Aim: To evaluate and compare skeletal, dental, and soft tissue parameters by therapeutic extraction of first premolar and nonextraction distalization of maxillary and mandibular arches in bimaxillary proclination using the skeletal anchorage system.
Materials and methods: About 40 orthodontic patients undergoing extraction or nonextraction treatment are enrolled in a randomized clinical trial. Participants are randomly assigned to either the extraction or nonextraction group and receive treatment augmented with skeletal anchorage. Mini implants were placed in the extraction group for retraction and infra-zygomatic crest (IZC) and buccal shelf screws were placed in the nonextraction group for distalization.
Observations and results: Comparison between the ages of the patients among both Groups showed no significant difference. A significant difference is observed in dental and soft tissue parameters before and after the treatment in group A, whereas skeletal parameters also showed significant changes along with dental and soft tissue parameters in group B.
Conclusion: There is a significant change in the position of incisors by retraction and facial profile improves gradually in group A while for group B, a marked change in lower facial height was even seen. On comparing both the groups, a highly significant difference can be seen with respect to the amount of incisor retraction and change in molar inclination. The time taken for retraction of incisors is less in comparison to distalization.
Clinical significance: With this, we can easily avoid premolar extraction, and in cases of impacted third molars distalization as when indicated can be helpful as a part of the nonextraction treatment plan.
Slaghour MA, Bakhsh AK, Hadi IH, et al. Dental occlusion and malocclusion: Prevalence, types and treatment. EC Dental Science 2019;1777.
Bills DA, Handelman CS, BeGole EA. Bimaxillary dentoalveolar protrusion: Traits and orthodontic correction. Angle Orthod 2005;75(3):333–339. DOI: 10.1043/0003-3219(2005)75[333:BDPTAO]2.0.CO;2.
Hoyte T, Ali A, Bearn D. Bimaxillary protrusion: Prevalence and associated factors in the Trinidad and Tobago population. Acta Scientific Dental Sciences 2018;2(12):110–116. Available from: https://www.actascientific.com/ASDS/pdf/ASDS-02-0387.pdf.
Khanum A, Prashantha GS, Mathew S, et al. Extraction vs non extraction controversy: A review. Journal of Dental and Orofacial Research 2018;14(1):41–48.
Shashidhar NR, Reddy SR, Rachala MR. Comparison of K-loop molar distalization with that of pendulum appliance - A prospective comparative study. J Clin Diagn Res 2016;10(6):ZC20–ZC23. DOI: 10.7860/JCDR/2016/19560.7931.
Wu X, Liu H, Luo C, et al. Three-dimensional evaluation on the effect of maxillary dentition distalization with miniscrews implanted in the infrazygomatic crest. Implant Dent 2018;27(1):22–27. DOI: 10.1097/ID.0000000000000706.
Kaya B, Şar Ç, Arman-Özçırpıcı A, et al. Palatal implant versus zygoma plate anchorage for distalization of maxillary posterior teeth. Eur J Orthod 2013;35(4):507–514. DOI: 10.1093/ejo/cjs059.
Iannucci JM, Howerton LJ. Dental radiography: Principles and techniques, 5th edition. St. Louis, Missouri: Elsevier/Saunders; 2017. p. 480.
Nayak A. Clinical photography: A to Z. APOS Trends Orthod 2017;7(1):19–28. DOI: 10.4103/2321-1407.199175.
Aljhani A, Zawawi KH. The use of mini-implants in en masse retraction for the treatment of bimaxillary dentoalveolar protrusion. Saudi Dent J 2010;22(1):35–39. DOI: 10.1016/j.sdentj.2009.12.007.
Upadhyay M, Yadav S, Nanda R. Vertical-dimension control during en-masse retraction with mini-implant anchorage. Am J Orthod Dentofacial Orthop 2010;138(1):96–108. DOI: 10.1016/j.ajodo.2010.03.014.
Jung MH. A comparison of second premolar extraction and mini-implant total arch distalization with interproximal stripping. Angle Orthod 2013;83(4):680–685. DOI: 10.2319/091112-726.1.
Ghosh A. Infra-zygomatic crest and buccal shelf-Orthodontic bone screws: A leap ahead of micro-implants – Clinical perspectives. Journal of Indian Orthodontic Society 2018;52(4_suppl2):127–141. DOI: 10.4103/jios.jios_229_18.
Pathak S, Patil T, Mahamuni A, et al. Mandibular buccal shelf and infra zygomatic crest – A safe zone for mini screw insertion. Indian J Orthod Dentofacial Res 2019;5(2):60–62. DOI: https://doi.org/10.18231/j.ijodr.2019.013.
Tsai HH. Cephalometric characteristics of bimaxillary dentoalveolar protrusion in early mixed dentition. J Clin Pediatr Dent 2002;26(4): 363–370. DOI: 10.17796/jcpd.26.4.lqn08w5827576j60.
Ismael AJ. Cephalometric characteristics of bimaxillary protrusion in adolescents. Al-Rafidain Dent J 2012;12(1):135–141. DOI: 10.33899/rden.2012.42654.
Farrow AL, Zarrinnia K, Azizi K. Bimaxillary protrusion in black Americans—An esthetic evaluation and the treatment considerations. Am J Orthod Dentofacial Orthop 1993;104(3): 240–250. DOI: 10.1016/S0889-5406(05)81725-1.
Chu YM, Bergeron L, Chen YR. Bimaxillary protrusion: An overview of the surgical-orthodontic treatment. Semin Plast Surg 2009;23(1): 32–39. DOI: 10.1055/s-0028-1110099.
