This case report evaluates the management of bimaxillary dentoalveolar protrusion in a female patient with a Class II malocclusion. The case required extraction of 1 st premolars for correction of the proclined and forwardly placed upper and lower front teeth and also for correction of crowding in upper and lower front teeth. Clinical and cephalometric evaluation revealed skeletal Class II malocclusion with crowding and a convex facial profile, an average to vertical growth pattern, potentially incompetent lips, a posterior divergent face, increased overjet and average overbite. Following fixed orthodontic treatment by removal of 1 st premolars in the upper and lower arch with retraction of anterior segment, a marked improvement in patient's smile, facial profile and occlusion was achieved and there was a remarkable increase in the patient's confidence and quality of life. The profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with Fixed appliance therapy.
The aim of orthodontic treatment in a bimaxillary protrusion case is to obtain an esthetically pleasing face with harmonious soft tissue profile, stable occlusion and pleasant smile. The etiology of bimaxillary protrusion is multifactorial involving both genetic and environmental causes like mouth breathing, tongue and lip habits and tongue volume. The following case report shows management of class I bimaxillary protrusion malocclusion in a hypodivergent case with extraction of all first premolars. The effective management of space without losing anchorage is itself a big challenge. The results produced a pleasant facial profile with attainment of good occlusion. The case required extraction of 1st premolars for correction of the proclined, forwardly placed and crowded upper and lower anterior teeth. Clinical and cephalometric evaluation revealed a Class I skeletal pattern and clinical examination revealed presence of an orthognathic facial profile, a horizontal growth pattern, increased overjet and average overbite, crowding in maxillary and mandibular anterior region, potentially incompetent lips, increased lip fullness and lip strain with an unaesthetic smile arc and a decreased nasolabial angle. Following fixed orthodontic treatment by removal of all 1st premolars and with retraction of anterior segment, a marked improvement in patient's smile, facial profile and occlusion was achieved and there was a remarkable increase in the patient's confidence and quality of life. The profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with fixed appliance therapy.
The most important procedures in orthodontic practice is bonding brackets to tooth enamel. The adhesive force should be enough to keep the bracket in position throughout the orthodontic treatment, but not strong enough to cause damage on its debonding to the enamel. Lopez, as well as Reynolds, suggests that shear strength should be 6-8. [1] Equivalent traction would be about 5 MPa.Since the inception of lingual orthodontics, it was necessary that orthodontist had to think of an optimal straight wire technique because of the reduced interbracket span on the lingual surfaces with its associated biomechanical consequences and the problems encountered while working on the lingual surface and also because of the anatomical irregularities of the teeth on that side. The introduction of computer-aided design/ computer-aided manufacturing (CAD/CAM) technology has made it possible to produce brackets with an adaptable base and with the necessary precision for all lingual surfaces, also it became obvious that there was a need for indirect bonding involving bracket positioning on cast models. Three popular indirect bonding systems are the Torque Angulation Reference Guide (TARG), Class and Pacon systems.Shear bond strength (SBS) is the main factor, which has to be considered in the evolution of bonding materials. The bond strength of the orthodontic bracket must be able to withstand the forces applied during the orthodontic treatment.
The following case report shows management of class I bimaxillary protrusion malocclusion with facial asymmetry in a hyperdivergent case with extraction of all first premolars. The effective management of space without losing anchorage is itself a big challenge. The results produced a pleasant facial profile with attainment of good occlusion. The case required extraction of 1st premolars for correction of the proclined, forwardly placed and crowded upper and lower anterior teeth. The patient presented with an occlusal cant on clinical evaluation and presence of a facial asymmetry on PA cephalogram. Lateral cephalometric evaluation revealed a Class I skeletal pattern and clinical examination revealed presence of facial asymmetry with chin deviation towards the patients left side, an orthognathic facial profile, a vertical growth pattern, increased overjet and average overbite, crowding in maxillary and mandibular anterior region, potentially incompetent lips, increased lip fullness and lip strain with an unaesthetic smile arc and a decreased nasolabial angle. Following fixed orthodontic treatment by removal of all 1st premolars and with retraction of anterior segment, a marked improvement in patient's smile, facial profile and occlusion was achieved and there was a remarkable increase in the patient's confidence and quality of life. Facial asymmetry was corrected non-surgically, simply by application of appropriate biomechanics with the help of temporary anchorage devices (TADs).
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