Case 3044
A 9-year-old male attended the dental office with his parents who had an initial chief complaint concerning his anterior open bite tendency (Fig. 8). History-taking was unremarkable and the parents were counseled about the possibility of their child needing orthognathic surgery after maturation. However, they preferred a preventive, non-invasive alternative. After receiving informed consent, physical examination was undertaken as well as a panoral radiograph (Fig. 9), which revealed that the tooth germs for #1 and #16 were not identifiable. A working diagnosis of apertognathia with midfacial hypoplasia was reached. The patient started treatment with fixed orthodontic brackets, including a facemask and elastics, but progress was slow. Therefore, the treatment plan was modified to include midfacial development. An upper biomimetic oral device was deployed and gradually the anterior open bite improved (Fig. 10). A lower Wireframe DNA appliance (Fig. 11) was used to re-coordinate the lower arch with changes in the upper arch. The case was finished with standard orthodontic brackets. In this patient, tooth #16 was found to be congenitally absent but using this biomimetic protocol the other three third molars erupted into occlusion (Fig. 12). The patient was advised to continue with oral myofunctional therapy exercises to retain the stability of the outcome.