Discussion
One of the most popular approach used for the treatment of Class II malocclusion is the correction of the horizontal and vertical overbite. The stability of the treatment outcomes depends on factors such as diagnostic methods, treatment planning procedures and the orthopaedic device used.10
In our case, we opted for treatment without extractions, but with the use of a CMA, we were able to achieve a correct relationship between the jaws, decreasing the overjet and correcting the overbite. The correction of this Class II malocclusion resulted in a significant improvement of the patient’s profile and therefore in his satisfaction with the treatment.
The literature includes articles that address the treatment of Class II malocclusion using miniscrews. Bechtold et al., for example, conclude that the total arch distalisation can achieve stable results lasting one year after retention and that long-term skeletal changes may not be expected because total arch distalisation may prevent it.11 Also, by using miniscrews, there is a minor steepening of the occlusal plane.
The use of CMA, together with fixed appliances, as treatment for this Class II pathology has been carried out previously. Rodríguez corrected a similar Class II malocclusion using these two methods.3 He explains that this appliance generates a distal rotation movement around the maxillary first molars’ palatal roots, allowing the mandible to advance as the maxillary first molars are de-rotated. For this reason, Class II correction can reduce the overjet, by promoting a change in the occlusal plane. His case provides clinical evidence of sagittal stability at least five years after treatment.
For the present clinical case, in addition to the CMA, it was necessary to use fixed multi-bracket appliances together with copper NiTi archwire, ligatures and elastics for the splinting and distalisation of the teeth. The surgical option was also considered because this type of malocclusion is one of the most complicated to treat in an adult patient. Combination of orthodontic treatment and bimaxillary orthognathic surgery is accepted despite the risk of relapse that these treatments may present.12 The patient’s refusal of surgical treatment was one of the main reasons for using the CMA.
Even though the results obtained were satisfactory, early treatment using functional appliances is recommended to reduce the incidence of incisal trauma to the permanent maxillary incisors, especially in patients with excessive overjet and/or incompetent lip closure, thus improving their self-esteem and social experiences using functional appliances.13 The age of our patient meant we could not employ these orthopaedic options.
Conclusion
The CMA is a device that can correct mild, moderate and severe sagittal dentoalveolar discrepancy. Furthermore, it has proved to be an efficient alternative to extractions when dealing with correction of a complete Class II malocclusion. The results obtained in this case and the patient’s satisfaction four years after the treatment confirmed the stability offered by the treatment approach taken in this case.
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