Decoding the facial asymmetry

Abstract

Introduction: When degree of facial asymmetry is noticeable, it negatively affects facial and smile esthetics. It may due to discrepancies in size and position between cranial base and maxilla/ mandible. Asymmetry due to occlusal interference may result in functional shift of the mandible which usually poses a challenge. So diagnosis and functional examination are keys to an esthetic and stable outcome. Objectives: This case report addresses the facial asymmetry in an adult patient who sought for improvement infacial appearance and occlusion. Case Description: A 26-year old male patient reported with chief complaint of noticeable facial asymmetry and irregularly positioned teeth. Clinical examination revealed mild facial asymmetry. Intraorally patient showed crowding, non-coincident dental midlines, anterior cross bite, missing 23 and root stump 46. Starting point in diagnosis and treatment of this case was establishing centric relation through guiding the mandible into centric relation rather than centric occlusion. During functional examination we observed discrepancyin CR-CO which was confirmed using PA-Ceph in centric rest position. Treatment was planned as deprogramming splint followed by fixed mechanotherapy. Post muscle deprogramming we were able to achieve “true” anatomic relationship of the mandible to the maxilla. Conclusion: Thus, the present case report aims at addressing important aspect of functional examination to be considered by the orthodontist while reaching an accurate diagnosis and treatment plan in such patient’s with challenging asymmetry. Keywords: Centric relation, Asymmetry, Deprogramming.