Bimaxillary Protrusion Cases Research Articles

Comparative evaluation of the position of incisive canal and its proximity to the maxillary central incisor roots with different incisor inclinations – A CBCT study

Objectives: The aim of this study was to evaluate and compare the incisive canal position and its proximity to maxillary central incisor roots at different incisor inclinations. Material and Methods: A 105 CBCT samples have been then divided into three groups on the basis of U1-SN and U1-NA when traced on lateral cephalogram into normal, proclined, and retroclined. Several linear measurements have been made in the axial plane at three different levels, that are palatal opening, mid-root level, and apex, in relation to the incisive canal. Angular measurements were also made in the sagittal plane. Results: A significant difference was found between the proximity of the maxillary right and left central incisor to the incisive canal in the proclined and retroclined group at the mid-root level and at the apex. There has been a major variation between the angles developed by the incisive canal to the palatal plane in all three groups. A significant correlation was also found between the angle formed by the incisive canal to the palatal plane and the tooth’s long axis to the palatal plane. Conclusion: The proclined group exhibits the shortest distance between the incisive canal and the incisors, implying the need for meticulous planning in Class II Division 1 and bimaxillary protrusion cases. This planning is crucial when aiming for extensive retraction and intrusion to prevent any contact with an incisive canal, thus reducing the root resorption risk.

Orthognathic Surgery Trending: Retrospective Ten Years Cases Analysis in Nineveh Province, Iraq.

The study aimed at analyzing patient's case sheets in regard to the incidence of skeletal discrepancy present in cases and its relation with the demographic profile of the sample. All these are chronicled for more than 10 years periods. This is a retrospective study analysis of the orthognathic case sheets for more than 10 years period. The total numbers of patients are 678. Patient's case sheet was already prepared by the Multi-Disciplinary Team Orthognathic Surgery Clinic in Al-Salam Teaching Hospital, which is the only authorized committee in Nineveh Health Directorate. The highest age percentage is between (18 and 27y/76%). Angle class III cases are the uppermost cases (36%) from the total. A significant P value is clear at the level ≤0.05 and ≤0.01 between surgery type and discrepancy in anterior segmental osteotomies (upper and lower) which is performed in bi-maxillary protrusion cases and Angle class II cases (0.01**). Similarly, anterior segmental osteotomies (upper jaw only) which are indicated in both open bite and Angle Class II cases documented as a statistically significant P value (0.02*). The positive correlation is shown in all variables with the disharmony or facial discrepancies. Esthetic and beauty as causes for treatment recorded more than function in relation to time series. This study documents that patients with skeletal class III accounted for the largest percentage (64%) in the study group. A high increase in patients number seeking treatment for their discrepancy is obvious with time from 2009 till 2022.

Effect of First Premolars Extraction with Maximum Retraction on Airway and Hyoid Bone Position in Class I Bimaxillary Dentoalveolar Protrusion Cases

Background: The aim was to determine the effect of first premolars extraction with maximum incisor retraction on airway magnitude and hyoid bone position in cases with bimaxillary dentoalveolar protrusion. Methods: Lateral cephalograms of patients with Class I skeletal and dental relationships were retrospectively recruited. Inclusion criteria were 15-30 years old patients having bimaxillary proclination who had undergone all first premolar extractions with maximum incisor retraction. Patients with dentofacial anomalies, chronic mouth breathing and those who had undergone tonsillectomy or adenoidectomy were excluded. Pre-and post-treatment lateral cephalograms were digitally analyzed for airway measurements and hyoid bone position. Paired samples T-test was used for statistical analysis. P-value<0.05 was considered statistically significant. Results: A total of 33 patients, comprising 22 females and 11 males, with a mean age of 24.39 ± 6.92 years were included. Statistically significant differences were found in airway dimensions from pre-treatment to post-treatment; upper airway size between soft palate and posterior pharyngeal wall (SPP-SPPW) was reduced by 1.91mm (12.78%), at uvula & middle posterior wall (U-MPW) by 2.51mm (20.60%), at tongue base to posterior-inferior point on middle pharyngeal wall (TB-TPPW) by 3.39mm (24.26%) and vallecular to lower pharyngeal wall by 1.51mm (9.94%). The vertical position of hyoid bone also significantly reduced as indicated by inferior movement of hyoidale (H) by 4mm (3.8%). There was no significant changes in the horizontal position of the hyoid bone. Conclusion: Premolar extraction with maximum retraction in bimaxillary protrusion cases can decrease the airway dimension and increase vertical position of hyoid bone.

