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acial asymmetry is one reason that patients seek orthognathic surgery combined with orthodontic
treatment. Common features of facial asymmetry
include a mandibular deviation to the right or left that increases gradually from the upper to the lower face. This is
usually associated with a cant of the maxilla and the
maxillary occlusal plane.1 Severt and Proft2 reported
that the frequencies of facial asymmetry are 5%, 36%,
and 74% in the upper, middle, and lower thirds of the
face, respectively. In such cases, dramatic improvement
a
Assistant professor, Department of Orthodontics, College of Dentistry, Kyung
Hee University, Seoul, Korea.
b
Postgraduate student, Department of Orthodontics, College of Dentistry, Kyung
Hee University, Seoul, Korea.
c
Associate professor and chair, Department of Orthodontics, College of Dentistry,
Kyung Hee University, Seoul, Korea.
d
Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry,
Kyung Hee University Medical Center, Seoul, Korea.
e
Professor and chair, Department of Orthodontics, School of Medicine, Ajou University, Suwon, Korea.
f
Clinical professor and interim chair, Division of Orthodontics, Department of Orofacial Science, University of California at San Francisco, San Francisco, Calif.
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conicts of Interest, and none were reported.
Supported by the National Research Foundation of Korea funded by the Korea
government (MEST) (number 2012R1A5A2051388).
Address correspondence to: Seong-Hun Kim, Department of Orthodontics, College of Dentistry, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul
130-701, Republic of Korea; e-mail, bravortho@gmail.com.
Submitted, August 2013; revised and accepted, August 2014.
0889-5406/$36.00
Copyright 2014 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2014.08.018
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Fig 1. A and B, Palatal and C and D, buccal corticotomy with piezosurgery (SONIC SURGEON 300;
Dong Il Technology, Hwasung, Korea); E and F, application of miniplates for intrusion of the posterior
segment.
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PATIENT 1
A 15-year-old girl came to the Kyung Hee dental hospital in Seoul, Korea, with the chief complaint of facial
asymmetry. She had a straight lateral prole, mesognathic facial type, eye-level canting (right side down),
lip-line canting (right side high), chin deviation to the
right, and an acceptable display of her maxillary anterior
teeth (Fig 2, A). The intraoral photographs showed an
Angle Class I malocclusion, severe anterior crowding,
an ectopically positioned maxillary left canine, a
mandibular dental midline discrepancy to the right,
and transverse compensation of the maxillary and
mandibular molars (Fig 2, B).
The cephalometric analysis indicated a hyperdivergent skeletal pattern (FMA, 32.8 ), normal relationships
of the maxilla (SNA, 80.7 ) and the mandible (SNB,
77.9 ), maxillary occlusal plane cant (left side down),
menton deviation to the right side (7.0 mm), and upright
maxillary and mandibular incisors (U1-FH, 108.2 ;
IMPA, 81.9 ) (Fig 3 and Table). Although her condyle
was thin and narrow, especially on right side, there
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Fig 4. Comparison between A, pretreatment and B, after-intrusion axial images of the maxillary left
posterior segment of patient 1. In 3 months, 3.5 mm of intrusion of the maxillary left molars was
achieved, and the molar compensation was corrected.
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(U1-FH, 116.5 ; IMPA, 88.9 ) and a favorable maxillomandibular relationship (Fig 8). The occlusal plane was
greater by 3 than before treatment (SN-OP, 21.2 to
24.6 ). The treatment results were well maintained at
8 months after debonding (Fig 9).
PATIENT 2
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Fig 8. A, Posttreatment superimposition between the pretreatment and nal cephalometric tracings; B,
the posteroanterior cephalogram; and C, the panoramic radiograph of patient 1.
maxilla is quite stable. Others also reported that maxillary stability after LeFort I osteotomy for cant correction does not differ from that for maxillary
advancement.28 There have been no long-term studies
about the stability of orthodontic intrusion with TSADs
for the treatment of canted occlusal planes. There are
limited data on the correction of anterior open bite.
Lee and Park29 reported a 10.4% relapse rate for the
intruded maxillary molars and an 18.1% relapse rate
for overbites at 1 year posttreatment. Baek et al30
also reported a 22.9% relapse rate for intruded maxillary molars and a 17.0% relapse rate for overbites at
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Fig 10. Intraoral photographs of patient 2: A-C, on the day of corticotomy; D-F, after intrusion.
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Fig 11. Comparison between A, pretreatment and B, after-intrusion axial images of the maxillary right
posterior segment of patient 2. In 2 months, 3.5 mm of intrusion of the maxillary right molars was
achieved.
Fig 12. Posteroanterior cephalograms: A, pretreatment, B, after intrusion, and C, after 1-jaw orthognathic surgery of patient 2. The midsagittal reference line, maxillary occlusal plane, and menton deviation are shown.
Ahn et al
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