title: Treatment of an asymmetric malocclusion: a case report.
abstract: OBJECTIVE
  This case report describes an adult female patient who presented with dental asymmetry associated with bilaterally missing lower first molars, accompanied by extruded and mesially-tipped lower second and third molars. Masticatory dysfunction and temporomandibular joint (TMJ) pain were present during mouth opening and likely related to a posteriorly positioned condyle and anterior disc displacement with reduction.
  
  
  METHODS
  Orthodontic treatment consisted of occlusal plane levelling and mandibular repositioning, achieved using a Multiloop Edgewise Archwire (MEAW) technique. Differential MEAW activation on each side and temporary occlusal composite bite blocks on the lower left third molar were necessary to increase the vertical dimension of the Class II side, which allowed extrusion of the left premolars to a Class I relationship.
  
  
  RESULTS
  The bilateral uprighting of the second and third molars was achieved by tip-back wire activation to level the occlusal plane and intrude these teeth. Elastics worn vertically on the right side and Class II elastics on the left side facilitated occlusal correction. Dental implants for fixed prosthetic rehabilitation of the missing lower left first molar were placed to stabilise the posterior occlusion. Articular disc recovery removed TMJ symptoms and the case was finished with stable sagittal and vertical occlusal relationships.
  
  
  CONCLUSIONS
  Successful management of a canted occlusal plane and the stabilisation of the posterior occlusion, resulted in a recovery of a displaced articular disc and improvement of facial symmetry.
authors: Teresa
authors: T
authors: Pinho
authors: José Júlio
authors: JJ
authors: Pacheco
authors: Filomena
authors: F
authors: Salazar
mesh_terms: D000328:Adult; D001641:Bicuspid / Q000473:pathology; D002508:Cephalometry / Q000379:methods; D019250:Dental Implants, Single-Tooth; D005146:Facial Asymmetry / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis; D008310:Malocclusion / Q000628:therapy*; D008335:Mandibular Condyle / Q000473:pathology; D008963:Molar / Q000473:pathology; D008964:Molar, Third / Q000473:pathology; D016382:Orthodontic Appliance Design; D009969:Orthodontic Wires; D010347:Patient Care Planning; D019224:Temporomandibular Joint Disc / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis; D016388:Tooth Loss / Q000473:pathology; D014087:Tooth Movement Techniques / Q000295:instrumentation / Q000379:methods; D014716:Vertical Dimension