1 63 the mandibular Spee curve was removed by using a mono-block and a vertical rubber at the premolar site. The dynamic treatment period was 23 month

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1 62 J Meikai Dent Med 37 1, 62 70, concave profile Spee 3 tripod Spee tripod A Case of Severe Skeletal Mandibular Protrusion Complicated with Deep Overbite Tohru YAMADA 1, Keiji KATAYAMA 2, Shigeyuki MATSUI 1, Yosuke SAKURAI 1, Au SASAKI 1, Manabu KOHARA 1, Takashi DOI 1, Hiroya HASEGAWA 1, Hiroshi TAKESHIMA 3, Jun SHIMADA 3 and Haruhide KANEGAE 1 1 Division of Orthodontics, Department of Human Development & Fostering, Meikai University School of Dentistry 2 Kei Dental & Orthodontic Clinic 3 Division of Oral and Maxillofacial Surgery, Department of Therapeutic & Diagnostic Sciences, Meikai University School of Dentistry Abstract : We recently experienced a case of skeletal mandibular protrusion complicated with vertical maxillary deficiency and successfully treated by a surgical orthodontic treatment with the summarized results described below. A female patient was first diagnosed as having skeletal mandibular protrusion and anterior cross-bite accompanied with mandibular counterclockwise rotation and vertical maxillary deficiency at her age of 23 years and 2 months. Taking the problem of discordant skeleton and concave profile into consideration, an application of surgical orthodontic treatment was decided and a mandibular ramus sagittal division was performed. In order to have an increased mandibular height, the orthodontic treatment before and after operation was mainly aimed to regain a clockwise mandibular rotation together with elongation of upper and lower molar regions. For the preoperative orthodontic treatment, the maxillary third molar was proximally moved after extraction of the maxillary second molar, while Spee curve was preserved in the mandible to prepare and arrange a tripod by 3 point contact composed of anterior teeth and bilateral molar sites. For the postoperative orthodontic treatment,

2 1 63 the mandibular Spee curve was removed by using a mono-block and a vertical rubber at the premolar site. The dynamic treatment period was 23 months for the preoperative orthodontic treatment and 11 months for the postoperative orthodontic treatment, 34 months in total. The reduced mandibular height due to temporomandibular orthodontic treatment was successfully avoided by serving the preoperative tripod as a fulcrum with the increased mandibular height. Key words : vertical maxillary deficiency, deep overbite, temporomandibular deformity, skeletal mandibular protrusion, temporomandibular orthodontic operation 1 short face type 2 long face type 3 short face type vertical maxillary deficiency VMD 1 overbite 23 4 concave profile Fig 1 Angle overjet 9 mm, overbite 6 mm normal taper arch length discrepancy 4.0 mm3.0 mm Fig Table 1 Facial angle Convexity A-B plane Mandibular plane Y-axis Occlusal plane Interincisal L-1 to Mandibular FH to SN SNA SNB ANB U-1 to FHplane U-1 to SNplane Gonial angle Ramus inclination Table 2 N-S N-Me N-ANS ANS-Me S -Ptm A -Ptm Ptm -Ms A -Ms Is-Is Mo-Ms Is-Mo Gn-Cd Pog -Go Cd-Go Ii-Ii Mo-Mi Ii-Mo S-S FH Cepharometric analysis. Mean Cepharometric analysis. Mean S.D S.D Pretreatment Posttreatment Pretreatment Posttreatment

2 SNB 94.5 ANB 6.3 Y-axis 55 Ramus inclination 70.

3 64 37, 2008 Fig 1 Facial views.pre-treatment, B post-treatment. X X Fig 3 X Fig 4 X Fig 5 Tables 1, 2 facial angle 98 SNA 88.2 SNB 94.5 ANB 6.3 Y-axis 55 Ramus inclination 70.5 Gn-Cd 132 mm, Pog -Gn 87.5 mm Lower facial height 44 mandibular arc 21 VMD FH

4 1 65 Fig 2 Intra oral views.pre-treatment, B post-treatment.

66 37, 2008 Fig 3 Panoramic tomography.pre-treatment, B posttreatment.

tripod 3 Spee Spee 3 Arch length discrepancy Fig 4 Superimposition of

1 2 Angle 3 VMD deep overbite, severe short face type 0.018 0.

5 66 37, 2008 Fig 3 Panoramic tomography.pre-treatment, B posttreatment. concave profile 1 Concave profile Angle 2 VMD severe short face type tripod 3 Spee Spee 3 Arch length discrepancy Fig 4 Superimposition of cepharometric tracing frontal. Pre-treatment, post-treatment. 1 2 Angle 3 VMD deep overbite, severe short face type standard edgewise bracket Spee Fig 6A Fig 6B mm Fig 6C Fig 7 Fig 6D 11 Fig 6E

6 1 67 Fig 5 Lateral cephalograms.pre-treatment, B post-treatment.

7 68 37, 2008 C D E Fig 6 Intra oral views.with a sectional arch in maxillary arch, B just before operation, C after operation, D mono block up-down elastics, E just before retention.

1 69 Fig 8 Superimposition pre-treatment and post-treatment 5

Begg S1 S5 Fig 8 1 S 1 2 S 2 3 S 3 4 S 4 5 S 5 E-line E-line

0 mm Fig 9 Superimposition of cepharometric tracing at S-N

8 1 69 Fig 8 Superimposition pre-treatment and post-treatment 5 Superimposition Areas Fig 7 Mono block used in this case. Begg S1 S5 Fig 8 1 S 1 2 S 2 3 S 3 4 S 4 5 S 5 E-line E-line tripod overbite 14 mm tripod 3.0 mm Fig 9 Superimposition of cepharometric tracing at S-N plane lateral Fig 9 concave type straight type overjet 9 mm 3.0 mm overbite 6.5 mm 2.0 mm Angle Fig 2 X Fig 3

9 70 37, 2008 tripod upright X 14.0 mm ANB facial axis, facial depth Fig 5 N-Me ANS-Me, lower facial height, mandibular plane angle Fig 5, Tables1, Short face type 4 VMD short face type 5 short face type 5 Spee deep overbite 3 tripod 6 11 Two-jow surgery One-jow surgery VMD 16, , 2006 Opdebeeck H and Bell WH : The short face syndrome. Am J Orthod 73, , 1978 Schendel SA, Eisenfeld J, Bell WH, Epker BN and Mishelevich DJ : The long face syndrome : vertical maxillary excess. Am J Orthod 70, , 1976 In ppl , 2000 Worms FW, Isaacson RJ and Speidel TM : Surgical orthodontic treatment planning : profile analysis and mandibular surgery. Angle Orthod 46, Sinclair PM, Thomas PM and Tucker MR : Common complications in orthognathic surgery : Etiology and management. In : Modern practice in orthognathic and reconstructive surgery, vol 1. Bell WH ed, Saunders, Philadelphia, pp61 62,

A Angle mmmm A X A SNASNB ANBFMA Uto FHFMIAUto NA mmlto NBmm Angle Distal Jet Distal Jet Distal Jet Distal Jet Distal Jet Distal Jet slot pre adjusted

A Angle mmmm A X A SNASNB ANBFMA Uto FHFMIAUto NA mmlto NBmm Angle Distal Jet Distal Jet Distal Jet Distal Jet Distal Jet Distal Jet slot pre adjusted key words Angle Acasereport of Angle Class II div. 1 with extraction of the upper second molars and the upper and lower four first premolars HIROKO TANAKA Aichi prefecture Obayashi Dental Clinic Summary