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Albertini E, Albertini P, Colonna A, Lombardo L. Invisible treatment with lingual appliance for the correction of an adult class II subdivision with asymmetrical Wilson and Spee curves: A case report. Int Orthod 2024; 22:100825. [PMID: 38035872 DOI: 10.1016/j.ortho.2023.100825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
This article describes a class II subdivision malocclusion successfully treated by an invisible lingual appliance. The combination of en-masse distalization by interradicular palatal mini-screws and inner unilateral class II auxiliaries, first by intermaxillary elastic, later by a class II coil spring, resulted in a dento-alveolar correction, allowing one to maintain the appliance completely invisible. At the same time, the inclination of buccal sectors was normalized by a correct torque expression with set-up overcorrections, resulting in a significant improvement of the buccal corridors. This case report demonstrates the possibility of successfully solving class II division 2 subdivision malocclusion in adult patients without surgery by means of a completely invisible appliance. It also demonstrates that correct levelling and torque expression, for the correction of asymmetrical Spee and Wilson curves, are achievable with an accurate set-up planning. On the other hand, it underlines the necessity of mini-screws, auxiliaries and set-up overcorrections in order to obtain the best results.
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Affiliation(s)
- Enrico Albertini
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi Borsari 46, Ferrara, Italy.
| | - Paolo Albertini
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi Borsari 46, Ferrara, Italy
| | - Anna Colonna
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi Borsari 46, Ferrara, Italy
| | - Luca Lombardo
- Postgraduate School of Orthodontics, University of Ferrara, Via Luigi Borsari 46, Ferrara, Italy
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Choi YJ, Suh H, Park JJ, Park JH. Anterior open bite correction via molar intrusion: Diagnosis, advantages, and complications. J World Fed Orthod 2024; 13:2-9. [PMID: 38185583 DOI: 10.1016/j.ejwf.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
Anterior open bite can be effectively treated nonsurgically via molar intrusion. This technique, involving the intrusion of posterior teeth using temporary skeletal anchorage devices, prompts counterclockwise rotation of the mandible. This rotation not only corrects anterior open bite but also contributes to a decrease in anterior facial height, improvements in lip incompetency, and forward movement of the chin. For successful outcomes, temporary skeletal anchorage devices, installed on both the buccal and palatal sides, must deliver equivalent intrusion force to the maxillary teeth. Treatment planning should consider factors such as skeletal discrepancies, vertical excess, incisor exposure, and configuration of the occlusal plane. Clinicians are advised to closely monitor periodontal changes and consider overcorrection to ensure lasting stability and maintenance of incisal overlap post-treatment.
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Affiliation(s)
- Yoon Jeong Choi
- Professor, Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea; Visiting Scholar, Division of Plastic and Reconstructive Surgery, Department of Surgery, Pediatric Craniofacial and Airway Orthodontics and Dental Sleep Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California
| | - Heeyeon Suh
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California
| | - Jung Jin Park
- Department of Orthodontics, Dental Hospital, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Hyun Park
- Professor and Chair, Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, Arizona; International Scholar, Graduate School of Dentistry, Kyung Hee University, Seoul, Korea.
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Raghis TR, Alsulaiman TMA, Mahmoud G, Youssef M. Skeletal and dentoalveolar changes after total maxillary arch distalization using the casted palatal plate vs. buccal miniscrews: A randomized clinical trial. Int Orthod 2023; 21:100808. [PMID: 37647676 DOI: 10.1016/j.ortho.2023.100808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To evaluate treatment changes after total maxillary arch distalization using the casted palatal plate compared with buccal miniscrews. MATERIAL AND METHODS This was a randomized, parallel, two-arm, single center trial. Participants were young adults with class II dental relationships and normal or horizontal growth patterns. The patients were treated with total distalization of the maxillary arch and were randomly allocated, according to the anchorage devices, between the plate group and the minivis group. The primary outcomes were sagittal, vertical and angular changes of molars and incisors, while the secondary outcomes were skeletal and soft tissue changes. Outcomes were evaluated on lateral cephalograms and blinding of outcome assessment was implemented. A multivariate analysis of Variance (MANOVA) tests were used and Bonferroni correction for multiple comparisons with P<0.001. RESULTS Forty patients (33 females and 7 males; mean age 20±3.1 years) where enrolled. A significant distalization of U6 was observed in both groups (4.33mm in the plate group and 1.88mm in the miniscrews group). It was combined with significant intrusion and non-significant distal tipping of the U6 in the plate group (1.85mm and 3.10°, respectively), while intrusion and distal tipping were non-significant in the miniscrew group (0.8mm and 2°, respectively). Both groups showed significant retraction and palatal inclination without vertical changes of U1. Only the plate group produced significant reduction of ANB and Wits. Upper and lower lips were retracted and the nasolabial angle increased significantly in both groups. There was no significant main effect of the appliance type on the comparison of treatment effects between the two groups (P=0.623). However, univariate comparisons showed that the plaque group showed greater distalization of the U6 (P<0.001). CONCLUSIONS Both the casted palatal plate and buccal miniscrews can be viable devices for total distalization of the maxillary arch in the treatment of class II patients. The casted plate may be considered when more extensive distalization is required.