Pre- and post- treatment changes in lip position: A retrospective cephalometric study on bimaxillary protrusion cases

Pre and Post treatment changes in lip position To determine the changes in lip position in pre and post treatment lateral Cephalogram in bimaxillary protrusion cases. Retrospective Cephalometric study on bimaxillary protrusion cases. The study comprised of 45 subjects (6 Male and 39 Females) aged between 18 to 26 years having Bimaxillary protrusion malocclusion and treated with all four first premolar extraction. The pre-treatment and post treatment lateral cephalograms were traced and landmarks were identified Statistical analysis used: Statistical Package for the Social Sciences (SPSS Version 23; Chicago Inc., IL, USA), Kolmogorov –Smirnov and Shapiro Wilk tests, One-way analysis of variance (ANOVA), Tukey's post hoc analysis. A positive correlation was found in changes in pre- and post-treatment changes in upper lip curvature, H-Line Angle, Upper sulcus depth, Upper lip strain, changes in the upper lip and the soft tissue from the nose tip, length of upper and lower lip, Nasolabial angle, Upper lip protrusion, Lower lip protrusion. However changes in Facial angle, Steiner’s S line, Upper and lower lip thickness were not statistically significant. Treatment of Bimaxillary protrusion cases with extraction of all four first premolars resulted in a significant improvement in facial profile, esthetics and enhanced the soft tissue harmony.

Comparison of the Mini-plate and Mini-screw for Retraction of Anterior Teeth in Severe Bimaxillary Protrusion Cases with Extraction of First Bicuspids: A Protocol for Randomised Controlled Trial

Comparison of the Mini-plate and Mini-screw for Retraction of Anterior Teeth in Severe Bimaxillary Protrusion Cases with Extraction of First Bicuspids: A Protocol for Randomised Controlled Trial

Full Arch Distalisation using Infrazygomatic Crest and Buccal Shelf Implants

This article reports the successful use of Infrazygomatic crest and buccal shelf implants in the maxilla and mandible to treat a female patient of age 13‐years. The patient had a skeletal Class I pattern and Angles class I malocclusion. Temporary anchorage devices (TADs) in the posterior dental region between maxillary and mandibular second premolar and first molar teeth on both sides were used as anchorage for full arch distalization. The patient received a satisfactory occlusion and an attractive smile. This technique requires minimal compliance and is particularly useful for correcting bimaxillary protrusion cases. Keywords: Class I Malocclusion, Distalization, Temporary Anchorage Devices

Retraction of Anterior Teeth with Temporary Anchorage Devices (TADS) – A Review

One of the most important contemporary use of Temporary anchorage devices also known as TADS is anterior teeth retraction, most commonly needed in bimaxillary protrusion cases or Class II dentoalveolar cases involving extraction of premolars. This function is performed by providing absolute anchorage by using direct or indirect means depending upon the mechanism used. Various clinicians have adopted different methods and different miniscrew systems for the purpose. The aim of this article is to describe some of these methods for their effective use in enabling this function of providing a powerful anchorage so that orthodontic concern of loosing anchorage in critical cases could be addressed efficiently.

Comparison of the hard and soft tissue changes of bimaxillary protrusion patients treated with Begg and MBT techniques: a cephalometric study

<p class="abstract"><strong>Background:</strong> The effective treatment of bimaxillary protrusion needs a sound knowledge of the mechanics and expertise to control the tooth movement and the unwanted side effects. To obtain a desired finish there is a need to study and compare the mechanics used for correction of bimaxillary protrusion. The aim of this study was to quantify and compare the skeletal, dentoalveolar and soft tissue effects of Begg and MBT mechanotherapies in the treatment of bimaxillary protrusion cases.</p><p class="abstract"><strong>Methods: </strong>In the present study, cephalometric comparison of the two mechanotherapies, Begg and MBT appliances was done retrospectively. The subjects were selected on the basis of pretreatment characteristics. The sample consisted of 40 patients (20 in each group) with an age range of 12-24 years. Pre- and post-treatment cephalograms were taken and traced on 75μm lacquered polyester acetate tracing papers using a 0.05” lead pencil.</p><p class="abstract"><strong>Results:</strong> The present study showed that Begg and the MBT appliances were equally effective in treating bimaxillary protrusion with first premolar extraction to satisfactory end results. Treatment with both the appliances resulted in significant amount of upper and lower anterior retraction and achievement of a pleasing facial appearance and profile.</p><p class="abstract"><strong>Conclusions: </strong>Good torque control, if used in Begg mechanotherapy will result in achieving similar treatment outcome as obtained with MBT technique.</p>

Comparative Evaluation of Anchorage Loss with Implant-Aided Retraction and Frictionless Mechanics with Conventional Anchorage in Bimaxillary Protrusion Cases.

