Multiloop Edgewise Archwire Technique Research Articles

Tratamento de má oclusão de Classe III subdivisão com mordida cruzada posterior unilateral através da técnica multiloop edgewise archwire (MEAW) – relato de caso

The aim of this study was to report a clinical case of treatment of Class III subdivision malocclusion with unilateral posterior crossbite using the Multiloop Edgewise Archwire (MEAW) technique. A 19-year-old male patient reported mandibular prognathism as the main complaint. He had Angle Class III malocclusion, unilateral posterior crossbite on the right side, top bite in the anterior region, non-coincident midlines and facial asymmetry. Due to the patients refusal of surgical treatment, dentoalveolar orthodontic compensation was proposed. The MEAW technique associated with 3/16” intermaxillary elastics were used. At the end of the treatment, a Class I occlusal relationship between canines and molars, correction of the unilateral posterior crossbite and coincidence between the midlines was obtained. The MEAW technique was effective in correcting Class III subdivision malocclusion and unilateral posterior crossbite.

Class III treatment with occlusal plane reconstruction – clinical case

Introduction: The therapeutic approach of anterior open bites and class III is a challenge in orthodontic treatment, especially when it is performed without Orthognathic Surgery. Several treatment modalities for this type of malocclusion have been proposed over the years, such as Kim’s proposed Multiloop Edgewise Arch Wire (MEAW) technique, which was described 20 years ago [1,2]. The objective of this study is to present a clinical case of anterior open bite and skeletal class III, whose clinical approach consisted of the use of three plane arches with the same principle of the technique previously described. Materials and methods: A 29-years-old male patient came to Egas Moniz orthodontic clinic with the main complaint “I know I have a jaw problem and I want to treat it” SIC. In clinical and radiographic analysis, an anterior open bite, skeletal class III, and transverse dimension reduction were diagnosed. After obtaining informed consent, the treatment consisted of the use of fixed bimaxilar apliance with modified arches in the lower jaw, straight arch in the upper jaw and intermaxillary elastics (3/16 6oz). Results: Following the proposed treatment plan, it was possible to close the anterior open bite by promoting the intrusion and upright of the posterior mandibular teeth, alteration of the occlusal plane and a slight extrusion and retroinclination of the anterior teeth. Discussion and conclusions: The three plane arches technique presents the same principles of the MEAW technique since they incorporate tip-back bends that promote intrusion forces in the posterior and anterior teeth. The elastics used between the upper canines and the lower canines promote an anterior extrusion force and enhance the forces of the arch that promote intrusion of the posterior teeth [3,4]. Using this technique, it was possible to obtain satisfactory results and long-term stability in orthodontic treatment without orthognathic surgery. Figure 1. Initial Intraoral photos and x-rays. Figure 2. Final Intraoral photos and x-rays.

Maxillary Orthopedic Expansion with Periodontally Accelerated Osteogenic Orthodontics

Background: A transverse skeletal discrepancy of the adult patient compromises occlusal stability and possibly implies muscular, articular, and aesthetic repercussions that depend on its severity. Historically, the treatment of transverse skeletal discrepancy has been accompanied by orthognathic surgery to disrupt sutures in order to expand the maxilla with disjunction devices. Purpose: To analyze current therapeutic approaches, such as periodontally accelerated osteogenic orthodontics, which become alternative treatment options for complex cases, decrease the severity of surgical procedures and adverse effects on the periodontal supporting tissue, improve the prognosis, and even reduce duration of treatment. Results: This report present the case of an adult female patient with complete unilateral left posterior crossbite and limitations of incisors’ crown/root ratio. The patient was successfully treated with transversal growth stimulation of the second quadrant by orthopedic expansion, performed immediately after corticotomies and lyophilized bone graft placement, followed by orthodontic treatment and multiloop edgewise arch wire technique. KEYWORDS transverse skeletal discrepancy; posterior crossbite; maxillary expansion; corticotomies; adult patient; multiloop edgewise arch wire; accelerated osteogenic orthodontics

