Three-dimensional cone-beam computed tomography comparison of shorty and standard Class II Carriere Motion appliance

ObjectivesTo compare treatment effects of the standard and shorty Class II Carriere Motion appliances (CMAs) on adolescent patients.Materials and MethodsFifty adolescents with Class II malocclusion formed group 1, who were treated with shorty CMA (n = 25, 12.66 ± 1.05 years), and age- and sex–matched group 2, who were treated with standard CMA (n = 25, 12.73 ± 1.07 years). Treatment effects were analyzed by tracing with Invivo software to compare pretreatment (T1) cone-beam computed tomography (CBCT) images with post-CMA (T2) CBCT images. A total of 23 measurements were compared within and between groups.ResultsIn groups 1 and 2, maxillary first molars showed significant distal movement from T1 to T2 (1.83 ± 2.11 mm and 2.14 ± 1.34 mm, respectively), with distal tipping and rotation in group 1 (6.52° ± 3.99° and 3.15° ± 7.52°, respectively) but only distal tipping (7.03° ± 3.45°) in group 2. Similarly, in both groups, the maxillary first premolars experienced significant distal movement with distal tipping but no significant rotation. In group 1, maxillary canines did not undergo significant distal movement. In both groups 1 and 2, mandibular first molars experienced significant mesial movement (1.85 ± 1.88 mm and 2.44 ± 2.02 mm, respectively). Group 1 showed statistically significantly less reduction in overjet and less canine distal movement with less distal tipping than group 2 (α < .05).ConclusionsThe shorty CMA achieved Class II correction similarly to the standard CMA, with less change in overjet and distal tipping movement of the maxillary canines.     

Long-term stability of miniscrew anchored maxillary molar distalization in Class II treatment

ObjectiveTo investigate treatment stability of miniscrew-anchored maxillary distalization in Class II malocclusion.Materials and MethodsThis 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.ResultsTotal 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.ConclusionsIn Class II treatment, miniscrew-anchored maxillary total arch distalization can provide stable distal movement of the maxillary first molars and central incisors.     

Upper airway changes after Xbow appliance therapy evaluated with cone beam computed tomography

Objective:To determine the treatment effects of the Xbow appliance on the upper airway dimensions and volume using cone-beam computed tomography (CBCT); to evaluate the cephalometric changes in the skeletal and dental structures of the skeletal Class II patients.Materials and Methods:The sample consisted of 25 Class II patients (11 male, 14 female) with a mean age of 11.1 ± 1.1 years. CBCT images were obtained at the beginning of the treatment (T0) and after the debonding of the Xbow (T1).Results:Changes in superior, middle, and inferior parts of the oropharynx in the retroglossal region and changes in the oropharyngeal airway volume were statistically significant (P < .05, P < .01). The differences favoring the Xbow for the changes in the direction of Class II correction included SNA, SNB, ANB, maxillary depth angles, and point A-NPg and Co-B distances. Data of the dental parameters showed palatal tipping and extrusion of the maxillary incisors, labial tipping of the mandibular incisors, and mesial movement and extrusion of the mandibular molars.Conclusions:Treatment with the Xbow appliance in Class II patients resulted in favorable increase in the oropharyngeal airway dimensions and volume. Further studies with larger study samples and with control groups are needed.     

Comparison between direct vs indirect anchorage in two miniscrew-supported distalizing devices

