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Aim of this report is to describe a case of a patient in mixed dentition with dento-skeletal class II malocclusion, deep bite, increased overjet and gummy smile. In this kind of clinical case the objectives of treatment were: to correct the dento-skeletal malocclusion, to obtain a correct overbite and overjet, to control the permanent teeth in a good eruption, to improve aesthetical conditions and to maintain clinical results. Treatment plan included just Occlus-o-guide®, the type that is indicated for mixed dentition (G type). The active phase of therapy was conducted in twelve months and the retention time was two years. Then the patient was controlled every three months and she used the appliance nighttime in alternance for one year more. Occlus-o-guide® was the indicated appliance to obtain all the objectives requested to solve the malocclusion. The early therapy with Occlus-o-guide® is easy, short and most of treated cases don’t need a second phase of orthodontic therapy.
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Interceptive therapy with elastodontic appliance: case report
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Case Report
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interceptive therapy
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Interceptive therapy with elastodontic appliance: case report
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1
    Interceptive therapy with elastodontic appliance:
    case report




                                                                                                        i
                                                                                                      al
                                                                                                    on
    Giuseppina Laganà, DDS1                                          mandibular advancement in order to correct Class II sa-
    Paola Cozza, MD, DMD2                                            gittal discrepancies, concurrently with a vertical opening
                                                                     in the anterior region to provide a greater vertical deve-
                                                                     lopment of the posterior teeth. Positioners usually achie-
    University of “Tor Vergata”, Rome, Italy                         ve minor tooth movement after orthodontic treatment as




                                                                                                  zi
    2 Professor and Head Department of Orthodontics
                                                                     a result of the elastomeric material (4,5).
    1 Assistant Professor Department of Orthodontics
                                                                     Class II malocclusion correction with eruption guidance ap-
                                                                     pliances produces the following statistically significant chan-




                                                                         na
                                                                     ges: increase in mandibular growth and degree of man-
    Corresponding author:                                            dibular protrusion, increase in lower anterior and total an-
    Dott.ssa Giuseppina Laganà                                       terior face height, lingual tipping and retrusion of the ma-
    Via G. Baglivi, 5/E                                              xillary incisors, protrusion of the mandibular incisors, in-
    00161 Rome, Italy
                                                                     creased mandibular molar mesial drifting and mandibular




                                                                       er
    Phone: mob +39 335 5310894 - Fax +39 06 44232321
                                                                     posterior dentoalveolar height, improvement in maxillo-
    E-mail: giuseppinalagana@libero.it
                                                                     mandibular and molar relationships, decrease in overjet
                                                                     and overbite and inhibition of the vertical development of
                                                                     the maxillary incisors (5).
    Summary
    Interceptive therapy with elastodontic appliance: case
    report.
                                                               nt    Aim of this report is to describe a case of a patient with
                                                                     class II skeletal and dental malocclusion, severe deep bite,
                                                                     increased overjet, retrognatic and gummy smile. This case
                                                     iI
    Aim of this report is to describe a case of a patient in         was solved during mixed dentition by using just Occlus-
    mixed dentition with dento-skeletal class II malocclu-           o-guide®.
    sion, deep bite, increased overjet and gummy smile.
    In this kind of clinical case the objectives of treatment
                                       on

    were: to correct the dento-skeletal malocclusion, to ob-         Materials and methods
    tain a correct overbite and overjet, to control the per-
    manent teeth in a good eruption, to improve aesthetical          The subject, F.B., a 9 year-old Caucasian female, was se-
    conditions and to maintain clinical results.                     lected from the Department of Orthodontics, University of
    Treatment plan included just Occlus-o-guide ®, the type
                              i


                                                                     Rome ‘Tor Vergata’. The subject satisfied the following se-
    that is indicated for mixed dentition (G type). The active
                           iz



                                                                     lection criteria: 9-11 years of age, mixed dentition, over-
    phase of therapy was conducted in twelve months and              jet>3 mm, overbite>3 mm, skeletal Class II malocclusion
    the retention time was two years. Then the patient was           (ANB>4°), retrognathic mandible (SNB<78°), no history of
    controlled every three months and she used the appli-
           Ed




