Korean J Orthod.  2009 Feb;39(1):54-65. 10.4041/kjod.2009.39.1.54.

Severe bimaxillary protrusion with adult periodontitis treated by corticotomy and compression osteogenesis

• Kim SH
• Lee KB
• Chung KR
• Nelson G
• Kim TW

• KMID: 1469139
• DOI: http://doi.org/10.4041/kjod.2009.39.1.54

Abstract

This paper describes the case of a 50-year-old female with a Class II malocclusion who presented with severe bimaxillary protrusion and generalized alveolar bone loss due to adult periodontitis. The treatment plan consisted of extracting both upper and lower first premolars and periodontal treatment. Anterior segmental osteotomy (ASO) of the mandible and upper anterior segment retraction using compression osteogenesis after peri-segmental corticotomy (Speedy orthodontics) was performed. Correct overbite and overjet, facial balance, and improvement of lip protrusion were obtained. However, a slight root resorption tendency was observed on the lower anterior dentition. The active treatment period was 9 months and the results were stable for 27 months after debonding. This new type of treatment mechanics can be an effective alternative to orthognathic surgery.

Keyword

Corticotomy; Speedy orthodontics; Skeletal anchorage; Compression osteogenesis; Anterior segment osteotomy; Adult periodontitis

MeSH Terms

Adult
Alveolar Bone Loss
Bicuspid
Chronic Periodontitis
Dentition
Female
Humans
Lip
Malocclusion
Mandible
Mechanics
Middle Aged
Orthognathic Surgery
Osteogenesis
Osteotomy
Overbite
Root Resorption

Figure

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  Fig 1. Facial and intraoral photographs before treatment show a very convex profile with significant mentalis muscle strain and reveal a Class II canine and Class I molar relationship.

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  Fig 2. Pretreatment study models.

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  Fig 3. Radiographs before treatment. A, Cephalogram; B, panoramic radiograph.

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  Fig 4. Schematic illustration of the anterior segment retraction method after perisegmental corticotomy. A, Titanium C palatal plate, drill free screws and C lingual retractor combined lingual retraction; B, labial retractor and C tube combined retraction mechanics.

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  Fig 5. Oral view during speedy orthodontics surgery. A, Oral view after buccal perisegmental corticotomy; B, anterior segmental osteotomy (ASO) on the lower anterior segment.

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  Fig 6. Cone beam CT view (PSR-9000N, Asahi Roentgen, Kyoto, Japan) after perisegmental corticomy. A, Transaxial view; B, 3 dimensional reconstruction view shows the labial perisegmental corticotomized area; C, arrows in sagittal view show depth of corticotomy.

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  Fig 7. Progress on lateral cephalograms. A, 1 week after immediate upper retraction; B, 7 weeks after retraction.

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  Fig 8. Progress in oral views. A and D, 1 week after retraction; B and E, 5 months after retraction; C and F, 6 months after treatment. Fixed appliances were applied for conventional orthodontic treatment.

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  Fig 9. Facial and intraoral photographs after treatment show good overjet, overbite, facial balance, and a reduction of hypermentalis activity.

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  Fig 10. Post-treatment study models.

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  Fig 11. Radiographs after treatment. A, Cephalogram; B, panoramic radiograph.

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  Fig 12. Superimpositions of lateral cephalograms: pretreatment (black line) to post-treatment (red line).

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  Fig 13. 27-month postretention intraoral photographs.

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