Management of anchorage and good control of molars in all three planes of space is necessary for optimal results. It is of paramount importance for the clinician to select the appropriate anchorage control. The aim of the study was to compare the anchorage loss from implant-aided retraction and frictionless mechanics retraction in bimaxillary protrusion cases. Cephalograms of 40 patients were evaluated in this retrospective study, segregated into two groups based on their retraction mechanics. Anchorage loss was determined from measurements made on pretreatment and postretraction lateral cephalograms. Mean and standard deviation from independent sample t-tests were used to analyze the anchorage loss between the two groups. Statistical analysis was carried out using SPSS version 20.0. In the implant-aided group, mean anchorage loss was 0.95 ± 0.36 mm; in the frictionless mechanics with conventional anchorage group, the mean anchorage loss was 2.44 ± 0.46 mm. The average interincisal angle in the frictionless mechanics group and the implant-aided retraction group was 99.45 ± 5.41° and 100.15 ± 4.85°, indicating similar incisor inclinations in the pretreatment group. Pretreatment interincisal angle measurement ensured that both groups had similar anchorage demands. Anchorage loss was greater in frictionless mechanics with conventional anchorage (2.44 m) when compared to implant-aided retraction mechanics (0.95 mm). Implant-aided retraction can thus be considered for cases requiring absolute anchorage.

What is the best soft-tissue reference plane to quantify lip change in bimaxillary protrusion cases? A retrospective cohort study

Objectives: The objective of the study was to evaluate the validity of five soft-tissue profile planes to actual horizontal lower lip changes following treatment of severe bimaxillary protrusion patients with vertical maxillary excess using extra-alveolar miniscrews. The null hypothesis was no differences in the incremental changes of horizontal lower lip changes from pre-treatment to post-treatment of the five methods compared to actual changes. Materials and Methods: Seventy adults were treated orthodontically with extractions for bimaxillary protrusion and “gummy” smile using extra-alveolar miniscrews. Lower lip horizontal position was assessed with pre- and post-treatment lateral cephalograms and five commonly used soft-tissue reference lines were used to measure horizontal lower lip treatment change. Results: Compared to actual therapeutic lower lip horizontal retraction (4.38 mm), soft-tissue references Ricketts’ E-line (3.89 mm) and Steiner’s S-line (3.88 mm) demonstrated no statistical difference (P > 0.05) from actual change. The five profile plane measures showed moderately high to high intercorrelations among themselves, but none of them were related to the actual amount of anteroposterior lip change that occurred. None of the five soft-tissue measurements showed a statistically significant difference (P > 0.05) between subgroups with least and greatest lower lip retraction. Conclusion: Under conditions of maximum lower lip retraction, Rickett’s E-line and Steiner’s S-line were fair measures of horizontal lower lip change. Although actual lower lip change and soft-tissue reference plane changes were correlated poorly, intercorrelations among the five soft-tissue references planes were moderately high. None of the five soft-tissue measurements was able to discriminate (P > 0.05) between treatments with least and greatest lower lip retraction. It may be concluded that Rickett’s E-line and Steiner’s S-line soft-tissue profile references are valid when there is considerable therapeutic retraction (4+ mm) of the lower lip.

