Use of the intraosseous screw for unilateral upper molar distalization and found well balanced occlusion
Head & Face Medicine
Use of the intraosseous screw for unilateral upper molar distalization and found well balanced occlusion
Ibrahim Erhan Gelgor 2
Ali Ihya Karaman 1
Tamer Buyukyilmaz 0
0 Cukurova University, Faculty of Dentistry, Department of Orthodontics , Adana , Turkey
1 Selcuk University, Faculty of Dentistry, Department of Orthodontics , Konya , Turkey
2 Kirikkale University, Faculty of Dentistry, Department of Orthodontics , Kirikkale , Turkey
Background: The aim of this study was to present a temporary anchorage device with intraosseous screw for unilateral molar distalization to make a space for the impacted premolar and to found well balanced occlusion in a case. Case presentation: A 13-year-old male who have an impacted premolar is presented with skeletal Class I and dental Class 2 relationship. The screw was placed and immediately loaded to distalize the left upper first and second molar. The average distalization time to achieve an overcorrected Class I molar relationship was 3.6 months. There was no change in overjet, overbite, or mandibular plane angle measurements. Mild protrusion (0.5 mm) of the upper left central incisor was also recorded. Conclusion: Immediately loaded intraosseous screw-supported anchorage unit was successful in achieving sufficient unilateral molar distalization without anchorage loss. This treatment procedure was an alternative treatment to the extraction therapy.
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Background
In the treatment of Angle Class II malocclusions, with
well-aligned lower teeth and a mandible in sagitally
normal position, upper anterior crowding and excessive
overjet can be treated with either distalization or extraction of
upper posterior teeth. Newly developed orthodontic
mechanics and their ease of application enabled
widespread use of nonextraction therapies[1].
Conventional extraoral appliances are usually used for
supporting maxillary molar anchorage or for distalization
purposes. However, patient cooperation is a serious
problem that has to be dealt with and moreover, orthodontic
mechanics requiring minimal patient cooperation are
desirable [2,3]. A number of treatment protocols that
minimize the need for patient compliance have been
suggested previously [4-12]. These techniques effectively
distalize the maxillary molars, however, in most of these
studies anchorage loss is unavoidable characterized by
maxillary incisor protrusion, an increase in overjet, and
decrease in overbite [6,7,11].
In recent years, studies have been directed toward the use
of osseointegrated implants [3,12-14], onplants [15], and
intraosseous screws [1] as anchorage units in orthodontic
patients.
Use of intraosseous screws for temporary orthodontic
anchorage devices is a new area of research [1,3,16].
Creekmore and Eklund [16] used a Vitallium screw for
intrusion of the upper incisors. Park et al [17] successfully
used maxillary microscrews for treatment of openbite
malocclusion. Liou et al [18] and Park et al [19,20] carried
out en masse distalization of upper and lower posterior
teeth using microscrew implant anchorage. In our
previous study [1], we prepared an anchorage unit for bilateral
upper molar distalization by placing an intraosseous
screw in twenty five cases. During the following 4.6
months, both the first and second molars were distalized
into an overcorrected Class I relationship without major
anchorage loss.
The aim of this study was to present use of the
intraosseous screw for unilateral upper molar distalization in a
case.
Case presentation
A 13-year-old male presented skeletal Class I relationship.
The patient's profile was mild convex. Vertical facial
proportions were normal, and there were no significant
asymmetries (Figure 1).
A full complement of permanent teeth was present except
left lower first molar. There was a huge caries in the lower
right first molar. Upper left second premolar was
impacted. In centric occlusion canine relationships were
Class I, and the incisors were in teeth a teeth relation. Both
the maxillary and the mandibular arches exhibited
moderate teeth disorderliness. Oral hygiene was moderate
(Figures 2, and 3).
In pretreatment cephalometric evaluation (Figure 4, Table
1); the maxilla was normal to the cranial base (SNA 86),
and in centric occlusion the mandible was normal
position to the cranial base (SNB 84). The ANB (2)
indicated a Class I skeletal relationship. The maxillary incisors
were slightly upright, while the mandibular incisors were
PFrigeturreeat2ment intraoral photographs of the patient
Pretreatment intraoral photographs of the patient.
somewhat protrusive. The mandibular plane was normal
relative to cranial base (SN-MP 31).
Treatment objectives
1. to establish Class I molar relationship.
2. to eliminate maxillary and mandibular arch disorders.
3. to erupt upper left second premolar because of the
patient's rejection of surgically extraction of the impacted
premolar.
4. to correct overbite, and overjet.
5. to align arches including midlin (...truncated)