Objective:To compare two distalizing devices supported by palatal miniscrews, the MGBM System (MGBM) and the Distal Screw appliance (DS), in dental Class II patients.Materials and Methods:Pretreatment (T1) and postdistalization (T2) lateral cephalograms of 53 Class II malocclusion subjects were examined. MGBM consisted of 29 patients (16 males, 13 females) with a mean pretreatment age of 12.3 ± 1.5 years; DS consisted of 24 patients (11 males, 13 females) with a mean pretreatment age of 11.3 ± 1.2 years. The mean distalization time was 6 ± 2 months for MGBM and 9 ± 2 months for DS. Initial and final measurements and treatment changes were compared by means of a Student’s t-test.Results:Maxillary superimpositions showed that the maxillary first molar distalized an average of 5.5 mm in the MGBM and 3.2 mm in the DS between T1 and T2; distal molar tipping was greater in the MGBM (10.3°) than in the DS (3.0°). First premolar showed a mean mesial movement of 1.4 mm, with a mesial tipping of 4.4° in the MGBM; on the contrary, first premolar showed a distal movement of 2.2 mm, with a distal tipping of 6.2°, in the DS.Conclusions:The MGBM system resulted in greater distal molar movement and less treatment time, resulting in more efficient movement than was associated with the DS; DS showed less molar tipping during distalization.     

Treatment effects of the Carriere® Motion 3D™ appliance for the correction of Class II malocclusion in adolescents

Objectives:To determine the treatment effects produced in Class II patients by the Carriere^® Motion 3D™ appliance (CMA) followed by full fixed appliances (FFA).Materials and Methods:This retrospective study evaluated 34 adolescents at three time points: T1 (pretreatment), T2 (removal of CMA), and T3 (posttreatment). The comparison group comprised 22 untreated Class II subjects analyzed at T1 and T3. Serial cephalograms were traced and digitized, and 12 skeletal and 6 dentoalveolar measures were compared.Results:Phase I with CMA lasted 5.2 ± 2.8 months; phase II with FFA lasted 13.0 ± 4.2 months. CMA treatment restricted the forward movement of the maxilla at point A. There was minimal effect on the sagittal position of the chin at pogonion. The Wits appraisal improved toward Class I by 2.1 mm during the CMA phase but not during FFA. Lower anterior facial height increased twice as much in the treatment group as in controls. A clockwise rotation (3.9°) of the functional occlusal plane in the treatment group occurred during phase I; a substantial rebound (−3.6°) occurred during phase II. Overjet and overbite improved during treatment, as did molar relationship; the lower incisors proclined (4.2°).Conclusions:The CMA appliance is an efficient and effective way of correcting Class II malocclusion. The changes were mainly dentoalveolar in nature, but some skeletal changes also occurred, particularly in the sagittal position of the maxilla and in the vertical dimension.     

Dental and skeletal effects after total arch distalization using modified C-palatal plate on hypo- and hyperdivergent Class II malocclusions in adolescents

ObjectivesTo compare the dental and skeletal treatment effects after total arch distalization using modified C-palatal plates (MCPPs) on adolescent patients with hypo- and hyperdivergent Class II malocclusion.Materials and MethodsThe study group included 40 patients with Class II malocclusion (18 boys and 22 girls, mean age = 12.2 ± 1.4 years) treated with MCPPs. Fixed orthodontic treatment started with the distalizing process in both groups. Participants were divided into hypo- or hyperdivergent groups based on their pretreatment Frankfort mandibular plane angle (FMA) ≤22° or ≥28°, respectively. Pre- and posttreatment lateral cephalograms were digitized, and 23 variables were measured and compared for both groups using paired and independent t-tests.ResultsThe hyper- and hypodivergent groups showed 2.7 mm and 4.3 mm of first molar crown distalizing movement, respectively (P < .001). The hypodivergent group had a slight 2.2° crown distal tipping of first molars compared with 0.3° in the hyperdivergent group. After distalization, the FMA increased 3.1° and 0.3°, in the hypodivergent and hyperdivergent groups, respectively (P < .001). SNA decreased in the hypodivergent group, while other skeletal variables presented no statistically significant differences in the changes between the groups.ConclusionsThe hypodivergent group showed more distal and tipping movement of the maxillary first molar and increased FMA than the hyperdivergent group. Therefore, clinicians must consider vertical facial types when distalizing molars using MCPPs in Class II nonextraction treatment.     

