7th World Implant Orthodontic Conference (WIOC)November 9~13, 2015, Dubai, UAE

7th World Implant Orthodontic Conference (WIOC)November 9~13, 2015, Dubai, UAE

7th World Implant Orthodontic Conference (WIOC)November 9~13, 2015, Dubai, UAE

Junji SugawaraSendai, Japan

Simultaneous Distalization of Bimaxillary Molars using

Miniplates for Non-Extraction Treatment

The 7th WIOC November 10-13, 2015, Dubai, UAE

SAS Biomechanics

Protraction

IntrusionDistalization

Distalization

Protraction

Distalization

Intrusion

In 1992, we first started orthodontic treatment utilizing the SAS. In 1999, we developed orthodontic miniplates

specifically designed for SAS biomechanics.

1990 1995 2000 2005 2010

Class II deep bite (Distalization of Mx Molars, Intrusion of Anteriors)

Cleft lip and palate (3D Molar Movement)

Retreatment (3D Molar Movement)

Presurgical Ortho. (3D Molar Movement)

Deeply impacted molars (Traction)

Crowding (Distalization of Bimax. Molars)

Surgery First (3D Molar Movement)

How have we used SAS over time?

Class III (Distalization of Mn Molars)

Open bite (Intrusion of Mx/Mn Molars)

1990 1995 2000 2005 2010

Class II deep bite (Distalization of Mx Molars, Intrusion of Anteriors)

Cleft lip and palate (3D Molar Movement)

Retreatment (3D Molar Movement)

Presurgical Ortho. (3D Molar Movement)

Deeply impacted molars (Traction)

Crowding (Distalization of Bimax. Molars)

Surgery First (3D Molar Movement)

How have we used SAS over time?

Class III (Distalization of Mn Molars)

Open bite (Intrusion of Mx/Mn Molars)

The First Bimaxillary Molar Distalization

Case

YM 24-08 Initial (May 27, 2002)

Cephalometric Analysis

PatientNorm

Panoramic Radiograph

YM 24-08 Initial (May 27, 2002)

Wax setup modelInitial

Treatment Goal

85

3

33

Implantation of Orthodontic Miniplates

Y-type

L-type(Modified T-type)

Treatment Progress

Feb 12, 2003 May 7, 2003 Aug 27, 2003

Nov 26, 2003 May 13, 2004 Oct 20, 2004

Treatment Progress

Feb 12, 2003 May 7, 2003 Aug 27, 2003

Nov 26, 2003 May 13, 2004 Oct 20, 2004

Treatment Progress

Feb 12, 2003 May 7, 2003 Aug 27, 2003

Nov 26, 2003 May 13, 2004 Oct 20, 2004

Treatment Progress

Feb 12, 2003 May 7, 2003 Aug 27, 2003

Nov 26, 2003 May 13, 2004 Oct 20, 2004

YM 27-04 At debonding (Nov 24, 2004)

Panoramic Radiograph

YM 27-04 At debonding (Nov 24, 2004)

YM 32-03 5-year follow-up (Nov 18, 2009)

YM 36-11 10-year follow-up (Jul 29, 2015)

Molar Distalization with SAS

3.8 mm

Sugawara J. et al. Distal movement of the maxillary molars in non-growing patients with the Skeletal Anchorage System (SAS). Am J Orthod Dentofac Orthop 126:723-33, 2006

3.2 mm

3.5 mmSugawara J. et al. Distalization of mandibular molars in adult patients with application of Skeletal Anchorage System (SAS). Am J Orthod Dentofacial Orthop 125:130-138, 2004

1.8 mm

In conclusion, the molars were predictably distalized in accordance with the individualized treatment goals, and this was without regard to patient age in non-growing patients.

3.5 mm

1.8 mm

3.8 mm

3.2 mm

1.8 mm

3.5 mm

Molar Distalization with SAS

Increase the Number of Non-Extraction Cases

Recent Case

HY 26-05 Initial (May 30, 2012)

Cephalometric Analysis

1. CDS Analysis 2. ANB: 4.03. Wits appraisal: 1.0

PatientNorm

Panoramic Radiographs

HY 26-05 Initial (May 30, 2012)

CBCT

Mx

Mn

HY 26-05 Initial (May 30, 2012)

LingualLingual

Treatment Goal

× ×

1. Retroclination of U1: 6 mm2. Maintain U1 vertical level3. Distalization of U6: 4 mm4. Distalization of L6: 6 mm

SAS Biomechanics

L-type(Modified T-type)

Y-type

Mx: 16 x 22 CNA, Mn: 16 x 22 CNA passive (Sep 25, 2012)

Intrusion and Distalization of Molars

Mx: 16 x 22 CNA, Mn: 16 x 22 CNA (Dec 21, 2012)

Intrusion and Distalization of Molars

Mx and Mn: 14 NiTi (Feb 08, 2013)

Leveling and Aligning of Entire Dentition

Mx: 16 x 16 Elgiloy, Mn: 12 NiTi (Apr 19, 2013)

Leveling and Aligning of Entire DentitionTight Ligation with Miniplates

Mx: and Mn: 16 x 22 Elgiloy (Jul 02, 2013)

Detailing

Mx: and Mn: 16 x 22 CNA (Oct 10, 2013)

Detailing and Finishing

Mx and Mn: 17 x 25 Elgiloy (Mar 05, 2014)

Detailing and finishing

HY 28-04 At debonding (Apr 16, 2014)

Cephalometric Analysis

1. CDS Analysis 2. ANB: 3.53. Wits appraisal: -4.0

Panoramic Radiograph

HY 28-04 At debonding (Apr 16, 2014)

CBCT

Mx

Mn

HY 28-04 At debonding (Apr 16, 2014)

Lingual Lingual

AfterBefore

Before and After4.5mm

4.0mm2.0mm

1.0mm

3.0mm 5.0mm

Before and After

AfterBefore

Total Treatment Time: 18.8 months

1-year follow-up (Aug 24, 2015)

Conclusion

1. We can predictably move bimaxillary molars distally at the same time in non-growing patients.

2. Since vertical control is possible with SAS, open bite is not a contraindication for molar distalization.

3. We can push the envelope of non-ext treatment by bimaxillary molar distalization.

4. CBCT is an indispensable tool to examine the alveolar housing and evaluate the extent to which the molars can be predictably distalized.