Nada a Ver 2007 Correction of Class II Deep Overbite And

7/31/2019 Nada a Ver 2007 Correction of Class II Deep Overbite And

1/11

S106

Correction o Class II deep overbite anddental and skeletal asymmetry with 2 types

o palatal miniscrewsCheol-Ho Paik,a Sug-Joon Ahn,b and Dong-Seok Nahmc

Seoul, Korea

From the Department o Orthodontics and Dental Research Institute, School o

Dentistry, Seoul National University, Seoul, Korea.aClinical assistant proessor.bAssistant proessor.cProessor.

Reprint requests to: Sug-Joon Ahn, Department o Orthodontics and Dental Re-

search Institute, School o Dentistry, Seoul National University, 28-22 Yunkeun-

Dong, Chongro-Ku, Seoul 110-768; Korea (ROK); e-mail: [email protected].

Submitted, September 2005; revised and accepted, February 2006.

0889-5406/$32.00

Copyright 2007 by the American Association o Orthodontists.

doi:10.1016/j.ajodo.2007;131:00

This case report describes the orthodontic treatment o a 31-year-old woman who had a Class II molar relationship,

anterior crowding, deep overbite, maxillary dental midline deviation, vertical maxillary asymmetry, and a hyperdivergent

acial pattern. The maxillary right frst premolar and the let second premolar were extracted asymmetrically to

correct the anterior crowding and the maxillary dental midline deviation. The maxillary molars were intruded with a

midpalatal miniscrew, which helped to correct the vertical molar asymmetry and close the mandibular plane. The

palatal miniscrew in the maxillary tuberosity was also used to provide anchorage reinorcement or retraction o

the anterior teeth. Ater orthodontic treatment, dental and acial esthetics were greatly improved by treatment o

anterior crowding and deep overbite, correction o the dental and skeletal asymmetry, and closure o the mandibularplane. At the 3-year ollow-up, most o the treatment results had been maintained. (Am J Orthod Dentoacial Orthop

2007;131:00)

The skeletal anchorage system has been intro-duced in orthodontics as a source o stable an-

chorage or orthodontic tooth movement.1-4 It

can help extend the feld o possible tooth movementby allowing more difcult movements to be achieved,

such as molar intrusion and distalization, which in-crease the anchorage burden. Recently, miniscrews or

mini-implants have been gaining in popularity. Their

advantages include decreased operative time, less po-tential morbidity, and a less invasive procedure be-

cause the size is small enough to allow placement inmost areas o the mouth where traditional implants and

onplants cannot be placed.2-5 The palate is a suitablearea or placement o miniscrews or several reasons,

including dense cortical bone, easy access, and lesssusceptibility to inammation.6 Miniscrews placed in

the palate have been used in various wayseg, or ad-

ditional anchorage during retraction o maxillary an-terior and posterior teeth, and intrusion o maxillary

posterior teeth.1,7,8

This patient had a Class II molar relationship anda deep overbite. In addition, she had anterior crowd-

ing, vertical maxillary asymmetry, a maxillary dental

midline deviation, and a hyperdivergent acial pattern.Asymmetric maxillary extraction with reinorced mini-

screw anchorage was planned to minimize the need orpatient compliance. Two types o palatal miniscrews

would be used to correct this malocclusion1 in the

midpalate and 1 in the right maxillary tuberosity. Themidpalatal miniscrew was placed to correct the verti-

cal molar discrepancy and intrude the maxillary molars.The miniscrew in the maxillary tuberosity was used

to provide absolute anchorage or retraction o the an-terior teeth. Good occlusion and acial esthetics were

achieved without the need or patient compliance, andthese results have been maintained or 3 years ater ac-

tive treatment.

DIAGNOSIS AND ETIOLOGY

A 31-year-old woman came or orthodontic evalu-

ation with a chie complaint o anterior crowding andprotrusive lips. She had a hyperdivergent acial pat-tern with a retrognathic mandible. Hyperactivity o

the mentalis muscle was observed with the lips sealed.

