PMC6833933_01
Supernumerary tooth and its position in relation to the adjacent teeth.
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The patient had a missing upper left second molar and a supernumerary tooth that was present palatal to the upper left first molar and second premolar (Fig 1). Vertical relations were normal (GoGn-SN=31.9 , FMA=26.8 ) and the patient had proclined maxillary and retroclined mandibular incisors (U1 to SN=105.3  and IMPA=83.9 ) (Fig 3A, Fig 10, Table 1). The palatal plan was rotated counterclockwise by 4.8  (Fig 8, Fig 10, Table 1). The palatal plane was rotated clockwise by 1.1 degrees (Fig 9, Fig 10, Table 1).
Pretreatment photographs of patient. A) Extraoral: profile; frontal at rest; frontal smiling. B) Intraoral: right side; frontal; left side.
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Clinical examination depicted a skeletal Class III malocclusion with a straight profile, retrognathic maxilla and upper lip (Fig 2A). The patient had an anterior crossbite with -2mm overjet and both canines and molars had a Class III dental relationship (Fig 2B).
A) Pretreatment lateral cephalometric radiograph. B) Pretreatment panoramic radiograph.
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Vertical relations were normal (GoGn-SN=31.9 , FMA=26.8 ) and the patient had proclined maxillary and retroclined mandibular incisors (U1 to SN=105.3  and IMPA=83.9 ) (Fig 3A, Fig 10, Table 1).
A) Intraoral photograph of plates and intermaxillary elastic. B) Schematic image of plates and elastic.
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American Orthodontics, Wisconsin, USA) between the hooks of the miniplates on both sides were used (Fig 4). A removable appliance with posterior bite blocks was also used to help remove occlusal interferences.
Removable appliance in the maxillary arch.
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The elastics force was measured at 250 g (Fig 5).
Post-orthopedic treatment photographs. A) Extraoral: profile; frontal at rest; frontal smiling. B) Intraoral: right side; frontal; left side.
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After eight months of orthopedic treatment, patient gained a 2-mm positive overjet and the anterior crossbite was eliminated (Fig 6B). Soft tissue and skeletal relationship were also improved (Fig 6A).
Final post-treatment photographs of patient. A) Extraoral: Profile; frontal at rest; frontal smiling. B) Intraoral: right side; frontal; left side.
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After twelve months of fixed orthodontic treatment, the ideal dental midline relationship, overjet, and overbite were achieved, and the orthodontic treatment was finished (Fig 7).
A) Post-orthopedic treatment lateral cephalometric radiograph. B) Post-orthopedic treatment panoramic radiograph.
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The palatal plan was rotated counterclockwise by 4.8  (Fig 8, Fig 10, Table 1).
A) Final post-treatment lateral cephalometric radiograph. B) Final post-treatment panoramic radiograph.
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The palatal plane was rotated clockwise by 1.1 degrees (Fig 9, Fig 10, Table 1).
A) Superimposition on anterior cranial base at sella. B) Superimposition at palate. C) Superimposition at mandibular plan. Red = after orthodontic treatment (T2); black = after orthopedic treatment (T1); green = before treatment (T0).
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Vertical relations were normal (GoGn-SN=31.9 , FMA=26.8 ) and the patient had proclined maxillary and retroclined mandibular incisors (U1 to SN=105.3  and IMPA=83.9 ) (Fig 3A, Fig 10, Table 1). The palatal plan was rotated counterclockwise by 4.8  (Fig 8, Fig 10, Table 1). The palatal plane was rotated clockwise by 1.1 degrees (Fig 9, Fig 10, Table 1).