Interdisciplinary treatment in an adult patient with skeletal class III malocclusion and retained upper canines: case report

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"autoresLista" => "Cecilia Andrea Vallejo Ordóñez, Hugo Alberto Vásquez Estrada, José Ramón Hernández Carvallo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Cecilia Andrea" "apellidos" => "Vallejo Ordóñez" ] 1 => array:2 [ "nombre" => "Hugo Alberto" "apellidos" => "Vásquez Estrada" ] 2 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Hernández Carvallo" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2395921518300084?idApp=UINPBA00004N" "url" => "/23959215/0000000500000004/v1_201802071836/S2395921518300084/v1_201802071836/es/main.assets" ] ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "CASE REPORT" "titulo" => "Interdisciplinary treatment in an adult patient with skeletal class III malocclusion and retained upper canines: case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e249" "paginaFinal" => "e254" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cecilia Andrea Vallejo Ordóñez, Hugo Alberto Vásquez Estrada, José Ramón Hernández Carvallo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Cecilia Andrea" "apellidos" => "Vallejo Ordóñez" "email" => array:1 [ 0 => "ceciliavallejo.89@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "1" "identificador" => "fn1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Hugo Alberto" "apellidos" => "Vásquez Estrada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "2" "identificador" => "fn2" ] ] ] 2 => array:3 [ "nombre" => "José Ramón" "apellidos" => "Hernández Carvallo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "3" "identificador" => "fn3" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Center of High Specialty «Dr. Rafael Lucio» (CAE)-UNAM" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento interdisciplinario en paciente adulto con maloclusión clase III esquelética con caninos superiores retenidos: presentación de un caso clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 592 "Ancho" => 1004 "Tamanyo" => 94141 ] ] "descripcion" => array:1 [ "en" => "Initial facial photographs, frontal and profile views, where a depresed middle third may be observed as well as an increased lower third, brachifacial biotype and a concave profile: all characteristic of a skeletal class III." ] ] ] "textoCompleto" => "INTRODUCTIONAdulthood is a stage of functional balance where growth has been completed and the individual reaches its greatest physical and intellectual development.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Adult patients with dento-skeletal deformities usually require treatments where most cases need interdisciplinary intervention, an example of this being the surgical-orthodontic treatment; however, these complex cases require a precise diagnosis, a careful treatment plan, and patient cooperation. A poor aesthetically pleasing facial appearance is usually the main cause of consultation but it is often accompanied with functional problems, temporomandibular joint disorders and psychosocial aspects.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Approximately 4% of the population has a dentofacial deformity that requires surgical-orthodontic treatment to correct it; the most common indications for surgical treatment are severe skeletal class II and class III patients and vertical skeletal discrepancies, in patients who have finished growth. Proffit et al, reported that from patients with surgical-orthodontic treatment, 20% suffer mandibular excess, 17% have maxillary deficiencies and 10% present both problems.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Malocclusions are usually clinically significant variations from the normal fluctuation of growth and morphology. They have two basic causes: 1) hereditary or genetic factors and environmental factors; 2) (trauma, physical agents, habits and diseases). However, it is often the result of a complex interaction between several factors that influence growth and development, and it is not always possible to describe a specific etiologic factor.Of all of these etiological factors there will be some that will influence more in a type of malocclusion than in another. Although both types of malocclusions (skeletal class II and III) may be morphogenetically determined, most of class III problems have very strong inherited components.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Due to the fact that in the adult patient growth has ceased, our therapeutic options are reduced to two treatment plans, either camouflage or orthognathic surgery. The key question that should be performed during treatment planning for an adult with a skeletal class III malocclusion is to determine the best way to go. The answer must be based on the required orthodontic movements, the stability of these changes and if the likely aesthetic result meets the expectations of the patient, considering that psychological factors are more complex in adult patients seeking orthodontic treatment, and that is why it is extremely important to have a clear idea of what are the wishes and expectations of our patients.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>,<a class="elsevierStyleCrossRef" href="#bib0030">6</a>On the other hand, when any other anomaly associated with the dentofacial deformity is present in an adult, such as retained canines, one must be careful in the treatment plan that will be carried out, specially in an interdisciplinary case, as it is necessary to properly plan the times in which to perform each procedure.The prognosis of orthodontic movement of a retained tooth depends on a variety of factors, such as the position of the impacted tooth with regard to the neighboring teeth, its angle, the distance that the tooth must travel and the possible presence of ankylosis.