                                                                     previous orthodontic therapy. Radiographs data were ta-
    ance nighttime in alternance for one year more.
                                                                     ken before (T0), after 12 months of active therapy (T1) and
    Occlus-o-guide ® was the indicated appliance to obtain
    all the objectives requested to solve the malocclusion.
                                                                     after 24 months of retention (T2). Her medical history sho-
    The early therapy with Occlus-o-guide ® is easy, short           wed nothing remarkable. The patient’s face was symme-
    and most of treated cases don’t need a second phase of           tric with gummy smile and low retrognatic profile (Figs. 1,2).
    orthodontic therapy.                                             Clinical examination showed right and left class II molar
                                                                     relationship, no crowding in mandibular arch, increased
IC




    Key words: elastodontics, deep bite, interceptive ther-          overjet, severe deep bite, coincident midlines.
    apy.                                                             Arches analysis showed a mixed dentition presenting in
                                                                     maxilla: right and left first molar, permanent right and left
                                                                     central incisor, permanent right and left lateral incisor, right
C




                                                                     and left cuspid in eruption, right and left first bicuspid and
    Introduction                                                     right and left deciduous second molar. In mandibular arch
                                                                     right and left first molar, permanent right and left central
    A new approach of interceptive treatment is “elastodon-          incisor, permanent right and left lateral incisor, right and
©




    tics” that is a particular type of orthodontic treatment using   left cuspid, right and left first bicuspid in eruption, right and
    removable appliances made with silicone elastomer. The           left deciduous second molar were observed (Figs 3,4,5).
    appliances are simple in construction and function, easy         No problems in opening and closure movements could be
    to use and safe; in mixed dentition the indicated applian-       noticed.
    ce is Occlus-o-guide® G type (1,2,3).                            Orthopantomography analysis showed all permanent te-
    Eruption guidance appliances present the combined cha-           eth at different formation stages and second upper and lo-
    racteristics of a functional appliance and a positioner. The     wer right and left deciduous molars (Fig. 6).
    characteristics attributed to functional appliances are          Cephalometric analysis (Fig. 7) revealed a skeletal Class

    22                                                                                     Annali di Stomatologia 2010; I (3-4): 22-28
    Interceptive therapy with elastodontic appliance: case report




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                                                                    Figure 3 - Occlusion in frontal view (T0).




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                                                                    Figure 4 - Occlusion in right lateral view (T0).
    Figure 1 - Face and smile (T0).
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                                                                    Figure 5 - Occlusion in left lateral view (T0).



                                                                    II malocclusion with mandibular retrusion (ANB=5, Nperp-
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                                                                    Pg=-7) in a hypodivergent subject (FH^MP=22), dental
                                                                    deep bite (overbite=6 mm), increased overjet (overjet=6
                                                                    mm), proclination of lower incisor and reclination of upper
                                                                    incisor (IMPA=100, U1^FH=108), alteration of profile
©




                                                                    (Nasolabial=112) (Table 1). The subject’s skeletal matu-
                                                                    rity was the prepubertal stage of CS2.
                                                                    In this clinical situation the treatment’s objectives were:
                                                                    - to treat class II malocclusion;
                                                                    - to control bicuspids and canines eruption;
                                                                    - to obtain a correct overbite and overjet;
                                                                    - to improve gummy smile and profile;
    Figure 2 - Profile (T0).                                        - to maintain long-term clinical results.

    Annali di Stomatologia 2010; I (3-4): 22-28                                                                             23
    G. Laganà et al.




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    Figure 6 - Orthopantomography before treatment (T0).




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    Figure 7 - Latero-lateral teleradiography before treatment (T0).
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    Treatment plan included just Occlus-o-guide® G type (Fig.          rapy. A check on her cooperation was made by an evident
    8). The active phase of therapy was totally conducted in           change of the appliance material: the appliance colour is
    twelve months: the patient was instructed to use the ap-           made to alter according to the number of hours it is used.
    pliance nighttime and two hours during the day. These two          Initial problems with use of Occlus-o-guide® included only
©




    hours were divided into four periods of half an hour. In each      excessive salivation: this effect, however, gradually redu-
    period the patient had to bite into the appliance keeping          ced after few days.
    the lips in contact. For the last twelve months the patient
    used Occlus-o-guide® just nighttime without exercises. Then
    the patient was controlled every three months and she used         Results
    the appliance nighttime in alternance for one year more.
    Good collaboration was obtained by the patient observed            In the examined case correction of class II malocclusion,
    in control visit once a month in all the time of active the-       increased overjet, crowding and deep bite can be obser-

    24                                                                                     Annali di Stomatologia 2010; I (3-4): 22-28
    Interceptive therapy with elastodontic appliance: case report


    Table 1 - Cephalometric analysis before treatment (T0), after one
    year of active treatment (T1) and after two years of retention (T2).

