Korean J Orthod.  2022 May;52(3):236-245. 10.4041/kjod21.203.

Maxillary space closure using a digital manufactured Mesialslider in a single appointment workflow

• Wilhelmy L
• Willmann JH
• Tarraf NE
• Wilmes B
• Drescher D

• KMID: 2529946
• DOI: http://doi.org/10.4041/kjod21.203

Abstract

New digital technologies, many involving three-dimensional printing, bring benefits for clinical applications. This article reports on the clinical procedure and fabrication of a skeletally anchored mesialization appliance (Mesialslider) using computer-aided design/computer-aided manufacturing (CAD/CAM) for space closure of a congenitally missing lateral incisor in a 12-year-old female patient. The insertion of the mini-implants and appliance was performed in a single appointment. Bodily movement of the molars was achieved using the Mesialslider. Anchorage loss, such as deviation of the anterior midline or palatal tilting of the anterior teeth, was completely avoided. CAD/CAM facilitates safe and precise insertion of mini-implants. Further, mini-implants can improve patient comfort by reducing the number of office visits and eliminating the need for orthodontic bands and physical impressions.

Keyword

Agenesis; Orthodontic mini-implant; Tooth movement; CAD/CAM

Figure

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  Figure 1 Pretreatment photographs. The maxillary right lateral incisor was congenitally missing.

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  Figure 2 Pretreatment radiographs. Panoramic radiograph was taken two months ahead.

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  Figure 3 Merging of the stereolithography (STL) file with the lateral cephalometric radiograph for implant positioning.

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  Figure 4 Insertion guide placed on the three-dimensional printed study model (left) and the diamond cylinder used to reduce resistance to sliding (right).

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  Figure 5 Final three-dimensional design of the Mesialslider.

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  Figure 6 Three-dimensional design of the Versalock tube (TADMAN, Gunningen, Germany).

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  Figure 7 Finalized computer-aided design/computer-aided manufacturing fabricated Mesialslider on printed study model.

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  Figure 8 Insertion and activation of the Mesialslider right before extraction of the deciduous canine.

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  Figure 9 Intraoral photographs after 5 months of treatment. Spaces were almost closed in the anterior region.

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  Figure 10 Intraoral photographs after 14 months of treatment.

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  Figure 11 Post-treatment photographs. The treatment duration was less than 24 months.

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  Figure 12 Post-treatment radiographs.

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  Figure 13 Three-dimensional comparative evaluation of the clinical outcome: analysis of the pre-treatment (blue) and post-treatment (white) conditions shows a so-called reverse anchorage loss.

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  Figure 14 Skeletal growth superimposition and analysis of vertical changes. A, Cranial base superimposition. B, Maxillary superimposition. C, Mandibular superimposition. Black line, pretreatment; Red line, posttreatment.

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