Perception of computerised predictions using cephalometric software facad in orthognathic surgery

Introduction: Orthognathic surgery has become a more acceptable treatment modality in conjunction with orthodontic treatment as esthetic awareness has been increased. The criteria for success of an orthognathic surgical procedure are not only centred on the correction of the skeletal and dental abnormalities, but also on an esthetic improvement as judged by both patients and practitioners. Using computer softwares for prediction of orthognathic surgical outcome is gaining more popularity. It was the purpose of the present study to examine the efficacy of prediction of soft tissue changes after performing orthognathic surgeries using the cephalometric software program FACAD. Aims and Objectives: The aim of the study is to assess the perception of facial profile attractiveness and soft tissue outcome in predicted profile images in patients undergoing orthognathic surgery. Materials and Methods: Total of 50 samples aged 20 to 25 years (35 females and 15 males) 20 skeletal class I bimaxillary protrusion cases, 20 skeletal class II cases and 10 skeletal class III cases. Cephalometric radiographs were scanned using Epson V 700 film scanner. The radiographic images were analysed using cephalometric software (FACAD 3.6 )and traced by identifying and placing a series of cephalometric points, both bony and soft tissue. Result: The study suggested that the predicted profile images of all the patients were attractive and rankings were decreasing from class I bimaxillary class III and then class II. The least score of attractiveness were given to class II patients. The predicted profile images of class I bimaxillary patients were more attractive. Conclusion: this study showed that the predicted profile images were attractive as suggested by three raters with class I bimaxillary most attractive and class II least attractive. In overall, laypersons and dental students ratings were somehow similar in the assessment of facial profile attractiveness in the predicted profile images.

Treatment of bimaxillary protrusion using intra- and extra-alveolar miniscrews associated to self-ligating brackets system.

ABSTRACTIntroduction: Moderate and severe bimaxillary protrusion impair the passive lip sealing and the facial and smile esthetics. The extraction of premolars can be avoided by the use of skeletal anchorage to retract both dental arches. This approach brings many advantages such as: prevents premolars extraction; simplifies orthodontic mechanics; there is no volume reduction of a premolar when smiling; control of overbite and gingival exposure. The utilization of this therapeutic approach, when associated with self-ligating brackets, can bring the possibility of spacing the appointments without damage to the treatment efficiency, and allows selection of the most appropriate torque prescriptions for each case. The intra-alveolar miniscrews are indicated for mild cases of bimaxillary protrusion, while extra-alveolar miniscrews may also be indicated for more severe cases. Objective: To report the treatment of three cases of mild, moderate and severe bimaxillary protrusion, in which intra- and extra-alveolar miniscrews were used, according to the retraction required. Conclusion: The retraction of both upper and lower dental arches using orthodontic intra- and extra-alveolar miniscrews, associated with self-ligating brackets, is an excellent tool to correct mild to severe bimaxillary protrusion, thus reducing the need of premolar extraction and simplifying the orthodontic management.

A case of bi-maxillary protrusion with ankylosed incisors treated with a multidisciplinary approach

A case of bi-maxillary protrusion with ankylosed incisors treated with a multidisciplinary approach

TAD driven whole dentition distalization with special considerations for incisal/gingival display and occlusal canting

Many orthodontists face difficulties in aligning incisors in an esthetically critical position, because the individual perception of beauty fluctuates with time and trend. Temporary anchorage device (TAD) can aid in attaining this critical incisor position, which determines an attractive smile, the amount of incisor display, and lip contour. Borderline cases can be treated without extraction and the capricious minds of patients can be satisfied with regard to the incisor position through whole dentition distalization using TAD. Mild to moderate bimaxillary protrusion cases can be treated with TAD-driven en masse retraction without premolar extraction. Patients with Angle's Class III malocclusion can be the biggest beneficiaries because both sufficient maxillary incisal display, through intrusion of mandibular incisors, and distalization of the mandibular dentition are successfully achieved. In addition, TAD can be used to correct various other malocclusions, such as canting of the occlusal plane and dental/alveolus asymmetry.

