| Objective: From a total of 27 patients with various patterns of Angle malocclusion treated under the guidance of my teachers during my master’s degree and training,one case of Angle class Ⅰ malocclusion,two cases of Angle class Ⅱ malocclusion,and one case of Angle class Ⅲ malocclusion were selected as the subjects of this report to completely describe the entire treatment process of the patients and retrospectively analyze and evaluate their orthodontic effects.This report records in detail the process changes in the entire orthodontic treatment of these four cases,summarizes their own experience in the course of orthodontic treatment,reflects on theoretical learning and clinical operation deficiencies,and provides a reference and basis for future clinical treatment in Angle’s various patterns of malocclusion.Methods: From October 2020 to February 2023,4 patients were selected in the Department of Orthodontics,and I was responsible for the whole process of diagnosis and treatment under the guidance of my teachers.Before and after the treatment,the front and side photos were taken,oral panorama and lateral cephalometric radiographs were taken,and the study model was taken.Model analysis and X-ray cephalometric analysis are performed.Before treatment,according to the clinical examination and above data analysis,list the problems,correctly diagnose,determine the treatment goals,give a reasonable treatment plan,and sign the informed consent form for orthodontic treatment after full communication with the patient.Case 1 Angle class Ⅱ division 1 malocclusion:male,16 years old,skeletal class II average growth pattern,the mandible retracted relative to the maxilla,upper airway tongue pharyngeal stenosis,upper and lower arch morphology narrowing with irregular tooth alignment,upper and lower anterior teeth lip tilt and protrusion,bilateral molars and canines distal middle pointed to pointed relationship,mandibular midline right shift 2mm,35,45 abnormal central cusp,posterior teeth part of the scissors bite and crossbite,long-term left chewing,early opening of the relevant joint clicks,bilateral auricular anterior tenderness,soft tissue profile is convex pattern.Case 2 Angle class I malocclusion: male,12 years old,skeletal class II average growth pattern,mandibular retrusion,upper and lower irregular tooth alignment,upper and lower anterior teeth lip tilt and protrusion,bilateral molars neutral relationship,bilateral canine teeth distal middle pointed to pointed relationship,soft tissue profile is convex pattern,open lip and teeth.Case 3 Angle class II division 1 subdivision malocclusion: female,38 years old,skeletal class II average growth pattern,upper and lower dentition defects and irregular tooth alignment,lower anterior teeth lip tilt,left molars distal middle pointed to pointed relationship,right molars neutral relationship,bilateral canine teeth distal middle pointed to pointed relationship,maxillary midline right shift 2mm,long-term right chewing habit,soft tissue profile is straight pattern.Case4 Angle class III.malocclusion: female,20 years old,skeletal class III average growth pattern,upper and lower irregular tooth alignment,upper anterior teeth lip tilt and protrusion,bilateral molars near middle pointed to pointed relationship,bilateral canine neutral relationship,maxillary midline right shift 1mm,soft tissue profile is concave pattern.Results: Case 1 Before orthodontics,18,28,38,48 were extraction,the width of the upper dental arch was expanded with an active appliance and the mandibular bracket was bonded at the same time,and the maxillary active appliance was stopped 3 months later and the maxillary bracket was bonded.At 13 months of fixed appliance,the maxilla wore a flat bite plate to open the anterior teeth to occlusion,and at 22 months,the microscrew implants was used to remotely move the upper arch.After about 22 months of treatment,the problem of narrowing of the upper and lower arches was basically solved,the occlusion of the right posterior teeth was established,the joint clicks disappeared in the early stage of opening,bilateral auricular anterior tenderness disappeared,the width of the airway increased,the protrusion of the upper anterior teeth decreased,the lip tilt decreased,the soft tissues profile changed greatly,the bilateral molars and canines distal middle pointed to pointed relationship the anterior teeth overjet about 8mm,mandibular midline right shift 2mm,which is still under treatment.Case 2 Physiologic anchorage Spee’s-wire system technique does not extract teeth to treat it.The gap obtained by widening the width of the posterior part of the upper arches and using the original maxilla to adduct the anterior teeth to improve the sagittal alignment,and finally perform fine adjustment of the occlusal,the treatment period is about 14 months.After the end of the treatment,the arch of the upper and lower jaw teeth was oval in shape,the cover was normal,the bilateral molars and canines were neutral,the maxilla and mandible midline was aligned,and the lateral appearance of soft tissues was significantly improved.After11 months of treatment,the appearance was better than after the treatment,the maxilla and mandible midlines were aligned,the molars maintained a neutral relationship,the overbite and overjet of the front teeth were basically normal,and the canines showed slight signs of recurrence,which basically maintained the treatment effect.Case 3 MBT orthodontic technique does not extract teeth to treat it.At 10 months of treatment,the patient is anxious to end the treatment,the overbite and overjet of the anterior teeth is basically normal,the right molars are basically neutral,the bilateral canines is neutral,the maxillary midline left shift 1mm,and the occlusal fossa relationship is good,but there is still a 1mm gap between 18,16 and 24 and 26,21 is a little close to the middle tilt,telling the patient that the patient needs to continue treatment,but the patient insists on ending the treatment,the total course of treatment is 11 months,and it is recommended that the mandibular denture repair 37 and 47.Case 4 MBT orthodontic technique does not extract teeth to treat it.After the upper and lower dentitions are arranged neatly,the lower dental arch is moved remotely using microscrew implants to the whole dentition,and after 6months,the lower dentition is moved to the design position,and finally fine-tuned,and the treatment is about 16 months.After the end of the treatment,the bilateral molars and canines had a neutral relationship,the overbite and overjet of the anterior teeth is normal,the midline of the maxilla and mandible was aligned,the upper anterior teeth were scattered in the gap closed,the occlusal was tight,and the lateral appearance of soft tissues was significantly improved.Conclusion: The manifestations of malocclusions are different,the formation mechanism is different,and the difficulty of treatment is different.As a master’s degree and student of the standardized training,in the clinical training and study of oral medicine for 33 months(rotating in oral and maxillofacial surgery and dental prosthesis for 17 months after enrollment,and entering orthodontics 16 months before graduation)(following the teacher to diagnose and treat patients immediately after enrollment),under the guidance of the teacher,I can diagnose and treat routine malocclusions,and also actively involve some difficult diseases.Through the summary and reporting of the above four cases,I deepened my understanding of the treatment of patients with malocclusion and understood the shortcomings in my treatment process,which provided some help for future clinical work. |
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