Little RM. Stability and relapse of mandibular anterior alignment: University of Washington studies. Semin Orthod 1999;5(3):191–204. DOI: 10.1016/s1073-8746(99)80010-3.
McReynolds DC, Little RM. Mandibular second premolar extraction—postretention evaluation of stability and relapse. Angle Orthod 1991;61(2):133–144. DOI: 10.1043/0003-3219(1991)061<0133:MSPEPE>2.0.CO;2.
Ono T. Should the “envelope of discrepancy” be revised in the era of three-dimensional imaging? J World Fed Orthod 2020;9(3S):S59–S66. DOI: 10.1016/j.ejwf.2020.08.009.
Yamaguchi M, Inami T, Ito K, et al. Mini-implants in the anchorage armamentarium: New paradigms in the orthodontics. Int J Biomater 2012;2012: 394121. DOI: 10.1155/2012/394121.
Chinnawar M, Diagavane P, Gilani R, et al. Expanding the scope of envelop of discrepancy with TAD: A review. J Res Med Dent Sci 2022;10(10):172–176. Available from: https://www.jrmds.in/articles/expanding-the-scope-of-envelop-of-discrepancy-with-tad-a-review.pdf.
Lim CY, In J. Randomization in clinical studies. Korean J Anesthesiol 2019;72(3):221–232. DOI: 10.4097/kja.19049.
Renjith V. Blinding in randomized controlled trials: What researchers need to know? Manipal Journal of Nursing and Health Sciences 2017;3(1):45–50. Available at: https://impressions.manipal.edu/mjnhs/vol3/iss1/14.
Verma D, Bindra PK, Ahluwalia R, et al. Mini screws – An absolute anchorage for en-mass retraction of bimaxillary dentoalveolar protrusion: A case report. J Contemp Orthod 2021;5(4):33–37. DOI: http://doi.org/10.18231/j.jco.2021.006.
Al-Sibaie S, Hajeer MY. Assessment of changes following en-masse retraction with mini-implants anchorage compared to two-step retraction with conventional anchorage in patients with class II division 1 malocclusion: A randomized controlled trial. Eur J Orthod 2014;36(3):275–283. DOI: 10.1093/ejo/cjt046.
Felemban NH, Al-Sulaimani FF, Murshid ZA, et al. En masse retraction versus two-step retraction of anterior teeth in extraction treatment of bimaxillary protrusion. J Orthod Sci 2013;2(1):28–37. DOI: 10.4103/2278-0203.110330.
Yao CC, Lai EH, Chang JZ, et al. Comparison of treatment outcomes between skeletal anchorage and extraoral anchorage in adults with maxillary dentoalveolar protrusion. Am J Orthod Dentofacial Orthop 2008;134(5):615–624. DOI: 10.1016/j.ajodo.2006.12.022.
Kim SH, Hwang YS, Ferreira A, et al. Analysis of temporary skeletal anchorage devices used for en-masse retraction: A preliminary study. Am J Orthod Dentofacial Orthop 2009;136(2):268–276. DOI: 10.1016/j.ajodo.2007.08.023.
Burstone CJ. The segmented arch approach to space closure. Am J Orthod 1982;82(5):361–378. DOI: 10.1016/0002-9416(82)90185-3.
Moser L, Di Lorenzo E, Serafin M, et al. Maxillary premolars extraction or molar distalization with or without TADs: Cephalometric evaluation of soft tissue changes in class II treatment. South European Journal of Orthodontics and Dentofacial Research 2020;7(1):4–11. DOI: 10.5937/sejodr7-23776.
Upadhyay M, Yadav S. Mini-implants for retraction, intrusion and protraction in a Class II division 1 patient. J Orthod 2007;34(3):158–167. DOI: 10.1179/146531207225022140.
Upadhyay M, Yadav S, Patil S. Mini-implant anchorage for en-masse retraction of maxillary anterior teeth: A clinical cephalometric study. Am J Orthod Dentofacial Orthop 2008;134(6):803–810. DOI: 10.1016/j.ajodo.2006.10.025.
Chen G, Teng F, Xu TM. Distalization of the maxillary and mandibular dentitions with miniscrew anchorage in a patient with moderate class I bimaxillary dentoalveolar protrusion. Am J Orthod Dentofacial Orthop 2016;149(3):401–410. DOI: 10.1016/j.ajodo.2015.04.041.
Deshmukh SV, Vadera KJ. Nonextraction treatment with en-masse distalization of maxillary dentition using miniscrews. J Indian Orthod Soc 2018;52(3):204–209. DOI: 10.4103/jios.jios_235_17.
Ramsundar K, Jain RK, Balakrishnan N. Dentoalveolar and airway changes following en masse distal movement of the maxillary dentition with infrazygomatic crest anchorage: A prospective study. J Int Soc Prev Community Dent 2023;13(1):62–67. DOI: 10.4103/jispcd.JISPCD_193_22.
Singh G, Gupta N, Goyal V, et al. En masse distalisation of maxillary arch using TADs (IZC); passive self-ligating appliance v/s clear aligner–a comparative cephalometric study. J Contemp Orthod 2019;3(3):11–17.
Becker K, Pliska A, Busch C, et al. Efficacy of orthodontic mini implants for en masse retraction in the maxilla: A systematic review and meta-analysis. Int J Implant Dent 2018;4(1):1–2. DOI: 10.1186/s40729-018-0144-4.