Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 0

Before

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 1

After

Lingual Orthodontics: Invisible orthodontic appliances.

The patient was an adult who claimed that “his teeth did not fit properly because his jaw was too big”. He demanded “invisible orthodontic appliances”.

He presented a skeletal class III, mandibular asymmetry, vertical plane. Malocclusion class III, anterior open bite, crossbite, deviation of the inferior midline, narrow upper arch. Thin periodontal biotype.

This type of cases where there is a core skeletal problem (discrepancy of size or position between the maxilla and the mandible) and we can not intervene in the orthopaedic level because the growth has been completed are complex and pose a major challenge. Usually, they require orthognathic surgery, extractions for dental compensations that “mask” the skeletal problem, or complex techniques of orthodontics using micro-screws or micro-implants.

Among the different types of invisible appliances, we chose personalized lingual appliances (custom-made braces and arches according to the established treatment plan), which offer high precision as well as maximum aesthetics, as the braces are not seen (they are placed in the inner side of the teeth).

We designed a plan involving an orthodontic treatment without extractions, at first not ruling out the possibility of combining it with orthognathic surgery, although in the end this option was rejected.

The length of treatment was approximately a year and a half.

The treatment was a success: the goals at the occlusal level were achieved (bite correction) as well as at the aesthetic level, with no need for orthognathic surgery nor complex mechanics.

The key to treatment was the transversal coordination of the arches by expanding the upper arch and adjusting the position of the incisors.

The sagittal correction was achieved thanks to intermaxillary rubber bands.

Another goal achieved was avoiding extreme dental compensations, which presented the risk of causing recessions (loss of gum which exposes the root). The excellent control over the movement of the roots provided by the lingual orthodontic appliances was of great help.

The smile aesthetics improved considerably thanks to the dental alignment and levelling, a right relation between the amount of teeth and gum exposed both at rest and smiling, and the effect “full mouth smile” thanks to the moderate expansion of the upper arch (always respecting the anatomic limits to avoid periodontal problems in the long term).

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 2

Right side before treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 3

Left side before treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 4

Right side during treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 5

Left side during treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 6

Front view during treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 7

Front view during treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 8

Right side after treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 9

Left side after treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 10

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Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 11

After

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 12

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Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 13

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Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 14

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Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 15

After

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 16

Before

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 17

After

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 18

Before

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 19

After

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 20

Smile before treatment

Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 21

Smile after treatment

Dra. Gema Olmos
Lingual Orthodontics. Treatment of complex malocclusion class III and open bite in adult patient 22

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