Case 14: Class II division 1, Mandibular advancement surgery,
periodontal disease, missing first bicuspids. Female age 33
Multidisciplinary case requirement was satisfied with this case
Start records
. Vertical
Frankfort to
mandibular plane
Palatal to
mandibular plane
. Wits
. Steiner
Start
Mean ± SD
26°
22° (18°- 28°)
28,5°
28° (24°- 33°)
9 mm
-1 - +2 mm
SNA
86°
82° ± 3,5
SNB
78°
80° ± 3,5
ANB
8°
2°-4° ± 2,5
GoGnSN
37°
33° ± 2,5
5,5 mm
26°
7,5 mm
4 mm
22°
4 mm
27°
25°
69°
67°
+ 1/NA
- 1/NB
. Y-axis to SN
Summary ceph measurements
- Large class II average
- Proclined upper incisors
Diagnosis Summary:
The missing teeth were possibly due to previous ortho attempt with removable
appliances. The periodontal limitation was one issue in favor of the surgical
approach to reduce treatment time and the amount of tooth movement. Skeletal
resistance, predicted by ANB +8 was significant and would be a problem with
orthodontic tooth movement approaches. Facial esthetics were effected by the
malocclusion and could be improved by surgery. Maxillary surgery was considered
but was not needed.
The patient was under treatment with a periodontist for 1 year after the initial
records were taken, and had consultations with a maxillofacial surgeon before the
start of orthodontics. This case fulfilled the requirement of 1 multidisciplinary case,
which impacted cuspids did not qualify.
Treatment Summary
Minimum anchorage was used to close the upper spaces, with efforts to keep the
upper midline centered. The upper molars were asymmetric at the start, with the
upper left molar being in a more mesial position than the upper right.
Pre-surgical orthodontics took 20 months, with visits to the periodontist every 3
months during this time. The surgery was completed in June 2002, and was
followed by 4 months of post-surgery orthodontic finishing.
Pre-surgery records
Final Records
Start
. Vertical
Frankfort to
mandibular
plane
Palatal to
mandibular
plane
. Steiner
Mean ± SD
26,5° 31,5°
22° (18°- 28°)
28,5°
28°
32,5°
28° (24°- 33°)
9 mm
4,5
0,5
-1 - +2 mm
SNA
86°
86°
86°
82° ± 3,5
SNB
78°
78,5° 80,5°
80° ± 3,5
ANB
8°
7,5°
5,5°
2° ± 2,5
GoGnSN
37°
36°
41°
33° ± 2,5
5,5 mm
1,5
4,5
4 mm
26°
10°
22°
22°
7,5 mm
4,5
9
27°
21°
30°
25°
69°
69°
69°
67°
. Wits
+ 1/NA
- 1/NB
. Y-axis to
SN
26°
Progress Finish
Summary ceph measurements
- Skeletal Class II changed into a class I.
- Vertical average measurement changed into a skeletal open
- Upper incisors are positioned in an ideal inclination and A-P
position
- Lower incisors are proclined and protrusive.
4 mm
Final Remarks:
There was a problem with the periodontal involved teeth tipping more than
would be expected while closing spaces. There was some space at the end between
teeth 14-13. Otherwise, the case was not so difficult with surgery to correct the class
II and deep bite.
Additional comments not a part of the examination
Doctor time: no assistant was employed at this practice
Consultations, take records, process records, diagnosis = 3.3 hours.
* one extra 20 minute consultation after the surgeon consult, otherwise same
Initial band and bond (direct) = 1.5 hours
Pre-surgery ortho:
3 visits @ 15 minutes = 0.75 hour
16 visits @ 20 minutes = 5.3 hours
Post-surgery ortho:
1 visit @ 20 minutes = 0.3 hour
3 visits @ 30 minutes = 1.5 hours
Deband, final records, fabricate and deliver retainers = 2 hours
Total Doctor Time = 14.65 hours
Estimated with 1 assistant = doctor 8.5 hours, assistant 6 hour