A Case in Which Distalization of Maxillary Molars by Using TADs and Anterior Maxillary Osteotomy Achieved Favorable Occlusion and Facial Profile

KATO YUHO, FUJIMOTO MAI, SASAKI AU, YAMAGUCHI KOJI, FUJIMOTO KOUTA, SONOKAWA TAKUYA, TATSUTA TSUNEYASU, SHIMADA JUN, YAMAMOTO NOBUHARU, SUDA NAOTO

doi:10.5927/jjjd.33.59

Anterior maxillary osteotomies are performed to correct sagittal and vertical discrepancies in the maxilla. For the successful application of an anterior maxillary osteotomy, the molar occlusion should be stable at the time of surgery. Temporary anchorage devices （TADs） are frequently used in the treatment of orthognathic cases, affecting the treatment objectives and planning in many cases. This study reports a case of an anterior maxillary osteotomy in which maxillary molars were distalized by TADs to achieve a favorable occlusion and facial profile. <br>A 29-year-old woman presented to our clinic with a chief complaint of lip protrusion. The molar relationship was Angle Class II and the maxillary and mandibular incisors were significantly proclined with 15.0mm of overjet. She had large SNA and ANB angles, and was diagnosed with Angle Class Ⅱ occlusion with maxillary excess. In the presurgical orthodontics, the bilateral maxillary second molars were extracted and the bilateral maxillary first molars were distalized by using TADs. In the mandible, the bilateral first premolars were extracted, the incisors were retroclined, and the molars were mesialized. The maxillary molars were distalized by 5.5mm to achieve an Angle Class Ⅰ molar relationship. Three-dimensional surgical planning software （ProPlan CMF, Materialise） was used to simulate the surgery. During the anterior maxillary osteotomy, the bilateral maxillary first premolars were extracted. The surgery resulted in posterior movement of ANS and the maxillary incisors by 5.0 and 11.0mm, respectively. <br>In this case, distalization of the maxillary molars enabled a functional Angle Class Ⅰ occlusion to be achieved with the application of an anterior maxillary osteotomy alone. Furthermore, significant retrusion of the protruded maxillary incisors improved the facial profile with a favorable chin shape and correction of incompetent lips. This case demonstrates that the use of TADs can improve the treatment outcome and open a new window for treatment planning and surgical options in orthognathic treatment.

A Case in Which Distalization of Maxillary Molars by Using TADs and Anterior Maxillary Osteotomy Achieved Favorable Occlusion and Facial Profile

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