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Affiliation(s)
- Tuqa Rashad Raghis
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria.
| | | | - Ghiath Mahmoud
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Mohamed Youssef
- Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria
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Root resorption in Class II malocclusion treatment with and without maxillary premolar extractions. Am J Orthod Dentofacial Orthop 2023; 163:389-397. [PMID: 36476368 DOI: 10.1016/j.ajodo.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Class II malocclusion treatment efficiency with maxillary premolar extractions has been reported. However, no study evaluated the root resorption associated with this protocol. Therefore, this study aimed to compare the degree of root resorption of the maxillary incisors in Class II malocclusion treatment with and without maxillary premolar extractions. METHODS The sample consisted of 56 patients with complete Class II malocclusion, divided into 2 groups. Group 1 comprised 28 patients (10 female, 18 male) treated with maxillary first premolar extractions, and group 2 was composed of 28 patients (16 female, 12 male) treated without extractions. The groups were matched regarding initial age, treatment time, crowding, initial malocclusion severity, finishing quality, initial overjet, and overbite. Periapical radiographs of the maxillary incisors were used to assess the degree of root resorption using a scoring system. In addition, treatment changes involving maxillary incisors were evaluated in lateral headfilms. Intergroup comparisons were performed with t, Mann-Whitney U, and chi-square tests (P <0.05). RESULTS Overjet, overbite, inclination, vertical positional changes, and vertical and horizontal apical displacements of maxillary incisors were similar between groups. There was no statistically significant difference between groups regarding root resorption of maxillary incisors. Root resorption degree ranged from mild to moderate in both groups. CONCLUSIONS Treating complete Class II malocclusion with 2 maxillary premolar extractions resulted in a similar root resorption as treating without maxillary premolar extractions. An individualized evaluation of root resorption predisposing factors should be performed for each patient.
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Liaw JJL, Wang SH, Tsai BMY. An unusual extraction pattern for retreatment in a patient with dental protrusion and a deficient soft-tissue chin. Am J Orthod Dentofacial Orthop 2022; 162:554-567. [PMID: 35753892 DOI: 10.1016/j.ajodo.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 11/01/2022]
Abstract
A patient with dental protrusion and deficient soft-tissue chin, previously treated with maxillary first premolar extraction, sought retreatment to improve his facial profile. Orthognathic surgery was proposed as the ideal treatment option, but the patient declined. Therefore, other orthodontic options were considered. The combined intrusion and retraction force systems supported with skeletal anchorage on both arches and a midpalatal miniscrew successfully reduced the protrusion and rotated the mandible counterclockwise to improve the facial profile and chin projection. Sagittal correction enhanced by active vertical control with skeletal anchorage and de-wedging with posterior extraction was illustrated. In addition, advancement genioplasty was performed after orthodontic treatment to improve the chin projection further. The mechanics and results of this retreatment case were discussed.
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Affiliation(s)
- Johnny J L Liaw
- Department of Orthodontics, National Taiwan University Hospital, and Beauty Forever Dental Clinic, Taipei, Taiwan.
| | | | - Betty M Y Tsai
- Department of Orthodontics, National Taiwan University Hospital, and Beauty Forever Dental Clinic, Taipei, Taiwan
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Stability of the Maxillary and Mandibular Total Arch Distalization Using Temporary Anchorage Devices (TADs) in Adults. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12062898] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Distalization with temporary anchorage devices (TADs) is commonly used to resolve crowding and to correct molar relationships in non-extraction cases. The purpose of this study was to quantify the treatment effects and post-treatment stability of total arch distalization with TADs in adults and thereby elucidate the clinical effect of this treatment modality. The subjects of the study were 39 adult orthodontic patients treated with total arch distalization with TADs. Lateral cephalograms and dental casts were taken at pretreatment (T0), post-treatment (T1), and the retention period (T2, 29.3 ± 12.8 months) to evaluate the vertical and horizontal movement of teeth, changes of arch width and molar rotation. It was concluded that even though there was a little relapse in the anteroposterior position of the maxillary and mandibular teeth during retention, there was no obvious relapse in the facial profile. Therefore, the total arch distalization can be used in patients with a moderate amount of arch length discrepancy effectively with stable retention.
