Palatal Anterior Teeth Retraction Assisted by Temporary Anchorage Devices - A Review

Abstract

Successful orthodontic resolution of bimaxillary dentoalveolar protrusion depends on successful retraction of anterior dentition, which also involves acquiring proper buccolingual inclination and vertical position of anterior teeth. To fulfill these requirements, clinicians have devised numerous biomechanical and surgical orthodontic options. A palatal retractor for retraction of maxillary anterior dentition is the result of clinician’s long-time creative endeavors and an evolution of the biomechanical design. A palatal retractor splints the maxillary anterior dentition on the lingual side with bonded mesh plates connected by a supporting wire. Two long palatally extended arms are soldered to the supporting wire where adequate retraction force can be applied. Palatal retractors have several advantages over conventional bracket/wire systems. The two most prominent ones are biomechanical superiority and esthetic invisibility. As the palatal retractor is positioned on the lingual surface of the maxillary anterior dentition, it is not visible from the frontal view and since the anterior dentition retraction constitutes a significant portion of the total treatment time in extraction orthodontic treatment, it is a distinct esthetic advantage. Biomechanical disadvantage of the conventional bracket/wire system lies in its innate ineffectiveness of the torque and vertical control because of the long distance between the point of force application and the center of resistance of the anterior dentition. A combination of TADs and palatal retractors provides the possibility of maximizing control of both the torque and vertical position. This article aims to describe clinical considerations, applications, and results of palatal retractor use in clinical cases. Keywords: extraction treatment, anterior teeth retraction, palatal retractors, temporary anchorage devices.