Case of Severe Maxillary Protrusion Accompanied by Crowding and Scissor Bite.

Abstract

This case involved a 30-year-old woman who visited our hospital with the main complaint of protrusion of the maxillary incisors and upper and lower lips. She had difficulty closing her lips, and a chin button was observed when the lips were closed. The skeletal pattern showed maxillary protrusion and mandibular retrusion, and the mandible showed severe high angle. Labial inclination of both the maxillary and mandibular incisors was found, as well as crowding. In addition, the maxillary left second molar showed buccal displacement, and scissor bite was evident in the left second molar region. The bilateral molar relationship was cusp-to-cusp class II malocclusion. Angle class II maxillary protrusion accompanied by crowding and left second molar scissor bite was diagnosed. Surgical orthodontic treatment was judged as the best approach to treat the jaw deformities. However, in line with the wishes of the patient, treatment was undertaken using implant anchors instead. Straight-wire brackets with a 0.022-inch slot were fitted. A lingual arch was placed in the mandible and plate-type implant anchors in the first molar region of the maxilla. Almost no change was observed in skeletal pattern as no surgery was performed. The maxillary incisors moved back 10 mm, however, and the mandibular incisors showed an improvement of 4 mm from L1 to APo. The upper and lower lips consequently moved back 7 mm with respect to the E-line. Active treatment required 3 years and 6 months. Esthetic and functional improvements were achieved.