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> After third molars, the upper canine is the most frequently retained. The incidence of retention of the upper canine has been reported in approximately 2% of patients seeking orthodontic treatment. At the same time, upper canines are often retained 10 times more than the lower ones, appearing with increasing frequency in the palatal aspect and being unilateral retention much more common than the bilateral one.Surgical procedures included in the surgical-orthodontic treatment of retained canines in patients with skeletal class III malocclusion may be classified according to the age of the patient, the dental development and the possibilities of eruption in: (a) conservative procedure (keep in the dental arch) and (b) late or radical procedure (remove the canine from the maxilla).<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Once the type of procedure to be performed has been determined, considering the characteristics according to the abovementioned classification, the patient must be informed about the treatment plan and its risks/benefits. If a conservative treatment is chosen, it must be carried out during the surgical preparation of the patient, during the presurgical orthodontic phase; on the contrary, if a late or radical treatment is to be made, the clinician should anticipate that an intervention of a prosthetic dentist at the end of orthodontic therapy might be required.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>MATERIAL AND METHODSA female patient, 44 years of age, entered the Orthodontics Clinic of the High Specialty Center «Dr. Rafael Lucio». The reason for consultation was: «Because I have baby teeth and I want to close the spaces». According to the clinical analysis the patient was diagnosed as a brachifacial biotype, with an oval-shaped face, a concave profile, sunken middle third, medium lips and straight nose (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). The intraoral analysis showed a bilateral molar class III, a non-assessable canine class due to the presence of the primary canines, cross bite at the level of the deciduous teeth and an edge-to-edge relationship in the anterior segment, with a overjet of 0 mm, as well as the presence of upper anterior diastemas (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). Thof e cephalometric and radiographic analysis revealed a skeletal class III due to prognathism, upper incisor proclination, increased mandibular body length, absence of upper and lower third molars, except of the upper right third molar, retained upper canines and no pathologic data in hard tissues (<a class="elsevierStyleCrossRef" href="#fig0015">Figures 3</a>and<a class="elsevierStyleCrossRef" href="#fig0020">4</a>, <a class="elsevierStyleCrossRef" href="#tbl0005">Table I</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Treatment planIt was a multidisciplinary treatment plan, where the specialties of periodontics, orthodontics, and maxillofacial surgery, implantology and oral rehabilitation intervened.Orthodontic treatment consisted in placement of 0.022” x 0.028” slot MBT appliances, indicating the removal of the third molar, as well as the deciduous canines to try to traction the permanent ones. After eight months of traction of the retained canines, it was determined by radiographic analysis that the movement was very slow and that there was involvement of the adjacent organs, manifested by root resorption, so it was decided, with an informed consent, to surgically remove the retained canines and subsequently rehabilitate them by prosthesis with osseointegrated implants.Once the presurgical phase of orthodontic treatment was complete, the patient was referred to the Maxillofacial Surgery Service for surgical prediction and planning, by which it was determined to perform: a 5 mm maxillary advancement, 5 mm retroclination of the anterior segment, 9 mm mandibular setback and finally, a descent and advancement of the chin of 4 mm and 7 mm, respectively.In the postsurgical phase space closure was completed, final coordination of the dental arches took place as well as the settlement and detailing of the occlusion.Retention was achieved through circumferential retainers on both arches plus fixed retention from lateral incisor to lateral incisor in the upper arch for the subsequent rehabilitation. Total treatment time was 34 months.RESULTSThrough this treatment an improvement in the maxillo-mandibular relationship was obtained, giving proper projection of the lips and improving the profile; canine guidance was achieved by means of prosthetics. Bilateral molar class I was also obtained as well as coincident midlines, improvement of the smile, a positive overjet and overbite, periodontal health and occlusal function.Prosthetic rehabilitation was performed to replace the upper canines using implants with fixed prostheses (<a class="elsevierStyleCrossRefs" href="#fig0025">Figures 5 to 8</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia>DISCUSSIONIn adult patients who begin orthodontic treatment, special care must be taken in all the details of the malocclusion. Rehabilitation with implants in the anterior region has always been a challenge in the dental practice. The aesthetic and functional maintenance of the implants with the adjacent natural teeth can be particularly difficult. In these cases, appropriate interdisciplinary treatment planning is essential.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Bailey and Johnston mentioned that historically, skeletal class III malocclusions have been treated only by mandibular setback; however, several studies indicate that bimaxillary procedures have become more frequent in the past 20 years.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Kwon indicates that the skeletal class III malocclusion is often combined with a vertical discrepancy and it has been suggested that vertical changes may affect the amount of mandibular relapse.