Abstract
Although most orthodontists avoid extractions, treating patients with biprotrusion traditionally involves removing teeth. In the current case report, a 15-year-old deaf patient had a Class II molar and canine relationships, 8 mm overjet and 3mm overbite, 3 mm of a discrepancy between U/L midline, crowding in both arches (3 mm in the upper and 7 mm in the lower). The first right upper molar (16) and the first right and left lower molars (36 and 46) were severely MIH affected. Extraction of the first four molars was proposed, since a large amount of space was required and three of the four molars were very compromised with severe MIH. Tooth 26 was extracted to maintain the symmetry of the arch and because the extraction of a premolar would not allow for alignment associated with class II correction of canines on the left side. During the closure of the extraction spaces, upper and lower third molars eruption was observed, in an appropriate position. Facial analysis shows us the coincidence of the upper midline with the face and good exposure of the incisors in the smile. There was considerable reduction of overjet and dental protrusion, enabling passive lip sealing. A perfect fit of the Class I superior teeth was not obtained since the patient considered that the treatment was already very good and did not want to collaborate with hygiene and the use of orthodontic appliances for more time.
Highlights
Orthodontic planning for Class II Angle patients with biprotrusion traditionally involves dental extractions, especially when it is associated with dental crowding
Extracting these elements is not the first choice, but when these teeth are compromised with extensive caries lesions or restorations, periodontal or endodontic problems, they may be chosen(Livas, Halazonetis, Booij, & Katsaros, 2011; Stalpers, Booij, Bronkhorst, Kuijpers-Jagtman, & Katsaros, 2007) and when the third molar is viable that will occupy the space left by the mesialization of the second tooth.(Baik et al, 2020) In addition to the adverse clinical conditions cited, there are those that result from structural defects, representing an option in the indication for extraction
Molar- incisor hypomineralization (MIH) is characterized by demarcated qualitative defects of enamel of systemic origin that affects one or more permanent first molars, with or without incisor involvement.(Weerheijm et al, 2003; Weerheijm, Jälevik, & Alaluusua, 2001) Clinically, the affected enamel is porous and fragile, often leading to a rapid collapse in the eruption and exposure to masticatory forces
Summary
Orthodontic planning for Class II Angle patients with biprotrusion traditionally involves dental extractions, especially when it is associated with dental crowding. Involvement and, with early loss.(Ghanim et al, 2017) In addition, the treatment has a very large financial impact on the patient and society, since the affected teeth develop caries relapses.(Elfrink et al, 2015). The objective of this case report is to present and discuss a treatment of a special need patient with an Angle Class II, biprotrusion with severe crowding and MIH molars
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