Lower facial height and soft tissue changes in bimaxillary protrusion cases

Background: Bimaxillary protrusion is frequently treated by extracting the four first premolars and retracting the incisor with maximum anchorage. This treatment may result in soft tissue changes, particularly in lip retraction, lip thickness, upper lip angle and nasolabial angle. However, the changes in facial height after orthodontic treatment often trigger controversies. Objectives: To determine the effects of incisor retraction on lower facial height and soft tissue changes in Class I malocclusion with bimaxillary protrusion treated by the extraction of the four first premolars. Methods: Pre-treatment and post-treatment lateral cephalometric radiograph samples of 25 patients treated with the standard Edgewise fixed appliance were collected. Each sample was traced and a reference line perpendicular to Sella-Nasion minus 7o through the true vertical line (TVL) was established. Arnett analysis was applied to calculate incisor retraction, lower facial height, lip retraction, lip thickness, upper lip angle and nasolabial angle changes. The results of the measurements were statistically analyzed using a paired T-test and Pearson correlation. Results: No statistically significant changes were found between upper incisor retraction and lower facial height ( p > 0.05) and upper lip thickness ( p > 0.05). The same lower incisor retraction occurred with lower facial height ( p > 0.05) and lower lip thickness ( p > 0.05). Significant positive correlation was found between upper incisor retraction and the changes in the upper lip retraction (r = 0.959, p < 0.05), upper lip angle (r = 0.775, p < 0.05) and nasolabial angle (r = 0.647, p < 0.05), while the lower incisor retraction had a positive correlation with the changes in lower lip retraction (r = 0.902, p < 0.05). Conclusion: The extraction of the four first premolars followed by the retraction of the incisor can cause changes in lip retraction, upper lip angle and nasolabial angle but not in lower facial height and lip thickness.

Post-orthodontic cephalometric variations in bimaxillary protrusion cases managed by premolar extraction - A retrospective study.

Bimaxillary protrusion is a common dentofacial condition associated with proclination of maxillary and mandibular incisors in relation to the dental and cranial bases resulting in soft tissue procumbency. The present retrospective study aimed to investigate dental and soft tissue profile changes using cephalometric analysis to evaluate bimaxillary protrusion patients after extraction of the first four premolars and subsequent retraction of the anterior teeth. Pre-treatment and post-treatment cephalometric radiographs of 46 Saudi patients (16 males and 30 females), 18-30 years of age with bimaxillary protrusion, were selected based on inclusion criteria. Dental and soft tissue landmarks were traced using the Dolphin® imaging software and statistically analyzed with SPSS® 21 software. The upper and lower incisors retroclined by a mean value of 9.6° and 9.65°, respectively, and an average distance of 4.1 mm. The level of maxillary incisor exposure was reduced by approximately 1.1 mm after treatment. A mean increase of 6.6° in the nasolabial angle was also observed. Multiple regression analysis showed that retraction of both upper and lower incisors by 1 mm would result in a 0.44 mm retraction of the upper and lower lips. A statistically significant increase in the nasolabial angle and upper lip length was found in relation to upper and lower incisor retraction and retroclination. A significant reduction was also evident in the post treatment upper incisor exposure, facial convexity angle and mentolabial sulcus depth.

Comparative study of the rate of tooth movement between corticotomy and piezocision to facilitate en masse retraction in bimaxillary protrusion

Objective: The aim of this study was to evaluate the rate of orthodontic tooth movement and the time needed for extraction space closure when corticotomy and piezocision were used to facilitate en-masse retraction in bimaxillary protrusion cases. Subjects and Methods: The sample of this study consisted of twenty subjects having Class I malocclusion with bimaxillary protrusion and requiring extraction of four first premolars and en-masse retraction of the anterior segments on both arches. The sample was randomly divided into two equal groups; group I:corticotomy was performed by using piezosurgery through flap reflection and group II: corticotomy was performed by using piezocision (flapless corticotomy). Study models were obtained just before surgery and in every month for 6 months after surgery to measure the rate of orthodontic tooth movement in both groups. After completing the en-masse retraction, the retraction time in months was recorded for the right and left sides and averaged. Results: Group I showed a statistically significant shorter retraction time than group II. Group I showed a statistically significant increase in the rate of tooth movement from the 2nd to the 5th month in the upper arch. For the lower arch, group I exhibited a significant increase in the rate of tooth movement in the 4th month. Conclusion: Corticotomy involving flap reflection showed a shorter retraction time and higher rates of tooth movement than piezocision during en-masse retraction.

Esthetic Improvement through Orthodontic Treatment Involving Extraction: Use of Orthodontic Anchor Screws.

