“Treat All with All” – A Multidisciplinary Approach for an Unusual Case Scenario
Keywords:multidisciplinary approach, unusual case, multiple impacted teeth, supernumerary teeth, class III skeletal, bi-jaw surgery.
Impaction of teeth is more common and widespread. Multiple impacted permanent teeth are usually
related to syndromes, metabolic and hormonal disorders. However, in non-syndromic cases impaction of
multiple teeth is rare. In this report, a case of A 23-years-old male patient with missing upper front teeth
and irregularly placed lower front teeth, difficulty in speech and mastication. physical examination was
not suggestive of any syndromes. On Extraoral examination the patient presented with a concave profile,
competent lips, shallow Mento-labial sulcus. On clinical and radiographic examination revealed Angle’s
class III malocclusion on class III skeletal base, with impacted 13,12,11 and 24, anterior cross bite, rotation
of 32,33,35,42,44, and horizontal growth pattern. Extraction of supernumerary teeth was carried out in all
the quadrants and PEA 0.22 ROTH appliance was used to align the arches. Bi-jaw surgery with mandibular
set back with bilateral split sagittal osteotomy and maxillary advancement with Le Fort I was done to attain
ideal overjet and overbite.
The objective of this report is to increase awareness of such cases especially in the absence of hereditary/
genetic/metabolic factors usually inherent in such scenarios. The patient management in such cases needs to
be planned all with all multidisciplinary approach.
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