Create Better Balance By Juan C. Echeverri, DDS, FAOS, Elsa A. Echeverri, DDS, FAAPD and Michelle O’Neill, DDS Finding A Solution to Distalization of Maxillary Arch in an Adult Patient Including Use of Temporary Anchorage Devices O ne of the many orthodontic challenges that many practitioners experience is the manage-ment of Class II patients. A Class ll classification is given to patients with a prognathic maxilla and a normal mandible, an average maxilla and a retrog-nathic mandible, or a prognathic maxilla and a retrog-nathic mandible. The solutions for these problems may include orthodontic treatment to create a better balance between the two arches with the objective of achieving an esthetic and functional relationship between the arches and with a proper relationship to the facial soft tissues. Sometimes, it is advisable or necessary to include a surgi-cal component in addition to the orthodontics which may be as simple as placing a temporary anchorage device (TAD), extraction of teeth, or as complex as orthognatic surgery. Part of the dilemma is the difficulty of distaliza-tion of the teeth in the upper arch without opening the bite in a wedge fashion. Another potential problem is an anterior displacement of the mandibular incisor area that may also include the alveolar bone component due to use of the mandibular arch as the anchorage unit. Some patients have also reported pain in the joint area due to use of intermaxillary arch forces.1 One of the techniques for Class II dental classification treatment involves extraction of maxillary bicuspids 26 September/October 2010 JAOS followed by retraction of canines and incisors to create a Class I canine occlusion coupled with a Class II molar occlusion. Other modalities avoid extraction of teeth, and utilize maxillary anterior teeth and the mandibular arch as anchorage for distalization of the molars, followed by distalization of the bicuspids, canines and finally the incisors. In this case report, we will discuss the treatment rendered to an adult patient who previ-ously had undergone extraction of four first bicuspids, and received some type of orthodontic therapy. The treatment plan called for distalization using an MDA appliance following the technique presented by Dr. Gerety in his course: Straight Wire Concepts: Diagnosis and Technique2 . Unexpected joint pain while using anchorage elastic force forced us to look for alternatives to anchor-age. This was found in the form of TADS. Two different techniques were tried and one proved to be effective. Medical and Dental History The patient was a 28-year-old Hispanic female employed as a hygienist in our office. She had recently consulted an orthodontist, and then requested a second opinion at our office. By 15 years of age, her dental history had included two years of orthodontic treat-ment with removal of the all first bicuspids. She had
Journal of the American Orthodontic Society September-October 2010: Page 26