From the rontal view, the maxillary incisor displayat rest was 4 mm, and the maxillary dental midline

was 3 mm to the let o the acial midline (Fig 1). Thepatient had no apparent medical problems. Intraorally,

she demonstrated moderate crowding in the maxillaryand mandibular arches, a deep overbite (5.1 mm),

and a large overjet (6.4 mm). Her canine relationship

was Class II on both sides (Fig 2). The dental casts

CASE REPORT


2/11

American Journal of Orthodontics and Dentofacial Orthopedics Paik, Ahn, and Nahm S107Volume 131, Number 4, Supplement 1

showed an almost ull-step Class II molar relationship

on the right and an end-on Class II relationship on thelet, which caused dental midline asymmetry in themaxillary arch due to orward drit o the maxillary

right posterior segment (Fig 3). Functional assess-

ment showed no marked discrepancy between centricocclusion and centric relation with no apparent signs

and symptoms o temporomandibular joint dysunc-tion. Oral hygiene and periodontal conditions were

relatively good.Panoramic radiographic assessment showed slight

root resorption o the maxillary let central incisor,

and the mandibular let third molar was tipped mesi-

ally and impacted horizontally (Fig 4). Lateral cepha-

lometric analysis (Fig 5, A; Table) showed a skeletalClass II relationship (ANB angle, 7.9; Wits appraisal,6.4 mm) due to a retrognathic mandible (SNB angle,

73.3; Pog to N perpendicular, 17.5 mm). The acial

pattern was hyperdivergent, as evidenced by a Frank-ort mandibular plane angle o 36.1. Although the

maxillary and mandibular incisors were normally po-sitioned, sot-tissue analysis showed protrusive upper

and lower lips to the Ricketts esthetic line due to theretrusive chin position.

Posteroanterior cephalometric analysis (Fig 5, B)

showed a chin point deviation to the let by 3.0 mm

Fig 1. Pretreatment acial photographs.

Fig 2. Pretreatment intraoral photographs.


3/11

S108 Paik, Ahn, and Nahm American Journal of Orthodontics and Dentofacial OrthopedicsApril 2007

rom the skeletal midline caused by vertical maxillaryasymmetry. The maxillary right frst molar was extrud-

ed 2.5 mm more than the let. The maxillary dental mid-line was deviated to the let, leading to a 3.0-mm dental

midline discrepancy. The mandibular midline was coin-

cident with the acial midline.

TREATMENT OBJECTIVES

The main treatment objectives were to normalizethe overjet and overbite relationships and to improve

the acial profle. For these goals, the maxillary incisors

would be retracted and intruded, and the midline devia-tion corrected. During retraction, the maxillary incisor

Fig 3. Pretreatment study models.

Fig 4. Pretreatment radiographs.


4/11


angulation would be maintained, and the anterior maxil-lary teeth would be retracted bodily. The bilateral Class

II canine relationship would need correction along withthe dental midline discrepancy.

An improved posterior occlusal relationship wouldalso be needed to obtain maximal intercuspation o theposterior teeth. Correction o the vertical discrepancy in

the maxillary molars would help to treat the acial asym-metry and improve the posterior occlusal relationships.

As a result, retraction o the maxillary and mandibu-lar incisors and bite opening would improve lip protru-

sion and reduce mentalis hyperactivity and lead to better

acial esthetics.

TREATMENT ALTERNATIVES

The patients chie complaint was anterior crowd-

ing and lip protrusion. Because o the skeletal discrep-ancy, the frst alternative was orthognathic surgery. In

this option, to resolve anterior crowding, the 2 maxil-

lary second premolars and the 2 mandibular frst pre-molars would be extracted and retracted with moderate

anchorage. Canting correction o the maxillary verticaldiscrepancy would be perormed to correct acial asym-

metry and improve the posterior occlusal relationships.Total maxillary impaction, which induces mandibular

autorotation and reduces tooth display, and concurrent

mandibular advancement surgery could be planned toimprove the acial profle. Advancement genioplasty

