Non-extraction camouflage treatment using extra-alveolar skeletal anchorage

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Australian Society of Orthodontists

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VOLUME 38 , ISSUE 1 (January 2022) > List of articles

Non-extraction camouflage treatment using extra-alveolar skeletal anchorage

Young-Jun Lee * / Jae Hyun Park * / Na-Young Chang * / Kang-Gyu Lee * / Jong-Moon Chae *

Citation Information : Australasian Orthodontic Journal. Volume 38, Issue 1, Pages 63-73, DOI: https://doi.org/10.21307/aoj-2022.007

License : (CC-BY-4.0)

Received Date : November-2021 / Accepted: January-2022 / Published Online: 27-January-2022

ARTICLE

ABSTRACT

A 23-year-old female patient with moderate crowding and a bilateral molar scissor-bite was successfully treated without tooth extraction. Extra-alveolar skeletal anchorage, involving a three-dimensional key plate in the maxilla and two miniscrews in the buccal shelf of the mandible, were used for distalisation, buccolingual uprighting, and the intrusion of molars by fixed orthodontic appliances. Cone-beam computed tomography was used to identify available posterior space for the distalisation and buccolingual correction of the molars in scissor-bite. The total treatment time was 24 months. Post-treatment results showed good occlusal relationships and smile aesthetics. Twelve-month post-treatment records demonstrated no significant relapse and a favourable facial balance.

Graphical ABSTRACT

Introduction

Angle1 introduced the concept of a line of occlusion, which postulated that arches can accommodate a complete dentition by bone growth stimulated by arch expansion, making the extraction of teeth unnecessary. However, Tweed2 determined that the line of occlusion concept could result in complications related to protrusive faces and unstable dentitions. Therefore, it was concluded that a considered extraction treatment plan would improve the facial profile and stability of the dentition as well as treat an underlying malocclusion.

Dental crowding is a common chief complaint expressed by orthodontic patients. The severity of the crowding is an important factor in determining whether to plan extraction or non-extraction treatment. Proffit3 suggested that non-extraction treatment should be considered in cases with less than 4 mm of crowding and extraction treatment when more than 10 mm of crowding was present. This creates a “grey” area of borderline patients who have moderate crowding (4–10  mm) which then becomes a challenge to determine which treatment option (extraction or non-extraction) might be preferable.4 Therefore, in borderline cases, the measurement of an arch length discrepancy and other factors such as patient compliance, facial profile, growth stage, and sagittal relationships should be carefully assessed.5

An inappropriate non-extraction treatment plan can result in incisor proclination and lip protrusion.5–7 Mandibular incisor proclination reduces the overbite and overjet but can result in instability of the dentition.6 Hence, incisor proclination should be limited by anatomic boundaries of the alveolar bone8 because bone dehiscence or gingival recession might occur when tooth movement exceeds these limits.9,10 This means that distalisation of the posterior dentition is required to improve or maintain an acceptable facial profile and reduce potential complications in non-extraction patients.

With the advent of temporary skeletal anchorage devices (TSADs),11–19 molar distalisation, as a component of non-extraction treatment, is becoming popular especially in cases of moderate crowding. TSADs are also helpful in treating a molar scissor-bite because of the possibility of simultaneous molar uprighting and intrusion.16,17 Recently, extra-alveolar TSADs11–18 are being widely considered and used rather than inter-radicular TSADs16,19 so that the risk of root contact during distalisation and intrusion of posterior teeth is reduced. Using extra-alveolar TSADs, the present case report describes the non-extraction camouflage treatment of an adult patient who presented with moderate crowding and a bilateral molar scissor-bite.

Diagnosis and aetiology

A 23-year-old female patient presented with the chief complaint of crowding. Her medical history was unremarkable but she showed temporomandibular joint (TMJ) disc displacement with reduction and intermittent locking. After a year of splint therapy conducted in the department of oral medicine, the TMJ symptoms of pain and limited mouth opening improved and so the patient represented to the orthodontic department.

The patient showed a favourable facial profile but, from the frontal aspect, there was a slight chin deviation to the left. Intraoral photographs and dental casts revealed tooth size-arch length discrepancies (TSALDs) of 8.5 mm in the maxilla and 8.0 mm in the mandible. The dental midline had deviated by 1.5 mm to the right in the maxilla and 1.0 mm to the left of the facial midline in the mandible. There was also a bilateral molar scissor-bite (Fig. 1).

