Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters
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1 DOI: /odfen/ J Dentofacial Anom Orthod 2013;16:106 Ó RODF / EDP Sciences C L I N I C A L C A S E S Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters Jacques FAURE 1 INTRODUCTION The clinical cases presented here show how the calculation of two indices can lead to a logical therapeutic decision. Monozygotic twin sisters, 7 years and 2 months old, came in for a consultation on 05/97: presenting with either retained primary lateral incisors or congenitally missing permanent lateral incisors. The dentist has mentioned the possibility of morphological problems after seeing periapical radiographic films and the mother is already worried. All of the radiographic documentation coupled with the delayed eruption of stunted and peg-shaped teeth into the arch confirm the predictive diagnosis: in addition, interceptive treatment using a quad helix expander will make it possible to solve the problem of a unilateral crossbite that afflicted both sisters. Even though the two children look strikingly alike, an in depth study of their records reveals differences that will require two different treatment choices. Caroline, twin T.1. Virginie, twin T.2. Address for correspondence: J. FAURE 10 place Lannes Auch faure_ja@club-internet.fr 1 Article available at or
2 C L I N I C A L C A S E S Caroline, twin T.1. 2 CLINICAL AND CEPHALOMETRIC EXAM 1 (T.1) presents a clear class II division 2 occlusion with a severe overbite, based on a schema of skeletal class I normodivergent (ANB 4, AoBo 0.5 mm, HFA 65) whereas 3 DENTAL MEASUREMENT AND INDICES As for dentition, T.1 has two lateral incisors that look unsightly since they are peg-shaped, with both a short root and crown, whereas T.2 has only a small right incisor with an unsightly left lateral incisor that is larger than the laterals of her sister. one T.1 The primary calculations show a Bolton Index of 0.82 (lower excess) and a very disturbed L/C relationship of The solution of substitution already brings these indices to more normal values, respectively 0.74 and 0.96; stripping on makes it possible to obtain almost ideal values, respectively 0.78 and The solution of substitution becomes that much more obvious since JACQUES FAURE Virginie, twin T.2. twin 2 (T.2), presents a less marked class II occlusion, and a facial schema skeletal class III linear and vertical excess (ANB 1, AoBo -1 mm, HFA 69) that will prove to be evolutionary. we do not wish to do lower extractions (given the slightly retruded profile) and therefore wish to preserve the class II buccal occlusion that is already solidly established. Additionally, a different solution would necessitate a priori some significant (prosthetic) enlargement of 12-22, that might be difficult to accomplish given the size of the roots. two T.2 The table quantifies the extent of the dental discrepancies and the clinically visible difference from T.1 is quite conspicuous. The right lateral incisor of T.2 has the correct dimension compared to that of her sister. The indices are slightly disturbed (Bolton 0.82, lower excess and L/C 2 Faure J. Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters
3 REGARDING MORPHOLOGICAL DIFFERENCES OF THE MAXILLARY ANTERIOR TEETH OF MONOZYGOTIC TWIN SISTERS Caroline, twin T ), but a solution of substitution would hardly improve the Bolton Index and would leave the L/C relationship just as far from the ideal (respectively 0.78 and 0.90). We chose to enlarge mm so as to increase the diameter to THERAPEUTIC CHOICES This rigorous calculation of T.1 is therefore going to lead to a solution of removal of 12-22, with substitution of for and maintaining the class II occlusion in harmony with the initial class II occlusion. 