Korean J Orthod.  2012 Oct;42(5):270-278. 10.4041/kjod.2012.42.5.270.

Correction of dental Class III with posterior open bite by simple biomechanics using an anterior C-tube miniplate

• Ahn HW
• Chung KR
• Kang SM
• Lin L
• Nelson G
• Kim SH

• KMID: 1435403
• DOI: http://doi.org/10.4041/kjod.2012.42.5.270

Abstract

In the correction of dental Class III molar relationship in skeletal Class II patients, uprighting of the mandibular posterior segments without opening the mandible is an important treatment objective. In the case reported herein, a C-tube miniplate fixed to the lower labial symphysis and connected with a nickel-titanium reverse-curved archwire provided effective uprighting of the lower molars, without the need of orthodontic appliances on the mandibular anteriors. Using this approach, an appropriate magnitude of force is exerted on the molars while avoiding any negative effect on the mandibular anteriors.

Keyword

Class III diagnosis; Miniplate; Anchorage; Relapse

MeSH Terms

Biomechanics
Humans
Mandible
Molar
Open Bite
Orthodontic Appliances
Recurrence

Figure

• 

  Figure 1 Schematic illustration of the molar uprighting protocol. Components include a C-tube plate on the symphysis, bonded target posterior teeth, and a reverse-curve NiTi archwire. A, B, Before activation. The reverse-curve NiTi archwire is engaged to the mesially inclined posterior teeth and rests apical to the head I-type C-tube miniplate. C, D, For activation, the midline of the wire is lifted by attaching it to a brass connector from the C-tube. The dotted pink line illustrates the path of force application of the archwire.

• 

  Figure 2 Pre-treatment intraoral photographs. A - E, Posterior open bite resulted from a previous treatment with a twin block-type removable appliance with a posterior bite block (F).

• 

  Figure 3 Pre-treatment. A, Panoramic radiograph and B, lateral cephalogram.

• 

  Figure 4 Surgical placement of the C-tube miniplate on the facial surface of the symphysis and engagement of the archwire. A, A 5-mm vertical incision along the midline (flap unnecessary). B, Adaptation of the miniplate. C, Fixation of the C-tube plate using 2 self-drilling miniscrews (diameter 1.5 mm, length 5 mm) and 1 or 2 sutures. D, E, The brass wire (diameter 0.8 mm) connects the tube hole to the 017 × 025-in reverse-curve NiTi archwire. F, Resin capping on the hook of the brass wire to prevent soft tissue irritation.

• 

  Figure 5 Treatment progress. A-C, Immediately after bonding; D-F, after 3 months; G-I, and after 4 months; J-L, molar uprighting achieved a Class I molar relationship and spontaneous bite closure.

• 

  Figure 6 Detailed changes in the incisors. A, Pre-treatment; B, after 1 month; C, after 4 months; D, after 7 months.

• 

  Figure 7 Post-treatment intraoral photographs.

• 

  Figure 8 Serial lateral cephalograms A-D, and overall superimposition E, initial (solid line) and post-treatment (dotted line). A, Pre-treatment; B, after 1 month; C, after 4 months. D, Debonding at 18 months; mandibular posterior teeth uprighted, and occlusal plane flatter.

• 

  Figure 9 Serial panoramic radiographs. A, Pre-treatment; B, after 1 month; C, after 4 months. D, Debonding at 18 months; mandibular molars were uprighted, and roots parallelism was achieved. Third molar position was improved.

• 

  Figure 10 One year retention extraoral and intraoral photographs.

• 

  Figure 11 One year retention. A, Lateral cephalogram; B, panoramic radiograph; and C, overall superimposition (post-treatment [solid line] and one year retention [dotted line]).

Reference

1. Kim YS, Cha JY, Yu HS, Hwang CJ. Comparison of mandibular anterior alveolar bone thickness in different facial skeletal types. Korean J Orthod. 2010. 40:314–324.