Figure 1.

Pre-treatment photographs, dental casts and radiographs.

10.21307_aoj-2022.007-f001.jpg

A lateral cephalometric analysis indicated a mild dental and skeletal Class II relationship (ANB, 4.7°), a hyperdivergent facial pattern (FMA, 31.0°), normal inclination of the incisors (U1- FH, 110.6°; IMPA, 93.3°), and verified excellence of the facial profile (UL/EL, 0.4; LL/EL, 1.8). A panoramic radiograph confirmed the presence of three third molars except in the maxillary left quadrant, and cone-beam computed tomography (CBCT) images identified a mesiodens located palatal to the maxillary incisors (Fig. 1; Tables I). In addition, mandibular yawing to the left created a mild asymmetry and a molar scissor-bite was noted and related to severe buccal tipping of the maxillary right second molar and severe lingual tipping of the mandibular molars (Fig. 2).

Table I.

Cephalometric measurements.

10.21307_aoj-2022.007-t001.jpg
Figure 2.

Pre-treatment cone-beam computed tomography. Top: (A) Frontal view, (B) Submentovertical view. The lower images are coronal section views showing the molar scissor-bite: (C) Severe buccal tipping of the maxillary right second molar, (D) Severe lingual tipping of the mandibular right second molar, (E) Normal buccolingual angulation of the maxillary left first molar and severe lingual tipping of the mandibular left first molar, (F) Normal buccolingual angulation of the maxillary left second molar and severe lingual tipping of the mandibular left second molar.

10.21307_aoj-2022.007-f002.jpg

Treatment objectives

The treatment objectives were to: (1) relieve the crowding, (2) establish a Class I molar relationship, (3) correct the dental midline deviation, (4) obtain a stable occlusal relationship, (5) maintain gingival health, and (6) improve the smile aesthetics.

Treatment alternatives

The first considered option was to extract the maxillary right first premolar and the maxillary left and mandibular second premolars to relieve the crowding and correct the dental midlines. A second option was to extract four premolars and, using TSADs, close the extraction spaces to align the dentition while preventing changes to the patient’s facial profile. A third option was non-extraction camouflage treatment, involving the distalisation and uprighting of the maxillary and mandibular posterior teeth using TSADs, coupled with expansion of the dental arch, proclination of the mandibular incisors, and interproximal reduction of the anterior teeth. The patient wished to minimise her facial profile change and refused the extraction of premolars, and so the third option was chosen.

Treatment progress

Before the initiation of orthodontic treatment, the three third molars and the mesiodens were extracted. A palatal TSAD (three-dimensional key plate; 3DKP, Anyang, Korea) along with three miniscrews (2.0 × 10.0 mm; 3DKP, Anyang, Korea) were placed in the midpalate to assist distalisation of the maxillary posterior teeth. A wavy stainless steel palatal wire (1.2  mm in diameter) incorporating distal arms was soldered to the maxillary first molar bands. Elastomeric forces were applied from the wave part of the palatal wire to the lever arms of the 3DKP to facilitate distalisation of the maxillary posterior teeth. Elastomeric forces were also applied from the attachments on the buccal sides of both maxillary second molars to the distal arms of the palatal wire to correct the buccal tipping of the maxillary second molars. Standard edgewise appliances incorporating 0.022 × 0.028-inch slots were placed in the mandibular arch, and levelling was achieved using a 0.014-inch nickel-titanium arch wire (Fig. 3A).

Figure 3.

Treatment progress intraoral photographs and cone-beam computed tomographic images. (A, B) Three-dimensional key plate (3DKP) with transpalatal WAVE wire and extension arms for distalisation and palatal uprighting of the maxillary molars, fixed orthodontic appliance for levelling of the mandibular dentition, and miniscrews in the buccal shelf for distalisation, buccal uprighting and intrusion of the mandibular molars. (C) Finishing.

10.21307_aoj-2022.007-f003.jpg

After two months of treatment, two miniscrews (1.6 × 10 mm; Jeil Medical, Seoul, Korea) were inserted in the mandibular buccal shelf between the mandibular first and second molars, and elastomeric forces were applied from lingual buttons on the mandibular molars to the miniscrews to address the posterior scissor-bite by buccal uprighting and intrusion of the molars (Fig. 3B).

