Treatment for adult female temporomandibular joint osteoarthritis-related severe retrognathia and anterior open bite using premolar extraction and customized lingual orthodontic appliance with vertical control for significant compensation: A case report

Abstract

This case report presents a satisfactory lingual appliance orthodontic treatment in a 21-year-old woman diagnosed with Angle Class I anterior open bite (AOB) malocclusion and severe high-angle skeletal Class II retrognathia, which was attributed to bilateral temporomandibular osteoarthritis (TMJOA) and disc perforation. Because of the absence of joint symptoms and presence of bilateral condyles in a stable state, no conservative or surgical treatments were performed for this patient. Four first premolars and four third molars were extracted before bonding of the customized lingual brackets. No miniscrews were used during the orthodontic process. Space closure was performed using the double cable method. Finally, the maxillary molars were found to have intruded and moved mesially during the space-closing process, which resulted in a 2.9° decrease in the mandibular plane angle. Owing to the counter-clockwise rotation of the mandible, the chin moved anteriorly and superiorly. In addition, the anterior teeth were largely retracted because of the advantage of this customized lingual appliance, resulting in significant changes in the nasolabial angle and chin contour. Two-year follow-up examinations further confirmed that no obvious relapse in occlusion and no further condylar resorption, even though bilateral anterior disc displacement without reduction was revealed. In conclusion, a patient with TMJOA-related severe chin retrognathia and AOB treated with a lingual appliance showed satisfactory improvement in facial profile and occlusion.