PMC5727631_01
Pretreatment facial photographs (19 years, 0 month).
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The extraoral examination pointed out to slight facial asymmetry, convex profile, and absence of passive lip sealing (Figure 1).
(a) Pretreatment intraoral photographs (19 years, 0 month). (b) Dental casts before treatment.
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The intraoral clinical examination and casts evaluation revealed that the patient was in permanent dentition phase, with the absence of teeth 36 and 46, Class I canine relationship, and biprotrusion (Figure 2). The curve of Spee was moderate (Figure 2).
Pretreatment panoramic (a) and lateral (b) radiographs at 19 years, 0 month.
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No significant indication of bone loss in the edentulous region was indicated (Figure 3(a)). The lateral cephalometric analysis indicated maxillary protrusion and minimum mandibular retrusion (Figure 3(b)).
T-loop positioned for edentulous space closure. In maxilla, the T-loop was symmetrically positioned, and in mandible, it was positioned displaced for the anterior region.
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T-loop symmetrically activated, type B, to provide anterior retraction and anchorage loss at the same time. The lower arch, on the other hand, had a T-loop displaced to the anterior, type A, enabling anterior retraction (Figure 4) without or with minimum anchorage loss of second molars. The preactivations of the T spring were conducted according to Kuhlberg and Burstone.
Posttreatment facial photographs (22 years, 1 month).
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By the final stage of the orthodontic treatment, we observed more pleasant facial aesthetics with improvement of the lip protrusion and passive lip sealing (Figure 5).
(a) Posttreatment intraoral photographs (22 years, 1 month). (b) Posttreatment dental casts.
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The major alterations were the retraction of the anterior teeth and space closure (Figures 6(a) and 6(b)).
Posttreatment panoramic (a) and lateral (b) radiographs at 22 years, 1 month.
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The panoramic radiograph pointed out average control of posterior lower teeth axial positioning and the presence of tooth 28 (Figure 7(a)). Lateral radiograph showed better inclination of upper and lower incisors, along with better lip sealing and improvement of soft tissue profile (Figure 7(b)).
Six-year follow-up facial photographs (28 years, 8 months).
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The facial characteristics obtained after the treatment were maintained throughout a six-year follow-up (Figure 8).
Six-year follow-up intraoral photographs (28 years, 8 months). (b) Six-year follow-up dental casts.
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Extraction spaces remained closed, and little alteration occurred in the positioning of the incisors (Figures 9(a) and 9(b)); panoramic and lateral radiographs demonstrated that the characteristics were maintained (Figures 10(a) and 10(b)).
Six-year follow-up panoramic (a) and lateral (b) radiographs at 28 years, 8 months.
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Extraction spaces remained closed, and little alteration occurred in the positioning of the incisors (Figures 9(a) and 9(b)); panoramic and lateral radiographs demonstrated that the characteristics were maintained (Figures 10(a) and 10(b)).
Superimpositions of the lateral cephalograms between the beginning, debonding, and 6-year follow-up stages: black line (19 years, 0 month); green line (22 years, 1 month); red line (28 years, 8 months).
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The superimposition of cephalometric tracings can show dental and profile modifications during orthodontic treatment through a 6-year follow-up (Figure 11).