Agenesis of mandibular second premolar in patient with dental bimaxillary protrusion
Identifieur interne : 002C07 ( Pmc/Corpus ); précédent : 002C06; suivant : 002C08Agenesis of mandibular second premolar in patient with dental bimaxillary protrusion
Auteurs : Carlos Alberto Estevanell TavaresSource :
- Dental Press Journal of Orthodontics [ 2176-9451 ] ; 2017.
Abstract
The present study reports the treatment carried out in a patient with mandibular second premolar agenesis associated with early loss of a deciduous second molar, deep overbite, severe overjet and dentoalveolar bimaxillary protrusion, which led to lip incompetence and a convex facial profile. The main objectives of this treatment were: to eliminate the spaces in mandibular arch, correct overbite, as well as eliminate bimaxillary protrusion and lip incompetence, thus leading to a balanced profile. The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as part of the requirements to obtain the title of BBO diplomate.
Url:
DOI: 10.1590/2177-6709.22.2.106-117.bbo
PubMed: 28658362
PubMed Central: 5484276
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Agenesis of mandibular second premolar in patient with dental bimaxillary protrusion</title><author><name sortKey="Tavares, Carlos Alberto Estevanell" sort="Tavares, Carlos Alberto Estevanell" uniqKey="Tavares C" first="Carlos Alberto Estevanell" last="Tavares">Carlos Alberto Estevanell Tavares</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28658362</idno><idno type="pmc">5484276</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484276</idno><idno type="RBID">PMC:5484276</idno><idno type="doi">10.1590/2177-6709.22.2.106-117.bbo</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">002C07</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002C07</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Agenesis of mandibular second premolar in patient with dental bimaxillary protrusion</title><author><name sortKey="Tavares, Carlos Alberto Estevanell" sort="Tavares, Carlos Alberto Estevanell" uniqKey="Tavares C" first="Carlos Alberto Estevanell" last="Tavares">Carlos Alberto Estevanell Tavares</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Dental Press Journal of Orthodontics</title><idno type="ISSN">2176-9451</idno><idno type="eISSN">2177-6709</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>ABSTRACT</title><p>The present study reports the treatment carried out in a patient with mandibular second premolar agenesis associated with early loss of a deciduous second molar, deep overbite, severe overjet and dentoalveolar bimaxillary protrusion, which led to lip incompetence and a convex facial profile. The main objectives of this treatment were: to eliminate the spaces in mandibular arch, correct overbite, as well as eliminate bimaxillary protrusion and lip incompetence, thus leading to a balanced profile. The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as part of the requirements to obtain the title of BBO diplomate.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gedrange, T" uniqKey="Gedrange T">T Gedrange</name></author><author><name sortKey="Boening, K" uniqKey="Boening K">K Boening</name></author><author><name sortKey="Harzer, W" uniqKey="Harzer W">W. Harzer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bergstrom, K" uniqKey="Bergstrom K">K Bergstrom</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rolling, S" uniqKey="Rolling S">S Rolling</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mamopoulou, A" uniqKey="Mamopoulou A">A Mamopoulou</name></author><author><name sortKey="H Gg, U" uniqKey="H Gg U">U Hägg</name></author><author><name sortKey="Schroder, U" uniqKey="Schroder U">U Schröder</name></author><author><name sortKey="Hansen, K" uniqKey="Hansen K">K Hansen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zimmer, B" uniqKey="Zimmer B">B Zimmer</name></author><author><name sortKey="Schelper, I" uniqKey="Schelper I">I Schelper</name></author><author><name sortKey="Seifi Shirvandeh, N" uniqKey="Seifi Shirvandeh N">N Seifi-Shirvandeh</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ostler, M" uniqKey="Ostler M">M Ostler</name></author><author><name sortKey="Kokich, V" uniqKey="Kokich V">V Kokich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kokich, V" uniqKey="Kokich V">V Kokich</name></author><author><name sortKey="Spear, Fm" uniqKey="Spear F">FM Spear</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Dental Press J Orthod</journal-id><journal-id journal-id-type="iso-abbrev">Dental Press J Orthod</journal-id><journal-id journal-id-type="publisher-id">dpjo</journal-id><journal-title-group><journal-title>Dental Press Journal of