-BlTE; CASE CO~IPLICATED BY AN NARROWNESS OF THE MAXILLARY ARCH*
T
IilS case is one of a type which I often see in my practice and for which in my opinion the new Angle mechanism is ideally suited. 1 shall endeavor to show how this appliance facilitates t.reatment. had J. H.. aged fifteen yeasts when he first came under my observation had his t,onsils and adenoids removed at thr age of five years. llr was a month-
Fig.
1.
Fig.
2.
breather, had one nasal passage completely obstruotccl, and suffered frcquently from common colds, but gave no other history as to what might cause his malocclusion. Fig, 1 shows the full face of the patient before treat.ment. Notice the extreme length and narrowness of the face. Fig. 2 shows the profile view. Note that t,he gonial angle is 148”. Fig. 3 shows views of the original model. ,2 is a view of the right side of the model. This view contains three dist,inct points of interest: first, there is an extreme abstraction of the premolars and first permanent molar; second, the orbital plane passes through the embrasure between bhe canine and first premolar; third, the occlusal contact is confined to the first permanent molars, although the slide may seem to portray contact hetween the second premolar-x. View C shows the left side of the model. Here the abstract.ion of the molars and ‘Read
before
the
New
York
Society
of
Orthodontisfs, , 0’7 -i
Xew
York
City,
November
14,
1932.
123
m O!P
8.E.P
,/-
I’
,/’
,’
IO
Angle
148 ’
Fig.
4.
124
Eugene
J. Kelly
premolars is practically the same as that on the right side. The orbital planr also passes through the embrasure between the canine and first premo1a.r. The occlusal contact is confined to the first and second permanent molars. Fig. 4 is a diagnostic chart showing the case recorded according t,o Simon ‘\ gnathostatic method. The following were noted: The na,rrowness of tlte maxillary arch; the location of the maxillary prosthion 10.5 mm. forward o!’ the orbital plane; the lack of any overbite in t.he ant.erior portion of t.he denture; the angulation present between the taye-ear plane and t,he occlusal plants ; the abstraction of the entire maxillary tirnture. S0t.e Pont ‘s measnrements. as well as Hawley’s on the chart.
Fig.
5.
Observe that a number ninety Hawley arch is indicated. Fig. 5 presents the differential diagnosis of the case according to the three plane system. First, the relat.ions of the lateral halves of the denture to the medium plane: In the maxilla we find a total, dental, alveolar, maxillary contraction that is medium in degree and asymmetrical in shape. In the mandible, we find a total, dent.al, alveolar contraction that is mild in degree and symmetrical in shape. Second. the relations of the denture t)o the orbital plane : In the maxilla we find a total, dental, alveolar, maxillary protraotion, medium in degree and symmetrical in shape. In the mandible we find a total, dental, alveolar, mandibular retraction, mild in degree and symmetrical in shape.
Correction
of Open-Bite
Fig.
7.
125
&E-P
O!P Ij ,/’ /‘II I’ /’ ,’ I
-1; ;Y
IOmIt.
Genial
Angle
143O Fig.
9.
Correction
of Open-Bite
127
Third, the relations of the denture to the horizontal plane : In the maxilla we find a total, alveolar, maxillary abstraction extreme in degree and symmetrical in shape. In the mandible we find a tot,al, alveolar, mandibular abstraction medium in degree, and asymmetrical in shape. Fig. 6 is an outline of treatment. The first operat,ion was the removal of the deciduous molar. The next step was the banding of the first permanent
Fig.
10.
Fig.
11.
Fig.
12.
molars in the maxillary series and the construction of a lingual arch wire. This was used for a period of approximately four months. Fig. 7 illustrates the appliance minus the lingual arch wire. In the maxillary arch all teeth anterior to the first permanent molars were banded with tie bracket bands. The first and second molars were banded with seamless molar bands. The attachments on the first molar bands consisted of extra wide tie brackets soldered to the buccal surfaces. The attachments on the second molars consisted of buccal tubes, 4 mm. in length, to accommodate the 0.022 x 0.028 labial arch wire. Round arch wires ranging from 0.018 to 0.022 were used to
128
Eu.gene J. Kelly
“step up” the arch until such a time as the edgewise arch could be used. However, the edgewise arch wire was used only for a comparatively short time. as intermaxillary elastics, namely, Baker’s and vertical, compound reciprocal were used. It was feared that if vertical elastics were used in conjunction with the 0.022 x 0.028 wire, a forward tipping of the apical ends of the anterior teeth would result with a stripping of bone from the root surfaces. The patient was seen once every t.hree weeks for twenty-six months Fig. 8 shows the results. Fig. 9 shows the chart of the completed oase. Fig. 10 shows a comparison of the original and finished maxillary models, and Fig. 11 shows a comparison of the original and finished mandibular models.
Fig.
13.
Fig.
14.
You will recall that when t,he chart of the original condition was shown, mention was made of the fact that a Hawley No. YO was indicated. Fig. 12 shows a Hawley chart No. 90 superimposed on the finished maxillary model. A comparison of the original and finished charts may be made from Figs. 4 and 9. Compare the widt,hs of t,he maxillary arches and the location of the prosthion on each chart. A diff’erence of about 5 millimeters is evident in the location of the prosthion on eaeh chart. Note also the change in the overbite and the change in the angulation between the eye-ear plane and the occlusal plane. Figs. 13 and 14 show the full face and profile view of the patient’s face after treatment. On the profile view the gonial angle measures 143”, a change of 5 degrees from the original measurement of 148”. I should like to acknowledge, at this time, my grateful appreciation to Dr. Ralph Waldron for the counsel, assistance, and encouragement he gave me which enabled me to carry this case to a successful termination,
OF AN OPEN-BlTE; CASE CO~IPLICATED BY AN NARROWNESS OF THE MAXILLARY ARCH*
T
IilS case is one of a type which I often see in my practice and for which in my opinion the new Angle mechanism is ideally suited. 1 shall endeavor to show how this appliance facilitates t.reatment. had J. H.. aged fifteen yeasts when he first came under my observation had his t,onsils and adenoids removed at thr age of five years. llr was a month-
Fig.