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Cone-beam computed tomography and digital model analysis of maxillary buccal alveolar bone thickness for vertical temporary skeletal anchorage device placement. Am J Orthod Dentofacial Orthop 2022; 161:e429-e438. [DOI: 10.1016/j.ajodo.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
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A Simple Technique Using a Modified Nance Appliance as Anchorage for Maxillary Molar Distalization—Two Case Reports. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Maxillary molar distalization to correct a dental Class II molar relationship and to create space to relieve crowding has been a long-lasting subject of debate in orthodontics. Generally, to distalize maxillary molars, an intra-arch distalization appliance is favored over an inter-arch appliance since it does not utilize mandibular dentition as an anchorage, so some unwanted side effects on mandibular incisors can be avoided. A variety of intra-arch appliances have been developed to distalize maxillary molars, such as the pendulum, Jones jig, first class appliance, distal jet, and modified C-palatal plate. Although they could achieve efficient molar distalization, the learning curve of proper appliance insertion and activation is relatively long. In addition, the appliances are not comfortable for the patients due to the bulky activation units, especially when the activation units are designed in the palatal area. The current manuscript describes a novel and effective maxillary intra-arch molar distalization appliance—a modified Nance appliance technique, which consists of: (1) palatally, a big acrylic button against the palatal rugae and connected to the premolars with wide mesh pads; (2) buccally, regular brackets on maxillary premolars and first molars with sectional round stainless steel archwires and open coil springs between the second premolar and first molar. Either bilateral or unilateral maxillary molar distalization can be achieved with this appliance, and the Class II elastics are not needed. It is simple to be fabricated, delivered, and activated, and it is comfortable for patients.
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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 2022; 161:798-808. [DOI: 10.1016/j.ajodo.2021.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/01/2022]
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Du B, Zhu J, Li L, Fan T, Tan J, Li J. Bone depth and thickness of different infrazygomatic crest miniscrew insertion paths between the first and second maxillary molars for distal tooth movement: A 3-dimensional assessment. Am J Orthod Dentofacial Orthop 2021; 160:113-123. [PMID: 34092464 DOI: 10.1016/j.ajodo.2020.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/01/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This research aimed to measure the bone depth and thickness of different insertion paths for safe placement of infrazygomatic crest miniscrews between the first (U6) and second maxillary molars (U7) by 3-dimensional (3D) reconstruction and to explore their clinical significance. METHODS Cone-beam computed tomography data from 36 adult orthodontic patients were obtained to generate 3D models (n = 72) of the infrazygomatic crest region. For each model, the bone depth and thickness of 27 different insertion paths were measured in the region between U6 and U7. The relationship between bone depth and thickness was statistically analyzed. The clinical risk for each insertion path was assessed according to the impacts of bone depth and thickness on insertion failure. RESULTS Maximum bone depth (median, 7.41 mm; mean, 8.42 mm) was present at 13 mm insertion sites with a gingival tipping angle of 50° and a distal tipping angle of 30°. Maximum bone thickness (median, 3.73 mm; mean, 4.00 mm) was present at 17 mm insertion site with a gingival tipping angle of 70° and a distal tipping angle of 30°. There was a significant negative correlation between bone depth and bone thickness (rs = -0.569, P <0.001). Failure rates were significantly different among different insertion paths (P <0.001). CONCLUSIONS Because the bone depth and thickness may affect the safe insertion of infrazygomatic crest miniscrews in the region between U6 and U7 and they are negatively related, a safe insertion protocol design for distal tooth movement should take both into consideration.
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Affiliation(s)
- Bingran Du
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangdong, China
| | - Jiuyu Zhu
- Department of Stomatology, the Third Affiliated Hospital of Xinxiang Medical University, Henan, China
| | - Lutao Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangdong, China
| | - Tiancheng Fan
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangdong, China
| | - Jinchuan Tan
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangdong, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, and Nanhai Hospital, Southern Medical University, Guangdong, China.
