An unusual extraction pattern for retreatment in a patient with dental protrusion and a deficient soft-tissue chin.

A patient with dental protrusion and deficient soft-tissue chin, previously treated with maxillary first premolar extraction, sought retreatment to improve his facial profile. Orthognathic surgery was proposed as the ideal treatment option, but the patient declined. Therefore, other orthodontic options were considered. The combined intrusion and retraction force systems supported with skeletal anchorage on both arches and a midpalatal miniscrew successfully reduced the protrusion and rotated the mandible counterclockwise to improve the facial profile and chin projection. Sagittal correction enhanced by active vertical control with skeletal anchorage and de-wedging with posterior extraction was illustrated. In addition, advancement genioplasty was performed after orthodontic treatment to improve the chin projection further. The mechanics and results of this retreatment case were discussed.

Interdisciplinary rehabilitation for mutilated dentition with mini-implants, autotransplants, and a dental implant.

A patient with mutilated dentition was treated to an acceptable result with the help of mini-implants for anchorage, autotransplantation of 2 teeth, one dental implant, and multiple prostheses. The major problems for this mutilated dentition were multiple missing teeth, bite collapse with posterior crossbites, deepbite with a canted gummy smile, and severe skeletal discrepancy of maxillary protrusion and mandibular retrusion. Mini-implant anchorage was applied to retract and intrude the maxillary arch to reduce the protrusion and rotate the mandible counterclockwise to improve the chin projection. Two autotransplantations, one dental implant, and multiple prostheses were used to accomplish a satisfactory full mouth rehabilitation with an interdisciplinary approach, including orthodontics, periodontics, endodontics, prosthodontics, and implantology. The understanding of biological principles, improvement in surgical protocol makes it possible to preserve the periodontal ligament (PDL) cells with atraumatic extraction after loosening the donor with orthodontic force and reduce the extraoral time with the 3-dimensional print-out replica segmented from cone-beam computed tomography for trying fitness. Soft wire splinting to gain initial stabilization and root canal treatment to avoid endotoxin further reduce the risk of root resorption, loss of attachment, and ankylosis. Autotransplantation could be considered as a part of full mouth rehabilitation. Orthodontic space management is also an important procedure to confirm the site of dental implant installation in the interdisciplinary collaboration.

Orthodontic considerations in hypodivergent craniofacial patterns.

This article examines the characteristics of hypodivergent craniofacial patterns and explores treatment modalities in response to these features. It discusses the impact of robust masticatory muscles, which produce heavy occlusal forces. In addition, it examines the use of Botox or splints to reduce gonial angles in individuals with a square face. A nonextraction treatment approach supported by temporary skeletal anchorage devices is recommended; however, if anatomical limitations persist, extraction may be necessary when arch expansion, molar distalization, incisor proclination, or interproximal reduction cannot create the necessary space. In hypodivergent cases where a nonextraction approach is impractical, a single-arch extraction strategy may be considered to prevent a reduction in the vertical dimension. Emphasizing esthetics, particularly maxillary incisor display, a protocol of total arch extrusion of the maxillary dentition assisted with temporary skeletal anchorage device, bite raisers, and interarch elastics is suggested.

Total arch extrusion with skeletal anchorage to improve inadequate maxillary incisor display in a case of vertical maxillary deficiency.

Inadequate maxillary incisor display can negatively impact facial esthetics. Various treatment options exist depending on the underlying cause and severity of the condition. Skeletal anchorage was used to extrude the maxillary dentition and rotate the mandible backward, enhancing visibility of the maxillary incisors. An extrusion assembly was introduced to achieve orthodontic extrusion. Use of bite raisers and interarch elastics was also discussed. Treatment results demonstrated successful achievement of the treatment goals. In addition to optimal occlusion, the patient's facial profile improved with increased lip fullness. There was an increase in vertical facial height, and maxillary incisor display was significantly improved, resulting in a more pleasant smile. Two-year postretention records evidenced the stability of total arch extrusion to improve maxillary incisor display.

Interdisciplinary management of orthodontic-dental implant-restorative patients.

This article addresses the management of dental implants in joint orthodontic-restorative cases, emphasising the role of temporary skeletal anchorage devices and interdisciplinary treatment. Focused on complex malocclusions that require dental implants, the article navigates through critical aspects such as diagnosis, treatment planning, implant positioning challenges and the strategic role of temporary skeletal anchorage devices in cases with compromised anchorage. Effective communication, collaborative efforts and strategic planning are highlighted in determining optimal implant numbers, locations and timing of placement. A collaborative, strategic approach to managing the complexities of joint orthodontic-restorative cases involving dental implants is recommended.