ENGLISH ASSIGNMENT

UNDERBITE

CREATED BY:
HESTI RAHAYU

1110070110039

LECTURER:
1. Dra Siti Zaura
2. Yulianita S,S
3. Primi Ovarianti M.pd

FACULTY OF DENTISTRY
BAITURRAHMAH UNIVERSITY
PADANG 2014
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Case:
The 14th years old girls , she had a severe discrepancy between her upper and lower jaws.
Analysis of her xrays showed that the discrepancy was mostly due to the relative size of her
lower jaw (her lower jaw was too large relative to her upper jaw). When there is a discrepancy
between the size and/or positions of the upper and lower jaws, the teeth ususally try to
compensate for this. If the lower jaw is in front of the upper jaw, usually you see that the upper
teeth are flared foward in an attempt to meet the lower teeth, and the lower teeth are leaned in, in
an attempt to meet the upper teeth. If the upper teeth are flared, you would expect to see spaces
between them, since as they flare out this moves them onto a larger perimeter and there is more
space for the teeth. If the lower teeth are leaned inward, you would expect them to be crowded,
since moving them inward places them on a smaller perimeter and they therefore have less
available space.

Her upper side teeth were also flared out to compensate for the fact that her arch forms were
displaced from their normal relationships. The animation below depicts this (you must have
animated gifs turned on in your browser's preferences to view the animation). A change in the
front to back relationships of the upper and lower arch forms affects the width relationships as
well:

I considered the following options for her treatment:

Option 1. Use braces alone without the removal of any teeth. This option would require that I
further compensate her teeth for the jaw discrepancy.To accomplish this, I would need to bring
all of her top teeth forward to the extent indicated by the red arrows above, move her bottom
teeth back that amount, or do some combination of moving her upper teeth forward and her
lower teeth back. This option would not address her lower jaw position which is the basic cause
of her teeth not fitting together. It is not possible to move her lower teeth back without the
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removal of any teeth, so this option would necessitate making all of the correction by moving her
upper teeth forward. Since they are already leaned forward, I would need to lean them forward to
such an extent to meet the bottom teeth that the upper teeth would be moved off the bone
(essentially extracting them) -- not a good idea. Option 1 is not a good one.
Option 2. Use braces alone with removal of teeth. this still does not address the basic cause of
her problem, but we did consider extracting a tooth on each side to create enough space to move
her lower teeth back. Since the bone was thin on the inside surface of her lower front teeth,
leaning them inward would have made them more prone to periodontal (gum) problems. In
addition, any treatment plan involving extractions and further compensating her teeth would
accentuate her chin and leave her upper front teeth leaned out - both of which we decided were
undesirable. We therefore decided against option 2.
Option 3. Braces in conjuction with jaw surgery (orthognathic surgery). Since this option
addressed the true cause of her problem and met the esthetic objectives that we had, we
proceeded with this option.

Treatment:
Since her teeth had compensated for her jaw discrepancy, and since the jaw surgery would
correct the jaw discrepancy, her initial treatment would involve putting her teeth in the proper
positions in her jaw bones (this is called "decompensating" the teeth). This required constricting
the width of her upper arch and leaning in her upper front teeth. The lower spaces were closed by
leaning her front teeth in. The space between her upper front teeth was closed before surgery.
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This pre-surgical stage took 16 visits (scheduled 1 month apart). She then had jaw surgery which
involved moving her lower jaw back to fit into proper position with her upper jaw (subcondylar
osteotomy). Post-surgical orthodontic treatment involved fine-tuning the coordination of the
widths of her upper and lower arches, and trying to correct her midlines 100%.