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> However Jākobsone, Moldez, Costa and Proffit stated that several studies established that stability was maintained after vertical changes in the position of the maxilla.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>Proffit mentioned, with respect to the time scale of postsurgical changes, that most of the changes, both skeletal and dento-alveolar, occur within the first six months after surgery, as it may be observed in the patient hereby presented. It is of vital importance that patients that have had dental decompensation, use orthodontic appliances for a few months after orthognathic surgery, to achieve stability in the dentoalveolar and skeletal structures and obtain an overall harmonic result.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>CONCLUSIONSkeletal class III malocclusions, as well as the other dentofacial deformities in adults, are cases of difficult diagnosis and, prognosis, due to the complexity of situations that are present in this group of patients. Suggesting a multidisciplinary treatment in patients with these characteristics who have, in addition, dental limitations (dental absences, periodontal disease, etc.) is of great importance for achieving the objectives set out in a well designed therapeutic plan, as the orthodontics alone would not be capable of restoring dentofacial harmony and thus avoiding success and stability in the treatments. The case of the patient that is reported in the present article complies with this interdisciplinary approach, obtaining results that solve the initial problem and, in this way achieving improvement in dentofacial aesthetics and in function." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres976431" "titulo" => "ABSTRACT" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Objective" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec946105" "titulo" => "Key words" ] 2 => array:3 [ "identificador" => "xres976432" "titulo" => "RESUMEN" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec946104" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "INTRODUCTION" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "MATERIAL AND METHODS" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Treatment plan" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "RESULTS" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "DISCUSSION" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "CONCLUSION" ] 9 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec946105" "palabras" => array:4 [ 0 => "Orthodontic-surgical treatment" 1 => "skeletal class III" 2 => "malocclusion" 3 => "retained canines" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec946104" "palabras" => array:4 [ 0 => "Tratamiento ortoquirúrgico" 1 => "clase III esquelética" 2 => "maloclusión" 3 => "caninos retenidos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "ABSTRACT" "resumen" => "IntroductionClass III malocclusion is considered the most severe within the classification of malocclusions. In most patients, the etiology may be divided in skeletal and dentoalveolar components. In the adult patient, because skeletal growth has ceased, treatment options are reduced to two possibilities: camouflage or orthognathic surgery. These complex cases require careful planning, a multidisciplinary approach and patient cooperation. Material and methodsA 44-year-old female with skeletal class III malocclusion, brachyfacial biotype, concave profile, bilateral molar class III, non-assessable canine class due to the presence of temporary canines; an edge-to-edge incisor relationship and anterior crossbite of the temporary canines. ObjectiveTo improve the maxillo-mandibular relationship obtaining good occlusal function as well as to improve the aesthetics of the patient through a multidisciplinary treatment. ResultsMaxillo-mandibular relationship was improved, canine guidance was achieved with implants and prosthesis, a bilateral class I molar relationship was obtained as well as good occlusal function. Periodontal health was maintained. ConclusionThe multidisciplinary approach was successful in achieving the desired therapeutic results of improved function, improved aesthetics and improved self-esteem in this patient." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Objective" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "RESUMEN" "resumen" => "IntroducciónLa maloclusión clase III es considerada como la más severa dentro de su clasificación. En la mayoría de los pacientes, la etiología de la misma puede estar combinada entre componentes esqueléticos y dentoalveolares. En el paciente adulto, debido a que el crecimiento esquelético ha cesado, las opciones de tratamiento se reducen a dos posibilidades: camuflaje o cirugía ortognática. Estos casos complejos requieren un planeamiento cuidadoso, una actuación multidisciplinaria y cooperación por parte del paciente. Material y métodosSe reporta caso de una paciente de género femenino de 44 años de edad con maloclusión clase III esquelética, biotipo braquifacial, perfil cóncavo, clase III molar bilateral, clase canina no valorable por presencia de caninos temporales, mordida borde a borde anterior y cruzada a nivel de caninos temporales. ObjetivoMejorar la relación maxilomandibular, obteniendo adecuada función oclusal; así como mejorar la estética de la paciente mediante el tratamiento multidisciplinario. ResultadosSe mejoró la relación maxilomandibular, se consiguió dar guía canina, mediante las prótesis con implantes, clase I molar bilateral, salud periodontal y función oclusal adecuada. ConclusiónEl caso de la paciente que se reporta en el presente artículo cumple con este enfoque interdisciplinario, obteniendo resultados que resuelven la problemática inicial y, de esta manera, logrando mejoría en la estética y función dentofaciales." