Mini-implants for en masse intrusion of maxillary anterior teeth in a severe Class II division 2 malocclusion

Abstract

This case report describes the treatment of a 16-year-old post pubertal male patient with a severe Class II division 2 malocclusion and 100% deep bite. In the first phase of treatment, a ‘Jones-Jig’ molar distalization appliance was used to distalize the maxillary molars by more than 6 mm, to achieve a Class I molar relation. In the second phase of treatment, mini-implants were inserted between the roots of the maxillary lateral incisor and canine to intrude all the maxillary anterior teeth en masse in a single step. Four millimetres of intrusion was achieved. The implants remained stable throughout treatment. In the mandibular arch the incisors were proclined to alleviate the severe crowding. Good overjet and overbite was achieved and has been maintained one year after completion of active orthodontic treatment.     

The treatment of severe 'gummy' Class II division 1 malocclusion using the maxillary intrusion splint.

This paper describes a modified Maxillary Intrusion Splint (M.I.S.) system which incorporates a near vertical pull headgear, and its use in the management of severe 'gummy' Class II division 1 malocclusion. The appliance was designed to reduce the visibility and vulnerability of the maxillary incisors in this difficult clinical situation by achieving the intrusion of maxillary teeth, restraining maxillary growth, and encouraging an element of subsequent forward mandibular rotation. The authors' initial experience using this system is presented in a retrospective cephalometric analysis of the lateral skull films of 26 treated patients contrasted with a similar number of comparable controls. The results showed that the principal effects of the M.I.S. were on the maxillary teeth giving decisive overjet control and incisor retraction with actual maxillary incisor intrusion. There was a similar effect on the maxillary molar and the M.I.S. provided effective en masse vertical control of the maxillary dentition. There was some degree of maxillary restraint in the M.I.S. group, but no noticeable difference in the change of mandibular position between the groups at the end of treatment. The possible reasons for this are discussed and suggestions made to improve this aspect of treatment in these patients.     

Mini-implants for retraction,intrusion and protraction in a Class II division 1 patient

Abstract

This case report demonstrates the clinical utility and versatility of mini-implants in carrying out different types of tooth movement in a 14-year-old boy with a ‘severe’ Class II division 1 malocclusion. Mini-implants were placed for ‘en masse’ retraction and intrusion of maxillary anterior teeth and for lower molar protraction. More than 11 mm of maxillary incisor retraction was achieved together with 3 mm of intrusion. There was significant reduction in the dentoalveolar protrusion and retraction of the upper lip, which resulted in decreased mentalis strain and improved chin projection. Cephalometric superimposition and panoramic radiographs showed no anchorage loss and good occlusion at the end of treatment.     

Mini-implants for retraction, intrusion and protraction in a Class II division 1 patient

This case report demonstrates the clinical utility and versatility of mini-implants in carrying out different types of tooth movement in a 14-year-old boy with a 'severe' Class II division 1 malocclusion. Mini-implants were placed for 'en masse' retraction and intrusion of maxillary anterior teeth and for lower molar protraction. More than 11 mm of maxillary incisor retraction was achieved together with 3 mm of intrusion. There was significant reduction in the dentoalveolar protrusion and retraction of the upper lip, which resulted in decreased mentalis strain and improved chin projection. Cephalometric superimposition and panoramic radiographs showed no anchorage loss and good occlusion at the end of treatment.     

Zygomatic anchorage for en masse retraction in the treatment of severe Class II division 1

An adult female patient who presented with a severe Class II division 1 malocclusion was treated by en masse retraction of upper anterior teeth against zygomatic anchorage. This case report describes the surgical and orthodontic procedures followed during the treatment. En masse retraction of the six anterior teeth by using zygomatic bone anchorage proved to be an efficient method for the correction of a severe overjet problem.     