would reduce the long lower acial height and move thechin orward. However, the patient rejected this option

because o the extensive surgeries.A nonsurgical approach with 2 alternatives was

presented to the patient. The frst option was to extract2 maxillary frst premolars and 2 mandibular secondpremolars to achieve bilateral Class I molar and ca-

nine relationships with ideal overbite and overjet. Thesecond option was to extract the maxillary right frst

premolar and the maxillary let second premolar anduse asymmetric mechanics with palatal miniscrews to

correct the dental midline deviation and the vertical

maxillary asymmetry. The result o the second optionwould be a bilateral Class I canine relationship and a

Class II molar relationship.The second option was selected because the asym-

metric extraction o the maxillary premolars would helpto provide space to resolve the dental midline discrepancy

and the incisor crowding. The palatal miniscrews would

be helpul or correcting the vertical molar discrepancyand controlling the anteroposterior molar position. This

plan, with palatal miniscrews and asymmetrical extrac-tion, could minimize the need or patient compliance.

TREATMENT PROGRESS

The maxillary right frst and let second premolars

and the horizontally impacted mandibular let third mo-lar were extracted. The maxillary and mandibular frst

Fig 5. Pretreatment lateral and posteroanterior cephalometric tracings.


5/11


and second molars were banded, and fxed preadjustededgewise appliances with .022-in slots were placed in

both arches. Initially, 0.014-in nickel-titanium leveling

archwires were placed.A transpalatal arch was attached between the maxil-

lary frst molars during initial leveling. A drill-ree mini-

screw (length, 6.0 mm; diameter, 1.6 mm; OSAS, Seoul,Korea) was placed in the midpalatal area between the

maxillary frst and second molars under local anesthe-

sia (Fig 6,A). Two weeks later, an elastic module (orce,150 g) was connected rom the miniscrew to the hook o

the transpalatal arch to intrude the maxillary molar and

Fig 6. Palatal miniscrews: A, in midpalate; B and C, in maxillary tuberosity.

Table. Summary o cephalometric analysis

Measurement Korean norm Before treatment After treatment

3 years after

treatment

Vertical skeletal relationships

FMA (o

) 28.8 36.1 32.7 32.8SN to mandibular plane angle (o) 35.3 44.7 42.7 42.8

Gonial angle (Ar-Go-Me) (o) 122.2 121.3 121.8 121.7

Total anterior acial height (N-Me) (mm) 130.3 132.2 130.7 130.2

Total posterior acial height (S-Go) (mm) 82.9 79.6 80.4 79.7

Total anterior acial height/total posterior acial height (%) 63.6 60.2 61.5 61.2

Maxillomandibular relationships

SNA angle (o) 81.1 81.2 79.1 79.4

SNB angle (o) 78.0 73.3 74.5 74.3

A to N perpendicular (mm) 0.5 0.1 2.5 2.0

Pog to N perpendicular (mm) 4.5 17.5 15.2 15.2

Facial convexity (N-A-Pog) (o) 7.6 17.4 11.1 11.4

ANB angle (o) 3.1 7.9 4.6 5.1

Wits appraisal (mm) 1.5 6.4 1.8 1.1

Dental relationships

Maxillary incisor to Frankort horizontal plane (o) 111.1 110.0 111.1 108.2

Interincisal angle (o) 124.1 121.4 120.4 122.7

Mandibular incisor to mandibular plane angle (o) 96.3 92.5 94.8 95.4

Overbite (mm) 3.1 5.1 2.9 3.1

Overjet (mm) 3.0 6.4 3.4 3.0

Sot-tissue relationships

Ricketts E-line to upper lip (mm) 0.0 2.1 1.6 2.3

Ricketts E-line to lower lip (mm) 0.1 4.9 1.7 1.7

A B C


6/11


maintain maximum anchorage conditions in the maxillaryright quadrant.

