PMC7441420_01
Pretreatment facial and intraoral photographs.
CRID2020-8854588.001.jpg
PMC7441420_01_CRID2020-8854588.001.jpg
fig1
In the lower arch, the incisors showed a severe lingual inclination and the premolars and molars showed an increased mesial inclination (Figures 1 and 2). Final Cephalometric radiography:taken immediately before appliance removal:(Figure 9, Table 1) revealed an improved skeletal relationship (ANB: 1 , SNA: 81.5 , SNB: 80.5 , Wits: -5 mm).
Pretreatment dental casts.
CRID2020-8854588.002.jpg
PMC7441420_01_CRID2020-8854588.002.jpg
fig2
In the lower arch, the incisors showed a severe lingual inclination and the premolars and molars showed an increased mesial inclination (Figures 1 and 2).
Pretreatment radiographs.
CRID2020-8854588.003.jpg
PMC7441420_01_CRID2020-8854588.003.jpg
fig3
The panoramic X-ray (Figure 3) revealed the presence of the four third molars, and endodontic treatment on the upper right central incisor (11) and the left upper pre-molar (25), with no presence of caries. III (3/16-in, 6.5 oz) intermaxillary elastics were incorporated. (Figure 6(c)); (3) Mandibular displacement, with downward and backward rotation, helped achieving an adequate molar and canine Class I relationship, as well as correcting the overbite and overjet (Figure 6(c)); (4) Reconstruction of the Occlusal Plane, modification of the posterior occlusal plane by incorporating a step down of the upper molars and a tip-back of the lower molars. In this phase, the occlusal plane was rotated (counterclockwise) increasing the vertical dimension of the maxilla (Figure 6(d) and 7(b)); and (5) Obtaining a Physiological Occlusion, with the use of a 0.020-inch stainless steel (SS) continuous arch and class III intermaxillary elastics, to achieve a good intercuspation (Figure 6(e)).
(a) 3D frontal view of the CBCT where the supernumerary tooth is visualized (red arrow) and (b) Coronal section of the supernumerary tooth showing no evidence of contact with the first lower premolar.
CRID2020-8854588.004.jpg
PMC7441420_01_CRID2020-8854588.004.jpg
fig4
A cone-beam computed tomography (CBCT) scan was performed to assess the area of the supranumerary tooth; an initial segmentation of the compromised teeth was performed and showed no contact or damages to the adjacent teeth (Figures 4 and 5). III (3/16-in, 6.5 oz) intermaxillary elastics were incorporated. (Figure 6(c)); (3) Mandibular displacement, with downward and backward rotation, helped achieving an adequate molar and canine Class I relationship, as well as correcting the overbite and overjet (Figure 6(c)); (4) Reconstruction of the Occlusal Plane, modification of the posterior occlusal plane by incorporating a step down of the upper molars and a tip-back of the lower molars. In this phase, the occlusal plane was rotated (counterclockwise) increasing the vertical dimension of the maxilla (Figure 6(d) and 7(b)); and (5) Obtaining a Physiological Occlusion, with the use of a 0.020-inch stainless steel (SS) continuous arch and class III intermaxillary elastics, to achieve a good intercuspation (Figure 6(e)).
3D reconstruction of supernumerary, cuspid, and premolar teeth: (a) vestibular view of segmented tooth, (b) lingual view, and (c) Inferior view.
CRID2020-8854588.005.jpg
PMC7441420_01_CRID2020-8854588.005.jpg
fig5
A cone-beam computed tomography (CBCT) scan was performed to assess the area of the supranumerary tooth; an initial segmentation of the compromised teeth was performed and showed no contact or damages to the adjacent teeth (Figures 4 and 5).
(a) Alignment and leveling with wires 0.014-inch NiTi, (b) MEAW arches with blue elgiloy 0.016 x 0.022-inch, (c) MEAW arches with blue elgiloy 0.016 x 0.022-inch and elastic 3/16 in, 4.5 oz elastic with Class III component, (d) MEAW arches and canine Class I, (e) 0.020-inch Stainless Steel continuous arches with the use of 3/16-in Class III elastics 4.5 oz.