To minimise the change in the vertical position and inclination of the maxillary incisors, brackets were not attached until sufficient space had been created for the alignment of the maxillary anterior teeth. After four months of treatment, 0.022 × 0.028-inch standard edgewise appliances were placed on the maxillary posterior teeth, and at eleven months, full fixed orthodontic treatment was started, to manage the asymmetric arch form. Approximately 2 mm of interproximal reduction (IPR) was performed on the incisors to create space for alignment and to reduce their proclination. At sixteen months, the maxillary right canine was aligned and levelled (Fig. 3C) and the finishing stage commenced to extend the total treatment time to 24 months. The fixed appliances were removed and bonded wire retainers plus circumferential retainers were provided for both arches.

Treatment results

Post-treatment facial photographs showed a significant improvement in smile aesthetics. Intraoral photographs, dental casts and radiographs revealed an adequate Class I dental relationship, good occlusal interdigitation, dental midline correction and a well-aligned dentition (Fig. 4).

Figure 4.

Post-treatment photographs, dental casts and radiographs.

10.21307_aoj-2022.007-f004.jpg

Good root parallelism was noted on a post-treatment panoramic radiograph, while the lateral cephalogram and CBCT images revealed the satisfactory distalisation of the maxillary right and left first molars (2.0 mm and 3.5 mm), respectively. Both of the mandibular first molars were distalised 1.5  mm and uprighted buccolingually. The mandibular incisors were proclined by 9.5° leading to mild lip protrusion and an increase in arch perimeter (Figs. 4, 5, 6, Table II). A slight posterior re-positioning of the mandible and condyle occurred.

Figure 5.

Superimposition of the lateral cephalograms at pre-treatment (black), post-treatment (red), 1 year post-treatment (green).

10.21307_aoj-2022.007-f005.jpg
Figure 6.

Superimposition. Cone-beam computed tomography (CBCT) images at pre-treatment (red) and post-treatment (green): (A) Sagittal and coronal views of the right side (a, first molars; b, second molars); (B) Sagittal and coronal views of the left side (c, first molars; b, second molars). Dental casts at pre-treatment (yellow) and post-treatment (blue): (C) Maxilla; (D) Mandible.

10.21307_aoj-2022.007-f006.jpg
Table II.

Dental arch width changes (mm).

10.21307_aoj-2022.007-t002.jpg

CBCT axial images showed that space remained adequate for the distalisation of the posterior teeth in the maxillary tuberosity area but there was a lack of space in the mandibular retromolar area. As a result after distalisation, the distal roots of the mandibular second molars had penetrated the mandibular lingual cortical plate (Fig. 7). Twelve-month post-treatment records revealed no significant relapse, periodontal problems, nor TMJ symptoms (Fig. 8).

Figure 7.

Posterior available space: (A) Pre-treatment of the manxilla (presence of the maxillary right third molar); (B) Post-treatment of the maxilla; (C) Pre-treatment of the mandible; (D) Post-treatment of the mandible.

10.21307_aoj-2022.007-f007.jpg
Figure 8.

Post-treatment photographs and radiographs at 12 months.

10.21307_aoj-2022.007-f008.jpg

Discussion

To obtain acceptable treatment results in borderline non-extraction patients, appropriate mechanics leading to distalisation of the posterior teeth, labioversion of the anterior teeth, IPR, and arch expansion should be individually and selectively planned to create the necessary alignment space.4,5

To address a TSALD of 8.5 mm and a dental midline deviation to the right in the maxilla, the left side was distalised by 3.5 mm and the right side by 2.0  mm using a 3DKP,15 which therefore increased the arch perimeter.20,21 Space creation was assisted by about 2.0 mm of IPR22 (Fig. 6, Table II). 3DKP15 is a palatal TSAD used with a waveform transpalatal archwire to assist the 3-dimensional movement of the maxillary posterior teeth by the application of elastomeric chains (Fig. 9A–C). A waveform wire of 1.2 mm incorporating distal arms was placed to facilitate the distalisation of the maxillary posterior teeth and correct the molar scissor-bite (Fig. 9A). The maxillary posterior teeth were distalised in a bodily fashion by the applied biomechanics (Fig. 9D) rather than by intrusion mechanics (Fig. 9E).15 Additionally, Bechtold et al.23 suggested that maxillary molar distalisation using skeletal anchorage was highly stable. The maxillary space was sufficient to distalise the posterior teeth,24–26 but the distalisation of the mandibular posterior teeth was limited.