1 mm stripping of 13 and 23 will create esthetic and functional balance; of course, the practitioner must also complete the stripping with a coronoplasty. The bite surfaces must be meticulously polished since this is required in all cases of slightly atypical final 5 TREATMENTS AND RESULTS Multi-bracket treatments lasted two years and two months and two years and five months: for T.1, initial documents were done in 09/01 and multi-bracket treatment lasted from 12/01 to 02/04; Virginie, twin T.2. and to bring the indices to 0.79 and 0.79 respectively. This unilateral enlargement has the advantage of respecting the 11/21 symmetry and of reducing the lateral/central difference that initially was significantly more noticeable on the right. occlusion (anterior substitution and class II occlusion). However for T.2, our treatment will preserve the dysmorphic teeth by performing a sizeable coronary reconstruction on the peg-shaped 22; by doing this, we will avoid any possible retrusion of the anterior dentition that is always detrimental to class III occlusion. Of course, we will therefore maintain the objective of a class I molar and canine. for T.2, initial documents were done in 09/01 and multi-bracket treatment lasted from 12/01 to 07/04; Follow-up treatment that has lasted now for 7 and ½ years has resulted in perfect stability. J Dentofacial Anom Orthod 2013;16: C L I N I C A L C A S E S
4 C L I N I C A L C A S E S Case 1 T.1 JACQUES FAURE Figures 1a to 1k T.1 Beginning of treatment a to c: profile, smile, face at rest portraits. 09/01 (11y 6m); d to f: intra-oral, right, anterior, left views. 09/01 (11y 6m); g to i: casts; right, anterior, left views. 09/01 (11y 6m); j to k: casts, upper and lower occlusal views. 09/01 (11y 6m). 4 Faure J. Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters
5 REGARDING MORPHOLOGICAL DIFFERENCES OF THE MAXILLARY ANTERIOR TEETH OF MONOZYGOTIC TWIN SISTERS Figures 2a to 2j T.2 Beginning of treatment a and b: profile and frontal at rest portraits, 09/01 (11y 6m); c to e: : right profile intra- oral, frontal and left views, 09/01 (11y 6m); f to h: casts, l right, anterior, left views, 09/01 (11y 6m); i and j: casts, lower and upper occlusal views, 09/01 (11y 6m). Case 2 T.2 J Dentofacial Anom Orthod 2013;16: C L I N I C A L C A S E S
6 C L I N I C A L C A S E S Case 1 T.1 JACQUES FAURE Figures 3a to 3c T.1. Beginning of treatment. Digital panoramic view, lateral cephalometric x-ray and traced profiles. 09/01 (11y 6m). Figure 4 T.1. Steiner chevrons, 09/01 (11y 6m) Figures 5a to 5c T.1. Intra-oral views (stages of polishing: 11/03), right profile (a), anterior (b), left profile (c). 6 Faure J. Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters
7 REGARDING MORPHOLOGICAL DIFFERENCES OF THE MAXILLARY ANTERIOR TEETH OF MONOZYGOTIC TWIN SISTERS Figures 6a to 6c T.2. Beginning of treatment. Lateral cephalometric x-ray, traced and digital panoramic view 09/01 (11y 6m). Figure 7 T.2. Steiner chevrons 09/01 (11y 6m). Figures 8a to 8c T.2. Intra-oral views (stages of polishing: 11/03), right profile, face, left profile. Case 2 T.2 J Dentofacial Anom Orthod 2013;16: C L I N I C A L C A S E S
8 C L I N I C A L C A S E S Case 1 T.1 Figures 9a to 9d T.1. a and b: step-up pseudo and pseudo 22-21; c: inset-11-21; d: Curve of Spee accentuated 10 degrees. JACQUES FAURE Figures 10a to 10f T.1. End of treatment a to c: profile, smile, frontal at rest portraits, 02/04 (13y 11m); d to f: intra-oral, right, anterior, left views, 02/04 (13y 11m). 8 Faure J. Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters
9 REGARDING MORPHOLOGICAL DIFFERENCES OF THE MAXILLARY ANTERIOR TEETH OF MONOZYGOTIC TWIN SISTERS Figures 12a to 12f T.2. End of treatment. a to c: profile, smile, frontal at rest portraits, 02/04 (13y 11m); d to f: intra-oral, right, anterior, left views, 02/04 (13y 11m). Case 2 T.2 Figures 11a to 11c T.2. a: step down 11-21; tip back 11; b: step up 11-12, step down 12-13; c: step up J Dentofacial Anom Orthod 2013;16: C L I N I C A L C A S E S