Treatment effects of the Forsus Fatigue Resistant Device used with miniscrew anchorage

Objective:To evaluate the dentofacial effects of the Forsus Fatigue Resistant Device (FRD) used with miniscrew anchorage (FRDMS) and compare them with those of conventional FRD and an untreated Class II control group.Materials and Methods:The sample consisted of 48 Class II subjects. Sixteen patients (13.68 ± 1.09 years of age) were treated with FRDMS, whereas 17 subjects (14.64 ± 1.56 years of age) were treated with only FRD. Also, a control sample of 15 untreated Class II subjects (14.13 ± 1.50 years of age) was constructed. Angular and linear measurements were made on 96 lateral cephalograms. Paired t, one-way analysis of variance, and Tukey tests were used for statistical analysis.Results:Class I molar relationship and overjet correction were achieved in an average period of 6.5 ± 1.97 and 5.5 ± 1.80 months in the FRDMS and FRD groups, respectively. No skeletal effect was determined in both treatment groups. Greater overbite correction was found in the FRD group. Retrusion and extrusion of maxillary incisors, distalization of maxillary molars, and extrusion of mandibular molars were significant in both treatment groups. Labial tipping of mandibular incisors was significantly greater in the FRD group than in the FRDMS group.Conclusion:Overjet and molar correction was totally dentoalveolar. Unfavorable labial tipping of mandibular incisors was effectively minimized with the usage of miniscrews.     

Maxillary molar distalization with miniscrew-supported appliances in Class II malocclusion: A systematic review

Objectives:To evaluate the quantitative effects of miniscrew supported appliances for maxillary molar distalization in Class II malocclusion.Materials and Methods:The systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles. The date of the last search was January 30, 2017. Methodological quality of the retrospective studies was graded by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP) and prospective studies by means of Newcastle–Ottawa Scale.Results:In total, 298 studies were identified for screening, and 14 studies were eligible. The Quality Assessment Tool for Quantitative Studies rated all of the four included retrospective studies as moderate. The Newcastle–Ottawa Scale rated seven studies as high quality and three studies as low quality. The mean molar distalization values varied from 1.8 mm to 6.4 mm. Mean distal tipping of molars varied from 1.65° to 11.3°. The mean distal movement of premolars and incisors varied from 1.75 mm to 5.4 mm and 0.1 mm to 2.7 mm, respectively.Conclusions:Miniscrew-supported appliances are effective in molar distalization with distal movement of premolars with minimal anchorage loss and distal tipping of the molar teeth.     

Long-term skeletal effects of high-pull headgear followed by fixed appliances for the treatment of Class II malocclusions

Objectives:The long-term skeletal effects of Class II treatment in growing individuals using high-pull facebow headgear and fixed edgewise appliances have not been reported. The purpose of this study was to evaluate the long-term skeletal effects of treatment using high-pull headgear followed by fixed orthodontic appliances compared to an untreated control group.Materials and Methods:Changes in anteroposterior and vertical cephalometric measurements of 42 Class II subjects (n = 21, mean age = 10.7 years) before treatment, after headgear correction to Class I molar relationship, after treatment with fixed appliances, and after long-term retention (mean 4.1 years), were compared to similar changes in a matched control group (n = 21, mean age = 10.9 years) by multivariable linear regression models.Results:Compared to control, the study group displayed significant long-term horizontal restriction of A-point (SNA = −1.925°, P < .0001; FH-NA = −3.042°, P < .0001; linear measurement A-point to Vertical Reference = −3.859 mm, P < .0001) and reduction of the ANB angle (−1.767°, P < .0001), with no effect on mandibular horizontal growth or maxillary and mandibular vertical skeletal changes. A-point horizontal restriction and forward mandibular horizontal growth accompanied the study group correction to Class I molar, and these changes were stable long term.Conclusions:One phase treatment for Class II malocclusion with high-pull headgear followed by fixed orthodontic appliances resulted in correction to Class I molar through restriction of horizontal maxillary growth with continued horizontal mandibular growth and vertical skeletal changes unaffected. The anteroposterior molar correction and skeletal effects of this treatment were stable long term.     