Ater correction o the vertical molar discrepancy,both the let and right molars were intruded to close

the mandibular plane; this would help to improve thepatients acial profle. During this stage, we needed

intrusion o both the maxillary and mandibular inci-sors, because intrusion o the maxillary molars would

induce premature contacts o the incisors. An exagger-

ated curve o Spee was applied to the maxillary archor intrusion o the maxillary incisors without extrusion

o molars. Class III elastics and an exaggerated reversecurve o Spee were also applied to the mandibular arch

to intrude the mandibular incisors without proclination.Ater the maxillary molars were intruded, the midpala-

tal miniscrew was removed to prevent unnecessary sot-tissue irritation. At the completion o vertical control,

a high-pull headgear was used to maintain the verticalmolar position at night.

A .019 .025-in stainless steel archwire with an-

terior hooks was placed to retract the maxillary anteri-or segment. At this time, a second miniscrew (length,

Fig 8. Posttreatment intraoral photographs.

Fig 7. Posttreatment acial photographs.


7/11


6.0 mm; diameter, 1.6 mm; OSAS) was placed in the

palate around the right maxillary tuberosity to providemaximum anchorage in the maxillary right quadrant

(Fig 6,B). An elastic module (orce, 150 g) was con-

nected rom the miniscrew to the right hook o the

transpalatal arch to help correct the dental midlinediscrepancy and the posterior occlusal relationships

in this area. The retraction orce was applied rom the

Fig 9. Posttreatment study models.

Fig 10. Posttreatment radiographs.


8/11


hook to the maxillary second molar on the right side

and to the maxillary frst molar on the let side orasymmetric retraction.

Brackets, bands, and the palatal miniscrew were re-moved ater 26 months o active treatment. Twist wire

fxed retainers (.0215 in) were attached to the lingualsuraces o the anterior segments o both arches imme-

diately ater debonding. A circumerential maxillary re-

tainer was also placed the day ater debonding .

TREATMENT RESULTS

The original treatment objectives were all achieved.

The patient developed an attractive and confdent smile.Posttreatment evaluation showed avorable dental and

acial changes (Figs 7 and 8). The acial profle and lip

support were improved, and the mentalis hyperactivity

was reduced. Incisor exposure during posed smiling wasimproved. Intraorally, both arches were well alignedand coordinated, the maxillary midline deviation was

corrected, and normal overbite and overjet relationshipswere achieved. The posterior occlusion had good over-

all intercuspation and was reasonably well settled in abilateral Class II molar relationship (Figs 8 and 9).

The posttreatment panoramic radiograph showed

good overall root parallelism (Fig 10). The let centralincisor and the other incisors showed no signs o urther

root resorption, despite the considerable amount o intru-

sion o the maxillary incisors. The posttreatment lateral

cephalometric radiograph and the superimposed tracingshowed that the anterior acial height and the Frankort

mandibular plane angle had decreased, reecting auto-rotation o the mandible by intrusion o the maxillary

molars (Figs 10 and 11, Table). The maxillary incisorswere retracted bodily and intruded, and the maxillary

posterior teeth were intruded and moved anteriorly. The

mandibular incisors were slightly retracted with intru-sion, and the mandibular posterior teeth were upright-

ed. There was considerable remodeling o subspinalethrough retraction o the maxillary incisors. There was

also general improvement in the sot-tissue relationshipand in nose, lip, and chin balance. Lip protrusion was

reduced, and the nasolabial angle was improved.

The posttreatment posteroanterior cephalometric

radiograph showed that the vertical discrepancy o themaxillary molars was corrected along with the mandib-ular asymmetry.

RETENTION EVALUATION

Ater debonding, the patient had regular ollow-upcare; she wore the circumerential maxillary retainer

24 hours a day or the frst year, ollowed by another

next year o nighttime wear, and every other night orthe third year. The lingual retainers will be kept semi-

permanently to enhance long-term stability. No apparent

Fig 11. Cephalometric superimposition o pretreatment and posttreatment stages.


9/11


changes were noted in the occlusion during this period.

