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International Journal of Medical and Dental Case Reports (2014), Article ID 281114, 4 Pages

C A S E R E P O R T

Camoufl age of Class II Division I malocclusion with retrusion utility arch: A case reportThomas Mathew1, Yoshinobu Shoji2

1Department of Orthodontics, School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia, 2Department of Oral & Maxillofacial Medicine, Faculty of Dentistry, Universiti of Teknologi MARA (UiTM), Shah Alam, Malaysia

AbstractIntroduction: There are diff erent treatment modalities for correction of Class II malocclusion. The camoufl age treatment is a method of extraction of premolars to correct borderline skeletal malocclusion. Utility arches have diff erent roles in various stages of orthodontic treatment. The retrusion utility arch is a useful method in camoufl age treatment to obtain intrusion and retrusion of the upper anterior teeth. Aim: The case report documented the treatment of 14-year-old boy with borderline skeletal Class II malocclusion with over jet of 7 mm, 100% deep bite and angle Class II molar, canine, and incisor relationships. Methods: The orthodontic treatment was initiated using 0.022″ Pre-adjusted edge-wise appliances (PEA) with extraction of 14 and 24 with maximum anchorage. After the initial leveling and alignment, intrusion and retraction of maxillary anterior teeth were done using 0.016″ × 0.022″ titanium molybdenum alloy retrusion utility arch. Elastic module tie back was used for upper canine retraction. Finishing and detailing was done after the space closure. Results: The treatment objective of normal over jet and overbite, correction of crowding and achieving Class I canine and incisor relationship were achieved. Conclusion: A stable, harmonious occlusion was achieved after 24 months of PEA treatment along with retrusion utility arch. An upper wrapped around retainer, and lower lingual bonded retainer were issued to retain the stable occlusion.

Keywords: Camoufl age, Class II malocclusion, retrusion utility arch

CorrespondenceDr. Thomas Mathew, Faculty of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur - 57000, Malaysia. Phone: 0060164844537.Email: drthomas_m@yahoo.co.in

Received: 18 October 2014Accepted: 30 November 2014

doi: 10.15713/ins.ijmdcr.15

How to cite the article: Mathew T, Shoji Y. Camoufl age of Class II Division I malocclusion with retrusion utility arch: A case report. Int J Med Dent Case Report 2014;1-6.

Introduction

There are diff erent treatment modalities for correction of Class II malocclusion. The growth modifi cation with functional appliance is the treatment of choice among growing patients. Among adult patients with severe skeletal Class II malocclusion orthographic surgery is the fi rst choice of treatment. The camoufl age treatment is a method of extraction of premolars to correct borderline skeletal malocclusion.[1] Recent studies have shown that dental compensation with camoufl age treatment has similar results as orthographic surgeries.[2]

Utility arches have diff erent roles in various stages of orthodontic treatment.[3] The retrusion utility arch is a useful method in camoufl age treatment to obtain intrusion and retrusion of the upper anterior teeth. The treatment of borderline skeletal Class II malocclusion requires careful diagnosis and treatment planning, taking into considerations both esthetic and functional needs of the patients.[4,5]

The following case report documented a 14-year-old Indian boy with Class II malocclusion with 7 mm over jet and 100%

deep-bite treated with pre-adjusted edgewise appliance (PEA) therapy and retrusion utility arch for intrusion and retraction of the maxillary incisors.

Aim

The case report documented the treatment of 14-year-old boy with borderline skeletal class II malocclusion with over jet of 7 mm, 100% deep bite and angle Class II molar, canine and incisor relationships.

Case Report

A-14-year-old Indian boy reported to the clinic with a complaint of proclined upper front teeth. On the extra-oral examination, the patient had mesoprosopic facial form and convex facial profi le [Figure 1a]. The Nasolabial angle was acute and the chin recessive with incompetent lips [Figure 1b]. The clinical FMA was low. Intra-orally, he presented with a Class II Division 1 incisor relationship and increased over jet of 7 mm

Mathew and Shoji Intrusion Arch: Camoufl age of Class II malocclusion

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[Figure 1c]. The overbite was increased to 8 mm (100% deep bite) [Figure 1d] and the molar relationship [Figure 1e and f] and canine relationships were full unit Class II on both sides. There was enamel–dentine fracture of 21 not involving the pulp in the maxillary arch [Figure 1g] and the mandibular arch was well aligned. [Figure 1h].

Diagnosis

A case of skeletal Class II with angles Class II Division 1 malocclusion.

Summary of Cephalometric Analysis

A case of skeletal Class II with prognathic anti inclined maxillae and retrognathic mandible with Angles Class II molar relation, bidental proclination and horizontal growth pattern [Figure 1i and Table 1].

Treatment plan

The orthodontic treatment plan comprised of PEA of 0.022″ Roth prescription brackets. After initial leveling and alignment retrusion utility arch was planned to be used for intrusion and retraction of maxillary anterior teeth. The upper wrap around the retainer and lower lingual bonded retainer was decided as retainers.

Fixed appliance stage

The orthodontic treatment was initiated using 0.022″ PEA [Figure 2a] with extraction of teeth 14 and 24 with maximum anchorage using trans palatal arch [Figure 2b]. The 0.022″ Roth prescription brackets were bonded on both upper and lower arches and alignment was initiated with 0.014″ nickel-titanium wire. After the initial leveling and alignment intrusion and retraction of upper anterior teeth was done using 0.016″ × 0.022″ titanium molybdenum alloy retrusion utility arch [Figure 3a and b].[6] The overbite was reduced to 2 mm and over jet was corrected to 1mm after 8 months of retrusion utility arch stage. Elastic module tie back was used for upper canine retraction.