Figure 9.

3-dimensional key plate (3DKP) and various types of transpalatal WAVE wire with extension arms. (A) Molar distalisation using the WAVE wire. (B) Molar mesialisation using the transpalatal WAVE wire (T-WAVE). (C) Asymmetric molar movement with modified WAVE wire (M-WAVE). Schematic diagram of two different lines of action for total distalisation of the maxillary dentition using the three-dimensional key plate (3DKP): (D) For bodily movement (yellow elastomers); (E) For intrusive movement (green elastomers).

10.21307_aoj-2022.007-f009.jpg

Therefore, the mandibular posterior teeth were only distalised by 1.0 mm using TSADs due to the lingual anatomical limitation of the alveolar cortical plate at root level, which was less than at crown level (Fig. 6, 7).24–26 The TSADs placed in the mandibular buccal shelf were also used to upright and intrude the lingually-inclined mandibular molars to correct the molar scissor-bite and therefore minimise the extrusion of the molars during buccal uprighting and limit rotation of the mandible.27 The mandible and condyle showed a slight posterior re-positioning due to mild molar extrusion during the correction of the scissor-bite and the establishment of the posterior occlusion, but the patient showed no further TMJ symptoms.

To address the 8.0 mm TSALD in the mandible, proclination and IPR of the mandibular incisors and expansion of the mandibular arch were performed.4,5,20–22 Tweed28 suggested that arch length will increase by 0.8 mm when the mandibular incisors are proclined by one degree. In the presented patient, the mandibular incisors were proclined by almost 10°, which increased the arch length by 8.0 mm. Caution should be exercised because these measurements are not predictable by sagittal calculation because the tooth movement occurs in three-dimensions. Therefore, a digital set-up model is recommended to ensure predictable results (Fig. 10). Unfortunately, there are possible anatomical or biological limitations such as bone dehiscence or gingival recession that cannot be predicted during a digital model set-up until further advances in technology occur.29

Figure 10.

Digital set-up model.

10.21307_aoj-2022.007-f010.jpg

The sagittal position of the mandibular incisors is considered to be an essential determinant of facial aesthetics and stability.30–32 Tweed30 advocated placing the mandibular incisors in an upright position over the basal bone to achieve optimum results. McLaughlin et al.31 also stated that the mandibular incisors should be positioned about 90° to 95° to the mandibular plane, and dental compensation should be limited to less than 5°, but can be extended up to 10° in particular cases. Maintaining the original position of the incisors may prevent relapse,33 but the presented patient required proclination of the mandibular incisors to generate the necessary arch length without the extraction of premolars.

The proclination of the mandibular incisors can result in relapse, bone dehiscence and gingival recession due to root movement through the labial alveolar bone.9 Fortunately, the presented patient showed no relapse nor periodontal problems because of the thick gingival biotype, and root movement did not exceed the anatomic alveolar limits (Fig. 11). These factors are worthy of consideration to reduce the effects of planned labioversion of the mandibular incisors.

Figure 11.

Cone-beam computed tomographic images to identify the labial alveolar bone thickness: (A) Pre-treatment; (B) Post-treatment.

10.21307_aoj-2022.007-f011.jpg

Since the incisors were minimally protruded to assist alignment of the dentition, the patient showed mild lip protrusion after treatment. After one year of retention, the lip protrusion had reduced, especially in the lower lip to E-line relationship. While these results are supported by previous studies,34,35 long-term observation is expected.

Conclusions

A skeletal Class II adult patient presenting with moderate crowding and a bilateral molar scissor-bite was successfully treated using extra-alveolar TSADs. This borderline case was managed by non-extraction distalisation and buccolingual uprighting of the posterior teeth accompanied by proclination of the mandibular incisors. A satisfactory occlusal relationship was achieved along with an acceptable facial profile.

Conflict of interest

The authors declare that there is no conflict of interest.