The occlusal settling improved, and the 3-year posttreat-ment stability was excellent (Figs 12 and 13). Comparison

o the posttreatment and 3-year retention cephalometrictracings showed negligible dental and skeletal changes

in the maxilla and the mandible (Fig 14, Table). Only aslight retroclination o the maxillary incisors and a slight

proclination o the mandibular incisors were observed.

DISCUSSION

Orthodontic miniscrews are being used increasinglyor absolute anchorage.1-5 A site suitable or orthodontic

miniscrews is the midpalate, because o its easy access

with little danger o damaging anatomical structures ex-

cept the incisive canal.6

The midpalate consists o densecortical bone, which contributes to the retention o im-

plants7 and miniscrews.9 Several studies reported thatthe thick dense cortical bone o the midpalate (average,

5.0-7.0 mm) can withstand a 6-mm vertical depth o theminiscrew, i the incisive canal is avoided and the midpal-

atal suture is closed.10-12 Nevertheless, the miniscrew canpenetrate the nasal oor in some patients, because bone

thickness around the midpalate has great individual varia-

tion.10,11 However, previous studies showed that hard andsot tissues around the penetrating implants were covered

with connective tissue and coated with respiratory mu-

Fig 12. Postretention acial photographs.

Fig 13. Postretention intraoral photographs.


10/11


cosa,13 and did not show signs o adverse tissue reactions

on the radiographic views.14 In our patient, the frst mini-screw was placed in the midpalate, away rom the incisive

canal. The size o the miniscrew was 1.6 mm in diameterand 6.0 mm in length; this could provide adequate bone

support or the continuous intrusive orce without ailureo the miniscrew and without adverse side eects.

The second miniscrew was placed into the upper part

o the palate around the maxillary tuberosity. The maxil-

lary tuberosity region is becoming increasingly involvedas part o comprehensive dental implant treatment plan-ning.15,16 The placement o implants in this region is oten

difcult because o insufcient bone volume due to themaxillary sinus and the relatively poor bone quality when

compared with the anterior segment o the maxilla.17 For

dental implants, occlusal orces in the posterior region aregreater than those exerted in the anterior region, and the

bone quality o the maxillary tuberosity is not sufcientto withstand these orces. However, the orthodontic load

on the miniscrew was much less than the occlusal orce,which will not cause excessive stress on the miniscrew.

In this patient, we confrmed that the sinus was not inthe insertion area (Figs 4 and 6, C); the sinus is the main

reason or insufcient bone volume. Thereore, the mini-

screw provided enough bony support to resist the 150 go orthodontic load despite its small size.

Dental midline discrepancies are difcult to correct,particularly in adults with Class II malocclusion. Many

approaches can be used to achieve an acceptable mo-lar relationship, including asymmetric headgear18 and

asymmetric interarch elastic wear.19 These approachesneed excellent patient compliance. In addition, attempt-

ing to achieve midline coordination with asymmetric

elastic wear, such as a combination o Class II and an-terior diagonal elastics, can be associated with undesir-

able side eects created by the elastics, such as extru-sion o the molar, increase in vertical dimension, and

concurrent clockwise rotation o the mandible.20

One approach or managing dental asymmetriesis to extract teeth asymmetrically; this will reduce the

dependency on patient compliance or elastic wear orextraoral appliances, and might even shorten treatment

time. In addition, asymmetric extractions help to simpli-y the treatment plan when dealing with buccal segment

asymmetries at the same time. This patient had a dentalmidline deviation combined with buccal segment asym-

metry (ull-step Class II on the right and end-on Class II

on the let), which needed asymmetric dental extractionsto achieve the desired treatment results. In this patient,

Class I closure mechanics were applied to the let max-

illary molar with the end-on Class II relationship; thishelped the let molar to ft into a Class II relationship.However, additional anchorage was required to correct

the dental midline deviation and the anterior crowding

on the right side, because the right molar was already ina ull-step Class II relationship. The palatal miniscrew

in the maxillary tuberosity area prevented anchorageloss o the maxillary molar on the right side.