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Kawamura J, Park JH, Kojima Y, Tamaya N, Kook YA, Kyung HM, Chae JM. Biomechanical analysis for total distalization of the maxillary dentition: A finite element study. Am J Orthod Dentofacial Orthop 2021; 160:259-265. [PMID: 33972141 DOI: 10.1016/j.ajodo.2020.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/01/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study aimed to identify the tooth movement patterns relative to various force angulations (FAs) when distalizing the total maxillary dentition. METHODS Long-term orthodontic movement of the maxillary dentition was simulated by accumulating the initial displacement of teeth produced by elastic deflection of the periodontal ligament using a finite element analysis. Distalization forces of 3 N were applied to the archwire between the maxillary canine and first premolar at 5 different FAs (-30°, -15°, 0°, 15°, and 30°) to the occlusal plane. RESULTS Maxillary incisors and molars showed lingual and distal tipping at all FAs, respectively. At a force angulation of 30°, almost bodily distalization of the total maxillary dentition occurred, but incisors showed considerable lingual tipping because of the effect of clearance gap (0.003-in, 0.022 × 0.025-in bracket slot, 0.019 × 0.025-in archwire) and elastic deflection of the archwire. Medial displacement of the maxillary anterior teeth occurred because of lingual tipping during distalization. The occlusal plane rotated clockwise at all FAs because of extrusion of the maxillary incisors and intrusion of the maxillary second molars, and the amounts decreased as FA increased. CONCLUSIONS Tooth movement patterns during distalization of the total maxillary dentition were recognized. With an understanding of the mechanics, a proper treatment plan can be established.
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Affiliation(s)
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A. T. Still University, Mesa, Ariz, Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | | | | | - Yoon-Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Hee-Moon Kyung
- Department of Orthodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Jong-Moon Chae
- Department of Orthodontics, School of Dentistry, Wonkwang University, Wonkwang Dental Research Institute, Iksan, South Korea, Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A. T. Still University, Mesa, Ariz.
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Simulation of miniscrew-root distance available for molar distalization depending on the miniscrew insertion angle and vertical facial type. PLoS One 2020; 15:e0239759. [PMID: 32970759 PMCID: PMC7514046 DOI: 10.1371/journal.pone.0239759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to evaluate the effects of miniscrew insertion angle and vertical facial type on the interradicular miniscrew–root distance available for molar distalization. Materials and methods Cone-beam computed tomography images of 60 adults with skeletal Class I occlusion exhibiting hyperdivergent (n = 20), normodivergent (n = 20), and hypodivergent (n = 20) facial types were used. Placement of a 6-mm long, 1.5-mm diameter, tapered miniscrew was simulated at a site 4 mm apical to the cementoenamel junction, with insertion angles of 0°, 30°, 45°, and 60° relative to the transverse occlusal plane. The shortest linear distance between the miniscrew and anterior root at four interradicular sites was measured: maxillary second premolar and first molar (Mx 5–6), maxillary first and second molars (Mx 6–7), mandibular second premolar and first molar (Mn 5–6), and mandibular first and second molars (Mn 6–7). Results Miniscrew–root distance significantly increased as the insertion angle increased from 0° to 60°. In the mandible, the distances significantly differed among vertical facial types, increasing in the following order: hyperdivergent, normodivergent, and hypodivergent. The minimum mean distance was found in the Mx 6–7 (30°; 0.86±0.35 mm), and the maximum mean distance was found in the Mn 5–6 (60°; 2.64±0.56 mm). The rates of miniscrews located buccally outside the root distalization path were up to 70% and 55% when the miniscrews were placed at 60° insertion angles in the Mx 5–6 and Mn 5–6 regions, respectively. Conclusions Miniscrew–root distance increased significantly with the increased insertion angle, and the amount of increase was affected by the miniscrew placement site and vertical facial type. To ensure adequate distalization of the posterior segment, the miniscrew should be inserted at an angle in the interradicular area between the second premolar and first molar.
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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. [PMID: 33378427 PMCID: PMC8032303 DOI: 10.2319/051619-335.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/01/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate treatment stability of miniscrew-anchored maxillary distalization in Class II malocclusion. MATERIALS AND METHODS This retrospective study included a distalization (n = 19) and a control (n = 19) group; a patient group with minor corrections served the control. Lateral cephalograms of 38 adult patients were taken before (T0), immediately after (T1), and 3-4 years after (T2) treatment. Horizontal and vertical movement and tipping of the maxillary first molars (U6) and central incisors (U1) were measured along with skeletal craniofacial parameters at three time points to compare the two groups regarding the achieved treatment effects and their stability. RESULTS Total arch distalization therapy led to 4.2 mm of distal movement of U6 without distal crown tipping (0.6° of axis change) and 3.3° of occlusal plane steepening. Over an average retention period of 42 months, maxillary total arch distalization provided high stability of treatment results, showing the same amount of mesial movement (0.7 mm) as the control group. CONCLUSIONS In Class II treatment, miniscrew-anchored maxillary total arch distalization can provide stable distal movement of the maxillary first molars and central incisors.
