Pacific Coast Society of Orthodontists Bulletin Summer 2015 - (Page 33)

Special Section CBCT Cone-Beam Computed Tomography Patient J.G. 8 years, 5 months Case Report Post-Treatment How would you treat this malocclusion? Treatment Plan A combination of Options 1 and 2 was selected. First, to address the patient's transverse jaw coordination, a wax bite was taken in a constructed position: the patient was instructed to close so that the midline of his mandibular incisors were overcorrected toward the left by 1 mm beyond the maxillary midline (7 mm activation toward left). To encourage vertical correction of the short side of his face - the side that is affected by hemifacial microsomia - no posterior occlusal coverage was placed on the right side of the bionator. This, in combination with a tongue shield to keep the tongue from resting interpolated between the dentition, was aimed at encouraging vertical tooth eruption of the short side of his mandible by correcting the posterior vertical facial height. Conversely, occlusal coverage was placed on the left posterior teeth in order to minimize vertical eruption on the unaffected side. His mandibular anteriors were encouraged to align by sequential selective removal of acrylic in the mandibular incisor trough of the bionator at each subsequent visit, until they were fully aligned. Progress photos 4 months Initial bionator timepoint - 8 years, 5 months Modified bionator appliance Summer 2015  PCSO Bulletin Compliance was excellent, and apparent improvements were noticeable after three months of bionator use. The patient reported being most comfortable replicating the constructed bite; however, he had to manipulate his jaw back to its previous centric occlusal relationship in order to masticate food. In an effort to maximize the growth modification possibility of the constructed bite when he was eating, toothcolored glass ionomer was added to the deciduous first and second molars and canines to guide the mandible into the constructed bite even without the bionator in place. This effectively allowed built-in full-time use of the constructed bite to promote differential condylar growth and thus improve skeletal symmetry. The patient tolerated the occlusal buildups well. They were taller on the right, which encouraged the erupting permanent first molars to establish the plane of occlusion along this constructed bite and discouraged eruption of the permanent first molars on the left side. The patient continued using the bionator full-time for a total of 12 months. Then, nighttime wear was prescribed. The composite buildups were left in place. 33

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2015

Staying Connected in a Large, Diverse Orgainziation
Palm Springs: A PCSO Favorite
Trustee Report
PCSO at a Glance
PCSO Member News
AAOF Report
Special Section on CBCT
CBCT Imaging Protocols Within PCSO Residency Programs
Cone-Beam Computed Tomography in Orthodontics - Benefits of Comprehensive Visualization
Case Report Pre-Treatment
CBCT in Today's Orthodontic Practice
Case Report Post-Treatment
Differentiating Posterior Crossbites with CBCT Volumetric Images
Apps for the Orthodontist
Dr. Ib Leth Nielsen, San Francisco, CA
Dr. Robert J. Bendzak
Dr. Arthur A. Dugoni's 90th Birthday Makes for a Special Alumni Meeting in San Francisco
Preparing for the Unexpected: Your Emotional SOS Plan, Part II
Resident Spotlight
Hygiene: A New Battle for an Old War
Dr. Peter Picard, 1919-2013

Pacific Coast Society of Orthodontists Bulletin Summer 2015