Korean J Orthod.  2016 Jul;46(4):253-265. 10.4041/kjod.2016.46.4.253.

Nonsurgical correction of a severe anterior deep overbite accompanied by a gummy smile and posterior scissor bite using a miniscrew-assisted straight-wire technique in an adult high-angle case

• Wang XD
• Zhang JN
• Liu DW
• Lei FF
• Zhou YH

• KMID: 2392205
• DOI: http://doi.org/10.4041/kjod.2016.46.4.253

Abstract

In the present report, we describe the successful use of miniscrews to achieve vertical control in combination with the conventional sliding MBTâ„¢ straight-wire technique for the treatment of a 26-year-old Chinese woman with a very high mandibular plane angle, deep overbite, retrognathic mandible with backward rotation, prognathic maxilla, and gummy smile. The patient exhibited skeletal Class II malocclusion. Orthodontic miniscrews were placed in the maxillary anterior and posterior segments to provide rigid anchorage and vertical control through intrusion of the incisors and molars. Intrusion and torque control of the maxillary incisors relieved the deep overbite and corrected the gummy smile, while intrusion of the maxillary molars aided in counterclockwise rotation of the mandibular plane, which consequently resulted in an improved facial profile. After 3.5 years of retention, we observed a stable, well-aligned dentition with ideal intercuspation and more harmonious facial contours. Thus, we were able to achieve a satisfactory occlusion, a significantly improved facial profile, and an attractive smile for this patient. The findings from this case suggest that nonsurgical correction using miniscrew anchorage is an effective approach for camouflage treatment of high-angle cases with skeletal Class II malocclusion.

Keyword

High mandibular plane angle; Vertical control; Gummy smile; Orthodontic miniscrew

MeSH Terms

Adult*
Asian Continental Ancestry Group
Dentition
Female
Humans
Incisor
Malocclusion
Mandible
Maxilla
Molar
Overbite*
Torque

Figure

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  Figure 1 Pretreatment facial photographs show mouth protrusion, retrognathic mandible, increased lower facial height, gummy smile and incompetent lips. Pretreatment intraoral photographs show an Angle Class II molar relationship, a severe anterior deep bite, moderate crowding of the lower arch, shifted lower midline, and old crown restorations with gingival inflammation in the maxillary incisors.

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  Figure 2 Pretreatment dental casts. An Angle Class II molar relationship, anterior deep bite (100%), moderate crowding of the lower arch and a posterior scissor bite between the maxillary and mandibular left second molars can be observed.

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  Figure 3 Pretreatment cephalogram (A), cephalometric tracing (B), and panoramic radiograph (C). Pretreatment cephalogram shows a skeletal Class II malocclusion with a retrognathic mandible and a very high mandibular plane angle. The maxillary incisors are lingually inclined and angled between the crowns and roots because of the angulated post-core crowns. Pretreatment panoramic radiographs show post-core restorations in the maxillary incisors, mesially impacted lower right third molar, and the root of the lower right second premolar is packed with filling materials.

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  Figure 4 Detailed treatment progression. A, Three months after bonding. Fixed appliances applied with 0.016-inch nickel-titanium archwires. The maxillary left palatal miniscrew is used for intrusion and lingual movement of the maxillary left second molar. B, Seven months after bonding. Severe gummy smile can be observed on full smile. Conventional sliding mechanics using 0.019 × 0.025-inch stainless steel archwire is used for space closure in both arches, with tiebacks to the miniscrews. The miniscrews are used to intrude the maxillary molars and anterior teeth. Class II intermaxillary elastics are used for a short time for mesial movement of the mandibular molars and correction of the molar relationship.

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  Figure 5 A, Correction of scissor bite using the maxillary left palatal miniscrew. An elastic tieback with a single power-chain unit is tied from the miniscrew to the maxillary left second molar. B, The maxillary molars are intruded using elastic tiebacks connected to the palatal miniscrews (approximately 50 gN). C, The maxillary molars are intruded using elastic tiebacks connected to the buccal miniscrews (approximately 50 gN). The space in both arches is closed using the elastic tiebacks (approximately 180 gN). D, The maxillary incisors are intruded using miniscrews with a light force (approximately 50 gN). E, At 7 months after bonding, a severe gummy smile can be observed. F, At 19 months after bonding, the gingival visibility has evidently decreased.

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  Figure 6 Facial and extraoral photographs obtained at 19 months after bonding. The gingival visibility has evidently decreased. A helical spring is used to reserve space for crowns or veneers on the maxillary incisors.

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  Figure 7 Post-treatment facial and intraoral photographs. The facial profile has been improved, ideal intercuspation with Class I molar and canine relationships are achieved; the overjet and overbite have been decreased, with space reservation for further restoration of the maxillary incisors.

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  Figure 8 Facial and intraoral photographs obtained after final restorations. The post-treatment facial photographs show the facial esthetics has been obviously improved with the chin deficiency corrected and the lower facial height decreased. The gummy smile is dramatically improved. The post-treatment intraoral photographs show Class I molar and canine relationships with normalized overjet and overbite.

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  Figure 9 Post-treatment dental casts. The dentition is well aligned, the scissor bite and deep overbite are corrected, and ideal intercuspation with solid lingual occlusion is achieved.

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  Figure 10 Post-treatment cephalogram, cephalometrict racing, and panoramic radiograph. The post-treatment cephalogram shows decreased mandibular plane angle and A-point-nasion-B point angle. The post-treatment panoramic radiograph shows acceptable root parallelism and no obvious apical root resorption.

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  Figure 11 Pre- and post-treatment cephalometric superimpositions showing marked differences before (blue) and after (red) treatment. A, Overall superimposition at sella-nasion plane. Convex profile is improved and contour-clockwise rotation of the mandible is observed. B, Maxillary superimposition at palatal plane (anterior nasal spine to posterior nasal spine). Retraction and intrusion of the upper incisors and intrusion of the upper molars are observed. C, Mandibular superimposition at mandibular plane (menton to gonion). Intrusion of the lower incisors and mesially movement of the lower molars are observed.

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  Figure 12 Facial and intraoral photographs obtained at 3.5 years after treatment. Stable occlusion and a satisfactory facial profile can be observed. A harmonious facial profile, an attractive smile, Class I molar and canine relationships and stable intercuspation are maintained.

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