Tratamento conservador de uma má oclusão Classe I de Angle, com atresia maxilar e apinhamento anterior

Abstract

This report describes the treatment of a 15-year-old female patient with Angle Class I malocclusion, severe maxillary anterior crowding, maxillary midline shift to the left, and maxillary atresia associated with posterior crossbite. The treatment consisted of palatal expansion using a modified Haas expander and placement of a standard Edgewise fixed appliance. Interproximal reduction was performed on mandibular incisors and canines to align anterior teeth, as well as to reduce Bolton discrepancy due to wide mandibular teeth. This case was submitted to the Committee of the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) in the Free Case category as part of the requisites to obtain the BBO Diploma. HISTORY AND ETIOLOGYThe main complaint of this 15-year-old female patient in good general health was the position of her maxillary left canine. During history taking, her guardians reported that her adenoids had not been removed. The size of her palatine tonsils was normal. The patient showed nasal breathing pattern, satisfactory oral hygiene and no severe periodontal condition. DIAGNOSISFacial examination did not reveal any evident asymmetries, but the lower third of the face was slightly longer than expected. The facial profile How to cite this article: Nojima LI. The conservative treatment of Class I malocclusion with maxillary transverse deficiency and anterior teeth crowding.

Interproximal wear versus incisors extraction to solve anterior lower crowding: A systematic review

“…Several clinical cases 1 , 2 , 5 , 9 , 12 - 15 , 17 - 21 , 30 , 31 , 38 reported interproximal wear or mandibular incisor extraction as potential therapies for mild or moderate anterior lower crowding in patients in permanent dentition, with Class I malocclusion and a pleasant facial profile. Nevertheless, there are yet few clinical trials or randomized controlled trials addressing this issue.…”

“… 13 Loss of interdental papilla or formation of triangular space are examples of common undesirable effects. 13 , 16 , 37 From an esthetic point of view, teeth with a triangular shape 2 , 31 may benefit from interproximal wear while those with a rectangular shape respond better to extraction.…”

“…Interproximal wear should be given priority when aiming at conservative treatment 2 , 30 with minor changes in a pleasant profile, 2 , 23 , 30 in Class I cases, 2 , 9 , 23 , 24 , 30 cases without mandibular dental excess (Bolton ≤ 3 mm), 15 , 16 mild to moderate mandibular crowding, 2 , 16 , 23 , 24 , 30 , 31 normal overjet and overbite, low incidence of caries, 2 proper oral hygiene, 31 teeth with a triangular shape, 2 , 31 potential for maxillary wear, and treatment confirmed by set-up model tests. 1 , 5 , 13 , 14 , 18 , 19 …”

“…Several case reports 1 , 2 , 5 , 9 , 12 - 15 , 17 - 21 , 30 , 31 , 38 addressing the issue were not included, given their low evidence and inference that these cases were successful. Lack of high-methodological-quality articles is a limitation of the present study.…”

“…Orthodontic planning for this type of deficiency may involve permanent teeth extraction 1 , 4 - 26 or other approaches that do not involve extractions, such as interproximal wear, 6 - 11 , 14 , 19 , 23 , 24 , 27 - 31 dental expansion, 7 - 11 , 14 distraction osteogenesis of the mandibular symphysis, 32 , 33 as well as a combination of different techniques. 14 …”