Angle’s Class II division 1 associated to mandibular retrusion and skeletal open bite: a 5-year post-orthodontic/orthopedic treatment follow-up

Abstract

Obtaining long term stability allied to functional and aesthetic balance is the main goal of any orthodontic-orthopedic therapy. This case report describes the orthodontic therapy applied to a 7-year-9-month old child, who presented a Class II, division 1 malocclusion associated to skeletal open bite. Functional and skeletal corrections (sagittally and vertically) were obtained by means of mandible advancement achieved with a closed Balter’s bionator appliance followed by a fixed appliance. This approach showed to be efficient in accomplishing both functional and aesthetic goals, that were kept stable five years after the treatment was finished. This case report was presented to the Board of Directors of the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as partial requirement to becoming a Diplomate of the BBO.

Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation

“…These results are in agreement with literature regarding the Herbst appliance effects, such as maintenance or reduction of maxillary incisors proclination, associated to maxillary dental arch retraction, as well as mandibular incisors proclination and forward movement of the mandibular teeth, 10 - 15 which are linked to positive although temporary stimulus of Herbst appliance on mandibular growth, and also on condyle and glenoid fossa forward remodeling. 26 , 32 , 33 …”

“…Evaluating the final results of both cases, it is reasonable to confirm the evidences pointed out by the literature about Herbst appliance. This device is more effective on the Silva FPL -Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation 26 orthopedic treatment of hypodivergent patients, which present a more forward direction of mandibular growth, 8,11,12,32 as can be highlighted in Case 2. On the other hand, the hyperdivergent patients usually present a limited facial improvement after the same orthopedic approach, with more effect on dentoalveolar structures.…”

“…These results are in agreement with literature regarding the Herbst appliance effects, such as maintenance or reduction of maxillary incisors proclination, associated to maxillary dental arch retraction, as well as mandibular incisors proclination and forward movement of the mandibular teeth, [10][11][12][13][14][15] which are linked to positive although temporary stimulus of Herbst appliance on mandibular growth, and also on condyle and glenoid fossa forward remodeling. 26,32,33 There were no false expectations among orthodontist and parents about an ideal facial improvement, and that was very important in Case 1 treatment. In these terms, is very important to highlight the positive but transitory effect of Herbst appliance on facial profile.…”

Alteração do perfil facial: Tratamento ortodôntico ou harmonização facial? / Change of facial profile: Orthodontic treatmentor facial harmonization?

“…O padrão II esquelético é caracterizado por uma discrepância sagital positiva entre maxila e mandíbula, apresenta uma convexidade facial aumentada em conseqüência do excesso maxilar, ou pela deficiência mandibular (ALHAMMADI et al, 2018). O prognóstico do tratamento da má oclusão de Classe II ou padrão II dependerá da severidade da má oclusão (RODRIGUES, 2017), pode-se optar por exodontias de alguns elementos dentários combinado ao tratamento ortodôntico ou até em alguns casos havendo a necessidade de uma intervenção cirurgias mais invasivas (JANSON et. al., 2009).…”

Different approaches to the treatment of skeletal Class II malocclusion during growth: Bionator versus extraoral appliance

“…The Bionator, developed by Wilhelm Balters in the 1950s, is a removable functional orthopedic activator that acts on both the orofacial muscle positioning and the primary anterior displacement of the mandible. It is used to correct Class II malocclusion by means of stimulation or acceleration of mandibular growth, combined with maxillary growth restriction and anterior displacement [22][23][24] . In addition, maxillary incisors are retroclined, the mandibular incisors, proclined, overjet is reduced and the Angle Class II molar relationship is corrected 17,20,23,24 .…”