Pacific Coast Society of Orthodontists Bulletin Winter 2019 - 32
Case Report
How would you treat this malocclusion?
Pretreatment
Case G.A., 41 years, 2 months
A 41-year, 2-month-old South Asian male
patient presents with the chief concern that
he "wants to look good and feel good and
his general dentist recommended orthodontic treatment." He was recently involved
in a motor vehicle accident and had to take
oxycontin and Vimovo for backache.
Diagnosis and Etiology
Extraoral and Intraoral Findings
The patient has a straight profile with a
slightly prognathic mandible and increased
lower anterior face height. His nasolabial
angle is obtuse with competent lips and a
retrusive upper lip. On smiling, his smile arc
is consonant but with an inadequate display
of upper incisors and no gingival display.
He has Class III malocclusion with 4 mm
Class III right and Class I left canine relationships in centric occlusion (CO). The molar
relationship cannot be determined, as both
mandibular first molars are missing in addition to his maxillary right third molar. In CO,
there is 3 mm anterior crossbite from the
maxillary right lateral incisor to maxillary
left canine (#7 to #11) with 50% overbite.
The patient has a significant anterior functional shift and can posture edge to edge in
centric relation (CR). Crowding is 7 mm in
the maxillary arch and 3 mm in the mandibular arch. There are multiple areas of gingival recession, minimal attached gingiva on
his mandibular anteriors, and multiple areas
of enamel demineralization. His maxillary
dental midline is coincident with his facial
midline, but his mandibular dental midline
is deviated 1.5 mm to the left in both CR and
CO. Temporomandibular joint evaluation is
normal with no signs or symptoms (Figures
1 and 2).
Radiographic Findings
A panoramic radiograph shows missing #1,
#19, and #30. There is an apparent vertical
32
Figure 1. Initial facial and intraoral photos (G.A., 41 years, 2 months)
Figure 2. Initial digital models
PCSO Bulletin Winter 2019
Pacific Coast Society of Orthodontists Bulletin Winter 2019
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