In providing orthodontic care for paediatric patients, clinicians often questions whether to begin treatment early-during the primary or early-transitional dentition-or wait until all or most of the permanent teeth are present. A comprehensive knowledge is necessary for planning the implementation of preventive therapy or the choice for interception is left. Early orthodontic treatment is effective and desirable in specific situations. The early treatment eliminates noxious habits, re-orientates dental-maxillary development and compensates for the structural discrepancy between teeth and bone. This leads to a timely correction of defects, which could have a negative aesthetic impact, therefore, contributing effectively to a better harmonization of the child with the human environment where he lives, and improving his feelings of acceptance within it. However, the evidence is equally compelling that such an approach is not indicated in many cases for which later, single-phase treatment is more effective. Therefore, clinicians must decide, on a case-by-case basis, when to provide orthodontic treatment.
Facial asymmetry and functional problems due to dentofacial discrepancy and soft tissue disparities are commonly managed by orthognathic surgery and augmentation procedures. Distraction osteogenesis is a relatively new technique of bone generation and reconstruction. A patient reported with the chief complaint of asymmetry of face and deviated chin; had temporomandibular joint ankylosis. Distraction device was applied with simultaneous release of ankylosis by gap arthroplasty. For management of mandibular deformity and discrepancy of the dentition, orthodontic therapy was done using MBT 0.022” prescription. Distraction was stopped when the midline of upper central incisor coincided with the midline of lower central incisor followed by stabilization period of ten weeks. The functional and esthetic results achieved were acceptable.
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