Korean J Orthod.  2020 Jul;50(4):278-289. 10.4041/kjod.2020.50.4.278.

Camouflage treatment of posterior bite collapse in a patient with skeletal asymmetry by using posterior maxillary segmental osteotomy

• Badr H
• Lee SY
• Park HS
• Ohe JY
• Kang YG
• Ahn HW

• KMID: 2504145
• DOI: http://doi.org/10.4041/kjod.2020.50.4.278

Abstract

Orthodontic treatment of posterior bite collapse due to early loss of molars and the consequent drift of adjacent teeth is complicated. When the posterior bite collapse occurs in patients with facial asymmetry, both transverse and vertical compensation are necessary for camouflage orthodontic treatment. In such cases, posterior maxillary segmental osteotomy (PMSO) can be an effective alternative procedure that simplifies the orthodontic treatment and shows long-term stability through dental compensation within the alveolar bone housing. This case report aimed to describe the orthodontic treatment of maxillary occlusal plane canting caused by severely extruded maxillary teeth in a patient with skeletal facial asymmetry that was corrected with PMSO along with protraction of the lower second molar to replace the space of the extracted first molar. The treatment duration was 18 months, and stable results were obtained after 2 years of retention.

Keyword

Posterior segmental osteotomy; Bite collapse; Facial asymmetry

Figure

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  Figure 1 Pretreatment facial and intraoral photographs.

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  Figure 2 Pretreatment cast models.

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  Figure 3 Pretreatment radiographs. A, Lateral cephalogram; B, panoramic radiograph; and C, cone-beam computed tomography images.

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  Figure 4 Cephalometric and dental visual treatment objective (VTO): the posterior teeth on the cephalometric VTO represent the collapsed side only (left). Posterior maxillary segmental osteotomy is planned on the left maxillary arch. In the mandibular arch, uprighting and protraction of the mandibular left molars and transverse compensation is planned. Black, Pretreatment; red, VTO.

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  Figure 5 Posterior maxillary segmental osteotomy procedure with a vertical bone cut (A) and a horizontal bone cut (B).

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  Figure 6 Treatment progression 2 weeks (A), 6 weeks (B), 10 weeks (C), 5 months (D), 11 months (E), and 16 months (F) after posterior maxillary segmental osteotomy.

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  Figure 7 Post-treatment facial and intraoral photographs.

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  Figure 8 Post-treatment cast models.

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  Figure 9 Post-treatment radiographs. A, Lateral cephalogram; B, panoramic radiograph; and C, cone-beam computed tomography images.

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  Figure 10 Cephalometric superimpositions between the pretreatment (black lines) and post-treatment stages (red lines): overall, maxilla, and mandible. For the mandibular molars, the dotted line represents the left second molar, and the solid line represents the right first molar.

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  Figure 11 Changes in vertical and transverse positions of maxillary posterior teeth and mandibular left premolars. A, Pretreatment; B, post-treatment; and C, superimposition. Solid line, Pretreatment; dotted line, post-treatment.

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  Figure 12 Temporomandibular joint position and morphology assessed using cone-beam computed tomography. A, Pretreatment; B, post-treatment.

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  Figure 13 Post-retention (2 years) facial and intraoral photographs.

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  Figure 14 Lateral cephalogram at 2-year retention (A), and cephalometric superimpositions between post-treatment (red lines) and post-retention stages (green lines): overall, maxilla, and mandible (B).

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