Download rapid uprighting of a lower second molar with miniscrew anchorage

CLINICAL DENTISTRY AND RESEARCH 2013; 37(1): 42-45
RAPID UPRIGHTING OF A LOWER SECOND MOLAR WITH
MINISCREW ANCHORAGE
Tülin Taner, DDS, PhD
ABSTRACT
Professor, Department of Orthodontics,
Faculty of Dentistry, Hacettepe University,
The aim of this case presentation is to report the rapid
Ankara, Turkey
uprighting of a mesially inclined second lower molar after loss
Aslıhan Zeynep Öz, DDS, PhD
of an adjacent first molar with a miniscrew anchorage in an
Clinical Instructor, Department of Orthodontics,
adult patient. 25 years old female patient applied with a chief
Faculty of Dentistry, Ondokuz Mayıs University,
complaint of upper anterior crowding and mesially inclined
Samsun, Turkey
lower right second molar tooth. The mesial inclination of the
lower right second molar was planned to be corrected with a
miniscrew anchorage. The use of miniscrew provide absolute
anchorage for molar uprighting. Orthodontic uprighting of
the mesially inclined second lower molar was achieved in four
months. After then, an Angle Class I molar relationship and a
good intercuspation of posterior teeth were accomplished.
Correspondence
Aslıhan Zeynep Öz, DDS, PhD
Department of Orthodontics,
Faculty of Dentistry,
Onkoduz Mayıs University,
55139 Samsun, TURKEY
Key words: Miniscrew, Uprighting, Uprighting spring
Phone: +90 362 3121919-4124
Fax: +90 362 4576032
E-mail: [email protected]
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Submitted for Publication: 09.12.2011
Accepted for Publication : 08.06.2012
Molar uprighting with absolute anchorage
INTRODUCTION
Mesial tipping of lower second molar after loss of lower first
molar is a common orthodontic problem for adult patients.
Tipping of molar teeth cause functional, periodontal and
prosthetic problems.1 Uprighting of the lower second molar
is indicated in these patients but this movement is often
limited by the anchorage available. Force required to move
the tooth exerts an equal and opposite force on anchorage
teeth. In addition, tipping a tooth distally generally extrudes
it. As a treatment option, uprighting springs2, dental
implants3 and miniscrews4 can be preferred to upright tipped
molars. In this study, a modified uprighting spring applied to
a miniscrew was used to minimize these effects.
CASE REPORT
25 years old female patient referred to Hacettepe University,
Department of Orthodontics, Ankara with a chief complaint
of anterior crowding. The extraoral examination showed a
straight profile (Figure 1). Intraorally, mild anterior maxillary
and mandibular crowding was recorded. Lower right first molar
was lost 7 years ago and the space have fully closed with
mesial inclination of lower right second molar (Figure 2). Upper
right first molar have a prosthetic restoration and a bridge was
constructed in the left posterior segment (Figure 2).
A panoramic radiograph revealed mesial inclination of the
lower right second molar and alveolar bone loss at the
mesial aspect (Figures 3 and 4).
Treatment Procedure
Maxillary teeth were banded and bonded using .018x.025
inch fixed orthodontic appliances. A miniscrew with a
diameter and length of 1.6 and 8 mm respectively was
placed into the interradicular alveolar bone between
mandibular first and second premolars. The miniscrew was
directly loaded after insertion. A modified spring was bent
from .016x.025 inch titanium molybdenum alloy wire and
inserted through the distal access of molar tube (Figure 5).
After uprighting of the second molar, mandibular teeth were
banded and occlusion were detailed (Figure 6).
Results
Uprighting of the mesially inclined lower right second
molar was achieved in four months. Total treatment time
was 13 months. Figures 7 and 8 show the posttreatment
intraoral and extraoral photographs and Figure 9 shows
the mandibular superimposition. Radiographic evaluation
indicated a new bone formation at the mesial aspect of the
lower right second molar (Figures 10 and 11).
DISCUSSION
Molar uprighting procedures have problems such as molar
extrusion and movement of the anchorage unit. Miniscrews
could provide adequate stability for uprighting of molar
teeth. However, intrusive mechanics have been frequently
required following uprigthing in these cases.1
In this case, a modified uprighting spring and a miniscrew
were used for uprighting of the mesially inclined second
molar. The spring was designed to be inserted through
the distal access of the molar tube to prevent excessive
extrusion of the tooth during uprighting. The miniscrew
was inserted in the alveoler bone between the premolars
and uprighting spring was applied directly to the miniscrew.
This application eliminated the use of additional intrusive
mechanics in this patient. After uprighting, molar extrusion
was minimal and could be eliminated by slightly abrading
the artificial crown of the upper right first molar.
The duration of molar uprighting was rather shorter, in
comparison with similar cases treated with microimplant
anchorage in the literature.5
CONCLUSION
The use of modified spring and miniscrew allowed to achieve
rapid uprighting of the mesially inclined lower second molar
with minimal extrusion.
Figure 1 Pretreatment extraoral photographs
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CLINICAL DENTISTRY AND RESEARCH
Figure 2 Pretreatment intraoral photographs
Figure 3 Pretreatment panoramic radiography
Figure 4 Pretreatment periapical radiography
Figure 6 Intraoral photograph after molar uprighting
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Figure 5 Uprighting spring
Molar uprighting with absolute anchorage
Figure 7 Posttreatment extraoral photographs
Figure 8 Posttreatment intraoral photographs
Figure 9 Mandibular superimposition
Figure 10Posttreatment panoramic radiography
REFERENCES
1.Shellhart WC, Oesterle LJ. Uprighting molars without extrusion. J
Am Dent Assoc 1999; 130: 381-385.
2.Proffit WR. Adjunctive treatment for adults. In: Rudolph P, editor.
Contemporary Orthodontics. St. Louis: Mosby; 2000: p. 620-621
3.Shellhart WC, Moawad M, Lake P. Case report: implants as
anchorage for molar uprighting and intrusion. Angle Orthod 1996;
66: 169-172.
Figure 11Posttreatment periapical radiography
4.Fritz U, Ehmer A, Diedrich P. Clinical suitability of titanium
microscrews for orthodontic anchorage-preliminary experiences. J
Orofac Orthop 2004; 65: 410-418.
5.Park HS, Kyung HM, Sung JH. A simple method of molar uprighting
with micro-implant anchorage. J Clin Orthod 2002; 36: 592-596.
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