Orthodontic treatment. Class III, open bite, crossbite, overcrowding, receding gums. Treatment by gum graft, corticotomy and bone graft, and orthodontic treatment with skeletal anchorage

The patient was a 21-year-old male showing:

• Class III and skeletal and dental open bite.
• Dentoalveolar compression.
• Border-to-border lateral crossbite on the left side.
• Overcrowding.
• Mandibular deviation to the right and deviation of the inferior midline to the right.
• Thin periodontal biotype and class II in Miller’s classification of gingival recession in the upper lateral areas, being more severe in the left side, where there was an occlusal trauma due to the class III and the crossbite.

Aim of treatment:

Covering the recessions to avoid injuries and root caries and increasing the thickness of the gum by means of a connective tissue graft.

Corticotomy+bone graft in order to perform with greater safety the orthodontic movements necessary to correct the transverse discrepancy and eliminate the occlusal trauma, avoiding a steady increase of the recessions.

Correcting the occlusal relationship (bite) to improve function, overcrowding, smile aesthetics and the occlusal trauma by improving the prognosis of the teeth suffering from recession.

Orthodontic treatment:

Three months after the connective tissue graft, a corticotomy with bone graft was performed.

Braces were cemented and an arch-widening Hyrax appliance was used, creating more space for the alignment of the anterior sector by turning it round twice a day for only two weeks.

Once that there was enough space, the alignment started. It was conducted using the thin 013 Niti double-arch, in order to prevent the rotation of the lateral incisors from causing an increase of the vestibular shift of the upper incisors, worsening the open bite.

The normal sequence with Damon arches then began, aiming to improve the torque of the lateral sectors by improving the position of the root in the alveolar process.

The piece 34 in the lower arch was extracted in order to correct the left canine class III and solve the overcrowding.

Initially, the lower incisors were not cemented to prevent the rotation of the canines from causing an increase of the vestibular shift of the lower incisors.

A micro-screw was used as indirect skeletal anchorage to avoid the mesialization of the posterior sector, which already presented a class III, and vertical rubber bands were used to prevent the bite from opening.

All the targets set were achieved.

Retention: results remain stable 4 years after the end of the treatment.  There are no problems of recession, bite or overcrowding.