Severe Bimaxillary Protrusion Research Articles

Dental, skeletal and soft tissue changes after bimaxillary protrusion treatment with temporary anchorage devices using different retraction mechanics

BackgroundTemporary anchorage devices (TADs), which are absolute anchorage, are used for retraction of the anterior teeth in cases of severe bimaxillary protrusion. There have been a number of studies regarding anterior tooth movement using TADs performed by simulation systems and actual treated materials with sliding mechanics. However, there are few studies regarding anterior tooth movement using TADs treated by loop mechanics The purpose of this study was to investigate the effect of TADs in anterior tooth movement using loop mechanics performed in actual cases of bimaxillary protrusion.MethodsThis study was performed in 20 adult patients with severe bimaxillary protrusion treated with four bicuspid extraction with sliding or loop mechanics (n = 10 in each mechanics) using TADs. The skeletal and denture patterns, as well as the soft tissue profile from pre-treatment (T0) and post-treatment (T1) lateral cephalograms, were compared between sliding and closing loop mechanics.ResultsThe use of TADs is useful for retraction of anterior teeth without molar anchorage loss. in sliding and loop mechanics. The upper anterior teeth were less lingual tipped and lower anterior teeth were more upright resulting in less clockwise rotation of the occlusal plane in loop mechanics compared to sliding mechanics.ConclusionAn oblique retraction force vector with a lower point of application causes less intrusion and more lingual tipping of upper anterior teeth as well as more clockwise rotation of the occlusal plane compared to a parallel retraction force vector.

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

Orthodontic Treatment of Severe Bimaxillary Dentoalveolar Protrusion with Skeletal Class II Malocclusion Without Using Miniscrews

Bimaxillary dentoalveolar protrusion is characterized by the proclined anterior teeth, protrusive lips, and a convex profile. A proper orthodontic treatment modality for efficient anchorage control is necessary to retract the anterior teeth and improve the facial esthetics significantly. The commonly used miniscrew could provide absolute anchorage, however, it is accompanied by some risks and complications, especially in adolescent females. This case report described a 16-year-old female with diagnosis of skeletal Class II, normal mandibular plane angle, and Angle Class I malocclusion associated with proclined upper and lower anterior teeth, excessive overjet, and a convex profile with lip incompetence. We extracted her four first premolars first. Then, the Tip-Edge Plus bracket system and differential force method were applied to replace the temporary anchorage device. The total treatment duration was 27 months. Her dentoalveolar protrusion was decreased, both lips were significantly retracted, the mentalis strain was reduced, and her chin projection was improved. This case demonstrated that differential tooth movement with controlled light orthodontic forces could be an effective strategy to treat severe bimaxillary protrusion.

Application of corticotomy associated with customized lingual orthodontics in treatment of severe bimaxillary protrusion in adults

Bimaxillary protrusion is a clinical condition with high prevalence rate, which damages facial esthetics and affects the mental health of patients. Its clinical manifestations include protrusion of lips, overexposure of teeth, vertical and sagittal overdevelopment of alveolar bone in the anterior areas of upper and lower anterior jaws, and so on. The common protocols for the treatment of severe bimaxillary protrusion is orthodontic treatment with exaction of premolars or combined orthognathic-orthodontic treatment. However, either method is of great difficulty. By systematic mechanical design, the author used the treatment system of customized lingual appliances associated with corticotomy to realize the vertical and torque control of the anterior teeth, and obtain the orthodontic treatment effect of both esthetics and health. The clinical strategies for the treatment of severe bimaxillary protrusion were provided.

Partial Glossectomy as an adjunct to Orthodontic Treatment of Anterior Open Bite Associated with Macroglossia: A Case Report

Orthodontic treatment of an anterior open bite is one of the most challenging malocclusions to treat, especially with respect to post-treatment stability. Complete diagnosis and targeted treatment is required for successful post treatment stability. In instances where macroglossia is the primary aetiology, partial glossectomy will greatly improve post treatment stability. The following case report describes a patient with severe anterior open bite and bimaxillary protrusion secondary to macroglossia. Treatment was successfully performed with partial glossectomy and straight wire orthodontics. Post-treatment relapse was minimal. CPD/Clinical Relevance: This article describes a review of the aetiology of anterior open bite and documents one possible treatment option, when the main aetiology of the malocclusion is of soft tissue origin

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.

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.

Bimaxillary Protrusion - A Case Report

Correction of a severe bimaxillary protrusion with maximum anchorage can be challenging. This case report describes the treatment of a girl with a bimaxillary protrusion. Orthodontic treatment included extraction of her 4 first premolars. The total treatment time was 18 months. Her dental proclination and facial appearance was significantly improved.

Facial attractiveness of skeletal class I and class II malocclusion as perceived by laypeople, patients and clinicians.

