Management of Post-Extraction Orthodontic Relapse Using Miniplate Anchorage: A Case Report

Total arch distalization with extraalveolar miniscrews for nonextraction treatment of a patient with low-angle Class II Division 1 malocclusion: a 10-year follow-up

Temporomandibular joint dysfunction (TMD) is a common clinical condition characterized by discomfort in the masticatory muscles and temporomandibular joint, limitations in mandibular movements, and clicking or crepitating sounds during jaw motion. To our knowledge, few reports have described the management of TMD associated with orthodontic relapse and skeletal open bite using a staged approach involving stabilization splint therapy followed by miniscrew-assisted clear aligner treatment. Therefore, this case report provides clinically relevant information on the management of TMD associated with orthodontic relapse. This case report presents a 26-year-old female patient with TMD and relapse in alignment after seven years of initial treatment. Clinical and radiographic evaluation revealed a skeletal open bite, Angle Class II division 1 subdivision malocclusion, 1mm mandibular midline deviation, mild crowding in the lower arch, condylar deformation, and degenerative changes within the TMJ. In the treatment, a maxillary stabilization splint was used full-time for seven months. After splint treatment, orthodontic correction was planned with clear aligners, incorporating maxillary molar intrusion and distalization supported by miniscrew anchorage. At the end of treatment, a stable Class I molar relationship, ideal overjet and overbite, and coincident midlines were achieved. Cephalometric analysis demonstrated mandibular anterior rotation and improved sagittal and vertical relationships. Post-treatment CBCT showed reduced bony contact and a more homogeneous joint space on the evaluated sections, suggesting adaptive changes in condylar position and joint relationship. At the one-year follow-up, the patient maintained stable occlusion with no signs of relapse. This case report suggests that miniscrew-assisted clear aligner treatment following stabilization splint therapy may be a minimally invasive treatment option for patients with TMD and skeletal open bite. This treatment approach may also contribute to improvements in occlusal relationships and TMD-related symptoms.

Lingual orthodontic treatment of a skeletal class II patient with miniscrew-assisted absolute anchorage in maxillary arch and total distalization in mandibular arch: a case report

To compare the amount of anchorage loss of the maxillary posterior teeth and amount of retraction of the maxillary anterior teeth between en masse retraction and two-step retraction of the anterior teeth. The sample consisted of 30 female adult patients with Class I malocclusion and lip protrusion who needed maximum posterior anchorage. The sample was subdivided into group 1 (n = 15, mean age = 21.4 years, en masse retraction) and group 2 (n = 15, mean age = 24.6 years, two-step retraction). Lateral cephalograms were taken before (T1) and after treatment (T2). Nine skeletal and 10 anchorage variables were measured, and independent t-test was used for statistical analysis. Although the amount of horizontal retraction of the maxillary anterior teeth was not different between the two groups, there was mild labial movement of the root apices of the upper incisors in group 2 at T2. There were no significant differences in the degree of anchorage loss of the maxillary posterior teeth between the two groups. Bodily and mesial movements of the upper molars occurred in both groups. Approximately 4 mm of the retraction of the upper incisal edges resulted from 1 mm of anchorage loss in the upper molars in both groups. No significant differences existed in the degree of anchorage loss of the upper posterior teeth and the amount of retraction of the upper anterior teeth associated with en masse retraction and two-step retraction of the anterior teeth.

An asymmetric molar relationship is challenging to diagnose and plan treatment. This case report describes a successful orthodontic treatment of a 17-year-old female patient with a full-cusp Class II molar relationship on the left side, anterior crowding, and lip protrusion. After extracting the maxillary left second molar, the maxillary left first molar was sufficiently distalized, establishing both Class I molar relationship. The maxillary left third molar successfully replaced the second molar. Lip protrusion was corrected by retracting the anterior teeth after extracting 4 premolars. The patient showed improved facial profile with good occlusion, which maintained well until 3-year retention. When the healthy third molar can replace the second molar, unilateral molar distalization after extracting the second molar could be a viable treatment option to correct severe asymmetric molar relationship.