Correction o a deep bite is difcult in adults, andthe results can be unstable. Bite correction by extrusion

o posterior teeth is unstable in adult patients.21 Further-

more, archwire systems or incisor intrusion, such as the

utility arch,22

can create a reactive orce that elongatesthe molars, and this can be detrimental to the acial pro-fle by counterclockwise rotation o the mandible, par-

ticularly in an adult with a hyperdivergent acial pattern.This means that additional anchorage is needed to intrude

the incisors. High-pull headgear is used or preparation

o molar anchorage, but it requires excellent patient co-operation. The miniscrew can be an excellent alternative

in this situation. In this patient, the maxillary incisorswere intruded by incorporating an exaggerated curve o

Spee into the maxillary archwire without extrusion o themaxillary molar with midpalatal miniscrew anchorage.

Fig 14. Cephalometric superimposition between post-treatment and postretention stages.


11/11


In addition, the net intrusion o the maxillary molars in-duced counterclockwise rotation o the mandibular plane,

with concurrent improvement o the acial profle. As a

result, we obtained skeletal eects resembling those o aLeFort I total maxillary impaction, which we originally

planned to correct this patients skeletal discrepancy.Apical root resorption is an undesirable and irre-

versible side eect o orthodontic therapy. Intrusion isa dangerous tooth movement, because axial orces are

concentrated in a relatively small area near the apex dueto the conical shape o the root.23 Extremely light orces

should be used to produce appropriate pressure in the

periodontal ligament.23 Many studies have reported theoptimum orce or intrusion. Burstone24 suggested 20 g

o orce or intrusion o anterior teeth, and Gianelly andGoldman25 recommended 15 to 50 g o orce or small

teeth. For intruding molars, rom 50 to 500 g per tooth

has been recommended, which is over 3 times greaterthan orces applied on anterior teeth.3,26,27 In this patient,

the maxillary anterior and posterior teeth were intrudedthrough various archwire systems and palatal miniscrews.

An archwire system with an exaggerated curve o Speewas used with midpalatal miniscrew anchorage or intru-

sion o the maxillary anterior teeth. This archwires werechanged slowly rom light round to heavy rectangular

wire. In the maxillary posterior teeth, 150 g o light orce

was used to intrude the maxillary molars. As a result, op-timal intrusion could be achieved without apparent root

resorption during the active treatment period.

CONCLUSIONS

Asymmetrical maxillary extraction and 2 types opalatal miniscrews were used to correct a Class II den-

tal relationship, anterior crowding with deep overbite,and maxillary dental and skeletal asymmetry without

patient compliance. This case report demonstrates thatthe palatal miniscrew anchorage method can provide the

additional orthodontic anchorage needed to intrude and

retract maxillary incisors and molars.

REFERENCES

1. Paik CH, Woo YJ, Boyd R. Treatment o an adult patient withvertical maxillary excess using miniscrew fxation. J Clin Or-

thod 2003;37:423-8.

2. Park YC, Lee SY, Kim DH, Jee SH. Intrusion o posterior teeth

using miniscrew implants. Am J Orthod Dentoacial Orthop

2003;123:690-4.

3. Umemori M, Sugawara J, Mitani H, Nagasaka H, Kawamura

H. Skeletal anchorage system or open-bite correction. Am J

Orthod Dentoacial Orthop 1999;115:166-74.

4. Kanomi R. Mini-implant or orthodontic anchorage. J Clin Or-

thod 1997;31:763-7.

5. Deguchi T, Takano-Yamamoto T, Kanomi R, Hartsfeld JK Jr,

Roberts WE, Garetto LP. The use o small titanium screws or

orthodontic anchorage. J Dent Res 2003;82:377-81.

6. Kyung SH, Lim JK, Park YC. The use o miniscrew as an an-

chorage or the orthodontic tooth movement. Korean J Orthod

2001;31:415-24.