Table 1: Cephalometric analysisParameter Mean Pre-treatmentSkeletal

NA angle 82 83

SNB angle 80 77

ANB angle 2 6

N perp to point A 1 4

GO GN to SN 32 27

Angle of inclination 90 91

Maxillary length 89 81

Mandibular length 105 102

Dental

U1 to NA angle 22 39

U1 to NA (mm) 4 10

U1 to SN angle 102 117

LI to NB angle 25 29

LI to NB mm 4 7

LI to A pog angle 22 25

LI to A pog mm 1-2 3

Inter-incisal angle 130 110

Figure 1: (a) Pre-treatment extra oral frontal, (b) pre-treatment extra oral profi le (c) pre-treatment overbite 100% (d) pre-treatment over jet (7 mm) (e) pre-treatment right molar relation (f) pre-treatment left molar relation (g) pre-treatment maxillary arch (h) pre-treatment mandibular arch (i) pre-treatment lateral ceph

AQ2

d

h

c

g

b

f

a

e

Intrusion Arch: Camoufl age of Class II malocclusion Mathew and Shoji

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[Figure 6b] and good functional Class II right molar relation [Figure 6c] and left molar relation [Figure 6d]. The maxillary arch [Figure 6e] and mandibular arch were well aligned [Figure 6f]. A maxillary wrap around retainer [Figure 7a] and

The remaining extraction space of 2 mm was closed using en masse retraction. Finishing and detailing was done using settling elastics after the space closure [Figure 4a an b].

A straight profi le [Figure 5a and b] stable harmonious occlusion was achieved by 24 months of active orthodontic treatment with normal overbite [Figure 6a] 1 mm over jet

Figure 2: (a) Strap up 0.022″ Roth (b) trans palatal archba

Figure 3: (a) Intrusion and retrusion utility arch (b) retrusion utility arch

b

a

Figure 4: (a) Settling elastics right side (b) setting elastics left side

b

a

Figure 5: (a) Post-treatment extra-oral frontal (b) post-treatment extra-oral profi le

AQ2

ba

Figure 6: (a) Post-treatment overbite (b) post-treatment over jet (c) post-treatment right molar relation (d) post-treatment left molar relation (e) post-treatment maxillary arch (f) post-treatment mandibular arch

dc

b

f

a

e

Figure 7: (a) Maxillary wrap around retainer (b) mandibular lingual bonded

ba

Mathew and Shoji Intrusion Arch: Camoufl age of Class II malocclusion

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mandibular lingual bonded retainer were used for retention phase [Figure 7b].

Discussion

Treatment assessment

The case reported in this article is a young 14-year-old male patient. The patient was an ideal choice for camoufl age treatment as his diagnosis was borderline skeletal Class II malocclusion. He presented with skeletal Class II pattern, mild maxillary prognathism, low FMA, over jet of 7 mm, 100% deep bite and Class II dental malocclusion.

The treatment duration was 24 months and all the treatment objectives were achieved. The over jet and overbite was reduced to 1 mm. The Class II canine and Class II incisor relation was changed to Class I relation and Class II molar relation was maintained in Class II relation.

Table 2: Comparison of lateral cephalometric fi ndingsPre-treatment Post-treatment

Skeletal

NA Angle 83 82

SNB Angle 77 79

ANB Angle 6 3

N perp to point A 4 2

GO GN to SN 27 30

Angle of inclination 91 91

Maxillary length 81 82

Mandibular length 102 104

Dental

U1 to NA angle 39 23

U1 to NA (mm) 10 4

U1 to SN angle 117 104

LI to NB angle 29 28

LI to NB mm 7 6

LI to A pog angle 25 24

LI to A pog mm 3 2

Inter incisal angle 110 127

The lateral cephalometric superimposition was compared between pre-treatment and post fi xed appliance treatment [Table 2 and Figure 8a]. The superimposition cephalometric tracing indicates that the mandibular to cranial base relation improved by 2°. The upper incisor proclination has reduced to normal limits, and mandibular plane has improved to average limits. The ANB Angle was reduced to 3°.

The post-treatment orthopantamograph [Figure 8b] radiograph suggested there was no evidence of root resorption in the upper anterior teeth and all the teeth had parallel roots.

Conclusion

A stable harmonious occlusion was achieved after 24 months of PEA treatment along with retrusion utility arch. An upper wrapped around retainer and lower lingual bonded retainer were issued to retain the stable occlusion.

References

1. Uribe F, Nanda R. Treatment of Class II, Division 2 malocclusion in adults: biomechanical considerations. J  Clin Orthod 2003;37:599-606.

2. Mihalik CA, Proffi t WR, Phillips C. Long-term follow-up of Class  II adults treated with orthodontic camoufl age: a comparison with orthognathic surgery outcomes. Am J Orthod Dentofacial Orthop 2003;123:266-78.

3. McNamara JA. Utility arches. J Clin Orthod 1986;20:452-6.4. Nanda R. Biomechanics and esthetic strategies in clinical

orthodontics. Philadelphia: W.B Saunders; 1997.5. Kuhlberg AJ, Glynn E. Treatment planning considerations for

adult patients. Dent Clin North Am 1997;41:17-27.6. McNamara JA Jr. Ordinary orthodontics: Starting in with the

end mind. World J Orthod 2000;1:45-54.

Figure 8: (a) Post-treFigure 8: (a) Post-treatment lateral ceph (b) post intrusion orthopantamograph

ba