Rationale of treatment for Class II division 2 malocclusion

Class II, division 2 malocclusion is a clinical entity which presents considerable difficulty in the provision of a stable treatment result. This article sets out the problems encountered, reviews teaching on the subject over a 20-year period and attempts to rationalize the current approach to treatment. The rationale presented shows the three-dimensional nature of the occlusal problem, and discusses the justification for expansion and proclination of lower incisors in relation to soft tissue influences and stability. The importance of correcting edge-centroid relationship and reducing inter-incisor angle is stressed. Non-extraction therapy, with some lower arch expansion and incisor advancement, is recommended and the reasoning behind this is explained with a case example to illustrate the points involved.     

Treatment of a Class II division 1 anterior open bite malocclusion.

A case report of an 11-year-old Caucasian female who presented with a Class II div I anterior open bite malocclusion. Overjet is 6 mm and the anterior open bite 2 mm. There was a history of digit sucking till she was eight years old. She was successfully treated by non-extraction with pre-adjusted Edgewise appliances and high-pull headgear for a period of 27 months.     

快速整体内收上颌前牙对犬牙根吸收影响的扫描电镜观察

目的研究牙槽外科辅助快速整体内收上颌前牙对实验犬前牙牙根的影响。方法建立牙槽外科辅助快速整体内收上颌前牙的比格犬动物模型后,连续加力12 d,速度0.5 mm/d,分别于加力停止并固定1 d,14 d,28 d后随机处死3只实验犬,拔出一侧上颌第三切牙,制备标本行扫描电镜观察。结果加力停止1 d及14 d后牙根吸收明显,停止加力28 d后,牙根吸收面积明显减小:牙根颈部28 d与1 d(t=25.075,P=0.014)、28 d与14 d(t=17.444,P=0.056)比较,差异有统计学意义;牙根尖部28 d与1 d(t=26.436,P=0.000)、28 d与14 d(t=18.229,P=0.003)比较,差异有统计学意义。结论牙槽外科辅助快速整体内收上颌前牙会造成一定程度的牙根吸收,随着加力停止后固定时间的延长,牙根吸收可明显修复。     

Lip shape and position in Class II division 2 malocclusion

OBJECTIVE: To determine whether differences exist in the shape and position of the lips between Class II division 2 and Class I malocclusions. MATERIALS AND METHODS: Lateral cephalometric radiographs of subjects with Class II division 2 (n = 30) and Class I (n = 30) incisor relationships were scanned at 300 dpi to produce digital images. These were subsequently digitized in random order. Twenty-one landmarks characterizing the upper and lower lips and the maxillary and mandibular central incisors were digitized. Procrustes algorithms optimally superimposed the landmark configurations to standardize size, location, and orientation. Discriminant analysis of the principal components of shape determined the differences between the Class II division 2 and Class I groups. RESULTS: The shape and position of the upper and lower lips differed significantly between the Class II division 2 group and the Class I group (P < .001). Principal component (PC) 1 (46% of the variance) involved an increase in the thickness of the upper and lower lips in the Class II division 2 group. PC2 (11% of the variance) was characterized by a relatively higher lip line in the Class II division 2 group. CONCLUSIONS: The shape and position of the lips differ between Class II division 2 and Class I malocclusions.     

Early treatment mechanics of the Class II division 2 malocclusion

A most common type of early malocclusion that the pediatric dentist comes in contact with daily is the developing Class II Division 2 malocclusion (Fig 1-a,b). It is the malocclusion that the parents of the children we serve bring to our attention. Parental concern is the early crowding that develops in the anterior of the lower arch with risk of periodontal involvement. This malocclusion is readily amenable to interception at age 7 or 8 and can proceed with a protocol of defined objectives and predictable outcomes (Fig 2). With efficient and effective utility arch wire (UAW) mechanics a state of normalcy can be achieved within six to eight months of treatment.     

Activator and Begg appliance management of a severe Angle Class II, division 1 malocclusion

A male patient aged 12 years 11 months presented with the chief complaint of prominent, spaced upper teeth and was keen to overcome his dental problem.