PMC5028823_01
Patient with symmetric face with a convex profile and a hyperdivergent growth pattern.
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During clinical examination, it was observed that the 27-year-old caucasian male patient presented a symmetric face with a convex profile and a hyperdivergent growth pattern (Figure 1).
Intraoral exam: (a) molar and cuspid Class III relation; (b) anterior crossbite; (c) tendency to posterior crossbite; (d, e) mild crowding on cuspids area in both upper and lower arches.
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The intraoral exam revealed a molar and cuspid Class III relation and an anterior crossbite as well as a mild crowding on cuspids area in both upper and lower arches and a tendency to posterior crossbite (Figure 2).
(a) Panoramic X-ray showed integrity of the permanent teeth and absence of upper third molars; (b) cephalometric analysis showed a severe vertical pattern, convex profile, increased lower facial height, a slightly retruded maxilla in relation to the cranial base, and a well-positioned mandible. The upper incisors were in a good inclination while the lower incisors were uprighted; (c) endodontic lesion in tooth 36.
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Panoramic X-ray showed integrity of the permanent teeth and absence of upper third molars although the lower third molars were present and already erupted into the arch (Figure 3(a)). The cephalometric analysis showed a severe vertical pattern, convex profile, increased lower facial height, a slightly retruded maxilla in relation to the cranial base, and a well-positioned mandible (Figure 3(b)).
(a) The treatment was conducted initially by the use of Haas expansion appliance; (b, c) the extraction was performed in two steps, first with the extraction of the mesial root of the first molar, followed by the extraction of the distal root after closing the resultant space with a retraction loop.
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The treatment was conducted initially by the use of Haas expansion appliance (Figure 4(a)) followed by an initial alignment and leveling of the upper and lower arches with a fixed edgewise appliance. The extraction was performed in two steps, first with the extraction of the mesial root of the first molar (Figures 4(b) and 4(c)) followed by the extraction of the distal root after closing the resultant space with a retraction loop.
After the alignment of the lower anterior segment, an H loop was inserted to finish the space closure by second molars avoiding its tipping. Class III elastics were used during this phase of the treatment.
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After the alignment of the lower anterior segment, an H loop (Figure 5) was inserted in order to finish the space closure by second molars mesial movement avoiding its tipping.
(a, b, c) Alteration in the patient's profile after treatment, dentoalveolar Class III correction, upper arch expansion, and leveling and alignment of the upper and lower arches; (d, e, f, g, h) intraoral pictures after complete treatment.
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The treatment resulted in a significant alteration in the patient's profile (Figures 6(a)-6(c)), dentoalveolar Class III correction, upper arch expansion, and leveling and alignment of the upper and lower arches (Figures 6(d)-6(h)).
(a, b) Movements of the upper and lower incisors can be noted in the cephalometric X-ray; (c) Upper removable appliance and a 3-3 lower retainer used for retention.
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A slight protrusion was also observed and lingual tipping of the upper and slight retraction and lingual tipping lower incisors dental compensation for unfavorable skeletal discrepancy the final lateral radiograph analysis (Figures 7(a) and 7(b)) are presented in Table 1. An upper removable appliance and a 3-3 lower retainer were used for retention (Figure 7(c)).
Flowchart of treatment with Haas expansion appliance.
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 Figure 8 summarizes the treatment with Hass expansion appliance that was carried out as 1 turn per day (0.2 mm) during 2 weeks and the appliance was kept in retention for 4 months.