Asymmetric severe skeletal Class II division 1 patient with temporomandibular joint disorder treated with zygomatic anchorage devices and Ni-Ti alloy wires.
OBJECTIVE
To describe the orthodontic treatment of a nongrowing 30-year-old woman with asymmetric severe skeletal Class II malocclusions (asymmetric Angle Class II), large overjet (16 mm), large overbite (8 mm), two congenitally missing mandibular incisors (presenting a deciduous anterior tooth), and signs and symptoms of temporomandibular joint disorder (TMD).


METHODS
We used novel improved super-elastic Ni-Ti alloy wires (ISWs) combined with Ni-Ti alloy coil springs, power hooks, and a zygomatic implant as reinforced anchorage to provide a constant and continuous mild force to the dentition.


RESULTS
We successfully distalized maxillary molars, premolars, and retracted anterior teeth and corrected the asymmetric Angle Class II molar relationship using this system of zygomatic anchorage in conjunction with ISWs, Ni-Ti alloy open-coil springs, and crimpable power hook. The maxillary molars were distalized, and postero-occlusal relationships were improved to achieve Class I canine and molar relationships on both sides. Intrusion of the upper molars made the mandibular plane close. Ideal overbite and overjet relationships were established. Facial esthetics were improved with decreased upper and lower lip protrusion, and no symptoms of TMD were observed after treatment.


CONCLUSIONS
The orthodontic treatment described here is a promising anchorage technique alternative to traditional techniques to improve severe skeletal Class II with TMD.
a  Assistant Professor, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University (TMDU), Tokyo, Japan.
Takayoshi
T
Ishida
Takashi
T
Ono
D000328:Adult; D000848:Anodontia / Q000628:therapy; D001641:Bicuspid / Q000473:pathology; D002508:Cephalometry / Q000379:methods; D003481:Cuspid / Q000473:pathology; D003722:Dental Alloys / Q000737:chemistry*; D004954:Esthetics; D005146:Facial Asymmetry / Q000628:therapy; D005260:Female; D006801:Humans; D007180:Incisor / Q000002:abnormalities; D008046:Lip / Q000473:pathology; D008312:Malocclusion, Angle Class II / Q000628:therapy*; D008963:Molar / Q000473:pathology; D009532:Nickel / Q000737:chemistry*; D052280:Orthodontic Anchorage Procedures / Q000295:instrumentation / Q000379:methods*; D016382:Orthodontic Appliance Design; D009969:Orthodontic Wires; D057887:Overbite / Q000628:therapy; D010347:Patient Care Planning; D013705:Temporomandibular Joint Disorders / Q000628:therapy*; D014025:Titanium / Q000737:chemistry*; D014087:Tooth Movement Techniques / Q000295:instrumentation / Q000379:methods; D015050:Zygoma / Q000473:pathology*
D003722:Dental Alloys; C040654:titanium nickelide; D009532:Nickel; D014025:Titanium
Molar distalization; Severe Class II division 1; Ti-Ni alloy wires; Zygomatic anchorage devices