Camouflage Treatment of a Severe Open Bite Case

Skeletal open bite is a complex and multifactorial anomaly. There are many reasons for the occurrence of open bite, including skeletal abnormal growth pattern; dental, respiratory, neurologic, and habitual factors; and tongue posture and function. Anterior open bite is one of the most difficult problems to treat in orthodontics. Various treatment modalities for the correction of an anterior open bite have been proposed such as extrusion of anterior teeth using intermaxillary elastics, multiloop edgewise archwire technique developed by Kim, inhibition of molar eruption using bite blocks and high-pull headgear during growth, and extraction therapy. The most effective treatment option in adult patients is the repositioning of both the maxilla and mandible through a surgical correction. Although satisfactory results can be achieved with orthognathic surgery, the complexity, risks and costs of surgery are disadvantages of the surgical treatment. With the advent of skeletal anchorage, a number of studies were released to introduce the treatment of anterior open bite by intrusion of maxillary posterior teeth. This report presents the treatment and long-term stability of an adult case of a severe anterior open bite treated by means of extraction of the 4 first molars.

Camouflage treatment of skeletal Class III malocclusion with multiloop edgewise arch wire and modified Class III elastics by maxillary mini-implant anchorage

To evaluate the effect of the multiloop edgewise arch wire (MEAW) technique with maxillary mini-implants in the camouflage treatment of skeletal Class III malocclusion. Twenty patients were treated with the MEAW technique and modified Class III elastics from the maxillary mini-implants. Twenty-four patients were treated with MEAW and long Class III elastics from the upper second molars as control. Lateral cephalometric radiographs were obtained and analyzed before and after treatment, and 1 year after retention. Satisfactory occlusion was established in both groups. Through principal component analysis, it could be concluded the anterior-posterior dental position, skeletal sagittal and vertical position, and upper molar vertical position changed within groups and between groups; vertical lower teeth position and Wits distance changed in the experimental group and between groups. In the experimental group, the lower incisors tipped lingually 2.7 mm and extruded 2.4 mm. The lingual inclination of the lower incisors increased 3.5°. The mandibular first molars tipped distally 9.1° and intruded 0.4 mm. Their cusps moved 3.4 mm distally. In the control group, the upper incisors proclined 3°, and the upper first molar extruded 2 mm. SN-MP increased 1.6° and S-Go/N-ME decreased 1. The MEAW technique combined with modified Class III elastics by maxillary mini-implants can effectively tip the mandibular molars distally without any extrusion and tip the lower incisors lingually with extrusion to camouflage skeletal Class III malocclusions. Clockwise rotation of the mandible and further proclination of upper incisors can be avoided. The MEAW technique and modified Class III elastics provided an appropriate treatment strategy especially for patients with high angle and open bite tendency.

Posterior scissor bite and lateral open bite with missing lower first molar and second premolar

This article presents an adult patient with scissor bite in the posterior region, lateral open bite with a missing first molar and a second premolar on the lower left side. The scissor bite was difficult to correct due to severe occlusal difficulties in the lower left arch with a highly titled and extruded third molar. After third molar extractions (except left mandibular molar), the first step was to upright the lower second molar with a helical loop, replaced in a second step by a multiloop edgewise archwire including the third molar in order to correct the occlusal plane, uprighting and intruding the posterior teeth (second and third molar) and extruding the lateral teeth (canine and first premolar). In a third step, after the occlusal space was obtained on the teeth with previous scissor bite, the upper second molar buccal inclination was also improved with a helical loop followed by a multiloop edgewise archwire technique.

Successful Treatment of Postpeak Stage Patients with Class II Division 1 Malocclusion Using Non‐extraction and Multiloop Edgewise Archwire Therapy: A Report on 16 Cases

AimTo determine cephalometrically the mechanism of the treatment effects of non-extraction and multiloop edgewise archwire (MEAW) technique on postpeak Class II Division 1 patients.MethodologyIn this retrospective study, 16 postpeak Class II Division 1 patients successfully corrected using a non-extraction and MEAW technique were cephalometrically evaluated and compared with 16 matched control subjects treated using an extraction technique. Using CorelDRAW® software, standardized digital cephalograms pre- and post-active treatments were traced and a reference grid was set up. The superimpositions were based on the cranial base, the mandibular and the maxilla regions,and skeletal and dental changes were measured. Changes following treatment were evaluated using the paired-sample t-test. Student's t-test for unpaired samples was used to assess the differences in changes between the MEAW and the extraction control groups.ResultsThe correction of the molar relationships comprised 54% skeletal change (mainly the advancement of the mandible) and 46% dental change. Correction of the anterior teeth relationships comprised 30% skeletal change and 70% dental change.ConclusionThe MEAW technique can produce the desired vertical and sagittal movement of the tooth segment and then effectively stimulate mandibular advancement by utilizing the residual growth potential of the condyle.