Background: Surface electromyography (sEMG) enables the non-invasive assessment of muscle activity and is widely used in orthodontics for evaluating masticatory muscles. However, little is known about the dynamic changes in facial expression muscles during orthodontic treatment. This study aimed to investigate alterations in facial muscle tone during the leveling and alignment phase in adult female patients undergoing fixed appliance therapy. Methods: The study included 30 female patients aged 20-31 years who underwent sEMG assessment at four time points: before treatment initiation (T0), at the start of appliance placement (T1), three months into treatment (T2), and six months into treatment (T3). Muscle activity was recorded during four standardized facial expressions: eye closure, nasal strain, broad smile, and lip protrusion. Electrodes were placed on the orbicularis oris, orbicularis oculi, zygomaticus major, and levator labii superioris alaeque nasi muscles. A total of 1440 measurements were analyzed using Friedman and Conover-Inman tests (α = 0.05). Results: Significant changes in muscle tone were observed during treatment. During lip protrusion, the orbicularis oris and zygomaticus major showed significant increases in peak and minimum activity (p < 0.01). Eye closure was associated with altered orbicularis oris activation bilaterally at T3 (p < 0.01). Nasal strain induced significant changes in zygomaticus and levator labii muscle tone, particularly on the right side (p < 0.05). No significant changes were noted during broad smiling. Conclusions: Orthodontic leveling and alignment influence the activity of selected facial expression muscles, demonstrating a dynamic neuromuscular adaptation during treatment. These findings highlight the importance of considering soft tissue responses in orthodontic biomechanics and suggest potential implications for facial esthetics and muscle function monitoring.

Correction of a gummy smile and lip protrusion by orthodontic retreatment with lingual appliances and temporary skeletal anchorage devices

In the present report, two techniques of space closure; two-step anterior teeth retraction (TSR) and en masse retraction (ER) were used in two adult patients who had bimaxillary protrusion and were treated with four premolar extractions and fixed orthodontic appliance therapy. Both patients had a Class I dental malocclusion and the same chief complaint, which is protrusive lips. Anterior teeth were retracted by two-step retraction; canine sliding followed by retraction of incisors with T-loop archwire in the first patient and by en masse retraction using Beta titanium alloy T-loop archwire in the second case. At the end of treatment, good balance and harmony of lips was achieved with maintenance of Class I relationships. The outcome of treatment was similar in the two patients with similar anchorage control. ER can be an acceptable alternative to the TSR during space closure since it is esthetically more acceptable. However, it requires accurate bending and positioning of the T-loop.

Objective: To evaluate the effect of dental crowding and lip protrusion on self-esteem and quality of life (QOL) in female orthodontic patients with Class I malocclusion. Materials and Methods: The study sample consisted of 201 patients (mean age 22.6 ± 3.0years) who sought orthodontic treatment. All the patients were evaluated before treatment in terms of their degree of dental crowding and lip protrusion. Rosenberg's Self-Esteem Scale and the Orthognathic Quality of Life Questionnaire (OQLQ) were used to determine self-esteem and QOL and to evaluate whether these values were related to malocclusion severity. Results: The results indicated that severe crowding and severe protrusion can result in lower self-esteem and poorer QOL (P < .05) than mild crowding and protrusion in Class I malocclusion. In the oral function component of the OQLQ, the severity of protrusion did not have significant effect. Conclusions: In Class I malocclusion, patients with mild crowding or protrusion had significantly better self-esteem and QOL scores than severe crowding or protrusion patients.