Here, we report two cases of dental bimaxillary protrusion in which orthodontic anchor screws were used to improve the esthetics of the mouth and lips and facilitate complete closure of the mouth. Case 1 was a woman with dental maxillary protrusion and constriction of the dental arches, with the main complaint of protrusion of the lips and mandibular crowding. The maxillary and mandibular dental arches were first widened and traction applied to the maxilla via orthodontic anchor screws. The maxillary incisors were retracted 10 mm and the mandibular incisors 3 mm, resulting in upper lip retraction of 3 mm and bottom lip retraction of 5 mm with respect to the E-line. The nasolabial angle increased to 20°, and the inter-vermilion angle, which indicates the thickness of the vermillion, decreased to 20°, improving esthetics by reducing the thickness of the lips. Case 2 was a woman with bimaxillary dental protrusion, with the chief complaint of protruding lips and a gummy smile. Orthodontic anchor screws were used to achieve posterior traction and intrusion in the maxillary incisor region to improve the gummy smile. The maxillary incisors were retracted 9 mm and the mandibular incisors 8 mm. In the soft tissues, this yielded upper lip retraction of 3 mm and bottom lip retraction of 4 mm with respect to the E-line. The nasolabial angle increased to 10° and the inter-vermilion angle decreased to 30°, improving esthetics by reducing the thickness of the lips. The gummy smile was also improved, with 4 mm intrusion of the maxillary incisors. Increased ease in closing of the mouth was also a major factor in patient satisfaction with the results of orthodontic treatment.

Gingival Zenith Positions and Levels of Maxillary Anterior Dentition in Cases of Bimaxillary Protrusion: A Morphometric Analysis.

To investigate the two clinical parameters, such as gingival zenith positions (GZPs) and gingival zenith levels (GZLs), of maxillary anterior dentition in bimaxillary protrusion cases and collate it with severiety of crown inclination. Gingival zenith position and GZL in 40 healthy patients (29 females and 11 males) with an average age of 21.5 years were assessed. Inclusion criteria involved absence of periodontal diseases, Angle's class I molar relationship, and upper anterior proclination within 25 to 45° based on Steiner's analysis; exclusion criteria included spacing, crowding, anterior restoration and teeth with incisor attrition or rotation. The GZP was evaluated using digital calipers from voxel-based morphometry (VBM), and GZL was assessed from the tangent drawn from GZP of central incisor and canines to the linear vertical distance of GZP of lateral incisor. All the central incisors showed a GZP distal to VBM with a mean average of 1 mm. Severe proclination between 40 and 45° showed a statistically significant variation. Lateral incisors displayed a mean of 0.5 mm deviation of GZP from the vertically bisected midline. In 80% of canine population, GZP was centralized. We conclude that the degree of proclination of maxillary anterior dentition was correlated to the gingival contour in bimaxillary cases. The investigation revealed that there is a variation in the location of GZP as the severity of proclination increases. This study highlights the importance of microesthetics in fixed orthodontic treatment. The gingival contour should be unaltered while retraction during management of bimaxillary protrusion.

Innovative Periodontal Surgery by Monocortical Corticotomy in Management of Bimaxillary Protrusion Cases: A Clinical Study

ABSTRACT Periodontal accelerated osteogenic orthodontics (PAOO) is a procedure applying the clinical science of alveolar corticotomy, particulate bone grafting, and the application of orthodontic forces, for accentuated tooth movement. This is theoretically based on the bone healing pattern known as the regional acceleratory phenomenon (RAP). A series of 12 cases, including 8 females and 4 males, were included in the study. The cases were referred from the Department of Orthodontia to the Department of Periodontology, ADC (R&amp;R), having bimaxillary protrusion with an increased overjet. After initial orthodontic alignment, buccal corticotomy procedure was planned. A full-thickness mucoperiosteal flap was reflected from maxillary canine to canine beyond the root apices. Vertical corticotomy cuts were given in the alveolar bone with piezo blades 2 mm apical to the crestal bone in the inter-radicular space midway between the root prominences and were joined by the horizontal cuts apically. Demineralized freeze-dried bone allograft (DFDBA) was placed in the surgical area. The flaps were sutured and pack was placed. Orthodontic retraction was started 2 weeks after the corticotomy procedure. Using this procedure, the treatment objectives were met in just half to one-third of the reported conventional treatment time and the large overjet was reduced to normal. Pre- and posttreatment clinical parameters were recorded, statistically analyzed, and corroborated with similar orthodontic treatment procedures without the use of the corticotomy technique. The present periodontal (PDL) intervention results in quick and stable results for the correction of bimaxillary protrusion cases. It enhances the esthetics and posttreatment orthodontic stability. How to cite this article Panwar M, Dubey D, Kosala M. Innovative Periodontal Surgery by Monocortical Corticotomy in Management of Bimaxillary Protrusion Cases: A Clinical Study. Int J Experiment Dent Sci 2017;6(2):55-60.