Physical attractiveness is dependent on facial appearance. The facial profile plays a crucial role in facial attractiveness and can be improved with orthodontic treatment. The aesthetic assessment of facial appearance may be influenced by the cultural background and education of the assessor and dependent upon the experience level of dental professionals. This study aimed to evaluate how the sagittal jaw relationship in Class I and Class II individuals affects facial attractiveness, and whether the assessor's professional education and background affect the perception of facial attractiveness. Facial silhouettes simulating mandibular retrusion, maxillary protrusion, mandibular retrusion combined with maxillary protrusion, bimaxillary protrusion and severe bimaxillary protrusion in class I and class II patients were assessed by five groups of people with different backgrounds and education levels (i.e., 23 expert orthodontists, 21 orthodontists, 15 maxillofacial surgeons, 19 orthodontic patients and 28 laypeople). Straight facial profiles were judged to be more attractive than convex profiles due to severe mandibular retrusion and to mandibular retrusion combined with maxillary protrusion (all P<0.05). Convex profiles due to a slightly retruded position of the mandible were judged less attractive by clinicians than by patients and laypeople (all P<0.05). Convex facial profiles are less attractive than Class I profiles. The assessment of facial attractiveness is dependent on the assessor's education and background. Laypeople and patients are considerably less sensitive to abnormal sagittal jaw relationships than orthodontists.

Treatment of Angle Class I Malocclusion with Severe Bimaxillary Protrusion using Miniscrew Implants and Periodontal Ligament Distraction

Treatment of Angle Class I Malocclusion with Severe Bimaxillary Protrusion using Miniscrew Implants and Periodontal Ligament Distraction

Treatment of Angle Class I Malocclusion with Severe Bimaxillary Protrusion using Miniscrew Implants and Periodontal Ligament Distraction

Bimaxillary dentoalveolar protrusion is common in Asian population. In this patient with procumbent upper and lower lips, excessive lip strain, proclined and protruded maxillary and mandibular incisors with vertical growth pattern, an acceptable treatment result, was achieved with 4-first-premolar extractions. This case report is presented with the aim, to describe the treatment approach for bimaxillary dentoalveolar protrusion using miniscrew implants for anchorage in upper arch and periodontal ligament distraction for canine retraction in lower arch and then retraction of incisors into the newly formed bone distal to lateral incisor. Treatment was completed in 18 months. The patient profile was improved, with reduction in lip procumbency, decrease in lip eversion and protrusion, and decrease mentalis strain. Dentally, the interincisal angulation improved significantly because both the maxillary and mandibular incisors were uprighted after space closer.

Three-dimensional soft-tissue and hard-tissue changes in the treatment of bimaxillary protrusion

Facial convexity related to bimaxillary protrusion is prevalent in many populations. Underlyingskeletal protrusion combined with increased dentoalveolar protrusion contributes to facial muscle imbalance and lip incompetence, which is undesirable for many patients. In this study, we evaluated the relationship between soft-tissue and hard-tissue changes in an orthodontically treated Asian population. Twenty-four consecutive adult Asian patients (mean age, 24 years), diagnosed with severe bimaxillary dentoalveolar protrusion, were evaluated using pretreatment and posttreatment cone-beam computed tomography. The patients were treated with 4 first premolar extractions followed by anterior retraction with either skeletal or intraoral anchorage. Serial cone-beam computed tomography radiographs were registered on the entire cranial base and fossa. Soft-tissue and hard-tissue changes were determined through landmark displacement and color mapping. Upper lip retraction was concentrated between the nasolabial folds and commissures. Lower lip retraction was accompanied by significant redistribution of soft tissues at pogonion. Soft-tissue changes correlated well with regional facial muscle activity. Significant retractions (2-4 mm) of the soft tissues occurred beyond the midsagittal region. Use of skeletal anchorage resulted in 1.5 mm greater lower lip retraction than intraoral anchorage, with greater retraction of the maxillary and mandibular incisor root apices. Profound soft-tissue changes accompanied retraction of the anterior dentition with both treatment modalities.

An Innovative Treatment Approach with Atypical Orthodontic Extraction Pattern in Bimaxillary Protrusion Case

This case report describes the treatment of a 23-year-old female with severe bimaxillary dentoalveolar protrusion and missing left mandibular first molar. Her chief concern was significant facial convexity. Generally treatment plan of such cases involves extraction of first premolars but absence of first molar complicates situation with problem of space management, anchorage requirement and post-treatment occlusion. This case report introduces thought provoking treatment approach of selecting atypical teeth for orthodontic extraction without compromising the quality of treatment outcomes. However, three first bicuspids were extracted while the mandibular left second premolar was distalized into the missing molar space and used as an abutment for replacement of the missing first molar by prosthesis. Despite the unusual asymmetric extraction of teeth, superimposition of the pretreatment and post-treatment cephalometric tracings shows excellent treatment outcomes and reduction of facial convexity by maximum retraction of the anterior teeth.

