Long-term stability of conservative orthodontic treatment in a patient with rheumatoid arthritis and severe condylar resorption

Rheumatoid arthritis is a chronic inflammatory condition that can result in progressive destruction of the articular surfaces of the joints, including the temporomandibular joint. The purpose of this article is to report the conservative correction of a Class II malocclusion in a woman with rheumatoid arthritis. The patient was 32 years 6 months old at the start of treatment. She had a convex profile and a skeletal Class II jaw-base relationship caused by severe condylar resorption. An anterior open bite of −2.0 mm and an excessive overjet of 10.0 mm were observed. Severe crowding was shown in the mandibular incisors. After 8 months of splint therapy, all first premolars were extracted, and 0.018-in preadjusted edgewise appliances were placed in both arches. Class II elastics were used during space closure. After 41 months of active orthodontic treatment, an acceptable occlusion was achieved, and the facial profile was considerably improved. From the cephalometric evaluations, the mandible was rotated counterclockwise, and the mandibular plane angle was significantly decreased. However, the anteroposterior position of the chin was not changed. The condylar resorption was not changed during and after orthodontic treatment. Conclusively, the proper facial profile was maintained, and the occlusion was stable after a 5-year retention period. Our results suggest the possibility of compromised treatment in a Class II malocclusion with an anterior open bite because of rheumatoid arthritis.