Camouflage treatment for skeletal Class III patient with facial asymmetry using customized bracket based on CAD/CAM virtual orthodontic system

Abstract

When considering camouflage orthodontic treatment for Class III malocclusion with skeletal facial asymmetry, it is crucial to preserve the favorable compensated posterior occlusion. Once the inclination of the compensated occlusion is changed during orthodontic treatment, unstable occlusion, such as crossbite or scissor bite may occur. A 23-year-old female patient had anterior spacing with Class III malocclusion and a mandibular asymmetry. A nonsurgical approach was adopted. The treatment objectives were to establish a Class I molar relationship with compensated inclination of the posterior dentition and to correct the midline deviation. To achieve these goals, the computer-aided design/computer-aided manufacturing (CAD/CAM) orthodontic system plus customized brackets was applied, and miniscrews were used to distalize the left mandibular dentition for midline correction. The results suggested that the CAD/CAM-based customized brackets can be efficiently used in camouflage treatment to achieve a correct final occlusion.

Keywords: Camouflage treatment; Class III malocclusion; Customized bracket.

Figure 1.

Pretreatment facial and intraoral photographs.

Figure 2.

Pretreatment models. Solid line indicates axis of the first molars.

Figure 3.

Pretreatment radiographs: (A) lateral cephalogram; (B) posteroanterior cephalogram; (C) panoramic.

Figure 4.

(A) Diagnostic setup using digital models to simulate upper dentition protraction and distalization of the mandibular left segment. Pink, pretreatment; white, simulation. (B) Virtual setup and customized bracket wire combination. (C) Customized bracket combined with transfer tray.

Figure 5.

The 0.016 × 0.022 inch stainless steel archwire was engaged in both arches. One elastic chain was placed from the mandibular right canine to a miniscrew in the left alveolar bone and one from the first molar bracket tube to a steel ligature connected to the miniscrew head in the retromolar area. The arrows point to the steel ligature.

Figure 6.

Posttreatment facial and intraoral photographs.

Figure 7.

Posttreatment models. Solid line, axis of the first molars.

Figure 8.

Posttreatment radiographs: (A) lateral cephalogram; (B) posteroanterior cephalogram; (C) panoramic.

Figure 9.

Retention radiographs: (A) lateral cephalogram; (B) posteroanterior cephalogram; (C) panoramic.

Figure 10.

Cephalometric superimposition. (A) pretreatment and posttreatment. Black, pretreatment; red, posttreatment; (B) posttreatment and retention. Black, posttreatment; red, retention.

Figure 11.

(A, B) Superimposition of debonding and retention model images. (C) Occlusal force (N) and contact area (mm²) result at 18 months of retention.