title: Nonextraction treatment with temporary skeletal anchorage devices to correct a Class II Division 2 malocclusion with excessive gingival display.
abstract: The patient was a 22-year-old Japanese woman who complained of a gummy smile. She had several other orthodontic problems, including crowding of the maxillary anterior teeth, retroclination of the maxillary central incisors, excessive maxillary incisor display, a deep overbite, Class II dental relationships, a Class II profile, and a long face. Two options for the correction of these problems were proposed. The first option was to extract the maxillary first premolars to correct the Class II relationship and implant a miniscrew to correct the gingival display; the second option was to place 2 miniplates for distalization of the maxillary molars and a miniscrew to correct the gingival smile without premolar extractions. The patient chose the second option. After placing a preadjusted bracketed system, 2 miniplates were placed in the zygomatic buttresses bilaterally with monocortical screws, and 1 miniscrew was fixed between the root apices of the maxillary central incisors. Distalization and intrusion of the maxillary molars and intrusion of the maxillary incisors were simultaneously started with those temporary skeletal anchorage devices functioning as absolute orthodontic anchors. The total treatment period was approximately 22 months. Her orthodontic problems were corrected. According to the cephalometric evaluation, the entire maxillary dentition was significantly distalized, and her maxillary incisors were successfully intruded, with the mandible showing a slight counterclockwise rotation. Thanks to the temporary anchorage devices combined with miniplates and a miniscrew, we were able to predictably achieve her treatment goals without premolar extractions, orthognathic surgery, and the need for patient compliance.
authors.affiliation: Assistant professor, Division of Oral Dysfunction Science, Graduate School of Dentistry, Tohoku University, Sendai, Japan. Electronic address: nishimura@dent.tohoku.ac.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Private practice, Saitama, Japan.
authors.forename: Minayo
authors.initials: M
authors.lastname: Sannohe
authors.affiliation: Lecturer, Division of Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagasaka
authors.affiliation: Professor, Division of Oral Dysfunction Science, Graduate School of Dentistry, Tohoku University, Sendai, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Igarashi
authors.affiliation: Visiting clinical professor, Division of Orthodontics, Department of Craniofacial Science, School of Dental Medicine, University of Connecticut, Farmington, Conn; chief orthodontist, SAS Orthodontic Centre, Ichiban-cho Dental Office, Sendai, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Sugawara
mesh_terms: D001860:Bone Plates; D002508:Cephalometry / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology*; D006801:Humans; D007180:Incisor / Q000473:pathology; D008312:Malocclusion, Angle Class II / Q000628:therapy*; D008904:Miniaturization; D008963:Molar / Q000473:pathology; D052280:Orthodontic Anchorage Procedures / Q000295:instrumentation*; D016910:Orthodontic Brackets; D057887:Overbite / Q000628:therapy; D010347:Patient Care Planning; D012904:Smiling; D014081:Tooth Extraction; D014087:Tooth Movement Techniques / Q000295:instrumentation; D016896:Treatment Outcome; D055815:Young Adult