The patient, aged 22, presented for an orthodontic consultation after many previous visits to various specialists, complaining of not finding a practitioner willing to undertake comprehensive dental treatment. She was dissatisfied with the aesthetics of her teeth, experienced difficulty speaking and reported problems with biting and swallowing food.
What problems have been diagnosed?
After a thorough dental examination and X-ray diagnosis, the following problems were identified in the patient:
- A bony malocclusion involving:
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- Underdevelopment of the jaw,
- Open anterior bite,
- Retained nine permanent teeth due to an undersized jaw,
- Congenital absence of two permanent tooth buds (teeth 16 and 15) and the presence of three persistent deciduous teeth (53, 73, 83),
- Two extra teeth: the mesiodens between the upper ones and the upper left bicuspid, which blocked the eruption of the permanent teeth.
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- Caries outbreaks in current teeth in the mouth.
- Speech and ENT problems including lack of proper nasal breathing, reduced muscle tone in the mouth, tongue, cheeks, interdental septation in all three ranks and abnormal swallowing pattern.
Proposed treatment step
1. Treatment of dental caries.
2. treatment with a speech therapist, including correcting the speech defect, increasing muscle tone in the facial area and working on correct tongue position and verticalisation.
3 Orthodontic treatment, which included the fitting of fixed braces on all current permanent teeth.
4 Under general anaesthesia, the surviving deciduous teeth were extracted, as well as the accessory teeth: the mesiodens and the left upper bicuspid. Nine permanent teeth were exposed, orthodontic brackets were applied and extractors were placed to orthodontic retraction of these teeth to the dental arches. Initially, gentle forces were applied due to the poor stabilisation of teeth 21 and 22 (the left upper one and two), which had little bone support after extra teeth were extracted. After 3 years of treatment, most of the intended effects.
5 The patient is currently scheduled for orthognathic surgery, including both Le Fort I surgery and a mandibular sagittal osteotomy. The aim of this complex surgery is to achieve an improvement in facial aesthetics through proper occlusal alignment, i.e. matching the upper teeth to the lower teeth. In addition, by repositioning the maxilla and mandible, the planned operation is expected to completely change the patient's facial features. These adjustments are expected to bring about a long-awaited improvement in both stomatognathic function and facial aesthetics, which is an important goal of this planned surgical procedure.
The patient's treatment is still continuing, so we will update on its effects.
FAQ:
What were the patient's main reasons for seeking a dental consultation?
The patient came in because she could not find a doctor willing to undertake comprehensive dental treatment, was dissatisfied with the aesthetics of her teeth, had difficulty speaking and had problems biting and swallowing food.
What problems was the patient diagnosed with during the consultation?
A bony malocclusion was diagnosed (underdevelopment of the jaw, open anterior bite, retained teeth, congenital absence of tooth buds, surviving deciduous teeth, extra teeth), foci of caries, as well as speech and laryngological problems (lack of proper nasal breathing, reduced oral muscle tone, seplenia, abnormal swallowing pattern).
What stages of treatment have been proposed to the patient?
Treatment of tooth decay, speech therapy, orthodontic treatment with the fitting of fixed appliances, removal of persistent deciduous and accessory teeth, exposure of permanent teeth, bonding of orthodontic brackets, fitting of orthodontic extractions and planned orthognathic surgery.
What did the planned orthognathic surgery consist of?
The planned surgery includes a Le Fort I operation and a mandibular sagittal osteotomy to improve facial aesthetics by properly aligning the bite and repositioning the maxilla and mandible.
What results were obtained after 3 years of treatment?
After 3 years of treatment, most of the intended effects have been achieved, but the patient's treatment is still continuing.
What were the patient's speech and ENT problems?
Problems included a lack of proper nasal breathing, reduced muscle tone in the mouth, tongue and cheeks, interdental septation and an abnormal swallowing pattern.
What surgical procedures were performed during treatment?
Under general anaesthesia, the surviving deciduous teeth and accessory teeth were extracted, nine permanent teeth were exposed, orthodontic brackets were applied and orthodontic extractors were placed.
What are the aims of the planned orthognathic surgery?
The aim of the surgery is to improve facial aesthetics and stomatognathic function by properly aligning the bite and altering facial features.
Has the patient's treatment been completed?
The patient's treatment continues and the effects will be updated.
What specialties were involved in the patient's treatment?
Specialists in orthodontics, speech therapy, dental surgery and ENT were involved in the treatment.
What were the causes of the patient's retained permanent teeth?
The permanent teeth were retained due to the jaw being too small and the presence of extra teeth blocking the eruption of the permanent teeth.
What measures have been taken in terms of speech therapy treatment?
Speech therapy included correcting the speech defect, increasing facial muscle tone and working on correct tongue position and verticalisation.
