title: Skeletal anchorage for orthodontic correction of severe maxillary protrusion after previous orthodontic treatment.
abstract: The correction of a severe maxillary protrusion in an adult by distal movement of the maxillary molars has been one of the most difficult biomechanical problems in orthodontics. This article reports on the treatment of an adult case of severe maxillary protrusion and a large overjet treated with a skeletal anchorage system. A female patient, age 22 years and 3 months, complained of the difficulty of lip closure due to severe maxillary protrusion with a gummy smile. Overjet and overbite were +7.6 mm and -0.9 mm, respectively. She had a history of orthodontic treatment in which her maxillary first premolars were extracted. In order to conduct distal movement of the maxillary molars, anchor plates were placed in the zygomatic process. After achieving a Class I molar relationship, retraction and intrusion of the maxillary incisors were performed. After a 2-year treatment, an acceptable occlusion was achieved with a Class I molar relationship. Her convex facial profile with upper lip protrusion was considerably improved, and the lips showed less tension in lip closure. After a 2-year retention period, an acceptable occlusion was maintained without recurrence of maxillary protrusion, indicating a stability of the occlusion. The result of this treatment indicated that skeletal anchorage is of great importance as a remedy for achieving intrusion and retraction of the maxillary incisors in cases of severe maxillary protrusion with a patient who had previous orthodontic treatment.
authors.affiliation: Department of Orthodontics and Craniofacial Developmental Biology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan. etanaka@hiroshima-u.ac.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Tanaka
authors.forename: Akiko
authors.initials: A
authors.lastname: Nishi-Sasaki
authors.forename: Takuro
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Clarice
authors.initials: C
authors.lastname: Nishio
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Kawai
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tanne
mesh_terms: D000328:Adult; D001641:Bicuspid / Q000601:surgery; D001860:Bone Plates; D005260:Female; D006801:Humans; D007180:Incisor / Q000473:pathology; D008046:Lip / Q000473:pathology; D008310:Malocclusion / Q000628:therapy*; D008437:Maxilla / Q000002:abnormalities*; D008963:Molar / Q000473:pathology; D008964:Molar, Third / Q000601:surgery; D052280:Orthodontic Anchorage Procedures / Q000295:instrumentation / Q000379:methods*; D018704:Orthodontic Retainers; D019233:Retreatment; D012690:Serial Extraction; D014087:Tooth Movement Techniques / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D015050:Zygoma / Q000601:surgery