Evaluation of the splint-supported Forsus Fatigue Resistant Device in skeletal Class II growing subjects

ObjectivesTo evaluate the use of the Forsus Fatigue Resistant Device (FFRD), supported with bimaxillary splints, in treatment of skeletal Class II malocclusion.Materials and MethodsData from 46 skeletal Class II females who received either conventional Forsus alone (FFRD group) (15 patients, 12.54 ± 0.90 years), FFRD and bimaxillary splints (splint-FFRD group) (15 patients, 12.29 ± 0.82 years), or were untreated controls (16 subjects, 12.1 ± 0.9 years) were retrieved from previous clinical trials. FFRD was inserted onto the mandibular archwire in the FFRD group after leveling and alignment with multibracket appliances. In the splint-FFRD group, Forsus was inserted between fixed maxillary and mandibular splints. Treatment continued until reaching an edge-to-edge incisor relationship.ResultsBoth treatment groups failed to induce significant mandibular skeletal effects compared to the normal growth exhibited by untreated controls. The splint-FFRD group showed significant reduction of SNA (−0.88° ± 0.51°) and ANB (−1.36° ± 0.87°). The mandibular incisors showed significant proclination in the FFRD (9.17° ± 2.42°) and splint-FFRD groups (7.06° ± 3.34°).ConclusionsThe newly proposed splint-supported FFRD was equally effective as the conventional FFRD in treatment of Class II malocclusion with dento-alveolar changes and additional maxillary restricting effect. It has an additional advantage of immediate initiation of the Class II correction.     

Anchorage control using miniscrews in comparison to Essix appliance in treatment of postpubertal patients with Class II malocclusion using Carrière Motion Appliance:: A randomized clinical trial

ObjectivesTo evaluate anchorage control using miniscrews vs an Essix appliance in treatment of Class II malocclusion by distalization using the Carrière Motion Appliance (CMA).Materials and MethodsTwenty-four postpubertal female patients with Class II, division 1 malocclusion were randomly distributed into two equal groups. CMA was bonded in both groups, and one group was treated with miniscrews as anchorage (12 patients, mean age = 18.0 years) while the other group was treated with an Essix appliance as anchorage (12 patients, mean age = 17.8 years). For each patient, two cone-beam computed tomographic scans were obtained: one preoperatively and another after completion of distalization.ResultsIn the Essix appliance group, there was a statistically significant anterior movement (2.2 ± 1.43 mm) as well as proclination of the lower incisor (5.3° ± 4.0°), compared to a nonsignificant anterior movement (0.06 ± 1.45 mm) and proclination (0.86° ± 2.22°) in the miniscrew group. The amount of maxillary molar distalization was higher in the miniscrew group (2.57 ± 1.52 mm) than in the Essix appliance group (1.53 ± 1.11 mm); however, the difference was not statistically significant.ConclusionsMiniscrews led to a decrease in the amount of anchorage loss in the mandibular incisors, both in terms of anterior movement and proclination.     

Dental and skeletal changes in mild to moderate Class II malocclusions treated by either a Twin-block or Xbow appliance followed by full fixed orthodontic treatment

Objective:To compare the short-term skeletal and dental effects of two-phase orthodontic treatment including either a Twin-block or an XBow appliance.Materials and Methods:This was a retrospective clinical trial of 50 consecutive Class II cases treated in a private practice with either a Twin-block (25) or XBow (25) appliance followed by full fixed orthodontic treatment. To factor out growth, an untreated Class II control group (25) was considered.Results:A MANOVA of treatment/observation changes followed by univariate pairwise comparisons showed that the maxilla moved forward less in the treatment groups than in the control group. As for mandibular changes, the corpus length increase was larger in the Twin-block group by 3.9 mm. Dentally, mesial movement of mandibular molars was greater in both treatment groups. Although no distalization of maxillary molars was found in either treatment group, restriction of mesial movement of these teeth was seen in both treatment groups. Both treatment groups demonstrated increased mandibular incisor proclination with larger increases for the XBow group by 3.3°. The Wits value was decreased by 1.6 mm more in the Twin-block group. No sex-related differences were observed.Conclusions:Class II correction using an XBow or Twin-block followed by fixed appliances occurs through a relatively similar combination of dental and skeletal effects. An increase in mandibular incisor inclination for the XBow group and an increased corpus length for the Twin-block group were notable exceptions. No overall treatment length differences were seen.     