1.
Fig.
2.
breather, had one nasal passage completely obstruotccl, and suffered frcquently from common colds, but gave no other history as to what might cause his malocclusion. Fig, 1 shows the full face of the patient before treat.ment. Notice the extreme length and narrowness of the face. Fig. 2 shows the profile view. Note that t,he gonial angle is 148”. Fig. 3 shows views of the original model. ,2 is a view of the right side of the model. This view contains three dist,inct points of interest: first, there is an extreme abstraction of the premolars and first permanent molar; second, the orbital plane passes through the embrasure between bhe canine and first premolar; third, the occlusal contact is confined to the first permanent molars, although the slide may seem to portray contact hetween the second premolar-x. View C shows the left side of the model. Here the abstract.ion of the molars and ‘Read
before
the
New
York
Society
of
Orthodontisfs, , 0’7 -i
Xew
York
City,
November
14,
1932.
123
m O!P
8.E.P
,/-
I’
,/’
,’
IO
Angle
148 ’
Fig.
4.
124
Eugene
J. Kelly
premolars is practically the same as that on the right side. The orbital planr also passes through the embrasure between the canine and first premo1a.r. The occlusal contact is confined to the first and second permanent molars. Fig. 4 is a diagnostic chart showing the case recorded according t,o Simon ‘\ gnathostatic method. The following were noted: The na,rrowness of tlte maxillary arch; the location of the maxillary prosthion 10.5 mm. forward o!’ the orbital plane; the lack of any overbite in t.he ant.erior portion of t.he denture; the angulation present between the taye-ear plane and t,he occlusal plants ; the abstraction of the entire maxillary tirnture. S0t.e Pont ‘s measnrements. as well as Hawley’s on the chart.
Fig.
5.
Observe that a number ninety Hawley arch is indicated. Fig. 5 presents the differential diagnosis of the case according to the three plane system. First, the relat.ions of the lateral halves of the denture to the medium plane: In the maxilla we find a total, dental, alveolar, maxillary contraction that is medium in degree and asymmetrical in shape. In the mandible, we find a total, dent.al, alveolar contraction that is mild in degree and symmetrical in shape. Second. the relations of the denture t)o the orbital plane : In the maxilla we find a total, dental, alveolar, maxillary protraotion, medium in degree and symmetrical in shape. In the mandible we find a total, dental, alveolar, mandibular retraction, mild in degree and symmetrical in shape.
Correction
of Open-Bite
Fig.
7.
125
&E-P
O!P Ij ,/’ /‘II I’ /’ ,’ I
-1; ;Y
IOmIt.
Genial
Angle
143O Fig.
9.
Correction
of Open-Bite
127
Third, the relations of the denture to the horizontal plane : In the maxilla we find a total, alveolar, maxillary abstraction extreme in degree and symmetrical in shape. In the mandible we find a tot,al, alveolar, mandibular abstraction medium in degree, and asymmetrical in shape. Fig. 6 is an outline of treatment. The first operat,ion was the removal of the deciduous molar. The next step was the banding of the first permanent
Fig.
10.
Fig.
11.
Fig.
12.
molars in the maxillary series and the construction of a lingual arch wire. This was used for a period of approximately four months. Fig. 7 illustrates the appliance minus the lingual arch wire. In the maxillary arch all teeth anterior to the first permanent molars were banded with tie bracket bands. The first and second molars were banded with seamless molar bands. The attachments on the first molar bands consisted of extra wide tie brackets soldered to the buccal surfaces. The attachments on the second molars consisted of buccal tubes, 4 mm. in length, to accommodate the 0.022 x 0.028 labial arch wire. Round arch wires ranging from 0.018 to 0.022 were used to
128
Eu.gene J. Kelly
“step up” the arch until such a time as the edgewise arch could be used. However, the edgewise arch wire was used only for a comparatively short time. as intermaxillary elastics, namely, Baker’s and vertical, compound reciprocal were used. It was feared that if vertical elastics were used in conjunction with the 0.022 x 0.028 wire, a forward tipping of the apical ends of the anterior teeth would result with a stripping of bone from the root surfaces. The patient was seen once every t.hree weeks for twenty-six months Fig. 8 shows the results. Fig. 9 shows the chart of the completed oase. Fig. 10 shows a comparison of the original and finished maxillary models, and Fig. 11 shows a comparison of the original and finished mandibular models.
Fig.
13.
Fig.
14.
You will recall that when t,he chart of the original condition was shown, mention was made of the fact that a Hawley No. YO was indicated. Fig. 12 shows a Hawley chart No. 90 superimposed on the finished maxillary model. A comparison of the original and finished charts may be made from Figs. 4 and 9. Compare the widt,hs of t,he maxillary arches and the location of the prosthion on each chart. A diff’erence of about 5 millimeters is evident in the location of the prosthion on eaeh chart. Note also the change in the overbite and the change in the angulation between the eye-ear plane and the occlusal plane. Figs. 13 and 14 show the full face and profile view of the patient’s face after treatment. On the profile view the gonial angle measures 143”, a change of 5 degrees from the original measurement of 148”. I should like to acknowledge, at this time, my grateful appreciation to Dr. Ralph Waldron for the counsel, assistance, and encouragement he gave me which enabled me to carry this case to a successful termination,