Torque control of maxillary anterior teeth with the double J retractor and palatal miniscrews during en masse retraction

Effect of Different Anchorage Reinforcement Methods on Long-Term Maxillary Whole Arch Distalization with Clear Aligner: A 4D Finite Element Study with Staging Simulation

The objective of this study was to examine how various anchorage methods impact long-term maxillary whole arch distalization using clear aligners (CAs) through an automated staging simulation. Three different anchorage reinforcement methods, namely, Class II elastics, buccal temporary anchorage device (TAD), and palatal TAD, were designed. Orthodontic tooth movement induced by orthodontic forces was simulated using an iterative computation method. Additionally, the automatic adjustment of the CA was simulated through the application of the thermal expansion method. The results indicated that the palatal TAD group had the largest retraction of incisors, followed by the buccal TAD group and the Class II elastic group, while the least was in the control group. The largest distal displacements and efficiency of molar distalization for the first and the second molars were noticed in the palatal TAD group. Arch width increased at the molar and premolar levels in all groups. The FEM results suggested palatal TAD had the best performance considering anterior teeth anchorage maintenance, both sagittally and vertically. However, attention should be paid to the possible increasement of arch width.

Rate of upper incisor retraction in Class II division 1 patients managed with palatal versus buccal miniscrew supported segmental orthodontics: Randomized parallel clinical trial

OBJECTIVE

This study was conducted to compare maxillary incisor retraction rates using buccal orthodontics with segmented arch approach supported by a buccal or palatal mini-screw in non-growing Class II Division 1 patients during a 3-month period.

PATIENTS AND METHODS

All patients between September 2018 and December 2021 with following criteria were included: non-growing class II division 1 protrusion, indication for premolar extraction, no or little crowding, normal overbite, no previous orthodontic treatment, no systematic disease, good oral hygiene, no periodontal problems or oral habits. Mini-implant was inserted buccally or palatally between upper second premolar and first molar bilaterally. Incisor retraction was manipulated by a 200-gram force through a nickel-titanium closed-coil spring extended from the mini-implant to the segmental design. Study casts were made before retraction and after every 4 weeks (T0: baseline, T1: 4 weeks, T2, 8 weeks, T3: 12 weeks). A repeated measures ANOVA was performed for total comparison of data (mm of retraction) on 3D casts. A pairwise t test with Bonferroni correction was used for comparison between two experimental periods for the same group. An independent samples t-test was also used for comparison between two groups for the same experimental period.

RESULTS

Of 30 patients meeting the eligibility criteria, only 28 were included with mean age 16±2.5 years. Repeated measures ANOVA revealed significant differences in incisor retraction between the time intervals for both buccal and palatal groups (P=0.001). In addition, the paired-sample t test indicated a significant difference between each time interval for both the buccal and palatal groups (P=0.001), except between T3 and T2 for the palatal group (P=0.09). The independent sample t-test revealed significant differences between the buccal and palatal groups at T1 (Mean: 0.55 [0.355-0.748],=0.001) and T2 (Mean: 1.4 [0.91-1.88], P=0.001); whereas no significant difference was found at T3 (Mean: 1.15 [0.67-1.63], P=0.945).

CONCLUSIONS

Anterior retraction using a segmental palatal model with mini-screws was effective regardless of the buccal or palatal situation of the minivis. Retraction of incisors with palatal miniscrews was significantly faster in the first two months.

Torque recovery of the maxillary incisors with a modified double J retractor in a Class II division 2 case treated with clear aligners

A patient with a Class II division 2 malocclusion is presented, illustrating the application of a modified double J retractor (DJR) and palatal miniscrews along with clear aligners to correct the malocclusion and normalize the incisor torque. In terms of incisor torque recovery, a nonextraction approach might be a good choice if the Class II correction could be successfully achieved with total arch distalization. When maxillary molar distalization was limited by anatomical boundaries, the treatment plan was changed to bilateral maxillary first premolar extractions, which led to even more retroclination of the maxillary incisors after space closure. Anterior interdental miniscrews were used to intrude the maxillary incisors. A modified DJR and palatal miniscrews were used to regain torque and achieve palatal root movement of the maxillary incisors. The treatment effects and biomechanical designs were evaluated for torque recovery of the retroclined maxillary incisors.