Treatment outcomes of Class II malocclusion cases treated with miniscrew-anchored Forsus Fatigue Resistant Device: A randomized controlled trial

Objective:To evaluate the skeletal, dental, and soft tissue effects of the Forsus Fatigue Resistant Device (FRD) used with miniscrew anchorage and compare them with those of the conventional Forsus FRD.Materials and Methods:This study was carried out on 38 patients. These patients were randomly allocated into three groups. The 14 patients in group 1 (aged 12.76 ± 1.0 years) were treated with the FRD appliance. In group 2, the 15 patients (aged 12.52 ± 1.12 years) received treatment with FRD using miniscrew anchorage, and the 9 patients in group 3 (aged 12.82 ± 0.9 years) received no treatment as a control group. Linear and angular measurements were made on lateral cephalograms before and immediately after Forsus treatment. Data were analyzed statistically using paired t-, ANOVA, and Tukey tests.Results:Class I molar relationship and overjet correction were achieved in both treatment groups. Although mandibular growth was statistically nonsignificant, there was a significant headgear effect on the maxilla. Mandibular incisor proclination, maxillary incisor retroclination, and distalization of maxillary molars were significant in both treatment groups. However, no significant differences were found between the treatment groups.Conclusions:Class II correction was mainly dentoalveolar in both treatment groups. Use of miniscrews with Forsus did not enhance mandibular forward growth nor prevent labial tipping of the mandibular incisors.     

Camouflage treatment of skeletal Class III malocclusion with multiloop edgewise arch wire and modified Class III elastics by maxillary mini-implant anchorage

Objective:To evaluate the effect of the multiloop edgewise arch wire (MEAW) technique with maxillary mini-implants in the camouflage treatment of skeletal Class III malocclusion.Materials and Methods:Twenty patients were treated with the MEAW technique and modified Class III elastics from the maxillary mini-implants. Twenty-four patients were treated with MEAW and long Class III elastics from the upper second molars as control. Lateral cephalometric radiographs were obtained and analyzed before and after treatment, and 1 year after retention.Results:Satisfactory occlusion was established in both groups. Through principal component analysis, it could be concluded the anterior-posterior dental position, skeletal sagittal and vertical position, and upper molar vertical position changed within groups and between groups; vertical lower teeth position and Wits distance changed in the experimental group and between groups. In the experimental group, the lower incisors tipped lingually 2.7 mm and extruded 2.4 mm. The lingual inclination of the lower incisors increased 3.5°. The mandibular first molars tipped distally 9.1° and intruded 0.4 mm. Their cusps moved 3.4 mm distally. In the control group, the upper incisors proclined 3°, and the upper first molar extruded 2 mm. SN-MP increased 1.6° and S-Go/N-ME decreased 1.Conclusions:The MEAW technique combined with modified Class III elastics by maxillary mini-implants can effectively tip the mandibular molars distally without any extrusion and tip the lower incisors lingually with extrusion to camouflage skeletal Class III malocclusions. Clockwise rotation of the mandible and further proclination of upper incisors can be avoided. The MEAW technique and modified Class III elastics provided an appropriate treatment strategy especially for patients with high angle and open bite tendency.     