Orthodontics</journal-title></journal-title-group><issn pub-type="ppub">2176-9451</issn><issn pub-type="epub">2177-6709</issn><publisher><publisher-name>Dental Press International</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28658362</article-id><article-id pub-id-type="pmc">5484276</article-id><article-id pub-id-type="doi">10.1590/2177-6709.22.2.106-117.bbo</article-id><article-categories><subj-group subj-group-type="heading"><subject>BBO Case Report</subject></subj-group></article-categories><title-group><article-title>Agenesis of mandibular second premolar in patient with dental bimaxillary protrusion</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Tavares</surname><given-names>Carlos Alberto Estevanell</given-names></name><xref ref-type="aff" rid="aff1"><bold><sup>1</sup></bold></xref></contrib><aff id="aff1"><label>1</label>Professor, Specialization course in Orthodontics, Associação Brasileira de Odontologia-RS (Rio Grande do Sul, Brazil)</aff></contrib-group><author-notes><corresp id="c1">Contact address: Carlos Alberto Estevanell Tavares Rua Furriel Luiz Antonio Vargas, 250, conj. 1404, Porto Alegre/RS - CEP: 90.470-130 - E-mail: <email>carlos.a.e.tavares@gmail.com</email></corresp><fn fn-type="COI-statement" id="fn1"><p>" The author reports no commercial, proprietary or financial interest in the products or companies described in this article.</p></fn></author-notes><pub-date pub-type="epub-ppub"><season>Mar-Apr</season><year>2017</year></pub-date><pmc-comment>Fake ppub date generated by PMC from publisher
pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><season>Mar-Apr</season><year>2017</year></pub-date><volume>22</volume><issue>2</issue><fpage>106</fpage><lpage>117</lpage><history><date date-type="received"><day>18</day><month>1</month><year>2017</year></date><date date-type="accepted"><day>03</day><month>3</month><year>2017</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License</license-p></license></permissions><abstract><title>ABSTRACT</title><p>The present study reports the treatment carried out in a patient with mandibular second premolar agenesis associated with early loss of a deciduous second molar, deep overbite, severe overjet and dentoalveolar bimaxillary protrusion, which led to lip incompetence and a convex facial profile. The main objectives of this treatment were: to eliminate the spaces in mandibular arch, correct overbite, as well as eliminate bimaxillary protrusion and lip incompetence, thus leading to a balanced profile. The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as part of the requirements to obtain the title of BBO diplomate.</p></abstract><trans-abstract xml:lang="pt"><title>RESUMO</title><p>O presente caso clínico relata o tratamento de uma paciente com agenesia de segundo pré-molar inferior associada à perda precoce do segundo molar decíduo, sobremordida profunda, sobressaliência exagerada e biprotrusão dentoalveolar, que causavam incompetência labial e perfil facial convexo. Os objetivos do tratamento foram eliminar os espaços presentes na arcada inferior, corrigir a sobremordida, eliminar a biprotrusão e a incompetência labial, harmonizando o perfil. Esse caso foi apresentado ao Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) como parte dos requisitos para obtenção do título de Diplomado pelo BBO.</p></trans-abstract><kwd-group><title>Keywords:</title><kwd>Tooth agenesis</kwd><kwd>Corrective Orthodontics</kwd><kwd>Tooth extraction.</kwd></kwd-group><counts><fig-count count="15"></fig-count><table-count count="1"></table-count><equation-count count="0"></equation-count><ref-count count="8"></ref-count><page-count count="12"></page-count></counts></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Tooth agenesis is part of orthodontic routine, being found among 4-5% of the overall population, without including third molars. Such an incidence increases to 9% when patients seeking orthodontic treatment are taken into consideration.<xref rid="B1" ref-type="bibr"><sup>1</sup></xref></p><p>With a prevalence of 2.5-4%, mandibular second premolars are the most commonly affected teeth, followed by third molars.<xref rid="B2" ref-type="bibr"><sup>2</sup></xref><sup>,</sup><xref rid="B3" ref-type="bibr"><sup>3</sup></xref> In most patients, agenesis affects both sides of the dental arch (nearly 60% of cases), whereas it affects a single tooth only on a smaller scale.<xref rid="B3" ref-type="bibr"><sup>3</sup></xref> With advances in Orthodontics, a number of therapeutic options became available for agenesis treatment, namely: spontaneous space closure, autotransplantation, implants, mini-implants, anchorage for space closure.