Long-term stability of an adult Class III open-bite malocclusion treated with multiloop edgewise archwire

This case report describes the treatment of a 17-year-old girl with an anterior open- bite and Class III malocclusion, who had a history of thumb-sucking habit in childhood. The multiloop edgewise archwire technique was used on the mandibular arch to facilitate uprighting of the mandibular posterior teeth, change the cant of occlusal plane, close the anterior open-bite, and correct the Class III malocclusion. At the end of treatment, Class I occlusion and correction of the anterior open-bite had been achieved. An examination 8 years 8 months after treatment revealed long-term stability of the treatment results.

Cephalometric evaluation of anterior open-bite nonextraction treatment, using multiloop edgewise archwire therapy

There are very few reports of extensive and detailed cephalometric investigations of nonextraction treatment changes for patients with anterior open bite. The purpose of this study was to evaluate changes in dentomaxillofacial morphology by way of lateral and oblique cephalograms of patients who had undergone multiloop edgewise archwire (MEAW) therapy for anterior open-bite correction. The subjects consisted of 21 Japanese female patients who received MEAW therapy without premolar extraction. The mean pre- and posttreatment ages were 16 years 9 months and 19 years, respectively. Lateral and oblique cephalograms were taken before and after treatment. Fifteen angular and 29 linear measurements were obtained from the lateral cephalograms; 17 angular and 20 linear measurements were obtained from the oblique cephalograms. Treatment changes were evaluated by the paired t-test. The upward and forward rotational changes of the mandible consequent to the use of the MEAWs and anterior vertical elastics were larger than the downward and backward rotational changes of the mandible, due to the extrusion of the posterior teeth by leveling and alignment. The uprighting and retrusion of the premolars and molars, and the extrusion, uprighting, and/or retrusion of the incisors and canines played important roles in the anterior open-bite nonextraction treatment by dint of the MEAW technique.

Cephalometric evaluation of the anterior open bite treatment

The present study was aimed at evaluating the treatment changes of anterior open bite malocclusion cases treated by means of the Multiloop Edgewise Arch Wire technique, which is considered one of the more effective treatment modalities for anterior open bite malocclusions. The open bite sample was composed of 16 young adults, 4 males and 12 females. The normal occlusion sample, as a controlled sample was composed of 58 young adults who had pleasing facial profiles and normal occlusions with no experience of orthodontic or prosthodontic treatment. The normal sample was subdivided by the cephalometric vertical facial relationships. Forty adults with cephalometric vertical facial relationships within the normal range of Korean standards were classified as Normal Occlusion Group 1. Eighteen adults with an increased vertical facial relationship but with normal occlusion, were classified as Normal Occlusion Group 2. Thirty-nine reference points were digitized on each film, and the computerized cephalometric analysis was obtained with 8 skeletal, 10 dentoalveolar, 17 teeth angulations, and 4 occlusal plane measurements. Treatment changes were determined by the paired t test, and the structural differences between the four groups were tabulated by the Student’s t test. The treatment changes were observed mainly in the dentoalveolar region in the upper and the lower occlusal planes, accompanied by the uprighting of the posterior teeth to the occlusal plane through the distal tipping movement of the entire dentition. After the treatment, there was a tendency for the structural feature of the open bite group to approximate those of the normal occlusion group 2. This ascertains that the treatment changes of open bite malocclusion produced by means of the multiloop edgewise arch wire technique are similar to those found in the natural dentoalveolar compensatory mechanism. (Am J Orthod Dentofacial Orthop 1999;115:29-38)