Korean J Orthod.  2020 Mar;50(2):145-154. 10.4041/kjod.2020.50.2.145.

Protraction of mandibular molars through a severely atrophic edentulous space in a case of juvenile periodontitis

Affiliations
  • 1Department of Stomatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. paulwu010203@zju.edu.cn
  • 2Department of Orthodontics, Affiliated Hospital of Stomatology, School of Medicine, Zhejiang University, Hangzhou, China.

Abstract

Moving the mandibular posterior teeth into a severely atrophic edentulous space is a challenge. A carefully designed force-and-moment system that results in bodily protraction of the posterior teeth with balanced bone resorption and apposition is needed in such cases. This report describes the treatment of a 19-year-old woman with missing mandibular first molars due to juvenile periodontitis. Miniscrews were used as absolute anchorage during protraction of the mandibular second and third molars. Bodily mesial movement of the mandibular second and third molars was achieved over a distance of 11 to 17 mm after 39 months of orthodontic treatment.

Keyword

Miniscrew; Anchorage; Adult treatment; Bodily tooth movement

MeSH Terms

Aggressive Periodontitis*
Bone Resorption
Female
Humans
Molar*
Molar, Third
Tooth
Young Adult

Figure

  • Figure 1 Pretreatment facial and intraoral photographs and panoramic radiograph.

  • Figure 2 Pretreatment study casts.

  • Figure 3 Lateral cephalogram, tracing, and superimpositions. A, Immediately after attaching the orthodontic appliances; B, posttreatment; C, one-year posttreatment; D, superimposition on sella-nasion plane at sella; E, on palatal plane at anterior nasal spine and on mandibular plane at menton.Black, Immediately after attaching the orthodontic appliances; red, posttreatment; green, 1-year follow-up.

  • Figure 4 “Fulcrums” at the virtual position of the mandibular first molar composed of stainless steel wire, bracket, and resin on the base of miniscrews. A, Right fulcrums; B, left fulcrums; C, panoramic radiograph.

  • Figure 5 A photo showing progress of 6 months into treatment and a diagram of the applied mechanics of mandibular second molar uprighting and protraction.

  • Figure 6 Photos showing progress at 17 months into treatment. Miniscrews were used in the mandibular arch to provide maximum anchorage.

  • Figure 7 Serial panoramic photograph showing protraction of the mandibular second molars.0M, 0 month; 4M, 4 months; 7M, 7 months; 13M, 13 months; 25M, 25 months; 29M, 29 months; 39M, 39 months; 51M, 51 months.

  • Figure 8 Posttreatment facial and intraoral photographs and panoramic radiograph.

  • Figure 9 Posttreatment study casts.

  • Figure 10 Intraoral photos showing the progressive protraction of the mandibular second molars.

  • Figure 11 One-year posttreatment facial and intraoral photographs.


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