Korean J Orthod.  2020 Jan;50(1):52-62. 10.4041/kjod.2020.50.1.52.

Distalization with a modified C-palatal plate for severe upper crowding and a missing lower incisor

Affiliations
  • 1Postgraduate Orthodontic Program, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA. JPark@atsu.edu
  • 2Graduate School of Dentistry, Kyung Hee University, Seoul, Korea.
  • 3Private Practice, Portland, OR, USA.
  • 4Department of Orthodontics, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea.

Abstract

This case report presents the orthodontic treatment of a 25-year-old patient with skeletal Class II and severe maxillary arch crowding, moderate mandibular arch crowding, anterior crossbite, and a missing lower incisor. He was treated with molar distalization using a modified C-palatal plate and temporary anchorage devices to create sufficient space for retraction. The total treatment duration was 21 months. After treatment, his occlusion and smile esthetics showed significant improvement. The modified C-palatal plate represents a treatment modality that enhances the prospects of non-extraction treatment and reduces the need for extraction.

Keyword

Class II; Distalization; Cephalometrics; Extraction vs. nonextraction

MeSH Terms

Adult
Crowding*
Esthetics
Humans
Incisor*
Malocclusion
Molar

Figure

  • Figure 1 Pre-treatment facial and intraoral photographs.

  • Figure 2 Initial digital models.

  • Figure 3 Pre-treatment radiographs. A, Panoramic radiograph; B, lateral cephalogram.

  • Figure 4 Digital simulations. A, Virtual set-up model for extraction of maxillary first premolars and mandibular incisor. B, Superimposition of the findings before and after simulation. C, Superimposition of three-dimensional crowns on lateral cephalogram (lateral head film aligned to the midsagittal plane of models) (Motion View Software, LLC).

  • Figure 5 Extraction of maxillary first premolars and mandibular incisor. A, Possible equilibration map. B, Expected tooth movement (Motion View Software, LLC).

  • Figure 6 Digital simulations. A, Virtual set-up model for extraction of maxillary first premolars. B, Superimposition of findings before and after simulation. C, Superimposition of three-dimensional crowns on lateral cephalogram (lateral head film aligned to midsagittal plane of models).

  • Figure 7 Extraction of maxillary first premolars. A, Possible equilibration map. B, Interproximal reduction to accommodate occlusion. C, Expected tooth movement.

  • Figure 8 Full-arch distalization of the maxillary arch (after 6 months of distalization).

  • Figure 9 Full-arch distalization of the maxillary arch (after 12 months of distalization). During the distalization of the maxillary arch, Class III elastics were engaged on the right side to establish Class I relationship and triangular elastics from the upper canine to lower canine and the first premolar on the left side.

  • Figure 10 Intraoral photographs showing the treatment progress (after 17 months of distalization).

  • Figure 11 Intraoral photographs showing the treatment progress (after 21 months of treatment). The lingual buttons attached to the maxillary second molars were engaged to the palatal plate to express lingual crown torque along with the torque in the 0.019 × 0.025-inch stainless steel wire.

  • Figure 12 Post-treatment facial and intraoral photographs (after 24 months of treatment).

  • Figure 13 Post-treatment digital models.

  • Figure 14 Post-treatment radiographs. A, Panoramic radiograph; B, lateral cephalogram.

  • Figure 15 Cephalometric superimposition. Black, Pre-treatment; Red, post-treatment.

  • Figure 16 Cone-beam computed tomography superimposition before and after maxillary total arch distalization (before, gray; after, yellow). MCPP, Modified C-palatal plate.

  • Figure 17 Superimpositions before and after cone-beam computed tomography and digital model superimposition (Orapix system; Cenos Co., Ltd.). A, Cone-beam computed tomography images (blue, initial; yellow, final). B, Digital model images (red, initial; green, final).

  • Figure 18 American Board of Orthodontics cast-radiograph evaluation score.


