Multiple impacted permanent teeth is uncommon and rarely reported in the literature. This article reports the treatment of an adolescent patient with multiple impacted teeth without systemic disease. A 9-year 2-month-old boy complained of a delay of eruption of the first molars. All first molars were unerupted, and the left deciduous second molar was a submerged tooth. The panoramic radiograph showed all permanent teeth except the incisors were unerupted and, especially for the first molars, spontaneous eruption was not expected. His medical history was uneventful. A lingual arch appliance and a segmental arch were placed on the mandibular and maxillary dentitions, respectively, to guide eruption of the impacted first molars. After traction of the first molars, eruption of the impacted lower premolars was induced. Furthermore, at 15 years the impacted mandibular second molars were also positioned properly by use of the lingual arch with auxiliary wires. After achieving traction of the impacted teeth, tooth alignment was initiated using multibracket appliances after the bilateral extraction of the second premolars. After 22 months of treatment with multibracket appliances, an acceptable occlusion was achieved with a Class I molar relationship. After 2 years of retention an acceptable occlusion was maintained without any relapse in the occlusion. Since a delay in the treatment of impacted teeth may induce secondary problems such as root dilacerations and ankylosis, it is highly recommended to perform early treatment of multiple impacted teeth during adolescence.

This case report demonstrates the treatment of a skeletal Class II high-angle adult patient with bimaxillary protrusion, angle Class I occlusion, and crowded anterior teeth. A ribbon-wise arch wire and a customized lingual appliance with anterior vertical slots were used to achieve proper torque control of the maxillary anterior teeth. An orthodontic anchor screw and a palatal bar were used for vertical control to avoid increasing the Frankfort-mandibular plane angle (FMA) by maxillary molar extrusion. Through the combined use of the ribbon-wise customized lingual appliance, palatal bar, and orthodontic anchor screw, vertical control and an excellent treatment result were achieved without the vertical and horizontal bowing effects peculiar to conventional lingual treatment.

Open bite is one of the most difficult malocclusions for orthodontists to treat because this pathological condition reflects the involvement of multiple factors, including dental, skeletal, functional, habitual, neurogenic, and traumatic factors. [1,2] Therefore, for proper diagnosis and treatment, it is essential to perform the right tests and assessments, including determining the causal factors and planning an appropriate treatment that fully takes into account orthodontic treatment mechanics. [3] In other words, it is important to develop a treatment plan that pays careful attention to tooth extrusion and mesial movement in both the upper and lower molar regions, performs sufficient vertical and anchorage control, provides sufficient torque control of the anterior teeth, and incorporates myofunctional therapy (MFT) for excluding functional factors such as tongue thrust.As described in this case study, we treated an adult patient with open bite and high-angle mandibular retrognathism, by using customized lingual brackets in combination with a skeletal anchorage system (SAS) and orthodontic anchor screws (OAS), and carefully controlled torque, anchorage, and vertical factors. Here, we report the satisfactory outcome of treatment. dIAgnosIs And etIoLogyA 22-year, 5-month-old woman with a chief complaint of open bite in the anterior region with misaligned teeth visited our clinic. Present medical historyAt the age of 18 years (1 st year university student), her maxillary third molars began to erupt bilaterally, and around the same time, the formation and rapid progression of open bite were noted. At the age of 19 years, the woman visited the department of oral and maxillofacial surgery at a local medical center for the treatment of unpleasant sensations (trismus and pain) at the temporomandibular joint (TMJ). She was diagnosed with left TMJ dysfunction and underwent bilateral extraction of the maxillary third molars and of impacted mandibular third

Objectives: If a skeletal anterior open bite malocclusion is treated by orthognathic surgery directed only at the mandible, the lower jaw is repositioned upward in a counter-clockwise rotation. However, this procedure has a high risk of relapse. In the present study, the key factors associated with post-surgical stability of corrected skeletal anterior open bite malocclusions were investigated. Material and methods: Eighteen orthognathic patients were subjected to cephalometric analysis to assess the dental and skeletal changes following mandibular surgery for the correction of an anterior open bite. The patients were divided into two groups, determined by an increase or decrease in nasion-menton (N-Me) distance as a consequence of surgery. Changes in overbite, the displacements of molars and positional changes in Menton were evaluated immediately before and after surgery and after a minimum of one year post-operatively. Results: The group with a decreased N-Me distance exhibited a significantly greater backward positioning of the mandible. The group with an increased N-Me distance experienced significantly greater dentoalveolar extrusion of the lower molars. Conclusions: A sufficient mandibular backward repositioning is an effective technique in the prevention of open bite relapse. In addition, it is important not to induce molar extrusion during post-surgical orthodontic treatment to preserve stability of the surgical open bite correction.

This study examined the long-term changes in tongue and pharyngeal airway morphology of a 7-year-old girl. She had a severe vertical jaw deformity with a 17-mm anterior open bite due to macroglossia. She had already