The treatment of Angle Class I malocclusion by atypical extraction is rather challenging. The extraction of four first premolars often manages it. However, in cases of compromised and non-restorable teeth, the extraction decision may be altered, making the anchorage and the treatment mechanics more challenging. This article reports the clinical case of a 16-year-old patient from Sudan who presented with a chief complaint “My teeth are crooked and sticking out.” He had Angle Class I malocclusion with a bimaxillary dentoalveolar protrusion. He had severe crowding in both arches and localized marginal gingivitis related to an ectopically erupted upper right canine (UR3) and lower right first premolar (LR4). The patient had a provisional restoration in the lower right first molar (LR6). Extraction of three first premolars and one first molar was the alternative of choice for this treatment, which restored function, providing improved periodontal health, achieved the desired facial esthetics, and allowed finishing with a stable and balanced occlusion. Management of angle class I malocclusion with atypical extraction patterns should be performed with careful mechanics and anchorage planning to obtain good results.
Severe class III malocclusion can be a great challenge, especially in adult patients. This case report describes an adult patient with severe skeletal class III malocclusion and with an obvious maxillary deficiency and mandibular excess causing both anterior and posterior crossbites in addition to a shift in the upper and lower midlines to the left concerning the facial midline. This was complicated by compensatory mechanisms such as the proclination of upper incisors and retroclination of lower incisors. Decompensation of the upper and lower arches was performed combined with upper arch expansion to relieve crowding in the upper arch and correct the posterior crossbite. This was followed by double jaw surgeries, including Le Fort I osteotomy in the maxilla and bilateral sagittal split osteotomy (BSSO) in the mandible. Orthodontic finishing procedures were then used to correct any other dental discrepancies. Remarkable esthetic and functional results were achieved with high patient satisfaction.
Orthodontic treatment time has been associated with certain parameters that can affect the different aspects of treatment regards to the patient and orthodontist. Therefore, a large set of research has focused on studying these factors. Many factors have been proposed in the literature as significant predictors for prolonged orthodontic treatment duration. In general, these factors are related to the patient, orthodontist, procedure, and severity of the underlying condition. Acquiring more knowledge about these factors can help orthodontists speed up the treatment plan, which might enhance the treatment outcomes and enhance the levels of satisfaction. In the current study, we have provided updated evidence regarding the different factors affecting orthodontic treatment time according to evidence from studies in the literature. Many factors were reported, including factors related to the procedure and the underlying condition, and factors related to the patient and orthodontist. Increasing knowledge and experience of the orthodontist might increase the level of satisfaction as it has been reported to significantly reduce the treatment duration. However, this should be accompanied by adequate patient compliance, which was also reported to be a significant predictor for prolonged treatment duration. Investigating the application of recent modalities that can speed up the treatment plan is not adequately validated, indicating the need for future validating studies.
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