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.

Torque control of maxillary anterior teeth with the double J retractor and palatal miniscrews during en masse retraction.

A double J retractor (DJR) and palatal miniscrews were used to retract maxillary anterior teeth after failure of buccal posterior miniscrews. The line of action passing through the center of resistance of the maxillary anterior teeth and the moment generated by the palatal miniscrews via torquing springs successfully controlled the overbite and incisor torque during space closure. The DJR and palatal miniscrews work well with labial fixed appliances to address bimaxillary protrusion.

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.