PMC6885264_01
Pretreatment facial and intraoral photographs.
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With severe extrusion of the maxillary molars, more severe on the left side, the maxillary midline deviated 2.0 mm to the right, and the mandibular deviated 1.0 mm to the left. (Figures 1 and 2). The cephalometric measurements and superimposition revealed a proclination of the maxillary incisors and the maintenance of a good profile line (Figure 9, Table 1).
Pretreatment dental casts.
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With severe extrusion of the maxillary molars, more severe on the left side, the maxillary midline deviated 2.0 mm to the right, and the mandibular deviated 1.0 mm to the left. (Figures 1 and 2).
Pretreatment panoramic radiograph, lateral cephalometric radiograph, and tracing.
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Both mandibular third molars were mesially tilted, and the maxillary incisor had big restorations. (Figure 3).
Progress starting the intrusion of maxillary left molars.
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Progress sequence of the intrusion of maxillary left molars from first to finishing stages.
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In spite of the good evolution, there was a reduction in the vertical distance of the maxillary left posterior teeth in relation to the mini-implant, thus making it necessary to replace the buccal mini-implant with a miniplate (Figures 5(a)-5(c)). NiTi springs were also used for the anterior retraction and thus facilitated the correction of the Class II dental relation and the maxillary midline deviation (Figures 5(d)-5(f)).
Progress panoramic radiograph.
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Prior to the removal of the maxillary and mandibular fixed appliances, temporary acrylic crowns were affixed over the lower implants, to maintain the recovered vertical dimension (Figure 6).
Posttreatment facial and intraoral photograph.
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Facially, her smile became symmetrical, balanced, and harmonious (Figure 7, facial). After the removal of the appliance, a fixed canine-to-canine retention (0.6 mm), was bonded, and a wraparound-type removable appliance were used for the full duration of a year, after which it was used for another year, but only at night during sleeping hours (Figures 7 and 8).
Posttreatment dental casts.
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After the removal of the appliance, a fixed canine-to-canine retention (0.6 mm), was bonded, and a wraparound-type removable appliance were used for the full duration of a year, after which it was used for another year, but only at night during sleeping hours (Figures 7 and 8).
Posttreatment panoramic radiograph, lateral radiograph, lateral cephalometric radiograph tracing, and superimposition: before treatment (black) and after treatment (red).
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The panoramic radiograph shows that the maxillary left molars' alveolar bone level is in good shape, reasonable root parallelism, and implant-prosthetic rehabilitation in the mandibular arch (Figure 9). The cephalometric measurements and superimposition revealed a proclination of the maxillary incisors and the maintenance of a good profile line (Figure 9, Table 1).
Pretreatment and posttreatment dental casts. Uneven occlusal plane.
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