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Quintessence Publishing: Journals: ORTHODONTICS
The Art and Practice of Dentofacial Enhancement

Formerly World Journal of Orthodontics

Edited by
Rafi Romano, DMD, MSc (Editor-in-Chief)

ISSN 2160-2999 (print) / ISSN 2160-3006 (online)

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Summer 2001
Volume 2 , Issue 2

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Nonsurgical and Nonextraction Treatment of a Skeletal Class III Patient with Severe Prognathic Mandible: Long-Term Stability

Etsuko Kondo, DDS, DDSc, Toshihide Ohno, DDS, DDSc, T. J. Aoba, DMD, DDS

Pages: 115-126

Aim: A case of skeletal Class III malocclusion with a prognathic mandible and temporomandibular disorder is presented. Treatment objectives included establishing a stable occlusion, eliminating temporomandibular disorder symptoms, and improving facial esthetics through nonextraction and nonsurgical treatment. Subject and Methods: The patient was a Japanese adolescent boy who had previously been classified as requiring orthognathic surgical procedures. Sequelae included abnormal behavior of the large tongue, short lingual frenum, bilateral imbalance of chewing muscle activity, enlarged palatine tonsils, and narrowing of the maxillary arch. The resultant occlusal interference caused the mandible to shift to one side, with a lack of clinical crown height of the posterior teeth, which in turn produced an abnormal occlusal plane and curve of Spee. The form and function of the joint were adversely affected by the structural and functional asymmetry. The aim was to expand the maxillary arch and bring the maxilla downward and forward. The reconstruction of a functional occlusal plane by uprighting the posterior teeth with full bracket appliances, combined with an expanded lingual arch or maxillary expansion plate should create a small interocclusal clearance between the maxillary and mandibular arches. Results: The laterally displaced mandible was corrected to a more favorable jaw relationship, with the backward movement of point B, a reconstructed functional occlusal plane, and the creation of an almost normal overjet and overbite during the early stage of treatment. Adequate posterior support and anterior guidance were established, achieving a good intercuspation of the posterior teeth and normal overbite and overjet that were favorably affected by early and late anteroposterior growth of the maxilla and mandible. Point A moved forward, in conjunction with forward movement of the mandible, contributing to the excellent improvement of the occlusal relationship of the jaw. A well-balanced lip profile was created, and psychosocial impairment was eliminated. Conclusion: Subsequent mandibular growth and temporomandibular joint adaptation has resulted in almost symmetric joint structure, increased labial inclination of the maxillary incisors, and stable inclination of the mandibular incisors. Creation of a favorable perioral environment with normalized tongue space, posture, and function; perioral muscle activity; and breathing was assisted by myofunctional therapy and the use of a tooth positioner during and after treatment. These factors contributed to the maintenance of the long-term occlusal stability. World J Orthod 2001;2:115-126.

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