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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
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.
