Case Report 2

     The second case report concerns another severe Class III open bite malocclusion, in this instance, of a female patient 21 years of age who had recently emigrated to the US from Korea (Fig. 2A, B).  (I often hear orthodontists say that the MEAW technique only works in Young Kim’s hands.  No, it isn’t so.  This case was treated by one of my students in California.)  As you can see, the prognathism was quite severe; thus, it was an ideal case for orthognathic surgery.  The treating clinician and I both evaluated the patient, and we recommended a surgical approach.  The patient however rejected the idea of having surgery, again because of limited financial resources.  The cephalometric analysis showed an ODI of 57 degrees and an APDI of 101 degrees, indicating a marked prognathism with an anterior open bite pattern (Fig. 2C).  An examination of the panoramic radiograph revealed that the roots of the upper incisors were resorbed considerably (Fig. 2D).  The potential problems associated with orthodontic treatment were discussed with the patient and the parents.  Again, this patient also wished only to be able to chew food properly. 

      The treatment plan was laid out as follows: 

1.    Because the third molars were ready to erupt, remove all four second molars.    

2.    Distalize the lower dentition and move the maxillary dentition forward.   

3.    After eruption of the third molars, band and protract them while the lower dentition is being distalized.

A Modified Offset Arch-Wire (MOAW), designed by Prof. S. Sato of Kanagawa Dental College, Kanagawa, Japan (Sato, 1991), was used initially (Fig. 2E,F).  The mechanism of the MOAW is to distalize the terminal molars: in this case, moving the first molars into the second molar extraction space.

     After one month of treatment with the MOAW device, the open bite was corrected and the incisors were in an edge-to-edge relationship (Fig. 2G,H).  At that time, MEAW therapy was initiated with Class III elastics (Fig. 2I, J).  Four months later, the Class III relationship was corrected and the third molars were banded (Fig. 2K, L).  Seven months later, the second molar extraction spaces were closed by protracting and uprighting the third molars.  The second MEAW therapy with short Class III elastics then was applied (Fig. 2M, N).  A good occlusion was obtained after four months, and all appliances were removed (Fig. 2O, P).  Even the facial profile seemed to have improved somewhat.  The total treatment took 16 months.  Cephalometrically, the superimposition showed marked changes in the dentition (Fig. 2Q, S, T).  Examination of the panoramic radiograph revealed that the amount of root resorption of the upper incisors that existed at the beginning of treatment did not change (Fig 2R).  A 12-month follow-up examination showed that the occlusion remained reasonably stable (Fig. 2U, V).  The profile, the cephalogram, and the panoramic film all showed excellent stability.