Treatment of a bilateral distoclusion with a linguoclusion of the maxillary buccal teeth

TREATMENT OF A BILATERAL DISTOCLUSION WITH A LINGUOCLUSION OF THE MAXILLARY BUCCAL TEETH· C. J. VOSMIK, D.D.S., CLEVELAND, OHIO BOY, age nine years, weight forty-seven pounds and height fortyH I STORY.eight inches. The dental arches of the father were in normal relationship. The mother exhibited a distoclusion with a protrusion of the maxillary incisors. At three years of age the child was subjected to an attack of influenza, the sequelae of which were pulmonary tuberculosis and acidosis. Tonsils and adenoids were removed at six and a half years. The child was a mouth-breather. His general health had been restored to a fairly normal state at the time orthodontia treatment was begun. Oral examination of the teeth revealed no cavities, and eruption of the teeth was taking place in a normal manner. Radiographic examination revealed that all the unerupted permanent teeth were present. Fig. 1 shows extraoral radiographs taken October, 1926. Attributed Etiology.-Mouth-breathing and an early loss of the mandibular deciduous first molars may be considered the immediate cause of the malocclusion. A general derangement and retardation of growth processes by the tuberculous infection may be regarded as a remote cause. Diagnosis.-Impressions were taken and casts of the denture were constructed. The malocclusion was classified as a bilateral distoclusion with a linguoclusion of the maxillary right and left first and second deciduous and first permanent molars. Fig. 2 shows views of casts made October, 1926. Treatment.-The teeth and dental arches were restored to a normal functional and anatomic relationship by the following plan of treatment: first, lateral expansion of the maxillary buccal teeth; second, labial movement of the mandibular incisors and lingual movement of the maxillary incisors; and third, a change in the relationship of the maxillary and mandibular dental arches. Molar bands carrying half round lingual tubes and 0.040 inch buccal tubes were placed on the four first permanent molars. The mandibular dental arch carried both a labial wire and a removable lingual wire. The labial wire carried 0.025 inch spring loops just anterior to the buccal tubes. The mandibular incisors were attached to the labial wire by means of wire ligatures and the loops gradually opened, thus causing the labial movement of the incisors. The lingual wire was used merely to stabilize the molars. In the maxillary dental arch treatment was begun with a labial wire, the ends of which were sprung out to exert lateral pressure on the first permanent molars. After the first permanent ·Presented to the American Board of Orthodontia, May, 1932.

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molars were placed in their proper labiolingual relationship with the mandibular teeth, the labial wire was made passive and hooks for intermaxillary elastics were attached. At this time a removable lingual wire carrying compound auxiliary springs in the region of the deciduous canines and molars was placed in the maxillary arch. The use of intermaxillary elastics was begun at this time. ResUlts Achieved.-The patient presented for treatment October 16, 1926. Due to the excellent cooperation of the patient in every respect the treatment progressed rapidly. In December, 1927, because a normal functional and anatomic relationship had been obtained and because the patient had apparently overcome the habit of mouth-breathing the appliances were reduced to simple lingual wires in both the maxillary and the mandibular arches. The lingual wires were the only appliances worn for the next year and a half or until May, 1929, at which time it was necessary to reinsert the mandibular labial wire to effect the rotation of both canines. All appliances were removed from the mouth in December, 1929. Figs. 3, 4, and 5 were made in February, 1932. Prognosis.-The prognosis is favorable that a normal functional and anatomic relationship will be maintained.