CRID2020-8854588.006.jpg
PMC7441420_01_CRID2020-8854588.006.jpg
fig6
Interferences, which was initially performed by installing an upper MOAW (Modified Offset Arch Wire) arch, made with 0.016 x 0.0022-inch blue elgiloy (RMO) wire. It was used to produce intrusion and buccal inclination of the upper incisors facilitating the crossbite correction (Figure 6(b)). III (3/16-in, 6.5 oz) intermaxillary elastics were incorporated. (Figure 6(c)); (3) Mandibular displacement, with downward and backward rotation, helped achieving an adequate molar and canine Class I relationship, as well as correcting the overbite and overjet (Figure 6(c)); (4) Reconstruction of the Occlusal Plane, modification of the posterior occlusal plane by incorporating a step down of the upper molars and a tip-back of the lower molars. In this phase, the occlusal plane was rotated (counterclockwise) increasing the vertical dimension of the maxilla (Figure 6(d) and 7(b)); and (5) Obtaining a Physiological Occlusion, with the use of a 0.020-inch stainless steel (SS) continuous arch and class III intermaxillary elastics, to achieve a good intercuspation (Figure 6(e)).
Occlusal plane evaluation, before (a) and at the end (b) of treatment. (a) Deficiency of vertical dimension (short yellow arrow), (b) increase of the vertical dimension (long yellow arrow) with counterclockwise rotation of the occlusal plane (green arrow).
CRID2020-8854588.007.jpg
PMC7441420_01_CRID2020-8854588.007.jpg
fig7
Plane-SN: 14 ), which reflected an increase in the vertical dimension of the maxilla (Figure 7).
Posttreatment extraoral and intraoral photographs.
CRID2020-8854588.008.jpg
PMC7441420_01_CRID2020-8854588.008.jpg
fig8
The dental arches were aligned and leveled and the upper and lower dental midlines were coincident (Figure 8).
Posttreatment radiographs.
CRID2020-8854588.009.jpg
PMC7441420_01_CRID2020-8854588.009.jpg
fig9
Panoramic X-ray showed a verticalization of the upper and lower molars and premolars, with acceptable parallelism and no signs of significant bone or root resorption (Figure 9). Final Cephalometric radiography:taken immediately before appliance removal:(Figure 9, Table 1) revealed an improved skeletal relationship (ANB: 1 , SNA: 81.5 , SNB: 80.5 , Wits: -5 mm).
Final CBCT. (a) Axial view of the supernumerary tooth; 3D reconstruction of teeth: (b) vestibular view of segmented teeth, (c) lingual view.
CRID2020-8854588.010.jpg
PMC7441420_01_CRID2020-8854588.010.jpg
fig10
In order to reevaluate the position of the remaining, a CBCT was required and the area segmented using ITK-SNAP 3.8 (USA) (Figure 10).
Pretreatment (black line) and posttreatment (red line).
CRID2020-8854588.011.jpg
PMC7441420_01_CRID2020-8854588.011.jpg
fig11
The vestibuloversion of the upper and lowers incisors can be observed (Figure 11).
Initial (blue color) and posttreatment (pink color). (a) Right side, (b) left side, (c) frontal view, and (d) occlusal.
CRID2020-8854588.012.jpg
PMC7441420_01_CRID2020-8854588.012.jpg
fig12
Three-dimensional (3D) superposition of the jaws was performed using Geomagic Qualify 2013 (USA), highlighting the extrusion of the upper molars and the vestibuloversion of the upper incisors (Figure 12).
Initial (blue color) and posttreatment (pink color). (a) Right side, (b) left side, (c) frontal view, and (d) occlusal.
CRID2020-8854588.013.jpg
PMC7441420_01_CRID2020-8854588.013.jpg
fig13
In the 3D superposition of the mandible, no extrusion of the lower molars and mild vestibuloversion of the lower incisors was observed (Figure 13).
Intraoral and extraoral photographs at 3 years posttreatment.
CRID2020-8854588.014.jpg
PMC7441420_01_CRID2020-8854588.014.jpg
fig14
A slight relapse was observed in the lower incisors; however, an occlusion with acceptable stability was observed (Figure 14).