CASE REPORTS

YUNITA PRANSISCA
21/475873/PKG/1476
Case report 1:
A complicated adult protrusion case treated
withTADs and interdiciplinary approach

24 years old female patient came to clinic with chief complaint severe protrusion and want to solve the problem with a
large decay at her upper right 1st molar.

Extraoral photo: she has a convex profile, perioral protrusion and mandibular retrognatism, facial asymmetry, the chin
point slighty deviated to the left.
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Diagnosis

Skeletal:
1. Skeletal class II
(SNA 83.1o, SNB 75.2o, ANB 7.9o)
2. High mandibular plane angle
(SN-MP 47.6o, FMA 36.7o)
3. Facial asymmtery

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Diagnosis
Dental:
1. Bilateral class II molar relationship
2. Bilateral class II canine relationship
3. Upper right 1st molar badly decayed
4. Upper left lateral incisor was
cantilever crown
5. Upper right lateral was in crossbite
6. OJ = 1.5mm at central incisor
7. OB= 0.5mm
8. Space deficiency upper arch=1mm
9. Extra space lower arch=3mm
10. Arch form: symmterical ovoid in
maxilla, asymmterical tapering
ovoid in mandible
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16x22 LH NiTi was used as initial archwire to align the upper arch and
reinforced the anterior torque control. Two miniscrews were installed at the
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infra-zygomatic. A resin tooth bonded with bracket and hung on the
archwire to maintaining the space.
Initial leveling and aligning stage completed and the canine relationship were
aproaching class I at both sides 6
Two miniscrews were added at the anterior subapical areas for overbite control
and anterior torque control
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After 20 moths of treatment, the profile didn’t improve much

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Overjet was not enough and the profile was still protruded. Added two buccal shelf
miniscrews for further retraction of the lower arch. Upper and lower anterior TAD
were also installed. 9
All spaces were closed. Molar and canine relationship achieved class I bilaterally.

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All the appliances were removed after 49 months active treatment.
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Serial profile changes during and after treatment. At the time of debonding, although the
profile improved a lot, the lower lip was still thick. At the time of 9 months follow up, the
lower lip became thinner and the perioral muscles became more relaxed.
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The crown length of upper anteriors became very short because of great
amount of retraction and intrusion. Periodontal surgery was performed at
the finishing stage.
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Case report 2:
Non-extraction
treatment of clas II
deepbite case

▪ Female, 15 years old

▪ Chief concern : anterior deepbite and missing 15
▪ Symmetrical face and concex profile
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molar and canine in class II relationship,
scissor bite on 14,24,25, and severe deepbite, missing 15

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1.5 month : Damon Q with standart torque, U/L 0.014 CuNiTi with
posterior bite turbo.

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2nd month 4th month 13th month

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2nd month 4th month 13th month

U 0.016 SS U 0.018 SS U 0.014x0.025 CuNiTi

L 0.016 SS L 0.018 SS L 0.014x0.025 CuNiTi
Cross elastic Clas II elastic
Class II C&M relationship 19
14th month 14th month 21th month

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 14th month 14th month 21th month

Failed to correct class Activated Advasync to

U 0.014x0.025 CuNiTi
II relationship with move mandible more
L 0.018x0.25 CuNiTi
elastic, change with forward to get canine and
Open position
Advasync molar class I relationship 21
25th month 39th month Final

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25th month 39th month Final

Close the space to get

canine and molar class
I relationship
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Final : Staight profile, good smile arch
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Compare before and after treatment : profile and occlusion

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What we can learn from this case:

1. In Damon system combined with advansync case, it can resolve clas II

maloclusion in non compliance patient
2. In this case she refused to extract 25 and 55, and use advasync
instead of using miniscrew.
3. Since mandibular growth does not occur in adult patient to assist
overjet and overbite corection, protraction of lower incisors accounted
for overjet and overbite correction in this patient.

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Case report 3:
Case report 4 :
Terimakasih