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

Seong-Hun Kim; Kye-Bok Lee; Kyu-Rhim Chung; Gerald Nelson; Tae-Woo Kim

doi:10.4041/kjod.2009.39.1.54

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

Original Article

Korean J Orthod 2009;39(1):54-64.

Published online: 21 January 2009

DOI: https://doi.org/10.4041/kjod.2009.39.1.54

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

Seong-Hun Kim^a, Kye-Bok Lee^b, Kyu-Rhim Chung^c, Gerald Nelson^d, Tae-Woo Kim^e

DMD, MSD

DMD

DMD, MSD, PhD

DDS

DDS, MSD, PhD

^aPostgraduate student, Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, and Assistant Professor, Department of Orthodontics, The Catholic University of Korea, Uijongbu St. Mary’s Hospital.

^bPrivate Practice, President of the Korean Society of Speedy Orthodontics.

^cPresident of the Korean Society of Speedy Orthodontics.

^dClinical professor and Vice Chair, Department of Orthodontics, The University of California San Francisco.

^eProfessor and Chairman, Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University.

Corresponding author: Tae-Woo Kim. Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, 28-2, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. ＋82 2 2072 2671; e-mail, taewoo@snu.ac.kr.

^* This study was partly supported by the Korean Society of Speedy Orthodontics, Alumni fund of the Department of Dentistry and Graduate School of Clinical Dental Science, The Catholic University of Korea.

Received 8 October 200820 November 2008 Accepted 23 November 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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)

Keywords: Corticotomy, Speedy orthodontics, Skeletal anchorage, Compression osteogenesis, Anterior segment osteotomy, Adult periodontitis

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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.

Fig 2.

Pretreatment study models.

Fig 3.

Radiographs before treatment. A, Cephalogram; B, panoramic radiograph.

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.

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.

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.

Fig 7.

Progress on lateral cephalograms. A, 1 week after immediate upper retraction; B, 7 weeks after retraction.

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.

Fig 9.

Facial and intraoral photographs after treatment show good overjet, overbite, facial balance, and a reduction of hypermentalis activity.

Fig 10.

Post-treatment study models.

Fig 11.

Radiographs after treatment. A, Cephalogram; B, panoramic radiograph.

Fig 12.

Superimpositions of lateral cephalograms: pretreatment (black line) to post-treatment (red line).

Fig 13.

27-month postretention intraoral photographs.

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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