Presurgical orthodontic management of a patient with Treacher-Collins Syndrome. A case report

Abstract

Treacher-Collins syndrome, or mandiblefacial dysostosis, is an autosomal dominant craneofacial disorder that involves tissues derived from the first and second branchial arches, that is, structures in the middle and inferior thirds of the face. An 18-year-old male with Treacher-Collins syndrome attended the dental clinic for orthodontic/surgical treatment. Before the surgery, the objectives of treatment were: to eliminate crowding, and to get symmetric canine relations, class II by 2 mm, overbite 20%, overjet=1 mm, and an appropriate bilateral cusp relation in the posterior segment. The procedures were: A 0,018” slot preadjusted appliance was used; first bicuspids in both arches were extracted; initial alignment and leveling was started; maxillary and mandibular cuspids were retracted considering a maximum inferior anchorage and a reciprocal superior anchorage; maxillary and mandibular anterior teeth were retracted; individual torques were applied; and the presurgical orthodontic treatment was finished on rectangular arches with surgical pins. After this orthodontic management optimal arch forms were obtained, as well as a canine and molar asymmetric relationship, overjet=4 mm between 21, 31 y 32; overjet=2.5 mm between 11, 41 and 42, and overbite 10%. With these acceptable findings without symmetric canine relationships, and even the orthodontic treatment needed some times to be interrupted due to a lack in compliance and effective oral hygiene by the patient, it was consider that the patient could continue to the surgical phase.