Biomechanical analysis of total arch maxillary distalization using infrazygomatic crest miniscrews: a finite element analysis study.

AIM: To evaluate the maxillary incisors and canine's immediate movement tendency using three different power arms (PA) height levels during total arch maxillary distalization supported on infrazygomatic crest (IZC) miniscrews according to finite element analysis (FEA). METHODS: Three finite element models of the maxilla were developed based on CBCT imaging of a teenage male patient presenting a Class II Division 1 malocclusion in the early permanent dentition. Maxillary complex, periodontium, orthodontic accessories, IZC miniscrews and an orthodontic wire were digitally created. The PAs were placed between canines and lateral incisors and projected at 4, 7, and 10 mm height distances. After that, distalization forces were simulated between PA and IZC miniscrews. RESULTS: The anterior teeth deformation produced in the FEA models was assessed according to a Von Mises equivalent. The stress was measured, revealing tendencies of initial maxillary teeth movement. No differences were found between the right and left sides. However, there was a significant difference among models in the under-stress areas, especially the apical and cervical root areas of the maxillary anterior teeth. More significant extrusion and lingual tipping of incisors were observed with the 4 mm power arm compared to the 7 mm and 10 mm ones. The 10 mm power arm did not show any tendency for extrusion of maxillary central incisors but a tendency for buccal tipping and intrusion of lateral incisors. CONCLUSION: The maxillary incisors and canines have different immediate movement tendencies according to the height of the anterior point of the en-masse distalization force application. Based on the PA height increase, a change from lingual to buccal tipping and less extrusion tendency was observed for the incisors, while the lingual tipping and extrusion trend for canines increased.

Total arch maxillary distalization using infrazygomatic crest miniscrews in the treatment of Class II malocclusion: a prospective study.

OBJECTIVES: To evaluate treatment effects in Class II patients using infrazygomatic crest (IZC) miniscrews (MS). MATERIALS AND METHODS: A prospective sample of 25 adolescents (14 females and 11 males; mean age: 13.6 ± 1.5 years) who underwent maxillary dentition distalization treatment with IZC MSs were recruited. Lateral cephalograms and digital models at the beginning of treatment (T1) and after Class II molar correction (T2) were obtained. To compare cephalometric and digital model changes, paired t-test and Wilcoxon test were used. A significance level of 5% was used. RESULTS: All patients achieved Class II molar correction over a mean period of 7.7 ± 2.5 months. The IZC MS therapy provided 4 mm of distalization; there was 1.2 mm of intrusion of the first molar with 11.2° distal tipping. The maxillary incisors were retracted 4.7 mm and tipped lingually 13.4°. Overjet and overbite showed a reduction of 3.6 mm and 2.4 mm, respectively. The occlusal plane rotated clockwise 2.8°. The upper lip was retracted by 1 mm and the nasolabial angle increased 5.1°. There was an increase in the interpremolar and intermolar distances. CONCLUSIONS: Total arch distalization of the maxillary dentition using IZC MS was effective in the treatment of Class II malocclusions.

A prospective clinical trial of the effects produced by the extrusion arch in the treatment of anterior open bite.

AIM: To evaluate the maxillary dentition effects of the extrusion arch for anterior open bite (AOB) correction in mixed dentition patients. MATERIALS AND METHODS: Fourteen subjects with an initial mean age of 9.17 ± 1.03 years presenting with dentoalveolar AOB (mean - 1.28 ± 1.46 mm) and normal facial pattern (FMA = 25.76°) were treated with an extrusion arch. The mean treatment period was 7.79 ± 2.58 months. Lateral cephalograms and dental models were taken before (T0) and after the correction of AOB (T1). Data were analyzed using paired t test to evaluate differences between T0 and T1. For all tests, a significance level of P < .05 was used. RESULTS: All patients achieved positive overbite at T1, with a mean increase of 3.07 mm. The maxillary incisors extruded 1.94 mm. Retroclination of the maxillary incisors (- 6.15°) and an increase in the interincisal angle (5.57°) were observed. There was a significant decrease in the distance between the incisal edge of the maxillary incisors and the molars (- 2.21 mm). There was significant mesial tipping of the maxillary molar (- 11.49°). Significant reductions of overjet (- 1.65 mm), arch perimeter (- 3.02 mm), and arch length (- 2.23 mm) were noted. The transverse maxillary intermolar distance did not change significantly. CONCLUSIONS: The use of a maxillary extrusion arch was effective in the treatment of AOB. Overbite increased due to incisor extrusion, as well as retroinclination and overjet reduction. However, side effects, such as mesial molar tipping and decreases in arch perimeter and length might occur.