Journal List > Korean J Orthod > v.39(1) > 1043612

Kim, Lee, Chung, Nelson, and Kim: Severe bimaxillary protrusion with adult periodontitis treated by corticotomy and compression osteogenesis

Abstract

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)

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Fig 1.
Facial and intraoral photographs before treatment show a very convex profile with significant mentalis muscle strain and reveal a Class II canine and Class I molar relationship.
kjod-39-54_f1.tif
Fig 2.
Pretreatment study models.
kjod-39-54_f2.tif
Fig 3.
Radiographs before treatment. A, Cephalogram; B, panoramic radiograph.
kjod-39-54_f3.tif
Fig 4.
Schematic illustration of the anterior segment retraction method after perisegmental corticotomy. A, Titanium C palatal plate, drill free screws and C lingual retractor combined lingual retraction; B, labial retractor and C tube combined retraction mechanics.
kjod-39-54_f4.tif
Fig 5.
Oral view during speedy orthodontics surgery. A, Oral view after buccal perisegmental corticotomy; B, anterior segmental osteotomy (ASO) on the lower anterior segment.
kjod-39-54_f5.tif
Fig 6.
Cone beam CT view (PSR-9000N, Asahi Roentgen, Kyoto, Japan) after perisegmental corticomy. A, Transaxial view; B, 3 dimensional reconstruction view shows the labial perisegmental corticotomized area; C, arrows in sagittal view show depth of corticotomy.
kjod-39-54_f6.tif
Fig 7.
Progress on lateral cephalograms. A, 1 week after immediate upper retraction; B, 7 weeks after retraction.
kjod-39-54_f7.tif
Fig 8.
Progress in oral views. A and D, 1 week after retraction; B and E, 5 months after retraction; C and F, 6 months after treatment. Fixed appliances were applied for conventional orthodontic treatment.
kjod-39-54_f8.tif
Fig 9.
Facial and intraoral photographs after treatment show good overjet, overbite, facial balance, and a reduction of hypermentalis activity.
kjod-39-54_f9.tif
Fig 10.
Post-treatment study models.
kjod-39-54_f10.tif
Fig 11.
Radiographs after treatment. A, Cephalogram; B, panoramic radiograph.
kjod-39-54_f11.tif
Fig 12.
Superimpositions of lateral cephalograms: pretreatment (black line) to post-treatment (red line).
kjod-39-54_f12.tif
Fig 13.
27-month postretention intraoral photographs.
kjod-39-54_f13.tif
Table 1.
Cephalometric measurements pre- and post treatment
Average (Female) Pre-treatment Post-treatment
SNA (°) 81.6 82.5 81.4
SNB (°) 79.2 79.3 76.1
ANB (°) 2.4 3.2 5.3
PFH/AFH(%) 85.1/127.4 (66.8%) 85.2/134.3 (63.4%) 85.5/135.5 (63.1%)
SN-OP (°) 17.9 18.7 19.0
FH-UI (°) 116.0 121.0 98.6
FMA (°) 24.3 32.2 32.5
IMPA (°) 95.9 93.7 96.4
FMIA (°) 59.8 54.1 51.1
UL-E plane (mm) -0.9 5.7 2.5
LL-E plane (mm) 0.6 8.2 0.9
Interincisal angle (°) 123.8 114.4 132.4
Mx 1 To NA(mm) 7.3 11.5 7.0
Mx 1 To NA (°) 25.3 30.7 15.7
Mn 1 To NB (mm) 7.9 12.3 11.2
Mn 1 To NB (°) 28.4 31.7 27.7
SN To PP (°) 10.2 5.2 3.4
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