<xref rid="B4" ref-type="bibr"><sup>4</sup></xref> The orthodontic mechanics of choice must consider whether agenesis affects both sides or not. Arguments in favor of contralateral tooth extraction are more common than unilateral space closure, due to potential difficulties involved not only in mesially displacing molars to an edentulous area, but also in achieving a satisfactory occlusion in the posterior region.<xref rid="B5" ref-type="bibr"><sup>5</sup></xref></p></sec><sec><title>CASE REPORT</title><p>A 11-year and 6-month-old female patient sought orthodontic treatment with chief complaint of dental protrusion and lip incompetence. Her family medical history presented with no major occurrences nor reported any trauma affecting her teeth or face.</p></sec><sec><title>DIAGNOSIS</title><p>Facial examination revealed a rather decreased nasolabial angle and an everted lower lip, in addition to lip incompetence. Smile line was considered adequate (<xref ref-type="fig" rid="f1">Fig 1</xref>).</p><p>Intraoral examination revealed 6-mm overjet and 60% of overbite, in addition to the presence of 5-mm space in the mandibular arch and minimal crowding in the maxillary arch. The #45 tooth was missing and #47 tooth was found to be impacted, whereas #46 tooth was 3.0 mm mesially displaced, in relation to #36 and #43 teeth, and distally displaced in relation to #33 tooth. Occlusal relationship was of Class I for molars and Class II for canines on the right side, and Class I for molars and edge-to-edge for canines on the left side (Figs <xref ref-type="fig" rid="f1">1</xref> and <xref ref-type="fig" rid="f2">2</xref>).</p><p>Radiographic analysis revealed #45 tooth congenitally missing, in addition to four developing third molars and absence of caries or other pathologies. Cephalometric analysis suggested Class II skeletal pattern (ANB = 5<sup>o)</sup>, predisposition to vertical facial growth (FMA = 29<sup>o</sup>, Y-axis = 64<sup>o)</sup> and bimaxillary protrusion, with lower and upper lips 2 and 3 mm forward in relation to the S-line, respectively (1.NA = 31<sup>o</sup>, 1.NB = 32.5<sup>o</sup>, and IMPA = 98<sup>o)</sup> (Figs 3 and 4).</p><p><fig id="f1" orientation="portrait" position="float"><label>Figure 1</label><caption><title>Initial facial and intraoral photographs.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf1"></graphic></fig></p><p><fig id="f2" orientation="portrait" position="float"><label>Figure 2</label><caption><title>Initial casts.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf2"></graphic></fig></p><p><fig id="f3" orientation="portrait" position="float"><label>Figure 3</label><caption><title>Initial panoramic radiograph.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf3"></graphic></fig></p><p><fig id="f4" orientation="portrait" position="float"><label>Figure 4</label><caption><title>Initial lateral cephalogram (A) and cephalometric tracing (B).</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf4"></graphic></fig></p></sec><sec><title>TREATMENT PLAN</title><p>Treatment objectives were as follows: to reduce overjet and overbite, achieve a Class I canine relationship, upright incisors, correct #47 tooth impaction, carry out space closure and achieve a symmetrical mandibular arch. As regards facial aesthetics, treatment objectives were: to decrease lip protrusion and increase lip seal. </p><p>Treatment plan included extraction of #14, #24 and #35 teeth, orthodontic appliance placement with 0.022 x 0.028-in slot metal brackets, and a sequence of 0.014-in, 0.016-in and 0.017 x 0.022-in NiTi archwires, followed by 0.018 x 0.025-in and 0.019 x 0.025-in SS archwires, in addition to retraction of #13, #23, #34, #44, #33 and #43 teeth with elastomeric chain. Subsequently, after tooth retraction, 0.019 x 0.025-in archwires with teardrop loops were used for incisors retraction and closure of remaining spaces. For finishing and torque control, maxillary and mandibular 0.019 x 0.025-in SS archwires were manufactured to be used in coordination. After fixed appliance debonding, a fixed canine-to-canine lingual bar retainer was placed in the mandibular arch, whereas a wrapround removable retention was placed in the maxillary arch.</p><p>Alternative treatment included distalization mechanics, such as extraoral appliance and intermaxillary elastics, in addition to keeping agenesis space unchanged for future prosthetic rehabilitation. Nowadays, the first choice for prosthetic rehabilitation of a congenitally missing premolar is implant treatment.