Two-stage orthodontic treatment outcomes of children with dentoalveolar class II malocclusion

Abstract

Background. During the rehabilitation of children with distal occlusion, it is not always possible to achieve the desired outcomes. In this context, the factors influencing the outcomes of treatment for class II malocclusions in children at different stages of occlusion development. Aim. To study two-stage orthodontic treatment outcomes in children with dentoalveolar class II malocclusion by the clinical case. Material and methods. We analyzed the physical examination results of the patient within the treatment from 6 to 17 years. Facial proportion symmetry, aesthetic, type of face, plaster dental models were determined by using the photographs. Orthopantomography was used to analyze the condition of temporary and permanent teeth, jaw bone tissue and to assess functional disorders. Orthodontic treatment in a mixed dentition period was carried out using removable devices, including those improved by the authors. In the permanent dentition, orthodontic brackets with power elements were used. Results. Untimely contacting the doctor, an insufficient level of motivation to implement recommendations for improving posture and dental care contributed to an increase in treatment duration. Keeping excessive cervical spine flexion and head tilted back, the bad habit of placing (pressure) the hand on the chin, and the rejection of a myo-gymnastic exercise (physical therapy) interfered with the synchronous (normal) development of the jaws. Premature loss of a temporary molar on one side led to dentoalveolar asymmetry and disruption of occlusal contacts. Additional orthodontic appliances were used to correct these deformities. Over-retained deciduous teeth led to the delayed eruption of permanent teeth and, presumably, to the curvature of their roots. Violation of the tooths root shape and asymmetry in permanent teeth crown size prevented the full correction of their position using highly effective modern non-removable orthodontic equipment. The anomalous position of the rudiment of the third molar, the refusal for timely tooth extraction further led to the increasing complexity of the surgical technique. Conclusion. The timing and effectiveness of orthodontic treatment of a patient with dentoalveolar class II malocclusion were influenced by a poor body posture, extraction of a primary molar, the delayed eruption and crown size asymmetry of permanent teeth, the presence of bad habits and minimal cooperation of the patient with the orthodontist.