Case 6640
A 22-year-old female attended the dental office with an initial chief complaint concerning her facial appearance (bimaxillary protrusion). Medical history-taking revealed a history of headaches and fainting with a suspicion of Moyamoya disease, which includes chronic and progressive narrowing of the intra-cranial arteries. Despite these findings, informed consent was obtained, and physical examination was undertaken followed by panoramic radiography (Fig. 13). A working diagnosis of bialveolar protrusion was reached. The treatment plan included extraction of four first premolars and the use of headgear for arch retraction with fixed orthodontics and mini screws to enhance the facial profile. After premolar extractions, her upper lip appeared to become rather thin, impacting the facial profile negatively (Fig. 14). Therefore, fixed orthodontic treatment was not initiated but to counteract this unwanted side effect, the patient elected on biomimetic oral appliance therapy instead. The patient was treated with an upper biomimetic device prior to a lower device being delivered approx. 3 mos. later. This treatment started in 2016 and gradually the facial profile improved (Fig. 15). Moreover, the third molars were now fully erupted (Fig. 16). At this stage, fixed appliance therapy was reinstituted to close the premolar extraction spaces.