Class II malocclusion treatment effects with Jones Jig and Distal Jet followed by fixed appliances

Objectives:To compare the skeletal, dentoalveolar, and soft tissue changes in Class II malocclusion patients treated with Jones Jig and Distal Jet distalizers followed by fixed appliances.Materials and Methods:The experimental groups comprised 45 Class II malocclusion subjects divided into two groups. Group 1 consisted of 25 patients treated with the Jones Jig, and group 2 consisted of 20 patients treated with the Distal Jet. Group 3 comprised 19 untreated Class II subjects. Cephalograms were analyzed before and after orthodontic treatment. For intergroup comparisons, one-way analysis of variance and post hoc Tukey tests were performed.Results:During treatment, the experimental groups exhibited significant increases in occlusal plane inclination and maxillary second molar mesial tipping. Additionally, the molar relationship improved and overjet decreased significantly in the experimental groups. The Jones Jig group showed greater mandibular incisor proclination and greater overbite reduction than the control group. No significant intergroup differences in nasolabial angle changes were found.Conclusions:Treatment protocols using the Jones Jig and Distal Jet followed by fixed appliances were effective in correcting Class II malocclusion by means of dentoalveolar changes without significant skeletal and soft tissue changes. The experimental groups showed occlusal plane clockwise rotation and greater mesial tipping of maxillary second molars when compared to the untreated group.     

Dentoskeletal effects produced by a Jasper Jumper with an anterior bite plane

Objective:The aim of this retrospective study was to evaluate the dentoskeletal effects produced by a modified Jasper Jumper with an anterior bite plane for the correction of Class II division 1 malocclusion.Materials and Methods:A sample of 32 growing patients (mean age  =  11.9 ± 1.4 years) with Class II division 1 malocclusion and increased overbite were treated with a modified Jasper Jumper (JJ) and anterior bite plane protocol and compared with a matched control group of 30 subjects with untreated Class II malocclusion (mean age 12.2 ± 0.8 years). Lateral cephalograms were taken before treatment (T1) and at the end of comprehensive treatment (T2). Mean treatment duration was 2.1 ± 0.4 years. The T1–T2 changes in the two groups were compared with Student’s t-tests for independent samples.Results:The JJ group was successfully treated to a Class I occlusal relationship with a significant reduction in overjet (–3.9 mm, P < .001) and overbite (–3.1 mm, P < .001). The JJ group exhibited a significant increase in mandibular length and a significant improvement in maxillomandibular sagittal skeletal relationships. The lower incisors were significantly proclined, while the lower first molars demonstrated significant movement in a mesial direction.Conclusions:Use of a modified JJ appliance and anterior bite plane is an effective protocol for the treatment of Class II malocclusion with increased overbite and greater skeletal (75%) than dentoalveolar (25%) effects mainly at the mandibular level.     

Asymmetric severe skeletal Class II division 1 patient with temporomandibular joint disorder treated with zygomatic anchorage devices and Ni-Ti alloy wires

Objective:To describe the orthodontic treatment of a nongrowing 30-year-old woman with asymmetric severe skeletal Class II malocclusions (asymmetric Angle Class II), large overjet (16 mm), large overbite (8 mm), two congenitally missing mandibular incisors (presenting a deciduous anterior tooth), and signs and symptoms of temporomandibular joint disorder (TMD).Materials and Methods:We used novel improved super-elastic Ni-Ti alloy wires (ISWs) combined with Ni-Ti alloy coil springs, power hooks, and a zygomatic implant as reinforced anchorage to provide a constant and continuous mild force to the dentition.Results:We successfully distalized maxillary molars, premolars, and retracted anterior teeth and corrected the asymmetric Angle Class II molar relationship using this system of zygomatic anchorage in conjunction with ISWs, Ni-Ti alloy open-coil springs, and crimpable power hook. The maxillary molars were distalized, and postero-occlusal relationships were improved to achieve Class I canine and molar relationships on both sides. Intrusion of the upper molars made the mandibular plane close. Ideal overbite and overjet relationships were established. Facial esthetics were improved with decreased upper and lower lip protrusion, and no symptoms of TMD were observed after treatment.Conclusion:The orthodontic treatment described here is a promising anchorage technique alternative to traditional techniques to improve severe skeletal Class II with TMD.     

