PMC5514341_01
PMC5514341_02
Pretreatment photographs (5 years and 1 month). (a) Extraoral photographs. (b) Intraoral photographs. (c) Orthopantomograms. (d) Posteroanterior and lateral cephalograms.
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On extraoral clinical examination, the patient was found to have an "elfin face" appearance, with a small nose, long philtrum, prominent lips, and zygomatic flattening, all of which are distinctive to WBS (Figure 1(a)). Intraorally, the patient had an anterior crossbite and a deep overbite (Figure 1(b)). Pretreatment radiographs included lateral and posteroanterior (PA) cephalograms and orthopantomograms (OPGs) (Figures 1(c) and 1(d)). The OPG showed that the bilateral maxillary second premolars and the bilateral mandibular first and second premolars were congenitally absent (Figure 1(c)).
PMC5514341_03
Intraoral photographs before the facemask treatment (9 years and 4 months).
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Intraoral examination showed that the overjet was -12.0 mm and the overbite was +3.0 mm (Figure 2).
Intraoral photographs during the observation period and after the facemask treatment (13 years and 1 month).
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Thereafter, the patient was regularly followed up three times each year until the next stage of treatment (Figure 3).
PMC5514341_04
Intraoral photographs during predistraction orthodontic treatment.
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After leveling of the lower arch, a utility arch made of 0.016 x 0.016-inch stainless steel wire was fitted to initiate intrusion of the lower incisors and minimize the overbite (Figure 4).
Facial (a) and oral (b) photographs before maxillary anterior segmental distraction osteogenesis (18 years and 6 months).
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After completion of the predistraction orthodontics, impressions were taken of the upper and lower arches (Figure 5).
Maxillary anterior segmental distraction osteogenesis (MASDO). (a) Distractor. (b) The numbers indicate the order of the procedures.
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An expansion screw oriented anteroposteriorly with an opening capacity of 15.0 mm was inserted into the plate (Figure 6(a)). The flap was then closed primarily and the distractor was cemented to the teeth (Figure 6(b)).
Facial (a) and oral (b) photographs after the consolidation period (19 years).
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The distractor was removed and a Nance appliance was placed so that postdistraction orthodontic treatment could resume (Figure 7).
Extraoral and intraoral photographs at 2 years and 8 months after debonding (24 years and 9 months). (a) Extraoral photographs. (b) Intraoral photographs. (c) Orthopantomograms. (d) Posteroanterior and lateral cephalograms.
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Prosthetic treatment of the area corresponding to the bilateral mandibular premolars was completed using dental implants, and observation of the patient's condition has continued (Figure 8).