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Jo SY, Bayome M, Park J, Lim HJ, Kook YA, Han SH. Comparison of treatment effects between four premolar extraction and total arch distalization using the modified C-palatal plate. Korean J Orthod 2018; 48:224-235. [PMID: 30003056 PMCID: PMC6041454 DOI: 10.4041/kjod.2018.48.4.224] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
Objective The purpose of this study was to compare the skeletal, dental, and soft-tissue treatment effects of nonextraction therapy using the modified C-palatal plate (MCPP) to those of premolar extraction (PE) treatment in adult patients with Class II malocclusion. Methods Pretreatment and posttreatment lateral cephalographs of 40 adult patients with Class II malocclusion were retrospectively analyzed. The MCPP group comprised 20 patients treated with total arch distalization of the maxillary arch while the PE group comprised 20 patients treated with four PE. Fifty-eight linear and angular measurements were analyzed to assess the changes before and after treatment. Descriptive statistics, paired t-test, and multivariate analysis of variance were performed to evaluate the treatment effects within and between the two groups. Results The MCPP group presented 3.4 mm of retraction, 1.0 mm of extrusion, and 7.3° lingual inclination of the maxillary central incisor. In comparison, the PE group displayed greater amount of maxillary central incisor retraction and retroclination, mandibular incisor retraction, and upper lip retraction (5.3 mm, 14.8°, 5.1 mm, and 2.0 mm, respectively; p < 0.001 for all). In addition, the MCPP group showed 4.0 mm of distalization and 1.3 mm of intrusion with 2.9° distal tipping of the maxillary first molars. Conclusions These findings suggest the MCPP is an effective distalization appliance in the maxillary arch. The amount of incisor retraction, however, was significantly higher in the PE group. Therefore, four PE may be recommended when greater improvement of incisor position and soft-tissue profile is required.
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Affiliation(s)
| | - Mohamed Bayome
- Department of Dentistry, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Postgraduate Studies, the Universidad Autonóma del Paraguay, Asunción, Paraguay
| | - Justyn Park
- School of Dentistry, University California San Francisco, San Francisco, CA, USA
| | - Hee Jin Lim
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Ah Kook
- Department of Orthodontics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Ho Han
- Division of Orthodontics, Department of Dentistry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Three-Dimensional Evaluation on the Effect of Maxillary Dentition Distalization With Miniscrews Implanted in the Infrazygomatic Crest. IMPLANT DENT 2018; 27:22-27. [DOI: 10.1097/id.0000000000000706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sırman SSH, Özcan M, Tozlu M. Treatment of a Class II Case with Palatally Inserted Distalization Mechanics in an Epilepsy Patient. Turk J Orthod 2017; 30:61-68. [PMID: 30112494 PMCID: PMC6007755 DOI: 10.5152/turkjorthod.2017.17020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/24/2017] [Indexed: 01/11/2024]
Abstract
This case report describes the protocol employed in the treatment of a patient with Class II malocclusion with mechanics including palatally positioned miniscrews. Treatment included the distalization of maxillary posterior teeth with mechanics including 2 miniscrews positioned on the palatal side. After a certain amount of distalization was achieved, the maxillary arch was bonded with Roth prescription brackets while the appliance was still active. When leveling of the upper arch was finished, the appliance was kept in the mouth as a retention device while the mandibular arch was bonded to continue treatment, which lasted for a total of 15.5 months. Mandibular and maxillary fixed retainers were placed at the end of active treatment. Pretreatment and post-treatment records revealed that vertical and sagittal skeletal cephalometric findings were not affected. Miniscrew anchorage used during distalization is an effective non-extraction treatment option for dental Class II malocclusion correction.
