INTERDISCIPLINARY MANAGEMENT OF ORTHODONTIC AND RESTORATIVE TREATMENT: A CLINICAL CASE REPORT

Abstract

Purpose: This case report describes a multidisciplinary, growth-centered, and patient-focused strategy in managing a complex malocclusion with bilateral posterior crossbite compounded by Molar-Incisor Hypomineralization (MIH), deleterious oral habits, tonsillar and adenoidal hypertrophy, mouth breathing, open-mouth sleeping, and snoring. Case report: The patient presented with a caries-prone early mixed dentition and multiple restorations, and underwent adenoidectomy and tonsillectomy before Phase I orthodontic treatment. Rapid maxillary expansion (RME) corrected maxillary transverse deficiency and posterior crossbite, followed by retention with a lingual plate. Noncompliance in the retention phase with the removable plate led to relapse. Preformed stainless-steel crowns were placed on the MIH-affected maxillary first permanent molars because of post-eruptive hard-tissue breakdown. Their improper cementation and overcontoured morphology interfered with the eruption of the maxillary second molars. Compromised endodontic treatment of the mandibular left first permanent molar exacerbated periapical pathology, requiring additional restorative and endodontic management. Treatment included crown removal, endodontic retreatment, definitive restorations, and strategic primary tooth extractions to facilitate eruption of the permanent successors. Relapse of maxillary transverse correction and an impacted maxillary canine necessitated Phase II orthodontics during the pubertal growth spurt, combining repeat RME and fixed appliance therapy. Subsequent diastema closure and space management facilitated alignment of the blocked-out canine. Myofunctional therapy complemented the orthodontic treatment and addressed persistent functional disturbances. Conclusions: The interdisciplinary approach corrected the transverse discrepancy, aligned the permanent dentition, restored functional occlusal relationships, and preserved MIH-affected first permanent molars, illustrating the value of coordinated orthodontic, restorative, endodontic, otorhinolaryngological, and functional management in growing patients.