7. Giancotti A, Greco M, Mampieri G, Arcuri C. Clinical manage-

ment in extraction cases using palatal implant or anchorage.

J Orthod 2004;31:288-94.

8. Cousley R. Critical aspects in the use o orthodntic palatal im-

plants. Am J Orthod Dentoacial Orthop 2005;127:723-9.

9. Henriksen B, Bavitz B, Kelly B, Harn SD. Evaluation o bone thick-

ness in the anterior hard palate relative to midsagittal orthodontic

implants. Int J Oral Maxilloac Implants 2003;18:578-81.

10. Kyung SH, Lim JK, Park YC. A study on the bone thickness o

midpalatal suture area or miniscrew insertion. Korean J Or-

thod 2004;34:63-70.

11. Kang SM, Ahn SJ, Lee SJ, Heo MS, Kim TW. Bone thickness

o the palate or orthodontic mini-implant anchorage in adults.

Am J Orthod Dentoacial Orthop 2007; in press.

12. Wehrbein H, Merz BR, Diedrich P. Palatal bone support or

orthodontic implant anchoragea clinical and radiological

study. Eur J Orthod 1999;21:65-70.

13. Geiger SA, Pesch HJ. Aminal experimental studies on the heal-ing around ceramic implantation in bone lesions in the maxil-

lary sinus region. Dtsch Zahnarztl Z 1977;32:396-9.

14. Branemark PI, Adell R, Albrektsson T, Lekholm U, Lindstrom

J, Rockler B. An experimental and clinical study o osseoin-

tegrated implants penetrating the nasal cavity and maxillary

sinus. J Oral Maxilloac Surg 1984;42:497-505.

15. Nocini PF, Albanese M, Fior A, De Santis D. Implant place-

ment in the maxillary tuberosity: the Summers technique

perormed with modifed osteotomes. Clin Oral Implants Res

2000;11:273-8.

16. Razavi R, Zena RB, Kahn Z, Gould AR. Anatomic site evalu-

ation o edentulous maxillae or dental implant placement.

J Prosthodont 1995;4:90-4.

17. Jafn RA, Berman CL. The excessive loss o Branemark fxtures

in type IV bone: a 5-year analysis. J Periodontol 1991;62:2-4.18. Nobel PM, Waters NE. Investigation into the behavior o sym-

metrically and asymmetrically activated ace-bows. Am J Or-

thod Dentoacial Orthop 1992;101:330-41.

19. Lewis PD. The deviated midline. Am J Orthod 1976;70:601-16.

20. Lamarque S. The importance o occlusal plane control during

orthodontic mechanotherapy. Am J Orthod Dentoacial Orthop

1995;107:548-58.

21. Bell W, Jacobs JD, Legan HL. Treatment o Class II deep bite by

orthodontic and surgical means. Am J Orthod 1984;85:1-20.

22. Ricketts RM, Bench RW, Gugino CR, Hilgers JJ, Schulho RJ.

Bioprogressive therapy. Denver: Rocky Mountain Orthodon-

tics; 1979. p. 111-26.

23. Dermaut LR, De Munck A. Apical root resorption o upper

incisors caused by intrusive tooth movement: a radiographicstudy. Am J Orthod Dentoacial Orthop 1986;90:321-9.

24. Burstone CR. Deep overbite correction by intrusion. Am J Or-

thod 1977;72:1-22.

25. Gianelly AA, Goldman HM. Biologic basis o orthodontics.

Philadelphia: Lea and Febiger; 1971.

26. Kalra V, Burstone CJ, Nanda R. Eects o a fxed magnetic

appliance in the dentoacial complex. Am J Orthod Dentoacial

Orthop 1989;95:467-78.

27. Melsen B, Fiorelli G. Upper molar intrusion. J Clin Orthod

1996;30:91-6.

Date post:	05-Apr-2018
Category:	Documents
Upload:	clinica-odontoklein
View:	218 times
Download:	0 times

Nada a Ver 2007 Correction of Class II Deep Overbite And

Documents