“Extraction Protocol for Facial Profile Correction in a Hypodivergent Case with Crowding and Severe Dental Protrusion” – A Case Report

Abstract

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.