Acknowledgment

This paper was supported by Wonkwang University in 2022.

References


  1. Angle EH . The malocclusion of the teeth Philadelphia, PA: SS White Co; 1907; pp. 21–24.
  2. Cross JJ . The tweed philosophy: the tweed years. Semin Orthod. 1996;2:231–236.
  3. Proffit WR . Orthodontic treatment planning: from problem list to specific plan. St. Louis: Mosby;2013.
  4. Soheilifar S , Soheilifar S , Ataei H , Mollabashi V , Amini P , Bakhshaei A . Extraction versus non-extraction orthodontic treatment: soft tissue profile changes in borderline class I patients. Dent Med Probl 2020;57:275–283.
  5. Ruellas ACO , Ruellas RMO , Romano FL , Pithon MM , Santos RL . Tooth extraction in orthodontics: an evaluation of diagnostic elements. Dental Press J Orthod 2010;15:134–157.
  6. Travess H , Roberts-Harry D , Sandy J . Orthodontics. Part 8: extractions in orthodontics. Br Dent J 2004;196:195–203.
  7. Bishara SE , Cummins DM , Jakobsen JR , Zaher AR . Dentofacial and soft tissue changes in Class II, division 1 cases treated with and without extractions. Am J Orthod Dentofacial Orthop 1995;107:28–37.
  8. Handelman CS . The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod 1996;66:95–109.
  9. Yared KF , Zenobio EG , Pacheco W . Periodontal status of mandibular central incisors after orthodontic proclination in adults. Am J Orthod Dentofacial Orthop 2006;130:6.e1–8.
  10. Baysal A , Uysal T , Veli I , Ozer T , Karadede I , Hekimoglu S . Evaluation of alveolar bone loss following rapid maxillary expansion using cone-beam computed tomography. Korean J Orthod 2013;43:83–95.
  11. Choi YJ , Lee JS , Cha JY , Park YC . Total distalization of the maxillary arch in a patient with skeletal Class II malocclusion. Am J Orthod Dentofacial Orthop 2011;139:823–833.
  12. Park JH , Saito T , Yoo SK , Alfaifi M , Kook YA . Distalization with a modified C-palatal plate for severe upper crowding and a missing lower incisor. Korean J Orthod 2020;50:52–62.
  13. Kook YA , Park JH , Kim Y , Ahn CS , Bayome M . Sagittal correction of adolescent patients with modified palatal anchorage plate appliances. Am J Orthod Dentofacial Orthop 2015;148:674–684.
  14. Kook YA , Park JH , Bayome M , Jung CY , Kim Y , Kim SH . Application of palatal plate for nonextraction treatment in an adolescent boy with severe overjet. Am J Orthod Dentofacial Orthop 2017;152:859–869.
  15. Seo YJ , Lee KG , Chang NY , Chae JM . Non-extraction treatment of a Class II adult patient with crowding using palatal plate. Clin J Korean Assoc Orthod 2020;10:103–112.
  16. Jung MH . Treatment of severe scissor bite in a middle-aged adult patient with orthodontic mini-implants. Am J Orthod Dentofacial Orthop 2011;139:S154–S165.
  17. Lee SA , Chang CCH , Roberts WE . Severe unilateral scissors-bite with a constricted mandibular arch: Bite turbos and extra-alveolar bone screws in the infrazygomatic crests and mandibular buccal shelf. Am J Orthod Dentofacial Orthop 2018;154:554–569.
  18. Chang CH , Lin LY , Roberts WE . Orthodontic bone screws: A quick update and its promising future. Orthod Craniofac Res 2021;24:75–82.
  19. Baek ES , Hwang S , Kim KH , Chung CJ . Total intrusion and distalization of the maxillary arch to improve smile esthetics. Korean J Orthod 2017;47:59–73.
  20. Germane N , Lindauer SJ , Rubenstein LK , Revere JH Jr , Isaacson RJ . Increase in arch perimeter due to orthodontic expansion. Am J Orthod Dentofacial Orthop 1991;100:421–427.
  21. Noroozi H , Djavid GE , Moeinzad H , Teimouri AP . Prediction of arch perimeter changes due to orthodontic treatment. Am J Orthod Dentofacial Orthop 2002;122:601–607.
  22. Lapenaite E , Lopatiene K . Interproximal enamel reduction as a part of orthodontic treatment. Stomatologija. 2014;16:19–24.
  23. Bechtold TE , Park YC , Kim KH , Jung H , Kang JY , Choi YJ . Long-term stability of miniscrew anchored maxillary molar distalization in Class II treatment. Angle Orthod 2020;90:362–368.
  24. Kim SJ , Choi TH , Baik HS , Park YC , Lee KJ . Mandibular posterior anatomic limit for molar distalization. Am J Orthod Dentofacial Orthop 2014;146:190–197.
  25. Kim HJ , Jang WS , Park HS . Anatomical limits for distalization of lower posterior molars with micro-implant anchorage. J Clin Orthod 2019;53:305–313.
  26. Kim KJ , Park JH , Chang NY , Seo HY , Chae JM . A cone-beam computed tomography evaluation of posterior available space in both arches relative to various skeletal patterns. Am J Orthod Dentofacial Orthop, in press.
  27. Lee SA , Chang CCH , Roberts WE . Severe unilateral scissors-bite with a constricted mandibular arch: Bite turbos and extra-alveolar bone screws in the infrazygomatic crests and mandibular buccal shelf. Am J Orthod Dentofacial Orthop 2018;154:554–569.
  28. Tweed CH . The Frankfort mandibular incisor angle (FMIA) in orthodontic diagnosis, treatment planning and prognosis. Angle Orthod 1954;24:121–169.
  29. Hou D , Capote R , Bayirli B , Chan DCN , Huang G . The effect of digital diagnostic setups on orthodontic treatment planning. Am J Orthod Dentofacial Orthop 2020;157:542–549.
  30. Merrifiled LL . Differential diagnosis. Semin Orthod 1996;2:241–253.
  31. Bennett JC , McLaughlin RP . Fundamentals of orthodontic treatment mechanics. Chapter 9. Non-extraction treatment. Le Grande Publishing, Quezon City, 2014.
  32. Derwich M , Minch L , Mitus-Kenig M , Zoltowska A , Pawlowska E . Personalized orthodontics: From the sagittal position of lower incisors to the facial profile esthetics. J Pers Med 2021;11:692.
  33. Little RM . Stability and relapse of mandibular anterior alignment: University of Washington studies. Semin Orthod 1999;5:191–204.
  34. Lee JS , Choy K , Park YC , Kim KH . Changes in lip and perioral soft tissue after bracket removal. Korean J Orthod 2007;37:125–136.
  35. Yook HT , Jang IS , Choi DS , An KY , Cha BK . The volumetric changes of the lips in orthodontic patients with bonding or debonding labial fixed orthodontic appliances. J Interdiscipl Med Dent Sci 2014;3:1.
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FIGURES & TABLES