<xref rid="B6" ref-type="bibr"><sup>6</sup></xref> However, implants are not stable before facial growth completion. Ostler and Kokich<xref rid="B7" ref-type="bibr"><sup>7</sup></xref> assessed long-term changes in the bone crest after deciduous second molar extraction, and showed that the bone crest decreased in 25% during the first four years after extraction and 5% during the following three years, thus totaling 30% in seven years. Resorption is more often at the buccal surface of the bone crest and although the authors have showed that gingival crest width is enough to receive implants after this period, they would have to be placed more lingually than ideal.<xref rid="B8" ref-type="bibr"><sup>8</sup></xref> Another alternative would be carrying out bone graft. Since the patient presented with bimaxillary protrusion, extraction of #14, #24 and #35 teeth was considered as being more favorable.</p></sec><sec><title>TREATMENT PROGRESS </title><p>Treatment was carried out as planned. After extraction of #14, #24 and #35 teeth, the fixed appliance was bonded to both arches. Subsequently, alignment and leveling were carried out with the use of NiTi and 0.020-in SS archwires. As a result of the use of those archwires, maxillary canines, first premolars and mandibular canines were retracted with elastomeric chain connected to second molars. After complete retraction of premolars and canines, retraction 0.019 x 0.026-in SS archwires with vertical teardrop loops were manufactured for space closure in both arches. An additional lower archwire with unilateral T-loop was rendered necessary for space closure finishing on the left side. Once space closure was complete, 0.019 x 0.026-in SS archwires were placed for finishing. The use of Class II bilateral intermaxillary elastics, especially on the left side, was rendered necessary for a few months. Treatment was concluded within the estimated time of 24 months (<xref ref-type="fig" rid="f5">Fig 5</xref>).</p><p><fig id="f5" orientation="portrait" position="float"><label>Figure 5</label><caption><title>Intermediate photographs (incisors retraction).</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf5"></graphic></fig></p></sec><sec sec-type="results"><title>RESULTS</title><p>Facial analysis carried out after orthodontic appliance removal suggested significant improvement in facial profile, which became straight by the end of treatment. The patient reported herein achieved spontaneous lip seal and a highly pleasing smile, with corrected smile line, showing 100% of anterosuperior teeth (<xref ref-type="fig" rid="f7">Fig 7</xref>).</p><p>Intraoral assessment revealed excellent intercuspation with molars and canines positioned in correct Class I relationship. Overbite and overjet correction was achieved and dental midlines were coinciding with each other and with the facial midline. Spaces and dental rotation were eliminated in both arches. Second molars were well positioned and in correct occlusion (<xref ref-type="fig" rid="f6">Figs 6</xref> and <xref ref-type="fig" rid="f7">7</xref>).</p><p>Final radiographs revealed root parallelism and absence of significant root resorption. It was also noted that due to extractions carried out during treatment, enough spaces were created, so as to allow eruption of all four third molars within natural time (<xref ref-type="fig" rid="f8">Fig 8</xref>).</p><p><fig id="f6" orientation="portrait" position="float"><label>Figure 6</label><caption><title>Final facial and intraoral photographs.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf6"></graphic></fig></p><p><fig id="f7" orientation="portrait" position="float"><label>Figure 7</label><caption><title>Final casts.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf7"></graphic></fig></p><p><fig id="f8" orientation="portrait" position="float"><label>Figure 8</label><caption><title>Final panoramic radiograph.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf8"></graphic></fig></p><p><fig id="f9" orientation="portrait" position="float"><label>Figure 9</label><caption><title>Final lateral cephalogram (A) and cephalometric tracing (B).</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf9"></graphic></fig></p><p>Cephalometric analysis suggested that Class II skeletal pattern remained unchanged (ANB = 5<sup>o)</sup>, in addition to a slightly decrease in predisposition to vertical facial growth (FMA = 28<sup>o</sup>, Y-axis = 62<sup>o)</sup>. Moreover, bimaxillary protrusion was eliminated and lower and upper lips remained 0.5 and 1mm forward in relation to the S-line, respectively (1.NA = 3mm, 1.NB = 3mm, and IMPA = 92<sup>o)</sup> (<xref ref-type="fig" rid="f9">Fig 9</xref>). </p><p>Analysis of initial and final cephalometric tracings superimposition revealed that the patient presented satisfactory growth pattern, incisors were relocated, especially the maxillary ones, and molars were in mesial position as a result of extractions carried out during treatment (<xref ref-type="fig" rid="f10">Fig 10</xref>).