International Medical Journal Vol. 26, No. 5, pp. 440 - 441 , October 2019

CASE REPORT

Orthodontic Management of Moderate Crowding, Anterior Crossbite and Dental Midline Shift

Haytham Jamil Alswairki1), Mohammad Khursheed Alam2)

ABSTRACTBackground: Malocclusion problems, improvement of patients' aesthetic, function and psychological problems can be suc-

cessfully managed orthodontically. Case presentation: In this case, 23-year-old female had Class III malocclusion, complicated with midline shifting, buccally

placed canines and 22 in crossbite position. Camouflage orthodontic treatment planned, in the progression of treatment, box elastics was used and inter proximal reduction in lower arch has been done.

Conclusion: A well-balanced occlusion by orthodontic management of the case has been done.

KEY WORDScrowding, crossbite, midline shift

Received on September 11, 2018 and accepted on January 27, 20191) Private Dental Clinic Jeddah, KSA2) Orthodontic Department, College of Dentistry, Jouf University Sakaka, KSACorrespondence to: Haytham Jamil Alswairki(e-mail: hitham.swerki@gmail.com)

440

INTRODUCTION

Malocclusion comes in many forms, among them crowding are most common. Malalignment of tooth/teeth, alveolar base and jaw are the most common problems. Most people are suffering from some degree of orthodontic problems. Heredity plays major roles as an etio-logic factor for different type of malocclusion1-7). Anterior cross bite / single tooth crossbite is a malocclusion in which the lingual/palatal mal-position of one or more maxillary anterior teeth in relation to the man-dibular anterior teeth when the teeth are in centric relation8-10). According to British standards Incisor classification, in class III malocclusion the lower incisor edges lie anterior to the cingulum plateau or middle third of the palatal surface of the upper incisors. In such cases, overjet is reduced or reversed11-15). In this clinical case presentation, management of mild to moderate crowding, reduced overjet, single tooth crossbites, dental midline shifting has been orthodontically managed.

CASE PRESENTATION

A 23 year old female patient, with the chief complaints of, "she doesn't like appearance of upper front teeth" (Figure 1). Mild Class III case planned to treat non extraction according to McLaughlin’s criteria for camouflage (upper incisor to palatal plane no greater than 120 degrees and lower incisor to mandibular plane no less than 80 degrees). Bilateral Class I molar relationship, overjet of 1mm, shallow overbite, moderate maxillary and mandibular crowding, protrusive upper (U1-SN = 120°), and average lower incisors (IMPA = 91°), healthy peri-odontium, centric relation and centric occlusion coincident.

Diagnosis: Class III (ANB = -5) , SN-Mp = 39 (high angle), FH-Mp = 28, well balanced profile, acute nasolabial angle, maxillary midline coincident with facial while mandibular midline shift 3 mm to

right, Facial height appeared to be normal with normal amount of tooth display (Figure 1 and 2).

Treatment plan

1) Band U6s and bond remaining Upper teeth. 2) Levelling and alignment. 3) Band L6s and bond remaining Lower teeth.4) Levelling and alignment. 5) Band 7s6) Finishing . 7) Retention with maxillary and mandibular Essix. Appliances and treatment progress:1) Band, 1st molars and bond remaining upper teeth with .022 pre-

adjusted MBT prescription edgewise appliance. 2) Initial levelling and alignment with 14 NiTi followed by 18 NiTi

after 6 weeks then 19X25 NiTi after 8 weeks until to reach 19X25 steel.3) Band, Lower 1st molars and bond lower teeth and start levelling

and alignment.4) Class III box elastic (U456-L34)4) Banding 7 (with buccal root torque in U7s to eliminate palatal

cusp hanging) 5) Final detailing, finishing elastics for 2 weeks, retention.

CONCLUSION

Patient was successfully managed with preadjusted edgewise appli-ance. Balanced occlusion, midline correction with good facial aesthetics are achieved (Figure 2 and 3).

C 2019 Japan Health Sciences University & Japan International Cultural Exchange Foundation

Alswairki H. J. et al. 441

REFERENCES

1) Nowrin SA and Alam MK. (2018). Chapter 1. Malocclusion: An Integral Part of

Orthodontic Learning. Nova Publisher. NY, USA. ISBN: 978-1-53613-123-9 eBook ISBN: 978-1-53613-124-6

2) Haque S, Nowrin, Shahid F, and Alam MK. (2018). Chapter 2. Global Prevalence of Malocclusion.□ Nova Publisher. NY, USA. ISBN: 978-1-53613-123-9 eBook ISBN: 978-1-53613-124-6

3) Haque S and Alam MK. (2018). Chapter 3. Etiology of Malocclusion.□ Nova Publisher. NY, USA. ISBN: 978-1-53613-123-9 eBook ISBN: 978-1-53613-124-6

4) Shahid F and Alam MK. (2018). Chapter 4. Classication of Malocclusion.□ Nova Publisher. NY, USA. ISBN: 978-1-53613-123-9 eBook ISBN: 978-1-53613-124-6

5) MK, Qamruddin I, Purmal K. Malocclusion: Causes, Complications and Treatment. Nova Publisher. NY, USA. ISBN: 978-1-53613-123-9 eBook ISBN: 978-1-53613-124-6

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11) Alam MK, Shahid F, Nowrin SA. Non-surgical treatments of skeletal class III maloc-clusion with sever anterior cross bite: A case report. International Research Journal of Medical Science. 2016; 4(12): 1-4.

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15) Alam MK, Che M Nasir NF, Purmal K, Rahman SA. Fixed and removable orthodontic appliance application for Class III malocclusion with anterior locked bite. IOSR Journal of Dental and Medical Sciences. 2015; 14(11): 87-95.

Figure 1. Pre-treatment intra oral photographs.

Figure 2. Pre and Post-treatment facial oral photographs.

Figure 3. Post-treatment intra oral photographs.