To evaluate the effect of dental crowding and lip protrusion on self-esteem and quality of life (QOL) in female orthodontic patients with Class I malocclusion. The study sample consisted of 201 patients (mean age 22.6 ± 3.0 years) who sought orthodontic treatment. All the patients were evaluated before treatment in terms of their degree of dental crowding and lip protrusion. Rosenberg's Self-Esteem Scale and the Orthognathic Quality of Life Questionnaire (OQLQ) were used to determine self-esteem and QOL and to evaluate whether these values were related to malocclusion severity. The results indicated that severe crowding and severe protrusion can result in lower self-esteem and poorer QOL (P < .05) than mild crowding and protrusion in Class I malocclusion. In the oral function component of the OQLQ, the severity of protrusion did not have significant effect. In Class I malocclusion, patients with mild crowding or protrusion had significantly better self-esteem and QOL scores than severe crowding or protrusion patients.

Nonsurgical treatment of an adult with a skeletal Class II gummy smile using zygomatic temporary anchorage devices and improved superelastic nickel-titanium alloy wires.

Background: Relapse occurs frequently, 70–90% of the time, and typically compromises the outcome of orthodontic therapy. Calcium carbonate (CaCO3), which is found in cuttlefish shells, can be used to make a better biomaterial. One example is carbonated hydroxyapatite, which is very similar to human bone tissue and can stop osteoclast activity on the pressure side of the retention phase. This is a factor in orthodontic relapse, which is when the bone doesn't remodel properly. In this study, a test was done to see if carbonated hydroxyapatite (CHA) could be used as an alternative material to stop orthodontic relapse. The test was based on how the RANK-RANKL, OPG, and TGF-β proteins interacted with each other.&#x0D; Method: CHA extracted from cuttlefish shells after 6 hours of calcination at 1000°C. RANK-RANKL, OPG, and TGF-β interactions were investigated in silico using molecular docking. &#x0D; Result: A cuttlefish shell extract containing CHA has the potential to be used as an alternate material to prevent orthodontic recurrence. CHA chemicals can disrupt the link between RANK and RANKL and enhance OPG and TGF-β expression. This induces enhanced proliferation, which increases the number of osteoblasts and osteoblast differentiation while decreasing the rate of osteoclast activity.&#x0D; Conclusion: Cuttlefish shell with CHA extract has the potential to be used as an alternative material to prevent orthodontic relapse.

This case report presents a treatment approach which combines clear aligners and skeletal anchorage, mainly micro-implants, to address crowding and lip protrusion in a middle-aged adult who presented with multiple prosthetic restorations. Tooth movements were strategically staged in a virtual setup, beginning with canine retraction using micro-implants to resolve anterior crowding, followed by en-masse distalisation of the dentition. For refinement, additional in-house aligners were employed alongside fixed auxiliaries. The total treatment duration was 9 months, demonstrating high time efficiency. Cone beam computed tomography superimposition indicated posterior tooth distalisation, slight dental arch expansion, and predominantly tipping movements of the distalised teeth. This approach of total arch distalisation rather than conventional sequential distalisation, proved to be temporally efficient against equivalent treatment results. Further research is warranted to improve biomechanical predictability and develop standardised treatment protocols.

Ravindra Nanda Flavio Andres Uribe Temporary anchorage devices in orthodontics 2008 Mosby Elsevier 431 pages; 368 illustrations; $165

Background: Evidence suggests that sleep bruxism is centrally regulated, and that the highest risk factor associated with sleep bruxism is obstructive sleep apnea. Current treatments for sleep bruxism include dental nightguards or occlusal splints, which are often provided without upper airway or sleep assessments. Methods: In this case report, we used biomimetic oral appliance therapy to address sleep bruxism by redeveloping the maxilla and repositioning the mandible in a 17 yr. old, female patient. Results: The upper airway volume increased by 313% (from 7.7 cm3 to 24.1 cm3) and the minimum upper airway cross-sectional area increased by 230% from (120 mm2 to 276.5 mm2), which improved both sleep bruxism and orthodontic relapse. Conclusion: We conclude that dentists and orthodontists can help in the recognition and treatment of both sleep bruxism and malocclusion, thereby preventing systemic co-morbidities associated with obstructive sleep apnea.