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:4 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "Third-year resident of the Orthodontics Specialty." "identificador" => "fn1" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "This article can be read in its full version in the following page: http://www.medigraphic.com/ortodoncia" ] 2 => array:3 [ "etiqueta" => "2" "nota" => "Professor od the Orthodontics Department." "identificador" => "fn2" ] 3 => array:3 [ "etiqueta" => "3" "nota" => "Head of the Orthodontics Department." "identificador" => "fn3" ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 592 "Ancho" => 1004 "Tamanyo" => 94141 ] ] "descripcion" => array:1 [ "en" => "Initial facial photographs, frontal and profile views, where a depresed middle third may be observed as well as an increased lower third, brachifacial biotype and a concave profile: all characteristic of a skeletal class III." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1011 "Ancho" => 2104 "Tamanyo" => 253992 ] ] "descripcion" => array:1 [ "en" => "Initial intraoral photographs. Note the bilateral molar class III, the non-assessable canine class due to the presence of deciduous canines, anterior edge-to-edge bite and crossbite at the level of the primary teeth, 0 mm overjet and the presence of upper anterior diastemas. Patient with mixed dentition." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 476 "Ancho" => 1001 "Tamanyo" => 54644 ] ] "descripcion" => array:1 [ "en" => "Initial panoramic radiograph, where the presence of 31 teeth may be observed as well as symmetrical condyles, asymmetric height of the mandibular ramus, 2:1 crown-root ratio, retained upper canines, presence of right upper and lower third molars and absence of left upper and lower third molars." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 755 "Ancho" => 876 "Tamanyo" => 65940 ] ] "descripcion" => array:1 [ "en" => "Initial lateral headfilm." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 677 "Ancho" => 1005 "Tamanyo" => 88687 ] ] "descripcion" => array:1 [ "en" => "Pre-surgical (left) and post-surgical (right) profile photographs." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 869 "Ancho" => 2105 "Tamanyo" => 215644 ] ] "descripcion" => array:1 [ "en" => "Final intraoral photographs after implant placement with their respective prosthetic rehabilitation replacing upper canines." ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 713 "Ancho" => 1003 "Tamanyo" => 90519 ] ] "descripcion" => array:1 [ "en" => "Frontal and profile final photographs." ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 661 "Ancho" => 1524 "Tamanyo" => 127524 ] ] "descripcion" => array:1 [ "en" => "Final panoramic radiograph and lateral headfilm." ] ] 8 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table I" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ricketts \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normal value \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Initial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Final \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Overjet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5 ± 2.5 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Interincisal angle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">130o ± 6o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">124 o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">132 o \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Lower incisor protrusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 ± 2.3 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Upper incisor protrusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.5 ± 2.3 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Lower incisor inclination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22o ± 4o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29o \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Upper incisor inclination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28o ± 4o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 o \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Labial protrusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">-2 ± 2 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">-4 mm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Facial taper \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68o ± 3.5o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71 o \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Mandibular plane \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26o ± 4o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 o \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Steiner \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Initial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Final \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• SNA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82o ± 2o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91 o \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• SNB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80o ± 2o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92 o \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• ANB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3o ± 2o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">-6 o \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">-1 o \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1653619.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Cephalometric analysis, Ricketts and Jarabak." ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores de riesgo de maloclusiones en adultos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. 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CASE REPORT

Tratamiento interdisciplinario en paciente adulto con maloclusión clase III esquelética con caninos superiores retenidos: presentación de un caso clínico

Cecilia Andrea Vallejo Ordóñez1,

Corresponding author

ceciliavallejo.89@gmail.com

Autor para correspondencia.

