A patient with mandibular deviation and 3 mandibular incisors treated with asymmetrically bent improved superelastic nickel-titanium alloy wires

Abstract

Skeletal and dental discrepancies cause asymmetric malocclusions in orthodontic patients. It is difficult to achieve adequate functional occlusion and guidance in patients with congenital absence of a mandibular incisor due to the tooth-size discrepancy. Here, we describe the orthodontic treatment of a 22-year-old woman with an asymmetric Angle Class II malocclusion, mandibular deviation to the left, and 3 mandibular incisors. The anterior teeth and maxillary canines were crowded. We used an improved superelastic nickel-titanium alloy wire (Tomy International, Tokyo, Japan) to compensate for the asymmetric mandibular arch and an asymmetrically bent archwire to move the maxillary molars distally. A skeletal anchorage system provided traction for intermaxillary elastics, and extractions were not needed. We alleviated the crowding and created an ideal occlusion with proper overjet, overbite, and anterior guidance with Class I canine and molar relationships. This method of treatment with an asymmetrically bent nickel-titanium alloy wire provided proper Class I occlusion and anterior guidance despite the mandibular deviation to the left and 3 mandibular incisors, without the need for extractions.

Hypodontia of mandibular incisors: considerations on the orthodontic treatment

“…However, the clinical alternatives to compensate this discrepancy and thus achieve ideal overjet and overbite are minimally invasive, either by placement of composite resin on the mandibular incisors, or by proximal stripping on the maxillary incisors. 18 , 19…”

“… 17 In adult patients, it is possible to perform orthodontic treatment for implant placement or to close the remaining space, finalizing with three mandibular incisors. 18 This treatment option leads to large tooth-size discrepancy between the dental arches, 19 which may also be present in approximately 60% of orthodontic patients, besides the cases of tooth agenesis. 20 , 21 , 22 …”

Correction of bilateral heavily impacted second molar with improved super-elastic nickel-titanium alloy wires

“…Here, we used the improved super-elastic nickel-titanium alloy wire (ISW) (L&H Titan, Tomy International, Tokyo, Japan) without loops, which has been successfully implemented as working archwire. [17][18][19][20] Although several reports have demonstrated the alignment of impacted mandibular second molars associated with mesially inclined third molars during early adolescence, 6,21,22 there has been no report regarding orthodontic management of such complications in an adult patient. In this case report, we describe the successful alignment-with good retention-of impacted bilateral mandibular second molars by using ISW in an adult female patient with severe posterior crowding.…”