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Progress report of the correction of an extreme case of distoclusion, utilizing occipital anchorage, the pin appliance and buccal planes
Case Reports PROGRESS REPORT OF THE CORRECTION O~' AN EXTREME CASE OF DISTOCLUSION, UTILIZING OCCIPITAL ANCHORAGE, THE PIN APPLIANCE AND BUCCAL PLANES* By
GEORGE
W.
GRIEVE,
D.D.S.,
TORONTO, CANADA
THIS case is not being reported with the idea of showing any particular accomplishment in treatment, but to demonstrate the futility of endeavoring to correct a distoclusion case of this magnitude by the use of the generally recognized technic-the Baker anchorage.
Fig. 1.
Fig. 2.
Intermaxillary anchorage, as developed by Dr. H. A. Baker and Dr. Edward H. Angle, has proved of great value in orthodontia, but as a result of faulty diagnosis this principle has been, and I am convinced is being today improperly applied by many practitioners in a large number of cases. Does anyone in this room still believe that in the treatment of a case of distoclusion it is proper procedure to carry the mandibular buccal teeth forward in the bone? If so, I believe, with all due respect and appreciation of the work of such men as Angle, Baker and others, that you are wrong. Have not a large number of the distoclusion cases which all of us have treated by the use of the Baker anchorage lapsed, more or less? 'Why did the mandibular incisors drop back and crowd after the removal of the appliances? Because in treatment the teeth were all carried forward of their normal position on the apical base; in fact in many of these cases the crowns at least of some or all 'Read before the American Society of Orthodontists, Buffalo, N. Y., April 30-May 3, 1928.
4fi7
458
George W. Grieve
of the mandibular teeth are too far forward before the work is commenced. I am on record as saying that I believe the apical ends of the roots of buccal teeth are rarely if ever too far d.stal in the bone itself, particularly in the mandible, and I feel that the time will come when you will all agree with me. I practiced orthodontia for eighteen years before I came to this conclusion, and I had many failures, most of which, with the kind indulgence of the patients, I stuck with in my effort to find out what was wrong, If the mandibular teeth are too far forward before we commence treatment, no appliance, no matter how efficient or how perfectly adjusted, will
Fig. 3.
Fig. 4.
Fig. 5.
hold these teeth so definitely that they will withstand the constant forward pull of the elastics over a long period of time and not move forward more or less. Then how are we going to correct these cases 1 We must utilize extraoral ar:chorage or remove some teeth. In extreme cases, such as the one being shown here today to bring out the point I am endeavoring to make, resort was made to both of these expedients. Figs. 1 and 2 show the photographs of the patient, a girl fourteen years old when treatment was commenced in July, 1926. You will notice a great overdevelopment of the whole maxillarv and nasa 1 regions, due to a chronic
Correction of Ertrcm« ('ase 0.1' T>i."/(J('/l/siOIl
459
rhinitis associated with mouth-breathing for years. It is impossible wholly to correct this over-development, Figs. 3, 4, and 5 show the original casts. All four first premolars were removed, and the pin appliance (F'ig. 6) was adjusted, with U-springs to carry the canines distally, utilizing the balance of the teeth as anchorage. About the end of May, 1927, I realized that it would be necessary to carry the maxillary molars and second premolars distally, and at that time occipital
Fig. 6.
Fig. 7.
Fig. 8.
anchorage was applied-to be worn at night and more if possible. Springs were now applied to carry the second maxillary molars distally, and later all the other teeth, one on each side at a time. About the middle of February, 1928, the molars and second premolars had been carried back as far as was possible with the amount of time available, and buccal planes were adjusted, as Dr. Rogers would say, "to place the teeth in mechanical advantage," in order that nature might ler:gthen the mandible slightly. Springs were continued to complete the distal movement of the canines, and the incisors are now being moved lingually.
460
Georqe W. Grieve
The patient lives over two thousand miles distant from Toronto, and as she has not been home in nearly two years, she is anxious to go at the end of the present school term in June. The appliances will be left on for possibly six months after she leaves me, and I feel that if no accident occurs during that period which her dentist cannot repair, the result will be fairly satisfactory. She wears plasters over her lips at night and is doing exercises for the development of the masseter-temporal group of muscles as well as those of the lips. Fig. 7 shows a cast made from a labial impression taken with compound recently, and Fig. 8 is a profile photograph. 2
BLOOR
E
STREET.
DISCUSSION
Dr. C. A. Ha,wley (Washi,ngton, D. C.) .-1 just want to say that I agree very emphatically with what Dr, Grieve has presented, and I want to call your attention just now to what he has said about the action of intermaxillary elastics. In the discussion of a paper by Dr. Leonard in Baltimore on Saturday, I presented some evidence of the effect of intermaxillary elastics which will soon be published. It is revealed by gnathostatic measurements, and while I have used intermaxillary elastics for over twenty years, I never have had revealed to me what they really did as I have lately. Dr. Grieve has also spoken of the desirability of moving the molar teeth backward. He says he has done it in this case, but he hasn't proved it. As the time is very short, I don't want to go further into the discussion of this case report, but I did want to call your attention to those facts.