Figure 1.

Pre-treatment photographs, dental casts and radiographs.

Full Size   |   Slide (.pptx)

Figure 2.

Pre-treatment cone-beam computed tomography. Top: (A) Frontal view, (B) Submentovertical view. The lower images are coronal section views showing the molar scissor-bite: (C) Severe buccal tipping of the maxillary right second molar, (D) Severe lingual tipping of the mandibular right second molar, (E) Normal buccolingual angulation of the maxillary left first molar and severe lingual tipping of the mandibular left first molar, (F) Normal buccolingual angulation of the maxillary left second molar and severe lingual tipping of the mandibular left second molar.

Full Size   |   Slide (.pptx)

Figure 3.

Treatment progress intraoral photographs and cone-beam computed tomographic images. (A, B) Three-dimensional key plate (3DKP) with transpalatal WAVE wire and extension arms for distalisation and palatal uprighting of the maxillary molars, fixed orthodontic appliance for levelling of the mandibular dentition, and miniscrews in the buccal shelf for distalisation, buccal uprighting and intrusion of the mandibular molars. (C) Finishing.

Full Size   |   Slide (.pptx)

Figure 4.

Post-treatment photographs, dental casts and radiographs.

Full Size   |   Slide (.pptx)

Figure 5.

Superimposition of the lateral cephalograms at pre-treatment (black), post-treatment (red), 1 year post-treatment (green).

Full Size   |   Slide (.pptx)

Figure 6.