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Affiliation(s)
| | - Mustafa Özcan
- Department of Orthodontics, Yeditepe University School of Dentistry, İstanbul, Turkey
| | - Murat Tozlu
- Department of Orthodontics, Yeditepe University School of Dentistry, İstanbul, Turkey
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Baek ES, Hwang S, Kim KH, Chung CJ. Total intrusion and distalization of the maxillary arch to improve smile esthetics. Korean J Orthod 2016; 47:59-73. [PMID: 28127540 PMCID: PMC5266123 DOI: 10.4041/kjod.2017.47.1.59] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/13/2016] [Accepted: 07/20/2016] [Indexed: 11/11/2022] Open
Abstract
This case report illustrates the successful treatment of a patient with skeletal Class II malocclusion and an unesthetic smile involving excessive gingival display and large buccal corridors. By applying dual buccal interradicular miniscrews, total intrusion of the maxillary dentition along with distalization was induced to improve both the occlusion and smile esthetics. In addition to the conventional cephalometric superimposition, three-dimensional superimposition was performed and evaluated to validate the treatment outcome.
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Affiliation(s)
- Eui Seon Baek
- Department of Orthodontics, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea
| | - Soonshin Hwang
- Department of Orthodontics, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea.; The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea.; The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chooryung J Chung
- Department of Orthodontics, Gangnam Severance Hospital, College of Dentistry, Yonsei University, Seoul, Korea.; The Institute of Craniofacial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
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18
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Noorollahian S, Alavi S, Shirban F. Bilateral en-masse distalization of maxillary posterior teeth with skeletal anchorage: a case report. Dental Press J Orthod 2016; 21:85-93. [PMID: 27409657 PMCID: PMC4944733 DOI: 10.1590/2177-6709.21.3.085-093.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/14/2015] [Indexed: 11/29/2022] Open
Abstract
Objective: The aim of this study was to introduce a new method for bilateral distal movement of the entire maxillary posterior segment. Case report: A 17-year-old girl with Class I skeletal malocclusion (end-to-end molar relationships, deviated midline and space deficiency for left maxillary canine) was referred for orthodontic treatment. She did not accept maxillary first premolars extraction. A modified Hyrax appliance (Dentaurum Ispringen, Germany) was used for bilateral distalization of maxillary posterior teeth simultaneously. Expansion vector was set anteroposteriorly. Posterior legs of Hyrax were welded to first maxillary molar bands. All posterior teeth on each side consolidated with a segment of 0.017 × 0.025-in stainless steel wire from the buccal side. Anterior legs of Hyrax were bent into eyelet form and attached to the anterior palate with two mini-screws (2 × 10 mm) (Jeil Medical Corporation Seoul, South Korea). Hyrax opening rate was 0.8 mm per month. Lateral cephalometric radiographs were used to evaluate the extent of distal movement. 3.5-mm distalization of posterior maxillary teeth was achieved in five months. Results: A nearly bodily distal movement without anchorage loss was obtained. Conclusion: The mini-screw-supported modified Hyrax appliance was found to be helpful for achieving en-masse distal movement of maxillary posterior teeth.
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Affiliation(s)
- Saeed Noorollahian
- Dental Implants Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Alavi
- Dental Materials Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farinaz Shirban
- Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim SJ, Hwang CJ, Park JH, Kim HJ, Yu HS. Surgical removal of asymptomatic impacted third molars: Considerations for orthodontists and oral surgeons. Semin Orthod 2016. [DOI: 10.1053/j.sodo.2015.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kook YA, Park JH, Bayome M, Sa'aed NL. Correction of severe bimaxillary protrusion with first premolar extractions and total arch distalization with palatal anchorage plates. Am J Orthod Dentofacial Orthop 2015; 148:310-20. [PMID: 26232840 DOI: 10.1016/j.ajodo.2014.10.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 01/01/2023]
Abstract
Correction of a severe protrusive soft tissue profile without orthognathic surgery can be challenging. This case report describes the treatment of a young woman with a severe bimaxillary protrusion. Orthodontic treatment included extraction of her 4 first premolars and total arch distalization of both arches using a palatal plate appliance. The total treatment time was 24 months. Her occlusion and facial appearance were significantly improved.