, Hugo Alberto Vásquez Estrada2, José Ramón Hernández Carvallo3

Center of High Specialty «Dr. Rafael Lucio» (CAE)-UNAM

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of the population has a dentofacial deformity that requires surgical-orthodontic treatment to correct it&#59; the most common indications for surgical treatment are severe skeletal class II and class III patients and vertical skeletal discrepancies&#44; in patients who have finished growth&#46; Proffit et al&#44; reported that from patients with surgical-orthodontic treatment&#44; 20&#37; suffer mandibular excess&#44; 17&#37; have maxillary deficiencies and 10&#37; present both problems&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Malocclusions are usually clinically significant variations from the normal fluctuation of growth and morphology&#46; They have two basic causes&#58; 1&#41; hereditary or genetic factors and environmental factors&#59; 2&#41; &#40;trauma&#44; physical agents&#44; habits and diseases&#41;&#46; However&#44; it is often the result of a complex interaction between several factors that influence growth and development&#44; and it is not always possible to describe a specific etiologic factor&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Of all of these etiological factors there will be some that will influence more in a type of malocclusion than in another&#46; Although both types of malocclusions &#40;skeletal class II and III&#41; may be morphogenetically determined&#44; most of class III problems have very strong inherited components&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Due to the fact that in the adult patient growth has ceased&#44; our therapeutic options are reduced to two treatment plans&#44; either camouflage or orthognathic surgery&#46; The key question that should be performed during treatment planning for an adult with a skeletal class III malocclusion is to determine the best way to go&#46; The answer must be based on the required orthodontic movements&#44; the stability of these changes and if the likely aesthetic result meets the expectations of the patient&#44; considering that psychological factors are more complex in adult patients seeking orthodontic treatment&#44; and that is why it is extremely important to have a clear idea of what are the wishes and expectations of our patients&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand&#44; when any other anomaly associated with the dentofacial deformity is present in an adult&#44; such as retained canines&#44; one must be careful in the treatment plan that will be carried out&#44; specially in an interdisciplinary case&#44; as it is necessary to properly plan the times in which to perform each procedure&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The prognosis of orthodontic movement of a retained tooth depends on a variety of factors&#44; such as the position of the impacted tooth with regard to the neighboring teeth&#44; its angle&#44; the distance that the tooth must travel and the possible presence of ankylosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> After third molars&#44; the upper canine is the most frequently retained&#46; The incidence of retention of the upper canine has been reported in approximately 2&#37; of patients seeking orthodontic treatment&#46; At the same time&#44; upper canines are often retained 10 times more than the lower ones&#44; appearing with increasing frequency in the palatal aspect and being unilateral retention much more common than the bilateral one&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgical procedures included in the surgical-orthodontic treatment of retained canines in patients with skeletal class III malocclusion may be classified according to the age of the patient&#44; the dental development and the possibilities of eruption in&#58; &#40;a&#41; conservative procedure &#40;keep in the dental arch&#41; and &#40;b&#41; late or radical procedure &#40;remove the canine from the maxilla&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Once the type of procedure to be performed has been determined&#44; considering the characteristics according to the abovementioned classification&#44; the patient must be informed about the treatment plan and its risks&#47;benefits&#46; If a conservative treatment is chosen&#44; it must be carried out during the surgical preparation of the patient&#44; during the presurgical orthodontic phase&#59; on the contrary&#44; if a late or radical treatment is to be made&#44; the clinician should anticipate that an intervention of a prosthetic dentist at the end of orthodontic therapy might be required&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">MATERIAL AND METHODS</span><p