2. Miyajima K, Iizuka T. Treatment mechanics in Class III open bite malocclusion with Tip Edge technique. Am J Orthod Dentofacial Orthop. 1996. 110:1–7.

3. Lee BR, Kang DK, Son WS, Park SB, Kim SS, Kim YI, et al. The relationship between condyle position, morphology and chin deviation in skeletal Class III patients with facial asymmetry using cone-beam CT. Korean J Orthod. 2011. 41:87–97.

4. Kim YH, Han UK, Lim DD, Serraon ML. Stability of anterior openbite correction with multiloop edgewise archwire therapy: A cephalometric follow-up study. Am J Orthod Dentofacial Orthop. 2000. 118:43–54.

5. Enacar A, Ugur T, Toroglu S. A method for correction of open bite. J Clin Orthod. 1996. 30:43–48.

6. Park YC, Lee HA, Choi NC, Kim DH. Open bite correction by intrusion of posterior teeth with miniscrews. Angle Orthod. 2008. 78:699–710.

7. Moon CH, Lee JS, Lee HS, Choi JH. Non-surgical treatment and retention of open bite in adult patients with orthodontic mini-implants. Korean J Orthod. 2009. 39:402–419.

8. Kim MJ, Park SH, Kim HS, Mo SS, Sung SJ, Jang GW, et al. Effects of orthodontic mini-implant position in the dragon helix appliance on tooth displacement and stress distribution: a three-dimensional finite element analysis. Korean J Orthod. 2011. 41:191–199.

9. Deguchi T, Kurosaka H, Oikawa H, Kuroda S, Takahashi I, Yamashiro T, et al. Comparison of orthodontic treatment outcomes in adults with skeletal open bite between conventional edgewise treatment and implant-anchored orthodontics. Am J Orthod Dentofacial Orthop. 2011. 139:4 Suppl. S60–S68.

10. Kuroda S, Yamada K, Deguchi T, Hashimoto T, Kyung HM, Takano-Yamamoto T. Root proximity is a major factor for screw failure in orthodontic anchorage. Am J Orthod Dentofacial Orthop. 2007. 131:4 Suppl. S68–S73.

11. Asscherickx K, Vande Vannet B, Wehrbein H, Sabzevar MM. Success rate of miniscrews relative to their position to adjacent roots. Eur J Orthod. 2008. 30:330–335.

12. Park J, Cho HJ. Three-dimensional evaluation of interradicular spaces and cortical bone thickness for the placement and initial stability of microimplants in adults. Am J Orthod Dentofacial Orthop. 2009. 136:314.e1–314.e12.

13. Kim SH, Yoon HG, Choi YS, Hwang EH, Kook YA, Nelson G. Evaluation of interdental space of the maxillary posterior area for orthodontic mini-implants with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2009. 135:635–641.

14. Chung KR, Kim SH, Kang YG, Nelson G. Orthodontic miniplate with tube as an efficient tool for borderline cases. Am J Orthod Dentofacial Orthop. 2011. 139:551–562.

15. Chang YI, Moon SC. Cephalometric evaluation of the anterior open bite treatment. Am J Orthod Dentofacial Orthop. 1999. 115:29–38.

16. Kim YH. Anterior openbite and its treatment with multiloop edgewise archwire. Angle Orthod. 1987. 57:290–321.

17. Küçükkeleş N, Acar A, Demirkaya AA, Evrenol B, Enacar A. Cephalometric evaluation of open bite treatment with NiTi arch wires and anterior elastics. Am J Orthod Dentofacial Orthop. 1999. 116:555–562.

18. Janson G, Valarelli FP, Beltrão RT, de Freitas MR, Henriques JF. Stability of anterior open-bite extraction and nonextraction treatment in the permanent dentition. Am J Orthod Dentofacial Orthop. 2006. 129:768–774.

19. Korean Association of Orthodontists. Cephalometric norm of Korean adults with normal occlusion. 1998. Seoul: Ji-Sung Publishing Co.;589–595.