</p></sec><sec><title>TEN YEARS AFTER TREATMENT</title><p>Records obtained ten years after orthodontic treatment conclusion revealed complete stability of achieved results. Third molars erupted in occlusion, except for #38 tooth, which remained semi-impacted, thus needing to be uprighted for further disimpaction (Figs <xref ref-type="fig" rid="f11">11</xref> and <xref ref-type="fig" rid="f12">12</xref>).</p><p>Radiographic assessment revealed healthy teeth and supporting structures (<xref ref-type="fig" rid="f13">Fig 13</xref>). Additionally, cephalometric analysis revealed that treatment results remained unchanged, whereas cephalometric tracings superimposition evinced that the patient presented considerable facial growth after orthodontic treatment completion (Figs <xref ref-type="fig" rid="f14">14</xref> and <xref ref-type="fig" rid="f15">15</xref>).</p><p><fig id="f10" orientation="portrait" position="float"><label>Figure 10</label><caption><title>Total (A) and partial (B) cephalometric superimpositions of initial (black) and final (red) tracings.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf10"></graphic></fig></p><p><fig id="f11" orientation="portrait" position="float"><label>Figure 11</label><caption><title>Facial and intraoral photographs ten years after orthodontic treatment.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf11"></graphic></fig></p><p><fig id="f12" orientation="portrait" position="float"><label>Figure 12</label><caption><title>Casts obtained ten years after orthodontic treatment.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf12"></graphic></fig></p><p><fig id="f13" orientation="portrait" position="float"><label>Figure 13</label><caption><title>Panoramic radiograph obtained ten years after orthodontic treatment.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf13"></graphic></fig></p><p><fig id="f14" orientation="portrait" position="float"><label>Figure 14</label><caption><title>Lateral cephalogram (A) and cephalometric tracing (B) obtained ten years after orthodontic treatment.</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf14"></graphic></fig></p><p><fig id="f15" orientation="portrait" position="float"><label>Figure 15</label><caption><title>Total (A) and partial (B) cephalometric superimpositions of initial (black) and final (red) tracings as well as tracings obtained ten years after orthodontic treatment (green).</title></caption><graphic xlink:href="2176-9451-dpjo-22-02-00106-gf15"></graphic></fig></p><p><table-wrap id="t1" orientation="portrait" position="float"><label>Table 1</label><caption><title>Initial (A), final (B) and ten years after orthodontic treatment (C) cephalometric values.</title></caption><table frame="hsides" rules="groups"><colgroup span="1"><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col><col span="1"></col></colgroup><tbody><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Measurements</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Normal</td><td align="left" rowspan="1" colspan="1">A</td><td align="left" rowspan="1" colspan="1">B</td><td align="left" rowspan="1" colspan="1">C</td><td align="left" rowspan="1" colspan="1">A/B diff.</td></tr><tr><td align="left" rowspan="1" colspan="1">Skeletal pattern</td><td align="left" rowspan="1" colspan="1">SNA</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">82o</td><td align="left" rowspan="1" colspan="1">87o</td><td align="left" rowspan="1" colspan="1">89o</td><td align="left" rowspan="1" colspan="1">88o</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">SNB</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">80o</td><td align="left" rowspan="1" colspan="1">82o</td><td align="left" rowspan="1" colspan="1">84o</td><td align="left" rowspan="1" colspan="1">83o</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">ANB</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">2o</td><td align="left" rowspan="1" colspan="1">5o</td><td align="left" rowspan="1" colspan="1">5o</td><td align="left" rowspan="1" colspan="1">4o</td><td align="left" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Wits</td><td align="left" rowspan="1" colspan="1">(Jacobson)</td><td align="left" rowspan="1" colspan="1">♀ 0 ±2 mm ♂ 1 ±2 mm</td><td align="left" rowspan="1" colspan="1">+3mm</td><td align="left" rowspan="1" colspan="1">+1mm</td><td align="left" rowspan="1" colspan="1">3mm</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Angle of convexity</td><td align="left" rowspan="1" colspan="1">(Downs)</td><td align="left" rowspan="1" colspan="1">0o</td><td align="left" rowspan="1" colspan="1">11o</td><td