Asymmetric severe skeletal Class II division 1 patient with temporomandibular joint disorder treated with zygomatic anchorage devices and Ni-Ti alloy wires

Abstract

Objective: To describe the orthodontic treatment of a nongrowing 30-year-old woman with asymmetric severe skeletal Class II malocclusions (asymmetric Angle Class II), large overjet (16 mm), large overbite (8 mm), two congenitally missing mandibular incisors (presenting a deciduous anterior tooth), and signs and symptoms of temporomandibular joint disorder (TMD). Materials and Methods: We used novel improved super-elastic Ni-Ti alloy wires (ISWs) combined with Ni-Ti alloy coil springs, power hooks, and a zygomatic implant as reinforced anchorage to provide a constant and continuous mild force to the dentition. Results: We successfully distalized maxillary molars, premolars, and retracted anterior teeth and corrected the asymmetric Angle Class II molar relationship using this system of zygomatic anchorage in conjunction with ISWs, Ni-Ti alloy open-coil springs, and crimpable power hook. The maxillary molars were distalized, and postero-occlusal relationships were improved to achieve Class I canine and molar relationships on both sides. Intrusion of the upper molars made the mandibular plane close. Ideal overbite and overjet relationships were established. Facial esthetics were improved with decreased upper and lower lip protrusion, and no symptoms of TMD were observed after treatment. Conclusion: The orthodontic treatment described here is a promising anchorage technique alternative to traditional techniques to improve severe skeletal Class II with TMD. (Angle Orthod. 2014;84:919-930.)

Relationship between orthodontics and temporomandibular disorders

“…Takayoshi Ishida et al suggested as an appropriate treatment for patients who exhibit signs of the TMDs (sound clicking and pain) with a skeletal Class II malocclusion division 1, the use of orthodontic temporary anchorage devices (TADs) and increased resiliency nickel-titanium wires, due to their successful use in correcting the specific malocclusion and the absence of clinical symptoms of the TMJ after the end of the treatment 54 . Also, the use of orthodontic mini implants as temporary anchorage devices for the intrusion of the upper molars is suggested by Kaku et al for the treatment of Angle Class II malocclusion, as the patients at the end of treatment and three years of follow-up period did not have any symptoms of the TMDs 55 .…”

Correction of bilateral heavily impacted second molar with improved super-elastic nickel-titanium alloy wires

“…Here, we used the improved super-elastic nickel-titanium alloy wire (ISW) (L&H Titan, Tomy International, Tokyo, Japan) without loops, which has been successfully implemented as working archwire. [17][18][19][20] Although several reports have demonstrated the alignment of impacted mandibular second molars associated with mesially inclined third molars during early adolescence, 6,21,22 there has been no report regarding orthodontic management of such complications in an adult patient. In this case report, we describe the successful alignment-with good retention-of impacted bilateral mandibular second molars by using ISW in an adult female patient with severe posterior crowding.…”

A patient with mandibular deviation and 3 mandibular incisors treated with asymmetrically bent improved superelastic nickel-titanium alloy wires

“…Although such occlusions are regarded as unesthetic, due to the discordance of the maxillary and mandibular midlines, ideal occlusion and anterior guidance during mandibular movement can be achieved with appropriate dental compensation, despite nonextraction of a mandibular incisor. 5,9,[11][12][13] In previous reports, the improved superelastic nickel-titanium alloy wire (ISW) (L&H Titan; Tomy International, Tokyo, Japan) has been used as a working archwire for clinical orthodontic treatment, [14][15][16][17] by incorporating bends that were achieved with a heated bending machine. 18,19 We here describe the treatment of a patient with an asymmetric Class II mandibular deviation to the left and 3 mandibular incisors.…”