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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2026, vol. 32, issue3
Subject Area: Dental Medicine
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DOI: 10.5272/jimab.2026323.7088
Published online: 17 September 2026
Case report
J of IMAB. 2026 Jul-Sep;32(3):7088-7102
INTERDISCIPLINARY MANAGEMENT OF ORTHODONTIC AND RESTORATIVE TREATMENT: A CLINICAL CASE REPORT
Karina Dobreva1
, Iliyana Atanasova2, Tsvetelina Borisova-Papancheva3,
1) Student, Faculty of Dental Medicine, Medical University – Varna, Bulgaria.
2) Department of Orthodontics, Faculty of Dental Medicine, Medical University – Varna, Bulgaria.
3) Department of Conservative Dentistry and Oral Pathology, Faculty of Dental Medicine, Medical University – Varna, Bulgaria.
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.
Keywords: Molar Hypomineralization, Palatal Expansion Technique, Malocclusion, Orthodontics, Endodontics, Mouth Breathing, Adenoidectomy, Myofunctional Therapy,
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Please cite this article as: Dobreva K, Atanasova I, Borisova-Papancheva T. Interdisciplinary Management of Orthodontic and Restorative Treatment: A Clinical Case Report. J of IMAB. 2026 Jul-Sep;32(3):7088-7102. [Crossref - 10.5272/jimab.2026323.7088]
Correspondence to: Karina Dobreva, Faculty of Dental Medicine, Medical University of Varna; 84, Tsar Osvoboditel Blvd., 9002 Varna, Bulgaria. E-mail: karina.dobreva@gmail.com
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Received: 20 November 2025
Published online: 17 September 2026