GEORGE
W.
GRIEVE,
D.D.S.,
TORONTO, CANADA
THIS case is not being reported with the idea of showing any particular accomplishment in treatment, but to demonstrate the futility of endeavoring to correct a distoclusion case of this magnitude by the use of the generally recognized technic-the Baker anchorage.
Fig. 1.
Fig. 2.
Intermaxillary anchorage, as developed by Dr. H. A. Baker and Dr. Edward H. Angle, has proved of great value in orthodontia, but as a result of faulty diagnosis this principle has been, and I am convinced is being today improperly applied by many practitioners in a large number of cases. Does anyone in this room still believe that in the treatment of a case of distoclusion it is proper procedure to carry the mandibular buccal teeth forward in the bone? If so, I believe, with all due respect and appreciation of the work of such men as Angle, Baker and others, that you are wrong. Have not a large number of the distoclusion cases which all of us have treated by the use of the Baker anchorage lapsed, more or less? 'Why did the mandibular incisors drop back and crowd after the removal of the appliances? Because in treatment the teeth were all carried forward of their normal position on the apical base; in fact in many of these cases the crowns at least of some or all 'Read before the American Society of Orthodontists, Buffalo, N. Y., April 30-May 3, 1928.
4fi7
458
George W. Grieve
of the mandibular teeth are too far forward before the work is commenced. I am on record as saying that I believe the apical ends of the roots of buccal teeth are rarely if ever too far d.stal in the bone itself, particularly in the mandible, and I feel that the time will come when you will all agree with me. I practiced orthodontia for eighteen years before I came to this conclusion, and I had many failures, most of which, with the kind indulgence of the patients, I stuck with in my effort to find out what was wrong, If the mandibular teeth are too far forward before we commence treatment, no appliance, no matter how efficient or how perfectly adjusted, will
Fig. 3.
Fig. 4.
Fig. 5.
hold these teeth so definitely that they will withstand the constant forward pull of the elastics over a long period of time and not move forward more or less. Then how are we going to correct these cases 1 We must utilize extraoral ar:chorage or remove some teeth. In extreme cases, such as the one being shown here today to bring out the point I am endeavoring to make, resort was made to both of these expedients. Figs. 1 and 2 show the photographs of the patient, a girl fourteen years old when treatment was commenced in July, 1926. You will notice a great overdevelopment of the whole maxillarv and nasa 1 regions, due to a chronic
Correction of Ertrcm« ('ase 0.1' T>i."/(J('/l/siOIl
459
rhinitis associated with mouth-breathing for years. It is impossible wholly to correct this over-development, Figs. 3, 4, and 5 show the original casts. All four first premolars were removed, and the pin appliance (F'ig. 6) was adjusted, with U-springs to carry the canines distally, utilizing the balance of the teeth as anchorage. About the end of May, 1927, I realized that it would be necessary to carry the maxillary molars and second premolars distally, and at that time occipital
Fig. 6.
Fig. 7.
Fig. 8.
anchorage was applied-to be worn at night and more if possible. Springs were now applied to carry the second maxillary molars distally, and later all the other teeth, one on each side at a time. About the middle of February, 1928, the molars and second premolars had been carried back as far as was possible with the amount of time available, and buccal planes were adjusted, as Dr. Rogers would say, "to place the teeth in mechanical advantage," in order that nature might ler:gthen the mandible slightly. Springs were continued to complete the distal movement of the canines, and the incisors are now being moved lingually.
460
Georqe W. Grieve
The patient lives over two thousand miles distant from Toronto, and as she has not been home in nearly two years, she is anxious to go at the end of the present school term in June. The appliances will be left on for possibly six months after she leaves me, and I feel that if no accident occurs during that period which her dentist cannot repair, the result will be fairly satisfactory. She wears plasters over her lips at night and is doing exercises for the development of the masseter-temporal group of muscles as well as those of the lips. Fig. 7 shows a cast made from a labial impression taken with compound recently, and Fig. 8 is a profile photograph. 2
BLOOR
E
STREET.
DISCUSSION
Dr. C. A. Ha,wley (Washi,ngton, D. C.) .-1 just want to say that I agree very emphatically with what Dr, Grieve has presented, and I want to call your attention just now to what he has said about the action of intermaxillary elastics. In the discussion of a paper by Dr. Leonard in Baltimore on Saturday, I presented some evidence of the effect of intermaxillary elastics which will soon be published. It is revealed by gnathostatic measurements, and while I have used intermaxillary elastics for over twenty years, I never have had revealed to me what they really did as I have lately. Dr. Grieve has also spoken of the desirability of moving the molar teeth backward. He says he has done it in this case, but he hasn't proved it. As the time is very short, I don't want to go further into the discussion of this case report, but I did want to call your attention to those facts.