Superimposition. Cone-beam computed tomography (CBCT) images at pre-treatment (red) and post-treatment (green): (A) Sagittal and coronal views of the right side (a, first molars; b, second molars); (B) Sagittal and coronal views of the left side (c, first molars; b, second molars). Dental casts at pre-treatment (yellow) and post-treatment (blue): (C) Maxilla; (D) Mandible.

Full Size   |   Slide (.pptx)

Figure 7.

Posterior available space: (A) Pre-treatment of the manxilla (presence of the maxillary right third molar); (B) Post-treatment of the maxilla; (C) Pre-treatment of the mandible; (D) Post-treatment of the mandible.

Full Size   |   Slide (.pptx)

Figure 8.

Post-treatment photographs and radiographs at 12 months.

Full Size   |   Slide (.pptx)

Figure 9.

3-dimensional key plate (3DKP) and various types of transpalatal WAVE wire with extension arms. (A) Molar distalisation using the WAVE wire. (B) Molar mesialisation using the transpalatal WAVE wire (T-WAVE). (C) Asymmetric molar movement with modified WAVE wire (M-WAVE). Schematic diagram of two different lines of action for total distalisation of the maxillary dentition using the three-dimensional key plate (3DKP): (D) For bodily movement (yellow elastomers); (E) For intrusive movement (green elastomers).

Full Size   |   Slide (.pptx)

Figure 10.

Digital set-up model.

Full Size   |   Slide (.pptx)

Figure 11.

Cone-beam computed tomographic images to identify the labial alveolar bone thickness: (A) Pre-treatment; (B) Post-treatment.

Full Size   |   Slide (.pptx)