id="par0045" class="elsevierStylePara elsevierViewall">A female patient&#44; 44 years of age&#44; entered the Orthodontics Clinic of the High Specialty Center &#171;Dr&#46; Rafael Lucio&#187;&#46; The reason for consultation was&#58; &#171;Because I have baby teeth and I want to close the spaces&#187;&#46; According to the clinical analysis the patient was diagnosed as a brachifacial biotype&#44; with an oval-shaped face&#44; a concave profile&#44; sunken middle third&#44; medium lips and straight nose <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0005"><span class="elsevierStyleItalic">Figure 1</span></a><span class="elsevierStyleItalic">&#41;</span>&#46; The intraoral analysis showed a bilateral molar class III&#44; a non-assessable canine class due to the presence of the primary canines&#44; cross bite at the level of the deciduous teeth and an edge-to-edge relationship in the anterior segment&#44; with a overjet of 0 mm&#44; as well as the presence of upper anterior diastemas <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0010"><span class="elsevierStyleItalic">Figure 2</span></a><span class="elsevierStyleItalic">&#41;</span>&#46; Thof e cephalometric and radiographic analysis revealed a skeletal class III due to prognathism&#44; upper incisor proclination&#44; increased mandibular body length&#44; absence of upper and lower third molars&#44; except of the upper right third molar&#44; retained upper canines and no pathologic data in hard tissues <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRef" href="#fig0015"><span class="elsevierStyleItalic">Figures 3</span></a><span class="elsevierStyleItalic">and</span><a class="elsevierStyleCrossRef" href="#fig0020"><span class="elsevierStyleItalic">4</span></a>&#44; <a class="elsevierStyleCrossRef" href="#tbl0005"><span class="elsevierStyleItalic">Table I</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Treatment plan</span><p id="par0050" class="elsevierStylePara elsevierViewall">It was a multidisciplinary treatment plan&#44; where the specialties of periodontics&#44; orthodontics&#44; and maxillofacial surgery&#44; implantology and oral rehabilitation intervened&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Orthodontic treatment consisted in placement of 0&#46;022&#8221; x 0&#46;028&#8221; slot MBT appliances&#44; indicating the removal of the third molar&#44; as well as the deciduous canines to try to traction the permanent ones&#46; After eight months of traction of the retained canines&#44; it was determined by radiographic analysis that the movement was very slow and that there was involvement of the adjacent organs&#44; manifested by root resorption&#44; so it was decided&#44; with an informed consent&#44; to surgically remove the retained canines and subsequently rehabilitate them by prosthesis with osseointegrated implants&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Once the presurgical phase of orthodontic treatment was complete&#44; the patient was referred to the Maxillofacial Surgery Service for surgical prediction and planning&#44; by which it was determined to perform&#58; a 5 mm maxillary advancement&#44; 5 mm retroclination of the anterior segment&#44; 9 mm mandibular setback and finally&#44; a descent and advancement of the chin of 4 mm and 7 mm&#44; respectively&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the postsurgical phase space closure was completed&#44; final coordination of the dental arches took place as well as the settlement and detailing of the occlusion&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Retention was achieved through circumferential retainers on both arches plus fixed retention from lateral incisor to lateral incisor in the upper arch for the subsequent rehabilitation&#46; Total treatment time was 34 months&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">RESULTS</span><p id="par0075" class="elsevierStylePara elsevierViewall">Through this treatment an improvement in the maxillo-mandibular relationship was obtained&#44; giving proper projection of the lips and improving the profile&#59; canine guidance was achieved by means of prosthetics&#46; Bilateral molar class I was also obtained as well as coincident midlines&#44; improvement of the smile&#44; a positive overjet and overbite&#44; periodontal health and occlusal function&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Prosthetic rehabilitation was performed to replace the upper canines using implants with fixed prostheses <span class="elsevierStyleItalic">&#40;</span><a class="elsevierStyleCrossRefs" href="#fig0025"><span class="elsevierStyleItalic">Figures 5 to 8</span></a><span class="elsevierStyleItalic">&#41;</span>&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">DISCUSSION</span><p