Orthodontic Management of Severe Dentoalveolar Collapse with Miniscrew-Assisted TMA Cantilever Springs and Bite Blocks

Abstract

Introduction: Management of mutilated cases is challenging, and adult patients often require orthodontic correction of occlusion before prosthetic replacement of missing teeth. Objective: To highlight the novel, simple, hygienic, and efficient miniscrew-supported Beta titanium molybdenum alloy (TMA) cantilever spring for uprighting severe mesially tipped molars for interdisciplinary treatment. Diagnosis and Treatment: A 23-year-old male patient presented with skeletal Class I relation, average growth pattern, Class II Division 1 malocclusion with dentoalveolar collapse, crowding, multiple missing, supraerupted teeth, and severe mesially tipped mandibular third molars. MBT appliance with 0.022˝ slot was used to achieve the objectives. 38 and 48 were uprighted and protracted with miniscrew implant-supported TMA cantilever springs to substitute 37 and 47. Mild intrusion of maxillary posterior teeth was done with acrylic bite blocks and transpalatal arch (TPA), followed by prosthetic replacement of missing teeth. Results: The patient had a consonant smile arc and a pleasing soft tissue profile. 38 and 48 were uprighted and protracted with good vertical control, and the mesial pockets were eliminated. 17 and 27 were intruded, and group function occlusion was established. Class I canine relationship, normal overjet, and overbite were achieved. Conclusion: Miniscrew supported TMA cantilevers are efficient for uprighting of severely tipped 38 and 48 without extrusion, unlike the conventional mechanics. 18, 28, 38 and 48 with good root forms can be protracted and substituted as 17, 27, 37 and 47 respectively to minimize or eliminate prosthetic rehabilitation.