    Sagittal skeletal                  T0            T1           T2

    SNA (°)                           78            77             79




                                                                                                             i
    SNB (°)                           73            74             76




                                                                                                           al
    ANB (°)                             5             3             3
    Nperp-A (mm)                        6             6             6
    Nperp-Pg (mm)                      -7            -6            2




                                                                                                         on
    Co-A (mm)                         88            90            94
    Co-Gn (mm)                        105           107           110

    Vertical skeletal




                                                                                                       zi
    FH^MP (°)                          22            21            24      Figure 8 - Occlus-o-guide® G type.
    FH^OP (°)                           8            12             8
    PP^MP (°)                          27            30            26
    N-ANS (mm)                         53            55            55




                                                                               na
    ANS-Me (mm)                        58            61            61      Clinical analysis of occlusion shows the good correction
    N-Me (mm)                         112           118           118      of dental class II malocclusion, overjet and overbite as-
    Co-Go (mm)                         40            44            54      sociated with good eruption of posterior teeth (Figs
    Gonial angle (°)                  123           127           128      11,12,13).
                                                                           Cephalometric analysis two years later the end of active




                                                                             er
    Maxillary dentoalveolar                                                treatment revealed the solution of skeletal class II ma-
                                                                           locclusion (ANB=3), control of divergence (FH^MP=22),
    U1^FH (°)                         108           112           112      good proclination of upper and lower incisor (U1^FH=112,
    U1^Pt A vert (mm)                 1,5            4             5
    U1 horizontal (mm)
    U1 vertical (mm)
    U6 horizontal (mm)
                                       48
                                       28
                                       15
                                                     49
                                                     28
                                                     16
                                                                   49
                                                                   28
                                                                   13
                                                                     nt    IMPA=100), normal overbite (overbite=2 mm) and overjet
                                                                           (overjet=3 mm) and important improvement of aesthetical
                                                                           values analysis (Nasolabial angle=110, UL-LE= -3, LL-LE=
                                                                           0) (Table 1) (Figs 14,15).
                                                          iI
    U6 vertical (mm)                   18            18            21
                                                                           At the end of therapy, after three years, the patient
    Mandibular dentoalveolar                                               shows correct intercuspidation, no crowding, normal
                                                                           overjet and overbite, right and left class I canine and mo-
                                            on

    IMPA (°)                          100           101           100      lar and skeletal maturity postpubertal stage of CS5.
    L1^Pt A-Pg (mm)                    2             3             3
    L1 horizontal (mm)                 50            56            56
    L1 vertical (mm)                   25            30            32      Discussion
    L6 horizontal (mm)                 21            25            26
                                i


    L6 vertical (mm)                   20            22            22      In the case treated by using Occlus-o-guide® the overbi-
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                                                                           te was simply corrected: the forces induced into the ap-
    Interdental                                                            pliance are orthopaedic and they generate 150 to 600
                                                                           pounds per square inch in the upper jaw. These forces con-
            Ed




    Interincisal (°)                  124           125           126      trol vertical and horizontal growth of the maxilla, allowing
    Overjet (mm)                        6            3             3       posterior teeth to erupt more than anterior teeth (6,7).
    Overbite (mm)                       6            2             2       Timing is therefore very important for successful in early
    Molar relationship (mm)            -1            1             2
                                                                           preventive treatment and it seems to be more critical in
    L1 vertical (mm)                   25            30            32
                                                                           overbite than in overjet correction. Proper retention of ear-
    L6 horizontal (mm)                 21
                                                                           ly preventive overbite correction seems to be dependent
    L6 vertical (mm)                   20            22           22
                                                                           on two different factors: collagenous fiber formation, par-
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    Soft tissue                                                            ticular interseptal, and alveolar and vertical jaw growth. Cor-
                                                                           rect time for proper fiber formation occurs when treatment
    UL-EL (mm)                         0             -4            -3      is initiated before or during active tooth eruption without
    LL-EL (mm)                         2             -2            0       any occlusal contact of opposing teeth (6).
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    Nasolabial angle (°)              112           104           110