id="par0085" class="elsevierStylePara elsevierViewall">In adult patients who begin orthodontic treatment&#44; special care must be taken in all the details of the malocclusion&#46; Rehabilitation with implants in the anterior region has always been a challenge in the dental practice&#46; The aesthetic and functional maintenance of the implants with the adjacent natural teeth can be particularly difficult&#46; In these cases&#44; appropriate interdisciplinary treatment planning is essential&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Bailey and Johnston mentioned that historically&#44; skeletal class III malocclusions have been treated only by mandibular setback&#59; however&#44; several studies indicate that bimaxillary procedures have become more frequent in the past 20 years&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Kwon indicates that the skeletal class III malocclusion is often combined with a vertical discrepancy and it has been suggested that vertical changes may affect the amount of mandibular relapse&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However J&#257;kobsone&#44; Moldez&#44; Costa and Proffit stated that several studies established that stability was maintained after vertical changes in the position of the maxilla&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Proffit mentioned&#44; with respect to the time scale of postsurgical changes&#44; that most of the changes&#44; both skeletal and dento-alveolar&#44; occur within the first six months after surgery&#44; as it may be observed in the patient hereby presented&#46; It is of vital importance that patients that have had dental decompensation&#44; use orthodontic appliances for a few months after orthognathic surgery&#44; to achieve stability in the dentoalveolar and skeletal structures and obtain an overall harmonic result&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">CONCLUSION</span><p id="par0100" class="elsevierStylePara elsevierViewall">Skeletal class III malocclusions&#44; as well as the other dentofacial deformities in adults&#44; are cases of difficult diagnosis and&#44; prognosis&#44; due to the complexity of situations that are present in this group of patients&#46; Suggesting a multidisciplinary treatment in patients with these characteristics who have&#44; in addition&#44; dental limitations &#40;dental absences&#44; periodontal disease&#44; etc&#46;&#41; is of great importance for achieving the objectives set out in a well designed therapeutic plan&#44; as the orthodontics alone would not be capable of restoring dentofacial harmony and thus avoiding success and stability in the treatments&#46; The case of the patient that is reported in the present article complies with this interdisciplinary approach&#44; obtaining results that solve the initial problem and&#44; in this way achieving improvement in dentofacial aesthetics and in function&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Class III malocclusion is considered the most severe within the classification of malocclusions&#46; In most patients&#44; the etiology may be divided in skeletal and dentoalveolar components&#46; In the adult patient&#44; because skeletal growth has ceased&#44; treatment options are reduced to two possibilities&#58; camouflage or orthognathic surgery&#46; These complex cases require careful planning&#44; a multidisciplinary approach and patient cooperation&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 44-year-old female with skeletal class III malocclusion&#44; brachyfacial biotype&#44; concave profile&#44; bilateral molar class III&#44; non-assessable canine class due to the presence of temporary canines&#59; an edge-to-edge incisor relationship and anterior crossbite of the temporary canines&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objective</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To improve the maxillo-mandibular relationship obtaining good occlusal function as well as to improve the aesthetics of the patient through a multidisciplinary treatment&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Maxillo-mandibular relationship was improved&#44; canine guidance was achieved with implants and prosthesis&#44; a bilateral class I molar relationship was obtained as well as good occlusal function&#46; Periodontal health was maintained&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The multidisciplinary approach was successful in achieving the desired therapeutic results of improved function&#44; improved aesthetics and improved self-esteem in this patient&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La maloclusi&#243;n clase III es considerada como la m&#225;s severa dentro de su clasificaci&#243;n&#46; En la mayor&#237;a de