Korean J Orthod.  2020 Jan;50(1):52-62. 10.4041/kjod.2020.50.1.52.

Distalization with a modified C-palatal plate for severe upper crowding and a missing lower incisor

• Park JH
• Saito T
• Yoo SK
• Alfaifi M
• Kook YA

• KMID: 2468641
• DOI: http://doi.org/10.4041/kjod.2020.50.1.52

Abstract

This case report presents the orthodontic treatment of a 25-year-old patient with skeletal Class II and severe maxillary arch crowding, moderate mandibular arch crowding, anterior crossbite, and a missing lower incisor. He was treated with molar distalization using a modified C-palatal plate and temporary anchorage devices to create sufficient space for retraction. The total treatment duration was 21 months. After treatment, his occlusion and smile esthetics showed significant improvement. The modified C-palatal plate represents a treatment modality that enhances the prospects of non-extraction treatment and reduces the need for extraction.

Keyword

Class II; Distalization; Cephalometrics; Extraction vs. nonextraction

MeSH Terms

Adult
Crowding*
Esthetics
Humans
Incisor*
Malocclusion
Molar

Figure

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  Figure 1 Pre-treatment facial and intraoral photographs.

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  Figure 2 Initial digital models.

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

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  Figure 4 Digital simulations. A, Virtual set-up model for extraction of maxillary first premolars and mandibular incisor. B, Superimposition of the findings before and after simulation. C, Superimposition of three-dimensional crowns on lateral cephalogram (lateral head film aligned to the midsagittal plane of models) (Motion View Software, LLC).

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  Figure 5 Extraction of maxillary first premolars and mandibular incisor. A, Possible equilibration map. B, Expected tooth movement (Motion View Software, LLC).

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  Figure 6 Digital simulations. A, Virtual set-up model for extraction of maxillary first premolars. B, Superimposition of findings before and after simulation. C, Superimposition of three-dimensional crowns on lateral cephalogram (lateral head film aligned to midsagittal plane of models).

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  Figure 7 Extraction of maxillary first premolars. A, Possible equilibration map. B, Interproximal reduction to accommodate occlusion. C, Expected tooth movement.

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  Figure 8 Full-arch distalization of the maxillary arch (after 6 months of distalization).

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  Figure 9 Full-arch distalization of the maxillary arch (after 12 months of distalization). During the distalization of the maxillary arch, Class III elastics were engaged on the right side to establish Class I relationship and triangular elastics from the upper canine to lower canine and the first premolar on the left side.

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  Figure 10 Intraoral photographs showing the treatment progress (after 17 months of distalization).

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  Figure 11 Intraoral photographs showing the treatment progress (after 21 months of treatment). The lingual buttons attached to the maxillary second molars were engaged to the palatal plate to express lingual crown torque along with the torque in the 0.019 × 0.025-inch stainless steel wire.

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  Figure 12 Post-treatment facial and intraoral photographs (after 24 months of treatment).

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  Figure 13 Post-treatment digital models.

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  Figure 14 Post-treatment radiographs. A, Panoramic radiograph; B, lateral cephalogram.

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  Figure 15 Cephalometric superimposition. Black, Pre-treatment; Red, post-treatment.

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  Figure 16 Cone-beam computed tomography superimposition before and after maxillary total arch distalization (before, gray; after, yellow). MCPP, Modified C-palatal plate.

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  Figure 17 Superimpositions before and after cone-beam computed tomography and digital model superimposition (Orapix system; Cenos Co., Ltd.). A, Cone-beam computed tomography images (blue, initial; yellow, final). B, Digital model images (red, initial; green, final).

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  Figure 18 American Board of Orthodontics cast-radiograph evaluation score.

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