Three-dimensional effects of the mini-implant–anchored Forsus Fatigue Resistant Device: A randomized controlled trial

Objective:To detect three-dimensionally the effects of using mini-implant anchorage with the Forsus Fatigue Resistant Device (FFRD).Materials and Methods:The sample comprised 43 skeletal Class II females with deficient mandibles. They were randomly allocated into three groups: 16 patients (13.25 ± 1.12 years) received FFRD alone (Forsus group), 15 subjects (13.07 ± 1.41 years) received FFRD and mini-implants (FMI group), and 12 subjects (12.71 ± 1.44 years) were in the untreated control group. Three-dimensional analyses of cone beam computed tomographic images were completed, and the data were statistically analyzed.Results:Class I relationship and overjet correction were achieved in 88% of the cases. None of the two treatment groups showed significant mandibular skeletal effects. In the FMI group, significant headgear effect, decrease in maxillary width, and increase in the lower facial height were noted. In the FMI group, retroclination of maxillary incisors and distalization of maxillary molars were significantly higher. Proclination and intrusion of mandibular incisors were significantly greater in the Forsus group.Conclusions:FFRD resulted in Class II correction mainly through dentoalveolar effects and with minimal skeletal effects. Utilization of mini-implant anchorage effectively reduced the unfavorable proclination and intrusion of mandibular incisors but did not produce additional skeletal effects.     

Comparison of two implant-supported molar distalization systems

Objective:To examine skeletal, dental, and soft tissue effects of the Miniscrew Implant Supported Distalization System (MISDS) and the Bone-Anchored Pendulum Appliance (BAPA).Materials and Methods:Among 28 patients displaying Angle Class II malocclusion, 14 patients with a mean age of 14.8 ± 3.6 years treated with MISDS were included in the first group, and 14 patients with a mean age of 14.5 ± 1.5 years treated with BAPA were included in the second group. The pretreatment and posttreatment lateral cephalograms were analyzed. Statistical evaluation was carried out using the paired Shapiro-Wilk test, the paired-sample t-test, and the unpaired t-test.Results:Upper posterior teeth were distalized successfully in both groups. Nearly bodily distalization was seen in the MISDS group, whereas significant distal tipping of the upper first molars was observed in the BAPA group (P < .001). There were no statistically significant changes in the sagittal position of the maxilla and mandible and in the position of the upper incisors as a result of treatment in either group.Conclusions:Both methods provided absolute anchorage for distalization of posterior teeth; however, almost translatory distal movement was encountered in the MISDS group, and substantial distal tipping of the maxillary molars accompanied distalization in the BAPA group.     

Combined use of miniscrews and continuous arch for intrusive root movement of incisors in Class II division 2 with gummy smile

Adequate intrusion and torque control of the retroclined maxillary incisors are critical for the treatment of Class II division 2 (div2) malocclusion. In addition, anterior retraction via lingual root movement can be challenging. This case report demonstrates a combined use of miniscrews and continuous arch with additional torque for intrusion, retraction, and torque control of maxillary incisors in the Class II div2 with gummy smile. A 20-year-old woman presented with multiple issues, including impacted canine, lip protrusion, prolonged retained mandibular primary molar, and two missing maxillary premolars. In order to improve her facial profile and eliminate the need for prosthetic work, the mandibular primary molar and contralateral premolar were extracted. Two miniscrews were placed at the maxillary buccal alveolar bone to apply the posterosuperior force for retraction of anterior teeth, with additional labial crown torque on the arch wire. The results were the intrusion (4 mm) and lingual root movement (17°) of the maxillary incisors without anchorage loss of maxillary molars, flattening of the Curve of Spee, and Class I molar relation that were maintained after 50 months of retention period. The combined use of miniscrews and continuous arch could be a reliable and effective treatment modality for torque control and intrusion of retroclined maxillary incisors in the Class II div2 patient.