Korean J Orthod.  2010 Aug;40(4):276-287. 10.4041/kjod.2010.40.4.276.

Severe bidentoalveolar protrusion treated with lingual Biocreative therapy using palatal miniplate

• Chung KR
• Jeong DM
• Park HJ
• Kim SH
• Nelson G

• KMID: 1975608
• DOI: http://doi.org/10.4041/kjod.2010.40.4.276

Abstract

This case report describes the treatment of a 23-year, 8-month-old female patient with a Class II malocclusion who showed severe bidentoalveolar protrusion and anterior crowding. The treatment plan consisted of extracting all the first premolars, decrowding and en masse retraction of the upper six anterior teeth and lower anteriors. The upper C-plate placed in the midpalatal area combined with lingual sheath fixtures were used as substitutes for posterior anchorage teeth during upper anterior retraction. Preadjusted brackets (0.022-inch) were used for upper anterior decrowding. A 0.9 mm diameter stainless steel lever-arm soldered to the main arch wire facilitated controlled retraction of upper anteriors. The upper and lower dentition was detailed using a tooth positioner during the finishing stage. Correct overbite and overjet were obtained by decrowding and retraction of the upper six anterior teeth into their proper positions. Use of the C-plate and lingual appliances provided ideal anchorage to enhance the improvement in facial balance. The active treatment period was 19 months. The treatment result was stable 13 months after debonding.

Keyword

Lingual orthodontics; En masse retraction; Biocreative therapy; Miniplate; Bidentoalveolar protrusion; C-plate

MeSH Terms

Bicuspid
Crowding
Dentition
Female
Humans
Infant
Malocclusion
Overbite
Stainless Steel
Tooth
Stainless Steel

Figure

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  Fig. 1 Treatment progress showing occlusal photos of C-lingual retractor and C-plate combined retraction. A, One week after force application; B, 5 months after force application; C, decrowding and finishing using 2-D lingual brackets.

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  Fig. 2 Clinical procedure of C plate combined lingual tube appliance. A, C-plate inserted in the midpalatal suture area; B, application of 0.9 mm diameter stainless steel archwire for extension arm; C, 0.9 mm diameter lingual tubes are soldered to the extension arm and adapted to the C plate arm; D, resin application to the extension arm and C plate arm.

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  Fig. 3 Bracket systems for C plate combined retraction mechanics. A, 0.022-in slot Delta force low friction system (left, frontal view; right, lateral view); B, 2-D lingual bracket system.

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  Fig. 4 Pretreatment extraoral and intraoral photographs.

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  Fig. 5 Pretreatment study models.

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  Fig. 6 Pretreatment lateral cephalometric radiograph (A) and panoramic radiograph (B).

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  Fig. 7 Progress intraoral photographs (A to E) and lateral cephalometric radiograph (F). En masse retraction of 6 anterior teeth with 0.016 × 0.022-inch stainless steel mushroom arch wire inserted in the C-plate combined lingual tube appliance hole, with power chains placed between the extended wire of the hole and cuspid bracket.

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  Fig. 8 Occlusal changes during the C-plate combined appliance dependent en masse retraction period. A, 4 months; B, 7 months; C, 12 months after force application.

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  Fig. 9 Intraoral photographs (A to E) and lateral cephalometric radiograph (F) after 13 months of active treatment.

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  Fig. 10 Posttreatment extraoral and intraoral photographs.

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  Fig. 11 Posttreatment lateral cephalometric radiograph (A) and panoramic radiograph (B).

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  Fig. 12 Superimpositions of lateral cephalometric radiographs: pretreatment (black line) to posttreatment (red line).

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  Fig. 13 13-month postretention intraoral photographs.

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