Reference

1. Poulton DR. The influence of extraoral traction. Am J Orthod. 1967; 53:8–18.
Article
2. Melsen B. Effects of cervical anchorage during and after treatment: an implant study. Am J Orthod. 1978; 73:526–540.
Article
3. Egolf RJ, BeGole EA, Upshaw HS. Factors associated with orthodontic patient compliance with intraoral elastic and headgear wear. Am J Orthod Dentofacial Orthop. 1990; 97:336–348.
Article
4. Editorial: AAO issues special bulletin on extraoral appliance care. Am J Orthod. 1975; 68:457.
5. American Association of Orthodontists Bulletin. Preliminary results of headgear survey. Bull. 1982; 1:2.
6. Gianelly AA, Bednar J, Dietz VS. Japanese NiTi coils used to move molars distally. Am J Orthod Dentofacial Orthop. 1991; 99:564–566.
Article
7. Hilgers JJ. The pendulum appliance for Class II non-compliance therapy. J Clin Orthod. 1992; 26:706–714.
8. Joseph AA, Butchart CJ. An evaluation of the pendulum distalizing appliance. Semin Orthod. 2000; 6:129–135.
9. Gianelly AA, Vaitas AS, Thomas WM, Berger DG. Distalization of molars with repelling magnets. J Clin Orthod. 1988; 22:40–44.
10. Gianelly AA, Vaitas AS, Thomas WM. The use of magnets to move molars distally. Am J Orthod Dentofacial Orthop. 1989; 96:161–167.
Article
11. Carano A, Testa M. The distal jet for upper molar distalization. J Clin Orthod. 1996; 30:374–380.
12. Bolla E, Muratore F, Carano A, Bowman SJ. Evaluation of maxillary molar distalization with the distal jet: a comparison with other contemporary methods. Angle Orthod. 2002; 72:481–494.
13. Locatelli R, Bednar J, Dietz VS, Gianelly AA. Molar distalization with superelastic NiTi wire. J Clin Orthod. 1992; 26:277–279.
14. Keleş A, İşgüden B. Unilateral molar distalization with molar slider (two case report). Turk J Orthod. 1999; 12:193–202.
15. Chung KR, Choo H, Kim SH, Ngan P. Timely relocation of mini-implants for uninterrupted full-arch distalization. Am J Orthod Dentofacial Orthop. 2010; 138:839–849.
Article
16. Kook YA, Bayome M, Trang VT, Kim HJ, Park JH, Kim KB, et al. Treatment effects of a modified palatal anchorage plate for distalization evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2014; 146:47–54.
Article
17. Kook YA, Park JH, Kim Y, Ahn CS, Bayome M. Sagittal correction of adolescent patients with modified palatal anchorage plate appliances. Am J Orthod Dentofacial Orthop. 2015; 148:674–684.
Article
18. Ghosh J, Nanda RS. Evaluation of an intraoral maxillary molar distalization technique. Am J Orthod Dentofacial Orthop. 1996; 110:639–646.
Article
19. Abels N, Schiel HJ, Hery-Langer G, Neugebauer J, Engel M. Bone condensing in the placement of endosteal palatal implants: a case report. Int J Oral Maxillofac Implants. 1999; 14:849–852.
20. Wehrbein H, Glatzmaier J, Mundwiller U, Diedrich P. The orthosystem--a new implant system for orthodontic anchorage in the palate. J Orofac Orthop. 1996; 57:142–153.
21. Yamada K, Kuroda S, Deguchi T, Takano-Yamamoto T, Yamashiro T. Distal movement of maxillary molars using miniscrew anchorage in the buccal interradicular region. Angle Orthod. 2009; 79:78–84.
Article
22. Park HS, Lee SK, Kwon OW. Group distal movement of teeth using microscrew implant anchorage. Angle Orthod. 2005; 75:602–609.
23. Bayome M, Park JH, Kook YA. Clinical applications and treatment outcomes with modified C-palatal plates. Semin Orthod. 2018; 24:45–51.
Article
24. Florvaag B, Kneuertz P, Lazar F, Koebke J, Zöller JE, Braumann B, et al. Biomechanical properties of orthodontic miniscrews. An in-vitro study. J Orofac Orthop. 2010; 71:53–67.
Article
25. Ryu JH, Park JH, Vu Thi, Bayome M, Kim Y, Kook YA. Palatal bone thickness compared with cone-beam computed tomography in adolescents and adults for mini-implant placement. Am J Orthod Dentofacial Orthop. 2012; 142:207–212.
Article
26. Mah SJ, Kim JE, Ahn EJ, Nam JH, Kim JY, Kang YG. Analysis of midpalatal miniscrew-assisted maxillary molar distalization patterns with simultaneous use of fixed appliances: a preliminary study. Korean J Orthod. 2016; 46:55–61.
Article
27. Yu IJ, Kook YA, Sung SJ, Lee KJ, Chun YS, Mo SS. Comparison of tooth displacement between buccal mini-implants and palatal plate anchorage for molar distalization: a finite element study. Eur J Orthod. 2014; 36:394–402.
Article
28. Vu T, Bayome M, Kook YA, Han SH. Evaluation of the palatal soft tissue thickness by cone-beam computed tomography. Korean J Orthod. 2012; 42:291–296.
Article
29. Kook YA, Park JH, Bayome M, Jung CY, Kim Y, Kim SH. Application of palatal plate for nonextraction treatment in an adolescent boy with severe overjet. Am J Orthod Dentofacial Orthop. 2017; 152:859–869.
Article
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