Comprehensive orthodontics to a boy with Down syndrome, Class III, impacted canine and endocarditis

OBJECTIVES: The Down syndrome (DS) is a congenital anomaly, affecting individuals of either gender and it is associated with an extra copy of the chromosome 21. The objective of this case report was to describe the early and comprehensive orthodontics of a patient with DS.

MATERIALS AND METHODS: A boy with DS presented for the orthodontic check-up at the age 9 years, when concave profile with moderate skeletal Class III and anterior crossbite were diagnosed in the mixed dentition. The treatment planning was to apply the facemask therapy for correcting his under developed maxillary basal bone.
As the treatment progressed, an unfavorable pathway for the eruption of the permanent canine at the right side was detected in the maxillary arch. We decided to avoid orthodontic traction due to the risk of infective endocarditis. Comprehensive orthodontics with edgewise appliances was followed afterwards, when the other permanent teeth were present.

RESULTS: Facial harmony and a beautiful smile were achieved together with a correct overbite, overjet and normal relationship between antagonist and proximal teeth. A fixed retention was bonded in the mandibular anterior teeth for preventing the incisors anterior projection, as a consequence of inadequate tongue posture.

CONCLUSIONS: The facemask therapy and comprehensive orthodontics were effective to treat a Class III malocclusion with anterior crossbite in patient with DS. In this case, it was reasonable to maintain the deciduous maxillary canine at the right side in occlusion, instead of tractioning the permanent canine, due to the risk of infective endocarditis.

CLINICAL SIGNIFICANCE: The orthodontic treatment allowed for a social inclusion of this boy with DS, in terms of facial appearance and normal physiological activities.

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