Severe bimaxillary dento-alveolar protrusion with dental anterior open bite treated with absolute anchorage – a case report

This article describes the orthodontic treatment of an 18-year-old boy with severe bimaxillary dento-alveolar protrusion and an anterior open bite. Orthodontic mini-implants were placed in the alveolar bone in all the four quadrants to provide anchorage for en masse retraction. The patient had an anterior tongue thrust with an anterior open bite. Successful dental retraction was achieved, along with closure of the anterior open bite. Facial aesthetics were improved for the patient, fullness of the upper and lower lips was reduced, and the interdental relationship was corrected. Clinical Relevance: To describe the use of mini-implants to provide anchorage in a case of severe bimaxillary dento-alveolar protrusion.

The use of mini-implants in en masse retraction for the treatment of bimaxillary dentoalveolar protrusion

This case report describes the treatment of a 22-year-old girl who had incompetent lips with severe bimaxillary dentoalveolar protrusion. The treatment of choice for such patients is usually extraction of four first premolars and retraction of the anterior teeth. To maintain the extraction space, maximum anchorage is required. Mini-implants were used to provide maximum anchorage for obtaining a good facial profile.

Bimaxillary protrusion with masseter muscle hypertrophy treated with titanium screw anchorage and masseter surgical reduction

This case report describes the treatment of a patient with bimaxillary protrusion and masseter muscle hypertrophy. At age 21 years 7 months, this woman had temporomandibular disorder (TMD) symptoms, severe bimaxillary protrusion, and a prominent mandibular angle with facial asymmetry. After an attempt to alleviate the TMD symptoms with occlusal splint stabilization, portions of the masseter muscle and the mandible were surgically removed. Titanium screws were placed bilaterally in both arches, and a retraction force was applied. After active treatment for 38 months, the convexity of the facial profile with lip protrusion was improved remarkably, and good occlusion was achieved. The prominent mandibular angle with facial asymmetry was improved as a result of the surgical reduction of the masseter muscle and the modeling ostectomy near the masseteric tuberosity. The TMD symptoms disappeared, and the jaw movement pattern became normal. Therefore, our results suggest that this combination treatment would be useful for masseter muscle hypertrophy for morphologic and functional problems.

Severe bimaxillary protrusion with adult periodontitis treated by corticotomy and compression osteogenesis

This paper describes the case of a 50-year-old female with a Class II malocclusion who presented with severe bimaxillary protrusion and generalized alveolar bone loss due to adult periodontitis. The treatment plan consisted of extracting both upper and lower first premolars and periodontal treatment. Anterior segmental osteotomy (ASO) of the mandible and upper anterior segment retraction using compression osteogenesis after peri-segmental corticotomy (Speedy orthodontics) was performed. Correct overbite and overjet, facial balance, and improvement of lip protrusion were obtained. However, a slight root resorption tendency was observed on the lower anterior dentition. The active treatment period was 9 months and the results were stable for 27 months after debonding. This new type of treatment mechanics can be an effective alternative to orthognathic surgery. (Korean J Orthod 2009;39(1):54-65)

Treatment of severe bimaxillary protrusion with miniscrew anchorage: treatment and complications

Abstract Background Problems involving excessive face height and severe bimaxillary protrusion are usually treated with orthognathic surgery. When this form of treatment is rejected, retraction and intrusion of the anterior teeth using skeletal anchorage afforded by miniscrews may be employed. Aims To describe the treatment of severe bimaxillary protrusion with the aid of miniscrews and to discuss the complications encountered during treatment. Methods Following extraction of the four first premolars, miniscrews were placed bilaterally in both jaws to permit maximum retraction of the anterior teeth, and intrusion of the posterior and upper anterior teeth. Results The upper incisors were retracted 12 mm and intruded 5 mm over 20 months. The mandible rotated forward and upward, the face height reduced and the facial aesthetics improved. During treatment an irregular ridge of bone developed labial to the upper incisors, bone was deposited in the incisive fossae and the apices of the upper incisors were resorbed. An alveoloplasty was carried out to recontour the labial bone and the incisive fossae. Conclusions Absolute anchorage provided by miniscrews may become an effective alternative to orthognathic surgery for treatment of severe bimaxillary protrusion. During extensive retraction, the teeth may contact structures not normally encountered during conventional orthodontic treatment.

Treatment of a class I malocclusion with severe bimaxillary protrusion

This report describes the treatment of a 20-year-old woman from Nigeria who had severe bimaxillary dentolveolar protrusion. The main issue in determining the appropriate treatment plan was the severity of the dentoalveolar protrusion. Four first premolars were extracted to reduce lip procumbancy. The change in the patient's facial esthetics was dramatic. Significant retraction of the upper and lower lips was achieved, and lip eversion and dentoalveolar protrusion were significantly improved. As the lips were retracted, mentalis strain was reduced; this improved chin projection. This case report was presented at an AAO meeting as part of the ABO student case display. It was chosen by committee to be published in the AJO-DO.