los pacientes&#44; la etiolog&#237;a de la misma puede estar combinada entre componentes esquel&#233;ticos y dentoalveolares&#46; En el paciente adulto&#44; debido a que el crecimiento esquel&#233;tico ha cesado&#44; las opciones de tratamiento se reducen a dos posibilidades&#58; camuflaje o cirug&#237;a ortogn&#225;tica&#46; Estos casos complejos requieren un planeamiento cuidadoso&#44; una actuaci&#243;n multidisciplinaria y cooperaci&#243;n por parte del paciente&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se reporta caso de una paciente de g&#233;nero femenino de 44 a&#241;os de edad con maloclusi&#243;n clase III esquel&#233;tica&#44; biotipo braquifacial&#44; perfil c&#243;ncavo&#44; clase III molar bilateral&#44; clase canina no valorable por presencia de caninos temporales&#44; mordida borde a borde anterior y cruzada a nivel de caninos temporales&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Mejorar la relaci&#243;n maxilomandibular&#44; obteniendo adecuada funci&#243;n oclusal&#59; as&#237; como mejorar la est&#233;tica de la paciente mediante el tratamiento multidisciplinario&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se mejor&#243; la relaci&#243;n maxilomandibular&#44; se consigui&#243; dar gu&#237;a canina&#44; mediante las pr&#243;tesis con implantes&#44; clase I molar bilateral&#44; salud periodontal y funci&#243;n oclusal adecuada&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El caso de la paciente que se reporta en el presente art&#237;culo cumple con este enfoque interdisciplinario&#44; obteniendo resultados que resuelven la problem&#225;tica inicial y&#44; de esta manera&#44; logrando mejor&#237;a en la est&#233;tica y funci&#243;n dentofaciales&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ricketts&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130<span class="elsevierStyleSup">o</span> &#177; 6<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">124 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">132 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; Lower incisor protrusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#177; 2&#46;3 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 mm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5 &#177; 2&#46;3 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 mm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22<span class="elsevierStyleSup">o</span> &#177; 4<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-4 mm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Steiner&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8226; SNB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80<span class="elsevierStyleSup">o</span> &#177; 2<span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">-6 <span class="elsevierStyleSup">o</span>&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 23959215
Original language: English

DOI:10.1016/j.rmo.2018.01.017

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	0	2
2024 October	71	18	89
2024 September	126	16	142
2024 August	89	31	120
2024 July	81	14	95
2024 June	64	7	71
2024 May	76	8	84
2024 April	106	19	125
2024 March	122	12	134
2024 February	119	18	137
2024 January	177	17	194
2023 December	129	15	144
2023 November	237	22	259
2023 October	176	19	195
2023 September	113	20	133
2023 August	63	19	82
2023 July	68	8	76
2023 June	58	20	78
2023 May	108	27	135
2023 April	75	15	90
2023 March	81	27	108
2023 February	44	22	66
2023 January	39	11	50
2022 December	48	27	75
2022 November	56	35	91
2022 October	46	12	58
2022 September	59	29	88
2022 August	59	17	76
2022 July	36	16	52
2022 June	58	23	81
2022 May	61	25	86
2022 April	78	16	94
2022 March	147	21	168
2022 February	135	12	147
2022 January	105	11	116
2021 December	65	19	84
2021 November	88	36	124
2021 October	61	15	76
2021 September	51	19	70
2021 August	50	7	57
2021 July	18	14	32
2021 June	45	8	53
2021 May	53	13	66
2021 April	112	11	123
2021 March	25	15	40
2021 February	23	11	34
2021 January	30	16	46
2020 December	18	16	34
2020 November	34	9	43
2020 October	36	13	49
2020 September	29	12	41
2020 August	44	24	68
2020 July	29	12	41
2020 June	31	9	40
2020 May	40	11	51
2020 April	40	14	54
2020 March	31	12	43
2020 February	48	5	53
2020 January	36	18	54
2019 December	34	11	45
2019 November	16	3	19
2019 October	40	11	51
2019 September	37	10	47
2019 August	27	6	33
2019 July	28	5	33
2019 June	57	8	65
2019 May	92	5	97
2019 April	87	7	94
2019 March	21	9	30
2019 February	33	8	41
2019 January	27	9	36
2018 December	13	7	20
2018 November	26	16	42
2018 October	36	23	59
2018 September	70	5	75
2018 August	12	0	12
2018 July	13	1	14
2018 June	12	2	14
2018 May	16	0	16
2018 April	23	1	24
2018 March	33	0	33
2018 February	10	2	12

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