Diagnosis and treatment objectives

Case 1 was a male born to healthy parents and weighed 3760 g at birth. At the age of 2 months, he suffered from acute respiratory failure and underwent a tracheotomy. He had micrognathia and cleft palate and was diagnosed as Robin sequence. Palatoplasty was performed at 1 year 2 months of age.

He visited our dental hospital at 9 years 1 month of age and demonstrated a slight retrognathic appearance (Figure 1A). A deep bite with 6.0 mm of overbite was noted, and overjet was 3.5 mm. He was in the mixed dentition and had severe crowding (arch length discrepancy: maxilla, 11.4 mm; mandible, 10.5 mm). SNA and SNB angles were significantly smaller, and mandibular plane and gonial angles were much larger than the Japanese norm (Table 1).1617 The SNA-SNB difference was 5.4°. Both upper and lower incisors were significantly retroclined.

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Table 1.  Cephalometric Measures Before and After the Active Treatment^a

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The treatment objectives were as follows: (1) to eliminate the arch length discrepancies in both arches by extraction and (2) to correct the deep bite and align both arches. Orthodontic treatment was initiated with a lingual arch to correct lingual displacement of the upper right and left lateral incisors. An edgewise multibracket appliance was placed in both arches with extraction of the upper right first premolar and left second premolar and lower first premolars at the age of 11 years 2 months.

Treatment results

Facial and oral photographs after the active treatment were taken at 15 years 10 months of age (Figure 1B). He obtained functional occlusion, but his retrognathic profile was somewhat worsened. Superimposed profilograms showed a large amount of vertical but a small amount of horizontal mandibular growth (Figure 1C).18 The SNA angle did not change but the SNB angle increased by 1.5° compared with the pretreatment values (Table 1). Both upper and lower incisors were significantly proclined during treatment.

Diagnosis and treatment objectives

Case 2 was a male born to healthy parents and weighed 2850 g at an uneventful birth. He had a cleft palate, and a palatoplasty was performed at 1 year 2 months of age.

He visited our dental hospital at 11 years 2 months of age with a slight retrognathic appearance (Figure 2A). A large overjet (7.0 mm) and a deep bite (overbite: 8.0 mm) were noted. Arch length discrepancies in the maxillary and mandibular arches were −6.0 and −11.3 mm, respectively. The lower left central and lateral incisors were fused. Both SNA and SNB were smaller than the Japanese norm1617 (Table 1). The SNB showed a significantly lower value, and the SNA-SNB difference was 8.0°. The gonial angle was near the norm, but the mandibular plane angle was significantly larger (Table 1). Both upper and lower incisors were significantly retroclined.

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The treatment objectives were as follows: (1) to eliminate the arch length discrepancies in both arches by extraction and (2) to correct the deep bite and large overjet and align both arches. An edgewise multibracket appliance was placed in both arches, and the patient was treated with extraction of upper second premolars and the lower right canine and left first premolar.

Treatment results

Facial and oral photographs after the active treatment were taken at 20 years 7 months of age (Figure 2B). The oral photographs showed a desirable occlusion, but the patient still had a slight retrognathic appearance. Downward and forward growth of the mandible had occurred (Figure 2C) and the SNB angle was increased by 2.0° (Table 1). In contrast, the SNA angle was unchanged compared with pretreatment. His upper incisors were retroclined and his lower incisors were significantly proclined during treatment.

Diagnosis and treatment objectives

Case 3 was a female born to healthy parents and weighed 2850 g at birth. At birth, she suffered from respiratory problems and therefore underwent oxygen inhalation. She had cleft palate and retrognathic appearance and was diagnosed as Robin sequence. Palatoplasty was performed at 1 year 2 months of age.

She visited our dental hospital at 9 years 1 month of age. A facial photograph taken at this time showed an apparent retrognathic appearance (Figure 3A). A large overjet (7.0 mm) and a deep bite (overbite: 7.0 mm) were noted. The lower right lateral incisor was congenitally absent and the upper left lateral incisor was a microtooth. Arch length discrepancies in the maxilla and mandible were −11.4 and −7.6 mm, respectively. Both the SNA and SNB angles were significantly smaller and the mandibular plane and gonial angles were much larger than the Japanese norm.1617 The SNA-SNB difference was 8.9° (Table 1). Both upper and lower incisors were significantly retroclined.

