PMC7204358_01
Initial extraoral views (August 2016).
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The most important craniofacial features were brachycephaly, convex/biprotusive profile, flat nasal bridge, closed nasolabial angle, apparent large mouth, and broad lips (Figure 1).
Initial intraoral views (August 2016).
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Intraoral findings included a partially complete mixed dentition with several deep caries or cavities in all primary molars, ovoid arcades, anterior crossbite, mild open bite, macroglossia, and tongue thrusting; soft tissues were normal, but generalized moderate gingivitis was present; there also was high labial frenum (Figure 2).
Oral rehabilitation treatment images (October 2016).
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Pit and fissure sealants were also applied on the four permanent first molars (October 2016) (Figure 3).
Postrehabilitation treatment (anterior view) (October 2016).
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Anterior teeth exhibited some small enamel chalky irregularities (Figure 4).
(a) Radiographic view and (b) Ricketts cephalometric analysis (June 2017).
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Then, the orthodontic clinical and cephalometric diagnosis (Figures 5(a) and 5(b)) was carried out, determining the presence of a pseudo-class III malocclusion.
Hyrax appliance (June 2017).
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A Hyrax appliance was placed for four months (June 2017) (Figure 6).
Fixed orthodontic appliance with Z springs (July 2018).
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November 2017, a laser labial frenulectomy was carried out. Nine months later, the Hawley appliance was substituted by a fixed Nance button with "Z" springs over the upper incisors for treating the anterior crossbite (Figure 7).
(a) Spongiotic localized juvenile hyperplasia localized above the upper right central permanent incisor (October 2017). (b) The same lesion disappeared without any type of treatment (July 2018).
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Unexpectedly, two months later, a gingival lesion appeared above the right upper central incisor, diagnosed presumptively as a "localized juvenile spongiotic gingival hyperplasia (LJSGH)" (Figure 8(a)); after discussing with the oral surgeon, it was decided only to observe the lesion, without any kind of treatment. It healed spontaneously during the next 10 months approximately (Figure 8(b)).
Recent intraoral views (July 2019).
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In July 2019, the occlusal problems have been almost resolved (Figure 9).
Radiographic control, Nance appliance (September 2019).
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The last appointment was in September 2019 for clinical and radiographic control (Figure 10).