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Treatment of bilateral distoclusion complicated by impaction of both mandibular second premolars
TREATMENT IMPACTION
OF BILATERAL DISTOCLUSION COMPLICATED OF BOTH MANDIBULAR SECOND PREMOLARS*
BY
C. J. VOSMIK, D.D.S., CLEVELAND, OHIO
H EWORP.-Girl,
aged ten years, weight sixty-six pounds, he&&t 9.&y-three in&es. The dental arches of both the f&her and the mother were in normal relationship. Of four children in the family two presented a normal relationship of the dental arches and two possessed distoclusions, During pregnancy the mother’s health and diet had been normal. Weight of child at birth was seven pounds and six ounces. Child was placed on diet of cow’s n&k from time of birth. Severe ease of malnutrition developed at six months. Child was then placed on synthetic diet, and improvement was noticed. Tonsils and adenoids were removed at five and a half years. Childhood diseases eon&&d of measles at seven years and chickenpox at eight and a half years. Child was a mouth-breather but had no sucking or pillowing habits. At the time the paGent presented for orthodontic treatment, general health was normal. Oral examination revealed hypoplasia of all incisors and first molars. Radiographic examination revealed the presence of unerupted msdibulsr right and left second premolars. Fig, 1 shows extraord radiographs taken before treatment was begun, June, 1927. Attdmttd Etiology.-Malnutrition and mouth-breathing may be considered the etiologie factors causing malocclusion. D&m&-Impressions were taken and casts of the denture were constructed. The malocclusion was classified as a bilateral distoclusion with a marked linguoclusion of all teeth in the mandibular aroh anterior to and including the first premolars. Fig. 2 shows views of the casts made in June, 1927, before treatment was begun. Trsatnzerct.-The teeth and dental arches were restored to a normal functional and anatomic relationship by the following plan of treatment : ( 1) lateral expansion of both the maxillary and the mandibular arches; (2) removal o!f points of interference by the alignment of the maxillary incisors; (3) space provided for the eruption of mandibular second premolars by the labial movement of all mandibular teeth anterior to and including the first premolars; and (4) a change in the relationship of,the maxillary and mandibular arches. Molar bands carrying half round lingual tubes and 0.040 inch buceal tubes were placed on the four first molars. Bands with lingual spurs were plaeod on the four maxillary incisors. Removable lingual wires carrying compound auxiliary springs in the region of premolars and canines were placed in both the *Presented
to
the
American
Board
of
Orthodontia,
851
May,
1932.
C. J. Vosnvik maxillary and the mandibular dental arches. Labial wires constructed of 0.040 inch round wire carrying spring loops of 0.025 inch wire just anterior to the buccal tubes were also placed in both the maxillary and the mandibular dental arches. The maxillary labial wire carried hooks for intermaxillary elastics. The incisor teeth in both the maxilla and the mandible were moved labially and rotated where necessary by ligating them to the labial wire with wire ligatures. Intermaxillary ela.stics were us?d from the time treatment was begun.
Fig.
Results.-The patient presented for treatment June, 1927. Treatmerit, progressed satisfactorily until July, 1928, when a severe infection developed‘iti the crypt of the partially erupted mandibular left second molar. This necessitated the removal of all appliances for a period of two months, during which time the patient was under the care of an oral surgeon. Fig. 3 shows views of casts taken at this time. September, 1928, the appliances were reinserted, and the treatment was then continued until February, 1930, when all appliances were removed and a
Bilateral
Distocl.zcsiow
gi:;
Hawley retainer was placed in the maxillary dental arch while a lingual retaining wire was placed in the mandibular dental arch. The retainers were removed February, 1931. Extraoral radiographs, Fig. 4, taken in March, 1932, show impacted :mandibular third molars. Surgical removal will probably be necessary.
Fig. 5 shows views of casts made March, 1932. Fig. 6 shows views of patient taken March, 1932. Pyogn&s.-Although the appljances were removed only a year ago, there has been so slight a change in the dentures since that. time that prognosis may be considered favorable for the maintenance of a normal functional and anatomic relationship.
