Romanian Journal of Medical and Dental Education

Vol. 8, No. 1, January 2019

EARLY ORTHODONTIC TREATMENT- CASE REPORT

Loredana Golovcencu1, Daniela Anistoroaei2*, Georgeta Zegan3* , Iulia Catalina Saveanu4
1
“Gr. T. Popa" U.M.Ph. - Iași, Romania, Faculty of Dentistry, Department of Orthodontics
2*
“Gr. T. Popa" U.M.Ph. - Iași, Romania, Faculty of Dentistry, Department of Orthodontics
3*
“Gr. T. Popa" U.M.Ph. - Iași, Romania, Faculty of Dentistry, Department of Orthodontics
4
“Gr. T. Popa" U.M.Ph. - Iași, Romania, Faculty of Dentistry, Department of Preventive Dentistry

Corresponding authors: Email: daniela.anistoroaei@umfiasi.ro; georgeta.zegan@umfiasi.ro

ABSTRACT

The early orthodontic treatment is one of the most frequent debates in orthodontics. The clues for early orthodontic
treatment are the early recognition of malocclusion, the proper timing for orthodontics and the initial therapies. In
this early phase the clinician can begin preventive therapy, functional therapy and interception in the first stage of
malocclusion in order to diminish or to stop the abnormal growth and development of jaws and dental arches. In this
paper we present a patient during mixed dentition period with class II skeletal malocclusion, vertical growth pattern,
treated by simple orthopedic and orthodontic procedures. The patient showed important correction of skeletal
imbalance, good dental alignment and class I occlusion at the end of the early phase of the orthodontic treatment.

Key words: early orthodontic treatment; interception;

INTRODUCTION correcting the etiologic factors ( dental

The early orthodontic treatment is
well known from old times, mentioned in
the writings of Hippocrates, Celsus and
Galen1. At the end of the IXI th century and
beginning of the XXth century orthodontists
like Pierre Robin, Andresen, Haupl, Balters
developed the activators in order to correct
as early as possible jaw discrepancies and
occlusion by dento facial orthopedics. Later,
McNamara2,3 emphasized the importance
and the benefits of two phase treatment, in
which the first phase was accomplished by
early correction of malocclusion and after
that the fixed therapy was applied.
According to Graber4 early orthodontic
treatment refers to prophylactic treatment by
caries, oral habits, premature loss of
temporary teeth), interceptive orthodontics
when the problem already occurred and
growth modification that acts like a
guideline in order to improve/change the
skeletal growth.
CASE PRESENTATION
A boy, 9 years old came to us with
the parent’s chief complaint “ abnormal
anterior appearance of the upper incisors,
like a rabbit”. The patient’s case history
showed the presence of thumb sucking
habit, especially during night. At the
extraoral exam we found a long face growth

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Vol. 8, No. 1, January 2019

pattern, with convex profile, unsealed lips
during rest and protrusion of upper incisors.
The intraoral exam revealed a long and
narrow upper dental arch, mixed dentition,
retrognathic mandible,class II division 1
malocclusion with 10 mm over jet and
“edge to edge” lateral occlusion(Fig.1).
The initial lateral cephalometric exam
showed class II skeletal malocclusion, with
hyperdivergent growth pattern and labially
tipped upper incisors (Fig.2). Dental status
in orthopantomography (Fig.3).

Figure 1. Intraoral initial exam

Figure 2. Cephalometric findings at the beginning of the treatment

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Vol. 8, No. 1, January 2019

Figure 3. Initial orthopantomography

TREATMENT OBJECTIVES Phase II – fixed appliance

Phase I – early treatment in the mixed In order to achieve these objectives ,

dentition
1. Stop the thumb sucking habit
2. Maxillary expansion with removable
appliance
3. Correction of class II skeletal
malocclusion
4. Correction of the upper incisors’
proclination and over jet
5. Reducing of the deep bite
6. Myofunctional therapy
we began the treatment with a removable
appliance with bite plane, labial bow and
expansion screw . The removable appliance
was worn 6 months, 20 hours per day and
the expansion screw was turned every 7
days (Fig.4). After the removable
appliance, the upper incisors proclination
was partially corrected, the over jet reduced,
and also the deep bite. The lateral occlusion
became normal by maxillary expansion.

Figure 4. Removable appliance and intraoral exam at the end of stage 1

We continued the treatment with mandibular advancement. We used in this

activator with upper and lower labial bows case the activator, despite it’s posterior
and midline screw in order to reduce rotation mandibular effect, because we
maxillary prognathism and to stimulate considered to be the best choice for

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Vol. 8, No. 1, January 2019

correction of the oral habits and skeletal
class II malocclusion(Fig.5). The activator
was worn 14 hours/day, 9 months. The
screw was turned every 2-3 weeks in order
to continue maxillary expansion. Figure 6
presents the cephalometric findings after
activator. The skeletal class II was not fully
corrected ( ANB = 6°) because the values
were extremely high at the beginning of the
treatment. ( ANB = 11°), close to surgical
approach. After 9 months the activator was
changed with a myofunctional appliance
(Multi-T® RMO) during night until
complete permanent dentition eruption in
order to stabilize the sagittal relation of the
dental arches by training the oral muscles
and the TMJ (Fig.6)

Figure 5. The activator in place Figure 6. The multi-T appliance in place

TREATMENT RESULTS

At the age of 11,5 years all permanent teeth occlusion and well aligned dental arches and
except the permanent second molar had improved skeletal sagittal and transverse
erupted and the patient exhibit class I relations (Fig. 7)

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Figure 7. Patient at the end of functional treatment

The lateral cephalometric exam treatment , but still in a vertical growth

shows improvement in sagittal jaw relations, pattern (Fig.8).
compared with the beginning of the

Figure 8. Cephalometric exam before (left) and after (right) early orthodontic treatment

CONCLUSIONS treatment brings the benefit of

functional treatment. By using
1. Early orthodontic treatment is an simple orthodontic and
excellent chance for the patients orthopedic appliances we can
with skeletal imbalances to create the proper environment for
improve the harmony within the gaining a predictable tissue
developing functional matrix of response for muscles, growing
both the growing jaws and bones and sutures in young
dentoalveolar structures5,6,7. patients.
2. Despite a longer treatment time,
the two stage orthodontic

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567-70
4. Graber L, Vanarsdall R, Vig K. Orthodontics. 5th Edition. Current principles and techniques.
Mosby, 2011

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