North Texas Dentistry Volume 4 Issue 4 - Page 16

SMILES SPOTLIGHT in the LEADERS IN NORTH TEXAS DENTISTRY CREATING UNFORGETTABLE SMILES Class III Skeletal Malocclusion 16 NORTH TEXAS DENTISTRY | How the patient presented Adolescent female patient presented with an underbite and front upper and lower teeth that did not touch. She had an inability to bite into foods, a condition that had worsened in recent years. Functional concerns included the habits of mouth breathing and snoring. Examination showed severe Class III molar relationship (full molar), anterior open bite, and a reverse overjet of approximately 5-6 mm. There was moderate maxillary dental crowding and a constricted maxilla with bilateral posterior cross-bite. The lower teeth were mildly crowded. The maxillary dental midline was coincident with facial midline, but the mandibular midline deviated to the right. Both maxillary 1st molars had heavy restorations. Both lingual tonsils were significantly enlarged, with the right tonsil crossing the midline and displacing the uvula. Facially, the upper lip was mildly retrusive, and the soft tissue profile concave with moderate maxillary infraorbital and paranasal hypoplasia; she also displayed mild mandibular asymmetry with chin deviated to the right side ~ 2mm. Head type was dolichocephalic, and the chinneck length appeared adequate. Oral hygiene was fair with mild generalized marginal gingivitis and some generalized extrinsic dental staining – especially lingual of maxillary incisors. Also noted was a lingual periodontal defect associated with the upper right 2nd bicuspid and an over-retained deciduous 2nd molar. Comprehensive diagnostic workup included full orthodontic diagnostic records, a thorough review of prior patient-supplied photographs from early c