REFERENCES

  1. Angle EH . The malocclusion of the teeth Philadelphia, PA: SS White Co; 1907; pp. 21–24.
  2. Cross JJ . The tweed philosophy: the tweed years. Semin Orthod. 1996;2:231–236.
  3. Proffit WR . Orthodontic treatment planning: from problem list to specific plan. St. Louis: Mosby;2013.
  4. Soheilifar S , Soheilifar S , Ataei H , Mollabashi V , Amini P , Bakhshaei A . Extraction versus non-extraction orthodontic treatment: soft tissue profile changes in borderline class I patients. Dent Med Probl 2020;57:275–283.
  5. Ruellas ACO , Ruellas RMO , Romano FL , Pithon MM , Santos RL . Tooth extraction in orthodontics: an evaluation of diagnostic elements. Dental Press J Orthod 2010;15:134–157.
  6. Travess H , Roberts-Harry D , Sandy J . Orthodontics. Part 8: extractions in orthodontics. Br Dent J 2004;196:195–203.
  7. Bishara SE , Cummins DM , Jakobsen JR , Zaher AR . Dentofacial and soft tissue changes in Class II, division 1 cases treated with and without extractions. Am J Orthod Dentofacial Orthop 1995;107:28–37.
  8. Handelman CS . The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae. Angle Orthod 1996;66:95–109.
  9. Yared KF , Zenobio EG , Pacheco W . Periodontal status of mandibular central incisors after orthodontic proclination in adults. Am J Orthod Dentofacial Orthop 2006;130:6.e1–8.
  10. Baysal A , Uysal T , Veli I , Ozer T , Karadede I , Hekimoglu S . Evaluation of alveolar bone loss following rapid maxillary expansion using cone-beam computed tomography. Korean J Orthod 2013;43:83–95.
  11. Choi YJ , Lee JS , Cha JY , Park YC . Total distalization of the maxillary arch in a patient with skeletal Class II malocclusion. Am J Orthod Dentofacial Orthop 2011;139:823–833.
  12. Park JH , Saito T , Yoo SK , Alfaifi M , Kook YA . Distalization with a modified C-palatal plate for severe upper crowding and a missing lower incisor. Korean J Orthod 2020;50:52–62.
  13. Kook YA , Park JH , Kim Y , Ahn CS , Bayome M . Sagittal correction of adolescent patients with modified palatal anchorage plate appliances. Am J Orthod Dentofacial Orthop 2015;148:674–684.
  14. Kook YA , Park JH , Bayome M , Jung CY , Kim Y , Kim SH . Application of palatal plate for nonextraction treatment in an adolescent boy with severe overjet. Am J Orthod Dentofacial Orthop 2017;152:859–869.
  15. Seo YJ , Lee KG , Chang NY , Chae JM . Non-extraction treatment of a Class II adult patient with crowding using palatal plate. Clin J Korean Assoc Orthod 2020;10:103–112.
  16. Jung MH . Treatment of severe scissor bite in a middle-aged adult patient with orthodontic mini-implants. Am J Orthod Dentofacial Orthop 2011;139:S154–S165.
  17. Lee SA , Chang CCH , Roberts WE . Severe unilateral scissors-bite with a constricted mandibular arch: Bite turbos and extra-alveolar bone screws in the infrazygomatic crests and mandibular buccal shelf. Am J Orthod Dentofacial Orthop 2018;154:554–569.
  18. Chang CH , Lin LY , Roberts WE . Orthodontic bone screws: A quick update and its promising future. Orthod Craniofac Res 2021;24:75–82.
  19. Baek ES , Hwang S , Kim KH , Chung CJ . Total intrusion and distalization of the maxillary arch to improve smile esthetics. Korean J Orthod 2017;47:59–73.
  20. Germane N , Lindauer SJ , Rubenstein LK , Revere JH Jr , Isaacson RJ . Increase in arch perimeter due to orthodontic expansion. Am J Orthod Dentofacial Orthop 1991;100:421–427.
  21. Noroozi H , Djavid GE , Moeinzad H , Teimouri AP . Prediction of arch perimeter changes due to orthodontic treatment. Am J Orthod Dentofacial Orthop 2002;122:601–607.
  22. Lapenaite E , Lopatiene K . Interproximal enamel reduction as a part of orthodontic treatment. Stomatologija. 2014;16:19–24.
  23. Bechtold TE , Park YC , Kim KH , Jung H , Kang JY , Choi YJ . Long-term stability of miniscrew anchored maxillary molar distalization in Class II treatment. Angle Orthod 2020;90:362–368.
  24. Kim SJ , Choi TH , Baik HS , Park YC , Lee KJ . Mandibular posterior anatomic limit for molar distalization. Am J Orthod Dentofacial Orthop 2014;146:190–197.
  25. Kim HJ , Jang WS , Park HS . Anatomical limits for distalization of lower posterior molars with micro-implant anchorage. J Clin Orthod 2019;53:305–313.
  26. Kim KJ , Park JH , Chang NY , Seo HY , Chae JM . A cone-beam computed tomography evaluation of posterior available space in both arches relative to various skeletal patterns. Am J Orthod Dentofacial Orthop, in press.
  27. Lee SA , Chang CCH , Roberts WE . Severe unilateral scissors-bite with a constricted mandibular arch: Bite turbos and extra-alveolar bone screws in the infrazygomatic crests and mandibular buccal shelf. Am J Orthod Dentofacial Orthop 2018;154:554–569.
  28. Tweed CH . The Frankfort mandibular incisor angle (FMIA) in orthodontic diagnosis, treatment planning and prognosis. Angle Orthod 1954;24:121–169.
  29. Hou D , Capote R , Bayirli B , Chan DCN , Huang G . The effect of digital diagnostic setups on orthodontic treatment planning. Am J Orthod Dentofacial Orthop 2020;157:542–549.
  30. Merrifiled LL . Differential diagnosis. Semin Orthod 1996;2:241–253.
  31. Bennett JC , McLaughlin RP . Fundamentals of orthodontic treatment mechanics. Chapter 9. Non-extraction treatment. Le Grande Publishing, Quezon City, 2014.
  32. Derwich M , Minch L , Mitus-Kenig M , Zoltowska A , Pawlowska E . Personalized orthodontics: From the sagittal position of lower incisors to the facial profile esthetics. J Pers Med 2021;11:692.
  33. Little RM . Stability and relapse of mandibular anterior alignment: University of Washington studies. Semin Orthod 1999;5:191–204.
  34. Lee JS , Choy K , Park YC , Kim KH . Changes in lip and perioral soft tissue after bracket removal. Korean J Orthod 2007;37:125–136.
  35. Yook HT , Jang IS , Choi DS , An KY , Cha BK . The volumetric changes of the lips in orthodontic patients with bonding or debonding labial fixed orthodontic appliances. J Interdiscipl Med Dent Sci 2014;3:1.

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