                                                                           Conclusions
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                                                                           The right choose of clinical case is the most important mo-
    ved associated with good aesthetical results of profile and            ment of therapy with Occlus-o-guide®. Different Authors
    correction of gummy smile. The profile analysis revealed               show solved clinical cases and suggest to use Occlus-
    an excellent result and it is possible to observe the reso-            o-guide® in non-extraction malocclusion cases with per-
    lution of gummy smile (Figs 9,10). The correction of ske-              manent canines and bicuspids at the start of eruption, in
    letal class II malocclusion was obtained in twelve months              order to correct overbite and overjet problems of any se-
    just using Occlus-o-guide® at the right time of eruption of            verity (6,1,8,9).
    permanent teeth.                                                       Careful supervision of the developing dentition and oc-

    Annali di Stomatologia 2010; I (3-4): 22-28                                                                                        25
    G. Laganà et al.




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                                           Figure 11 - Occlusion in frontal view (T2).




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    Figure 9 - Face and smile (T2).
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                                           Figure 12 - Occlusion in right lateral view (T2).
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                                           Figure 13 - Occlusion in left lateral view (T2).
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                                           clusion, correct diagnosis, correct choose of clinical case
                                           and right time of treatment are important considerations
                                           to obtain good results and to prevent complications. The
©




                                           patient’s collaboration is essential with this kind of thera-
                                           py and younger subjects are usually better patients than
                                           teenagers (10,11).
                                           Occlus-o-guide® is a safe appliance that gives clinical re-
                                           sults in few months of patient collaboration. As other type
                                           of interceptive therapies it can substantially avoid future
                                           problems that a deep bite can create and reduce the real
    Figure 10 - Profile (T2).              “risk” of orthodontic fixed appliances.

    26                                                            Annali di Stomatologia 2010; I (3-4): 22-28
    Interceptive therapy with elastodontic appliance: case report




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    Figure 14 - Orthopantomography after two years of retention (T2).




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    Figure 15 - Latero-lateral teleradiography after two years of retention (T2).


    References                                                               3. Skomro P. Orthodontic appliance made from silicone ela-
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                                                                                stomer, evaluated clinically and from patients opinions after
     1. Corbett MC. Class II treatment with elastodontics. J Clin Or-           treatment for malocclusion. Ann Acad Med Stetin
        thod 1992;26(7):419-424.                                                2000;46:293-304.
     2. Methenitou S, Shein B, Ramanathan G, Bergersen EO. The               4. Janson G, Alves da Silva CC, Bergersen EO, Castanha
        prevention of overbite and overjet development in the 3 to 8            Henriques JF, Pinzan A. Eruption guidance appliance ef-
        year old by controlled nighttime guidance of incisal erup-              fects in the treatment of Class II, Division 1 malocclu-
        tion: a study of 43 individuals. The Journal of Pedodontics             sions. Am J Orthod Dentofacial Orthop 2000;117(2):
        1990;4(14):219-230.                                                     119-129.


    Annali di Stomatologia 2010; I (3-4): 22-28                                                                                           27
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     5. Janson G, Nakamura A, Chiqueto K, Castro R, de Freitas             1985;2 (1):17-33.
        MR, Castanha Henriques JF. Treatment stability with the         8. Cunat JJ, Strychalski ID, Warunek SP. The use of silicone
        eruption guidance appliance. Am J Orthod Dentofacial Or-           elastomeric positioner-type appliances in space closure:
        thop 2007;131(6): 717-728.                                         three case reports. Am J Orthod Dentofacial Orthopedic
     6. Bergersen EO. Preventive and interceptive orthodontics in          1991;100(4):306-11.
        the mixed dentition with the myofunctional eruption gui-        9. Rollet D, Graindorge JC, Guenzennec P. A new concept: ela-




                                                                                                         i
        dance appliance: correction of overbite and overjet. Journal       stodontics. Rev Orthop Dento Faciale 1991; 25(2):149-167.




                                                                                                       al
        of Pedodontics 1988;12(2):292-324.                             10. Viazis AD: Efficient orthodontic treatment timing. Am J Or-
     7. Bergersen EO. The eruption guidance myofunctional ap-              thod Dentofacial Orthop 1995;108(5):560-1.
        pliance: case selection, timing, motivation, indications and   11. Rondeau BH. Class II malocclusion in mixed dentition. J




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        contraindications in its use. The Functional Orthodontist          Clin Pediatr Dent 1994;19(1):1-11.




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