10 C L I N I C A L C A S E S Case 1 T.1 JACQUES FAURE Figures 13a to 13c T.1 End of treatment. Casts, right, anterior, left views, 02/04 (13y 11m). Figures 14a and 14b T.1 End of treatment. Casts, upper and lower occlusal views, 02/04 (13y 11m). Figures 15a and 15b T. 1. End of treatment. 10 Faure J. Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters
11 REGARDING MORPHOLOGICAL DIFFERENCES OF THE MAXILLARY ANTERIOR TEETH OF MONOZYGOTIC TWIN SISTERS Figures 16a to 16c T.2. End of treatment. Casts, right, anterior, left views, 02/04 (13y 11m). Figures 17a and 17b T.2. End of treatment. Casts upper and lower occlusal views, 02/04 (13y 11m). Figures 18a and 18b T.2. End of treatment. Lateral cephalometric x-ray and traced profile views, 02/04 (13y 11m). Case 2 T.2 J Dentofacial Anom Orthod 2013;16: C L I N I C A L C A S E S
12 C L I N I C A L C A S E S Case 1 T.1 JACQUES FAURE Figures 19a to 19f T.1. Post-treatment 7 ½ years later. a to c: profile, smile, frontal at rest portraits, 06/11 (21 y 3m). d to f: intra-oral right, anterior, left views, 06/11 (21y 3m). Figures 20a to 20c T.1. Post-treatment 7 ½ years later. Digital panoramic view, lateral cephalometric x-ray and tracing 06/11 (21y 3m). 12 Faure J. Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters
13 REGARDING MORPHOLOGICAL DIFFERENCES OF THE MAXILLARY ANTERIOR TEETH OF MONOZYGOTIC TWIN SISTERS Figures 21a to 21g T.2. Post-treatment 5 ½ years later. a to c: profile, smile, frontal at rest portraits, 06/09 (19y 3m); d to f: intra-oral right profile, anterior, left, 06/09 (19y 3m); g: reconstruction of 22, colored detail. Figures 22a to 22c T.2. Post-treatment 7 ½ years later. Digital panoramic view, lateral cephalometric x-ray and tracing 06/11 (21y 3m). Case 2 T.2 J Dentofacial Anom Orthod 2013;16: C L I N I C A L C A S E S
14 C L I N I C A L C A S E S Case 1 T.1 Cephalometric Values Figure 24 T.1. Steiner analysis. 6.3 FMIA FMA IMPA SNA SNB ANB AoB0 Occlusal Plane Z Angle Upper Lip Total Chin Post Facial Ht Ant Facial Ht Post/Ant Index Evolution Relationship 7.8 Normal sup Normal sup. Norms 5/97 7a 2m Cephalometric Values SNA SNB ANB SND 1/NAmm 1/NA o 1/NBmm 1/NB o Pog/NB 1/1 Occl/SN GoGn/SN SE SL 1/ENA-ENP /98 8a 5m Norms 5/97 7a 2m JACQUES FAURE 11/99 9a 6m 8/98 8a 5m 37.5 Substit. Sup /01 2/04 11a 6m 13a 11m 11/99 9a 8m 11/05 15a 8m 9/01 11a 6m /11 21a 3m 2/04 13a 11m 11/05 15a 8m Substit. Sup Figure 23 T.1. Tweed analysis. 6/11 21a 3m Figure 25 T.1. Table of measurements and indices. The initial Bolton Indices and L/C of 0.82 and 0.54 are hardly acceptable; the substitution option, completed by a coronoplasty that reduces by 1 mm, leads to new values close to the standards: 0.78 and Faure J. Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters 6.6
15 REGARDING MORPHOLOGICAL DIFFERENCES OF THE MAXILLARY ANTERIOR TEETH OF MONOZYGOTIC TWIN SISTERS Figure 26 T.2. Tweed analysis. Cephalometric Values SNA SNB ANB SND 1/NAmm 1/NA o 1/NBmm 1/NB o Pog/NB 1/1 Occl/SN GoGn/SN SE SL Cephalometric Values FMIA FMA IMPA SNA SNB ANB AoB0 Occlusal Plane Z Angle Post Facial Ht Ant Facial Ht Post/Ant Index Norms Norms Figure 27 T.2. Steiner analysis. Case 2 T.2 J Dentofacial Anom Orthod 2013;16: C L I N I C A L C A S E S
16 C L I N I C A L C A S E S JACQUES FAURE Normal Sup Substit. Sup Inf Normal Sup Substit. Sup. Figure 28 T.2. Table of measurements and indices. The "problem" table shows the Bolton indices and L/C of 0.82 and 0.70 that will increase, by enlarging the diameter of 22, to the new values of 0.79 and Faure J. Regarding morphological differences of the maxillary anterior teeth of monozygotic twin sisters
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