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The treatment objectives were as follows: (1) to eliminate the arch length discrepancies in both arches by extraction and (2) to correct the deep bite and large overjet and align both arches. An edgewise multibracket appliance was placed in both arches with extraction of the upper left lateral incisor and second premolar.

Treatment results

Facial and oral photographs after the active treatment were taken at 16 years 2 months of age (Figure 3B). Her retrognathic profile was improved, and she obtained functional occlusion. The mandibular growth was mainly toward the downward direction (Figure 3C). The SNA angle was unchanged, but the SNB angle increased by 1° (Table 1). Significant labial tipping of the lower incisors was noted (Table 1).

Diagnosis and treatment objectives

Case 4 was a female born to healthy parents and weighed 2320 g at birth. She had micrognathia and cleft palate. At the age of 3 months, she had cyanosis and was diagnosed as Robin sequence. Palatoplasty was performed at 2 years of age.

She visited our dental hospital at 10 years 7 months of age with a slight retrognathic appearance (Figure 4A). Deep bite was noted with 8.0-mm overbite and overjet of 2.0 mm. Arch length discrepancies in the maxilla and mandible were −10.6 and −4.9 mm, respectively. The lower right lateral incisor was congenitally absent, and the upper right and left lateral incisors were microteeth. SNA and SNB angles were smaller than the Japanese norm, and SNA-SNB difference was near the Japanese norm (Table 1).1617 The mandibular plane angle was larger, but the gonial angle was not significantly different from the Japanese norm.16 Both upper and lower incisors were significantly retroclined.

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The treatment objectives were as follows: (1) to expand the maxillary arch laterally, (2) to promote the mandibular growth, (3) to eliminate the arch length discrepancies in both arches, and (4) to correct the deep bite and align both arches. Orthodontic treatment was initiated with a rapid palatal expansion appliance or expander, followed by the use of a jumping plate to promote mandibular growth. At 15 years of age, an edgewise multibracket appliance was placed in both the arches with extraction of upper right and left lateral incisors.

Treatment results

Facial and oral photographs after the active treatment were taken at 19 years 10 months of age (Figure 4B). A facial photograph taken at this time still showed a slight retrognathic profile, but functional occlusion was attained. Prosthetic treatment was planed in the position of the upper left lateral incisor. Growth of the mandible was entirely in a downward direction (Figure 4C). There was no increase in the SNA and SNB angles (Table 1). Significant labial tipping of the upper and lower incisors was noted (Table 1).

Diagnosis and treatment objectives

Case 5 was a female born to healthy parents and weighed 3020 g at birth. She exhibited characteristic micrognathia and cleft palate at birth and was diagnosed as Robin sequence. Palatoplasty was performed at 1 year 2 months of age.

She visited our dental hospital at 9 years 3 months of age. A retrognathic appearance was noted from a facial photograph (Figure 5A). A large overjet of 10.0 mm and an overbite of 4.0 mm were seen. Severe crowding was seen in both arches (arch length discrepancy: maxilla, 12.2 mm; mandible, 9.4 mm). Both SNA and SNB angles were smaller than the Japanese norm1617 (Table 1). The SNB showed a significantly lower value and the SNA-SNB difference was 7.5° (Table 1). The mandibular plane and gonial angles were much larger than the Japanese norm. The lower incisors were significantly retroclined, but the inclination of the upper incisors was almost the same as the Japanese norm.

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The treatment objectives were as follows: (1) to expand the maxillary arch laterally, (2) to eliminate the arch length discrepancies in both arches, and (3) to correct the large overjet and align both arches. Orthodontic treatment was initiated with a Porter-type maxillary expansion appliance, followed by treatment with an edgewise multibracket appliance in both the arches with extraction of upper and lower first premolars.

Treatment results

Facial and oral photographs after the active treatment were taken at 16 years 3 months of age, and good functional occlusion was obtained (Figure 5B). However, she still exhibited a retrognathic profile. Downward and forward growth of the mandible was seen (Figure 5C). The SNA angle did not change, but the SNB angle increased by 1.2° during treatment (Table 1). Significant lingual and labial tipping of upper and lower incisors was noted, respectively (Figure 5C).