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Affiliation(s)
- Yoon-Ah Kook
- Professor, Department of Orthodontics, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
| | - Jae Hyun Park
- Associate professor and chair, Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A. T. Still University, Mesa, Ariz; adjunct professor, Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Mohamed Bayome
- Research assistant professor, Graduate School, Catholic University of Korea, Seoul, Korea; visiting professor, Department of Postgraduate Studies, Universidad Autonóma del Paraguay, Asunción, Paraguay
| | - Noor Laith Sa'aed
- Postgraduate student, Department of Dentistry, College of Medicine, Catholic University of Korea, Seoul, Korea
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21
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Miresmaeili A, Sajedi A, Moghimbeigi A, Farhadian N. Three-dimensional analysis of the distal movement of maxillary 1st molars in patients fitted with mini-implant-aided trans-palatal arches. Korean J Orthod 2015; 45:236-44. [PMID: 26445718 PMCID: PMC4593868 DOI: 10.4041/kjod.2015.45.5.236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 04/19/2015] [Accepted: 05/12/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate three-dimensional molar displacement after distalization via miniscrews and a horizontal modification of the trans-palatal-arch (TPA). METHODS The subjects in this clinical trial were 26 Class II patients. After the preparation of a complete set of diagnostic records, miniscrews were inserted between the maxillary 2nd premolar and 1st molar on the palatal side. Elastic modules connected to the TPA exerting an average force of 150-200 g/side parallel to the occlusal plane were applied. Cone-beam computed tomography was utilized to evaluate the position of the miniscrews relative to the adjacent teeth and maxillary sinus, and the direction of force relative to molar furcation. The distances from the central point of the incisive papilla to the mesiopalatal cusps of the 1st maxillary molars and the distances between the mesiopalatal cusps of the left and right molars were measured to evaluate displacement of the maxillary molars on the horizontal plane. Interocclusal space was used to evaluate vertical changes. RESULTS Mean maxillary 1st molar distalization was 2.3 ± 1.1 mm, at a rate of 0.4 ± 0.2 mm/month, and rotation was not significant. Intermolar width increased by 2.9 ± 1.8 mm. Molars were intruded relative to the neighboring teeth, from 0.1 to 0.8 mm. CONCLUSIONS Distalization of molars was possible without extrusion, using the appliance investigated. The intrusive component of force reduced the rate of distal movement.
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Affiliation(s)
- Amirfarhang Miresmaeili
- Department of Orthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran. ; Hamadan Dental Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ahmad Sajedi
- Department of Orthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moghimbeigi
- Department of Biostatistics, Faculty of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nasrin Farhadian
- Department of Orthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
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22
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Treatment of unilateral posterior crossbite with facial asymmetry in a female patient with transverse discrepancy. Am J Orthod Dentofacial Orthop 2015; 148:154-64. [DOI: 10.1016/j.ajodo.2014.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/01/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022]
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Chen G, Chen S, Zhang XY, Jiang RP, Liu Y, Shi FH, Xu TM. A new method to evaluate the positional stability of a self-drilling miniscrew. Orthod Craniofac Res 2015; 18:125-33. [PMID: 25704236 DOI: 10.1111/ocr.12065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the positional stability of miniscrews during orthodontic treatment change in cone-beam computed tomography (CBCT). SETTING AND SAMPLE POPULATION Twenty adult volunteers were enrolled. METHODS In all participants, at least two maxillary first premolars were extracted because of protrusion. Each volunteer received six miniscrews in the maxilla, including two loaded miniscrews to retract anterior teeth and four unloaded miniscrews. CBCT scans were obtained at the beginning of space closure (T1) and approximately 11.8 months later (T2). Three-dimensional miniscrew models were constructed at T1 and T2, and the central axes were calculated using a principal component analysis (PCA) technique. Finally, we measured and compared the angle change of all the miniscrews from T1 to T2. RESULTS The angle change values of the unloaded and loaded miniscrews were 1.64 ± 1.25° and 1.67 ± 1.15°, respectively. No significant differences in the angle change were observed. CONCLUSION Cone-beam computed tomography images revealed both the unloaded and loaded miniscrews to be positionally stable during en-masse retraction in this study.
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Affiliation(s)
- G Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - S Chen
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Y Zhang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - R P Jiang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Y Liu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - F H Shi
- Key Lab of Machine Perception, MOE, Peking University, Beijing, China
| | - T M Xu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
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Kook YA, Bayome M, Trang VTT, Kim HJ, Park JH, Kim KB, Behrents RG. Treatment effects of a modified palatal anchorage plate for distalization evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2014; 146:47-54. [DOI: 10.1016/j.ajodo.2014.03.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 03/01/2014] [Accepted: 03/01/2014] [Indexed: 11/29/2022]
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Scanavini PE, Jóias RP, Vasconcelos MHF, Scanavini MA, Paranhos LR. Assessment of first molars sagittal and rotational position in Class II, division 1 malocclusion. Dental Press J Orthod 2013; 18:106-11. [PMID: 24351157 DOI: 10.1590/s2176-94512013000600016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study assessed the anterior-posterior positioning of the upper and lower first molars, and the degree of rotation of the upper first molars in individuals with Class II, division 1, malocclusion. METHODS Asymmetry I, an accurate device, was used to assess sixty sets of dental casts from 27 females and 33 males, aged between 12 and 21 years old, with bilateral Class II, division 1. The sagittal position of the molars was determined by positioning the casts onto the device, considering the midpalatal suture as a symmetry reference, and then measuring the distance between the mesial marginal ridge of the most distal molar and the mesial marginal ridge of its counterpart. With regard to the degree of rotation of the upper molar, the distance between landmarks on the mesial marginal ridge was measured. Chi-square test with a 5% significance level was used to verify the variation in molars position. Student's t test at 5% significance was used for statistical analysis. RESULTS A great number of lower molars mesially positioned was registered, and the comparison between the right and left sides also demonstrated a higher number of mesially positioned molars on the right side of both arches. The average rotation of the molars was found to be 0.76 mm and 0.93 mm for the right and left sides, respectively. CONCLUSIONS No statistically significant difference was detected between the mean values of molars mesialization regardless of the side and arch. Molars rotation, measured in millimeters, represented ¼ of Class II.
