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43 古芸家 / Yun-Chia Ku
43 古芸家 / Yun-Chia Ku
Main Instructor
Department / Institution Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Linkou branch, Taiwan
Classification case report

A skeletal Class II malocclusion with lower anterior spacing combined bilateral mandibular first molar missing is considered very difficult to treat orthodontically without surgery and implant. This case report describes the mechanism of closing lower molar space.

Skeletal Class II patient with facial asymmetry with lower spacing, lower first molar missing with narrow alveolar bone width.

Treatment Overview:
A 35-year-old female presented with a facial asymmetry Class II malocclusion complicated with bilateral missing of mandibular first molars and lower anterior spacing. Patient rejected to receive orthognathic surgery. Extrusion of maxillary first molars was noted. The mandibular adjacent second molars were tipped mesially. Third molar were present on lower both side. After initial aligning the dentition, bilateral maxillary miniscrews were placed for canting correction and maxillary anterior teeth retraction. Mandibular second molars were uprighted and protracted with Class II elastic. Orthodontics treatment combine miniscrews in maxilla resulted in closing all mandibular space without implant and orthognathic surgery. The overall duration for the entire treatment was 29 months.

Consider the age of patient and resorption of mandibular alveolar crest, a close observation of gingiva recession in mandibular second molars was needed. The possibility of opening space for implantation of mandibular first molars was informed in the beginning of treatment.
Nonsurgical Treatment for Closing Mandibular First Molar and Lower Anterior Space in Adult with Skeletal Class II Combined Facial Asymmetry