Main Instructor Piin-Ru Jih
Department / Institution Department of Stomatology, National Cheng Kung University Hospital, Tainan, Taiwan
Classification Case report
Skeletal class II with high mandibular plane is one of the most difficult condition in orthodontic treatment. Especially when the patient cared about the profile and did not want to receive surgery. This case presents using TADs for facial profile improvement.
A 30-year-old woman came with the chief complaint of upper lip protrusion. The cephalometric analysis demonstrated a skeletal Class II(ANB=7.5°) and hyperdivergent facial pattern (SN-Mp=45°). The dental diagnosis were upper incisor protrusion and anterior open contact. The soft tissue findings showed acute nasolabial angle, recessive chin, mentalis muscle strain and upper and lower lip relative protrusive to E-line. She did not consider orthognathic surgery. So the treatment plan were:(1)Tooth 18 28 38 48 14 24 34 44 extraction(2)Alignment and leveling(3)Maxillary four temporary anchorage devices (TADs) for posterior teeth intrusion and mandibular two TADs for posterior teeth vertical control. After treatment, facial profile improved(upper lip and lower lip retracted 5mm). The posterior molar intruded 2mm, resulting in mandible counterclockwise rotation (Pog forward 2mm).
Discussion and Summary
TAD is a powerful anchorage controlling the sagittal and vertical tooth position. This case report showed the importance of vertical control in camouflage orthodontic treatment for adult skeletal class II high-angle case. By using TADs we may offer different options to patients to achieve profile improvement.
Nonsurgical Treatment of Skeletal Class II High Mandibular Plane with TAD