Condylar remodelling in a severe class II deep bite dento-skeletal malocclusion treated with an ortho-surgical approach: A five-year follow-up case report.

Condylar displacement and remodelling are phenomena closely related to orthognathic surgery and critically involved in occlusal and skeletal stability. The aim of the present case report is to describe over time condylar displacement and surface remodelling after bilateral split sagittal osteotomy (BSSO) in an adult patient with severe class II skeletal malocclusion treated with ortho-surgical approach. A male of 21years comes to our observation. The extraoral examination shows a symmetrical square-shaped face, a convex profile, an acute nasolabial angle and a deep labiomental fold. Intraoral examination reveals a class II division 2 with a 2mm deviation of the mandibular midline to the left and the presence of a scissor bite of the bicuspids between quadrants II and III. The Spee curve and overbite are extremely accentuated (OV 14.3mm) as the overjet (11.1mm). Axiographic reconstructions of CBCT show a normal shape and position of both condyles. The cephalometric analysis shows a reduced lower facial height, a normal upper jaw position, a mandibular underdevelopment masked by a very developed symphysis and an extremely low divergence (FMA 11.2°). BSSO for mandibular setback was performed in the 13th month of orthodontic therapy. Original CBCT data before surgery (T0), at the end of treatment (T1), 2years postoperatively (T2) and 5years postoperatively (T3) were collected and reconstructed for 3-dimensional (3D) qualitative analyse. At the end of the surgical-orthodontic treatment (26months), good function and good aesthetics were achieved. The qualitative and comparative analysis of the superimpositions and the cuts made on the CBCT at T0, T1, T2, T3 showed a physiological remodelling and adaptation of the condyles.

Condylar reshaping in a TMD patient after ortho-prosthetic treatment: A 20-year follow-up case report.

Temporomandibular disorders (TMDs) involve different conditions with similar symptoms and signs affecting the temporomandibular joints (TMJs), the muscles of mastication, or both. The symptoms and signs of TMDs are several: pain and tenderness in and around the TMJs and muscles of mastication, limitation and lack of coordination in jaw movement, joint sounds - clicking and/or crepitus, episodes of closed lock or open lock, headaches. In the TMD, degenerative joint disease (DJD), also called osteoarthritis (OA), may be a local condition or part of a systemic disease. According to the Research Diagnostic Criteria for Temporomandibular Disorders RDC/TMD, OA involves the presence of reported symptoms and clinical signs. As regards the possible causes, the literature indicates that mechanical load may act as a trigger factor for a various degenerative modification resulting in con-dylar resorption when host remodeling capacity is lost. Although the role of occlusion in the etiology of TMD is not absolutely assessed, occlusal interferences could affect TMD. The aim of this case report is to present the history over time (20 years follow-up) of a female adult patient with osteoarthritis of TMJs, who showed an adaptative reshaping of the condyles and to consider the possible relation with orthodontic treatment and occlusal rehabilitation. Key words:TMD, osteoarthritis, condylar reshaping, adult treatment.

Treatment of an upper impacted cuspid using ultrasonic surgery and a modified RPE. A case report.

This case report describes the possibility to use a modified rapid palatal expander like anchorage to reposition an included maxillary cuspid. Moreover it is enphasized the use of an ultrasonic device during surgery to expose the impacted tooth.

The Herbst appliance updated.

The aim of this paper is to analyze the evolution that the Herbst appliance has experienced in the last 30 years. In particular the different designs proposed for the Herbst appliance are examined and the related differences in clinical management, indications, and treatment effects are also illustrated. The two major challenges in the clinical management of the Herbst appliance are represented by the choice of the type of stabilization and by the control of the proclination of the lower incisors. The use of acrylic splints presents a set of relevant advantages: the construction technique is simple, the appliance can be worn easily by the patients, and the height of the splint can be adjusted to the growth pattern. Moreover, the acrylic splint Herbst can be used to reposition the mandible in cases with temporomandibular disorders. As for the proclination of the lower incisors, an accurate assessment of the neuromuscular pattern of the individual patient before treatment can provide the clinician with reliable criteria to evaluate the risk for incisor proclination during Herbst therapy.

Long-term follow-up of a young adult patient with a Class II malocclusion treated with a Herbst appliance.

A 13-year, 9-month-old girl presented with the chief complaint of crowding and protrusion of her anterior teeth. She was dolichofacial with a Class II Division 1 occlusion and had reached the final phase of her skeletal growth. Clinical symptoms and tomograms were indicative of a TMJ dysfunction. Because orthognathic surgery was not accepted by the patient and her parents, a Herbst appliance became the choice of treatment. An optimal occlusion and a good facial appearance were achieved after 24 months of treatment. TMJ tomograms at the end of treatment showed a more physiologic condylar position. Long-term follow-up 7 years after the end of treatment showed a very stable occlusion and an acceptable facial appearance.

Management of the Herbst splint appliance in Class II malocclusion with different growth pattern.

Class II malocclusion treatment can be successfully performed with the Herbst appliance stabilized with acrylic splints. Using this kind of stabilization a posterior open bite is always present when the appliance is removed. Two case reports are presented to illustrate how it is possible to manage the post- Herbst phase in different types of growth pattern in order to obtain the best aesthetical and functional results.

Osteoarthritis of the temporomandibular joint in an adult patient with Hashimoto thyroiditis: case report.

This case report documents the treatment of a female patient, 37 years 6 months of age, with a Class II open bite malocclusion with severe osteoarthritis of the temporomandibular joint associated with Hashimoto disease, a chronic inflammatory disease of the thyroid in which autoimmune factors play a prominent role. The simultaneous treatment of both pathologies (malocclusion and thyroiditis) led to the cessation of pain and dysfunctional symptoms in both temporomandibular joints.