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Asymmetrical distalization of maxillary molars with zygomatic anchorage, improved superelastic nickel-titanium alloy wires, and open-coil springs. Am J Orthod Dentofacial Orthop 2013; 144:583-93. [DOI: 10.1016/j.ajodo.2012.10.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 11/23/2022]
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Makino M, Choi YY, Nojima K, Nishii Y, Sueishi K. Characteristics of dentoskeletal morphology and treatment changes in 2-maxillary premolar extraction: A comparison with 4-premolar extraction. J World Fed Orthod 2013. [DOI: 10.1016/j.ejwf.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Migliorati M, Benedicenti S, Signori A, Drago S, Barberis F, Tournier H, Silvestrini-Biavati A. Miniscrew design and bone characteristics: an experimental study of primary stability. Am J Orthod Dentofacial Orthop 2012; 142:228-34. [PMID: 22858333 DOI: 10.1016/j.ajodo.2012.03.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the correlations between bone characteristics, orthodontic miniscrew designs, and primary stability. METHODS Four different miniscrews were placed in pig ribs. The miniscrews were first scanned with a scanning electron microscope to obtain measurable images of their threads. Subsequently, the maximum insertion torque of the screws and the maximum load value in the pullout force tests were measured; furthermore, bone specimen characteristics were analyzed by using cone-beam computed tomography. For each bone sample, the insertion site cortical thickness as well as both cortical and marrow bone density were evaluated. The nonparametric Kendall rank correlation (tau) was used to evaluate the strength of the associations among the characteristics measured. The nonparametric Kruskall-Wallis test was used to evaluate the differences among the groups, and post-hoc comparisons were assessed by using the Nemenyi-Damico-Wolfe-Dunn test. RESULTS A significant dependence was found between pitch and maximum insertion torque (tau, -0.49). Positive correlations were also found between pullout force and maximum insertion torque (tau, 0.64), cortical thickness (tau, 0.36), and marrow bone density (tau, 0.35). CONCLUSIONS In this in-vitro experimental study, strong correlations were observed among miniscrew geometry, bone characteristics, and primary stability.
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Affiliation(s)
- Marco Migliorati
- Department of Orthodontics, School of Dentistry, Genoa University, Genoa, Italy.
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Bechtold TE, Kim JW, Choi TH, Park YC, Lee KJ. Distalization pattern of the maxillary arch depending on the number of orthodontic miniscrews. Angle Orthod 2012; 83:266-73. [PMID: 22970751 DOI: 10.2319/032212-123.1] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the effects of linear force vector(s) from interradicular miniscrews on the distalization pattern of the maxillary arch in adult Class II patients. MATERIALS AND METHODS Twenty-five adult patients with mild to moderate Class II dentition and minimal crowding were collected. Either single (group A, n = 12) or dual (group B, n = 13) miniscrews were inserted on the posterior interradicular area to deliver a distalizing force to the main archwire. The displacement patterns of maxillary incisors and molars were measured and compared. RESULTS Significant distalization in the molars and incisors was shown in both groups. Significantly greater distalization and intrusion of the first molar and intrusive displacement of the incisor, together with significant reduction of the mandibular plane, were noted in group B, in contrast to the rotation of the occlusal plane in group A. CONCLUSIONS Interradicular miniscrews predictably induced total arch distalization, leading to the correction of Class II. Additional miniscrews in the premolar area appear to facilitate intrusion and distalization of the entire arch according to the position of the force vectors.
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Affiliation(s)
- Till E Bechtold
- Department of Orthodontics, Eberhard Karls University, Tübingen, Germany
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