align="left" rowspan="1" colspan="1">9o</td><td align="left" rowspan="1" colspan="1">11o</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Y-axis</td><td align="left" rowspan="1" colspan="1">(Downs)</td><td align="left" rowspan="1" colspan="1">59o</td><td align="left" rowspan="1" colspan="1">64o</td><td align="left" rowspan="1" colspan="1">62o</td><td align="left" rowspan="1" colspan="1">67o</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Facial angle</td><td align="left" rowspan="1" colspan="1">(Downs)</td><td align="left" rowspan="1" colspan="1">87o</td><td align="left" rowspan="1" colspan="1">85o</td><td align="left" rowspan="1" colspan="1">84o</td><td align="left" rowspan="1" colspan="1">88o</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">SN-GoGn</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">32o</td><td align="left" rowspan="1" colspan="1">28o</td><td align="left" rowspan="1" colspan="1">29o</td><td align="left" rowspan="1" colspan="1">29o</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">FMA</td><td align="left" rowspan="1" colspan="1">(Tweed)</td><td align="left" rowspan="1" colspan="1">25o</td><td align="left" rowspan="1" colspan="1">29o</td><td align="left" rowspan="1" colspan="1">28o</td><td align="left" rowspan="1" colspan="1">27o</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">Dental pattern</td><td align="left" rowspan="1" colspan="1">IMPA</td><td align="left" rowspan="1" colspan="1">(Tweed)</td><td align="left" rowspan="1" colspan="1">90o</td><td align="left" rowspan="1" colspan="1">98o</td><td align="left" rowspan="1" colspan="1">92o</td><td align="left" rowspan="1" colspan="1">91o</td><td align="left" rowspan="1" colspan="1">6</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1.NA (degrees)</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">22o</td><td align="left" rowspan="1" colspan="1">31o</td><td align="left" rowspan="1" colspan="1">21o</td><td align="left" rowspan="1" colspan="1">21o</td><td align="left" rowspan="1" colspan="1">10</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1-NA (mm)</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">4 mm</td><td align="left" rowspan="1" colspan="1">4mm</td><td align="left" rowspan="1" colspan="1">3mm</td><td align="left" rowspan="1" colspan="1">3mm</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1.NB (degrees)</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">25o</td><td align="left" rowspan="1" colspan="1">32o</td><td align="left" rowspan="1" colspan="1">24o</td><td align="left" rowspan="1" colspan="1">23o</td><td align="left" rowspan="1" colspan="1">8</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1-NB (mm)</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">4 mm</td><td align="left" rowspan="1" colspan="1">3mm</td><td align="left" rowspan="1" colspan="1">3mm</td><td align="left" rowspan="1" colspan="1">3mm</td><td align="left" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1 1 - Interincisal angle</td><td align="left" rowspan="1" colspan="1">(Downs)</td><td align="left" rowspan="1" colspan="1">130o</td><td align="left" rowspan="1" colspan="1">113o</td><td align="left" rowspan="1" colspan="1">129o</td><td align="left" rowspan="1" colspan="1">132o</td><td align="left" rowspan="1" colspan="1">16</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1-APo</td><td align="left" rowspan="1" colspan="1">(Ricketts)</td><td align="left" rowspan="1" colspan="1">1 mm</td><td align="left" rowspan="1" colspan="1">4mm</td><td align="left" rowspan="1" colspan="1">1mm</td><td align="left" rowspan="1" colspan="1">2mm</td><td align="left" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1">Profile</td><td align="left" rowspan="1" colspan="1">Upper lip - S-line</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">0 mm</td><td align="left" rowspan="1" colspan="1">3mm</td><td align="left" rowspan="1" colspan="1">1mm</td><td align="left" rowspan="1" colspan="1">-2mm</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Lower lip - S-line</td><td align="left" rowspan="1" colspan="1">(Steiner)</td><td align="left" rowspan="1" colspan="1">0 mm</td><td align="left" rowspan="1" colspan="1">2mm</td><td align="left" rowspan="1" colspan="1">0,5mm</td><td align="left" rowspan="1" colspan="1">0mm</td><td align="left" rowspan="1" colspan="1">1,5</td></tr></tbody></table></table-wrap></p></sec><sec><title>FINAL CONSIDERATIONS</title><p>Orthodontic treatment with extraction of maxillary first premolars and left mandibular second premolar proved to be a viable treatment option for this case of agenesis of mandibular second premolar, on the right side and bimaxillary protrusion. 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