OF BILATERAL DISTOCLUSION COMPLICATED OF BOTH MANDIBULAR SECOND PREMOLARS*
BY
C. J. VOSMIK, D.D.S., CLEVELAND, OHIO
H EWORP.-Girl,
aged ten years, weight sixty-six pounds, he&&t 9.&y-three in&es. The dental arches of both the f&her and the mother were in normal relationship. Of four children in the family two presented a normal relationship of the dental arches and two possessed distoclusions, During pregnancy the mother’s health and diet had been normal. Weight of child at birth was seven pounds and six ounces. Child was placed on diet of cow’s n&k from time of birth. Severe ease of malnutrition developed at six months. Child was then placed on synthetic diet, and improvement was noticed. Tonsils and adenoids were removed at five and a half years. Childhood diseases eon&&d of measles at seven years and chickenpox at eight and a half years. Child was a mouth-breather but had no sucking or pillowing habits. At the time the paGent presented for orthodontic treatment, general health was normal. Oral examination revealed hypoplasia of all incisors and first molars. Radiographic examination revealed the presence of unerupted msdibulsr right and left second premolars. Fig, 1 shows extraord radiographs taken before treatment was begun, June, 1927. Attdmttd Etiology.-Malnutrition and mouth-breathing may be considered the etiologie factors causing malocclusion. D&m&-Impressions were taken and casts of the denture were constructed. The malocclusion was classified as a bilateral distoclusion with a marked linguoclusion of all teeth in the mandibular aroh anterior to and including the first premolars. Fig. 2 shows views of the casts made in June, 1927, before treatment was begun. Trsatnzerct.-The teeth and dental arches were restored to a normal functional and anatomic relationship by the following plan of treatment : ( 1) lateral expansion of both the maxillary and the mandibular arches; (2) removal o!f points of interference by the alignment of the maxillary incisors; (3) space provided for the eruption of mandibular second premolars by the labial movement of all mandibular teeth anterior to and including the first premolars; and (4) a change in the relationship of,the maxillary and mandibular arches. Molar bands carrying half round lingual tubes and 0.040 inch buceal tubes were placed on the four first molars. Bands with lingual spurs were plaeod on the four maxillary incisors. Removable lingual wires carrying compound auxiliary springs in the region of premolars and canines were placed in both the *Presented
to
the
American
Board
of
Orthodontia,
851
May,
1932.
C. J. Vosnvik maxillary and the mandibular dental arches. Labial wires constructed of 0.040 inch round wire carrying spring loops of 0.025 inch wire just anterior to the buccal tubes were also placed in both the maxillary and the mandibular dental arches. The maxillary labial wire carried hooks for intermaxillary elastics. The incisor teeth in both the maxilla and the mandible were moved labially and rotated where necessary by ligating them to the labial wire with wire ligatures. Intermaxillary ela.stics were us?d from the time treatment was begun.
Fig.
Results.-The patient presented for treatment June, 1927. Treatmerit, progressed satisfactorily until July, 1928, when a severe infection developed‘iti the crypt of the partially erupted mandibular left second molar. This necessitated the removal of all appliances for a period of two months, during which time the patient was under the care of an oral surgeon. Fig. 3 shows views of casts taken at this time. September, 1928, the appliances were reinserted, and the treatment was then continued until February, 1930, when all appliances were removed and a
Bilateral
Distocl.zcsiow
gi:;
Hawley retainer was placed in the maxillary dental arch while a lingual retaining wire was placed in the mandibular dental arch. The retainers were removed February, 1931. Extraoral radiographs, Fig. 4, taken in March, 1932, show impacted :mandibular third molars. Surgical removal will probably be necessary.
Fig. 5 shows views of casts made March, 1932. Fig. 6 shows views of patient taken March, 1932. Pyogn&s.-Although the appljances were removed only a year ago, there has been so slight a change in the dentures since that. time that prognosis may be considered favorable for the maintenance of a normal functional and anatomic relationship.