Korean J Orthod.  2009 Aug;39(4):257-272. 10.4041/kjod.2009.39.4.257.

Treatment of skeletal Class II adult patient with vertical and transverse problems caused by nasal airway obstruction using microimplant anchorage

Affiliations
  • 1Department of Orthodontics, School of Dentistry, Wonkwang University, Korea. jongmoon@wonkwang.ac.kr
  • 2The Korean Orthodontic Research Institute Inc., Korea.

Abstract

This case report describes the treatment of an adult patient with a Class I canine and molar relationship but a convex profile with a retrognathic mandible and marked lip protrusion, as well as an excessive lower anterior facial height and reduced transverse width on both arches due to a nasal airway obstruction. The constricted arches were expanded by surgically-assisted rapid palatal expansion and the application of a Schwarz appliance to the maxilla and mandible. Acceptable facial balance was obtained using contemporary directional force technology with microimplant anchorage (MIA), which provided horizontal and vertical anchorage in the maxillary and mandibular posterior teeth, as well as intrusion and torque control in the maxillary anterior teeth, resulting in a favorable counterclockwise mandibular response. The total treatment period was 29 months and the results were acceptable for 13 months after debonding.

Keyword

Airway; Microimplant; Class II; Expansion

MeSH Terms

Adult
Humans
Lip
Mandible
Maxilla
Molar
Nasal Obstruction
Tooth
Torque

Figure

  • Fig 1 Pretreatment facial and intraoral photographs.

  • Fig 2 Pretreatment radiographs.

  • Fig 3 Surgical assisted rapid maxillary expansion on the maxilla and Schwarz appliance on the mandible.

  • Fig 4 Photographs after 28 day expansion of the maxilla and mandible.

  • Fig 5 Photographs after 3.5 months of retention of the maxilla and 5 months of expansion of the mandible.

  • Fig 6. A Denture preparation: retraction of the maxillary and mandibular canines to level six anterior teeth.

  • Fig 6. B Denture correction: en masse retraction with a closing loop archwire supported by mandibular posterior MIs, intruding forces with elastomeric chain between the main archwires and maxillary and mandibular posterior MIs, and unilateral Class III elastics to correct asymmetry.

  • Fig 6. C Denture correction: en masse retraction with closing loop archwire supported by maxillary posterior and anterior microimplants.

  • Fig 6. D Denture completion: directional force and finishing with Class II and cusp seating elastics, and elastomeric chain and microimplants.

  • Fig 7 Post-treatment facial and intraoral photographs.

  • Fig 8 Post-treatment radiographs.

  • Fig 9 13-month retention photographs and radiographs.

  • Fig 10 A, Pretreatment and post-treatment cephalometric superimposition; B, post-treatment and 13-month retention cephalometric superimposition.

  • Fig 11 Schematic illustration of the contemporary directional technology using MIA in the case of Class II div.1 bialveolar protrusion. A, Before treatment; B, placement of posterior MIs, canine retraction for leveling in both arches; C, placement of maxillary anterior MI, en masse retraction of six anterior teeth, using loop mechanics in both arches; D, directional forces; E, Tweed occlusion; F, denture recovery.


Cited by  2 articles

Non-surgical treatment and retention of open bite in adult patients with orthodontic mini-implants
Cheol-Hyun Moon, Joo-Sin Lee, Hyun-Sun Lee, Jin-Hugh Choi
Korean J Orthod. 2009;39(6):402-419.    doi: 10.4041/kjod.2009.39.6.402.

Three-dimensional finite element analysis for determining the stress distribution after loading the bone surface with two-component mini-implants of varying length
Bohm Choi, Dong-Ok Lee, Sung-Seo Mo, Seong-Hun Kim, Ki-Ho Park, Kyu-Rhim Chung, Gerald Nelson, Seong Ho Han
Korean J Orthod. 2011;41(6):423-430.    doi: 10.4041/kjod.2011.41.6.423.


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