Professional Documents
Culture Documents
INTRODUCTION
767
768
DU, O
ZSOY
AYDOG
769
Figure 2. (a) Group 1, intrusion with mini-implants. (b) Group 2, intrusion with mandibular utility arch.
rigid segmental anterior unit, two self-drilling miniscrews (1.2-mm diameter; 6 mm long; Absoanchor,
Dentos, Taegu, Korea) were placed between the
mandibular lateral and canine teeth. Standard periapical radiographs were taken to check the position of the
screws in relation to the neighboring roots. One week
after insertion of the screws, NiTi closed-coil springs
(3M Unitek, Monrovia, Calif) were adjusted to give an
approximate intrusive force of 6080 g to four lower
incisor teeth (Figure 2a). All of the patients were
provided with adequate information related to maintenance of the oral hygiene. The patients were followed
at 4-week intervals, and force levels were checked at
each follow-up visit.
In group 2, leveling of the mandibular incisors was
performed, as described for group 1. After the leveling
was completed, a custom-made mandibular utility arch
(0.16 3 0.16inch Blue Elgiloy wire; Ormco, Glendora,
Calif) was inserted for incisor intrusion. A 45u tip back
bend and 45u of buccal root torque were bent into the
molar segment, and 510u of lingual crown torque was
placed in the incisor segment, as proposed by Bench
et al.7 The intrusive force of 75 g was checked before
tying the archwire, and the force levels were checked
every 4 weeks (Figure 2b).
Intrusion was completed when the incisors were at
the same level as the mesiobuccal cusps of the
mandibular first molars. Conventional lateral cephalometric radiographs were taken at pretreatment and at
the end of intrusion. An additional lateral cephalometric
radiograph postleveling was not taken to reduce the
amount of radiation absorbed by the patients. The
radiographs were traced in a dark room on a light box.
A constructed Frankfort horizontal reference plane (7u
to sella nasion line) was used as the horizontal
reference. A vertical reference plane perpendicular to
the horizontal reference was constructed from point T
(the most superior point of the anterior wall of the Sella
Turcica at the junction with the tuberculum sella).
DU, O
ZSOY
AYDOG
770
16.0 6 1.7
16.3 6 2.9
Gender
Male
Female
Treatment duration,
months
X 5 mean.
SD 5 Standard deviation.
P
.788
3
10
5 (47)
3
10
4 (27)
.057
771
SNA,u
SNB,u
ANB,u
GoGn/SN,u
FMA,u
HRP/PP,u
HRP/MnP,u
N-ANS
ANS-Me
N-Me
Wits
VRP-A
VRP-B
Max1-HRP,u
Max1-PP,u
Max6-PP,u
IMPA,u
Mand1-NB,u
Mand6-MnP,u
Occlusal plane-HRP
Max1/Mand1,u
Mand1-VRP,
Mand1-VRP(cr)
Mand6-VRP,
Max6-VRP,
PP-Max6,u
HRP-Mand1(cr)
HRP-Mand1(tip)
Mand1-NB, mm
Overjet
Overbite
E-upper lip
E-lower lip
Nasolabial angle
Labiomental angle
Upper lip-VRP
Lower lip-VRP
Xi-Pm/Mand6,u
Xi-Pm/Mand6, mm
Xi-Pm/Mand1 (cr)
Xi-Pm/Mand1 (tip)
Xi-Pm/Mand1,u
.006a
.093
.223
.889
.185
.044a
.914
.385
.910
.855
.687
.168
.122
.843
.736
.657
.840
.235
.660
.707
.563
.095
.324
.186
.226
.336
.215
.390
.333
.511
.579
.104
.173
.200
.218
.228
.081
.272
.340
.261
.940
.549
DU, O
ZSOY
AYDOG
772
Table 3. Skeletal Measurements and their Statistical Evaluation
Measurements
SNA
SNB
ANB
VRP-A
VRP-B
Wits
HRP/PP
N-ANS
ANS-Me
N-Me
GoGn/SN
FMA
HRP/MnP
Groups
Pretreatment,
X 6 Sx [Median
(min-max)]
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
79.2
82.2
74.5
76.4
5.5
6
64.0
66.2
53.9
57.2
6.5
5
3
1.5
55.1
53.5
62.0
62.2
117.1
116.5
30.0
30.3
21.5
24.8
24.6
24.4
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
Postintrusion,
X 6 Sx [Median
(min-max)]
6 2.88
79.1 6 2.91
6 2.20
82.1 6 2.23
6 2.96
74.6 6 3.13
6 2.51
76.8 6 2.36
(21 to 7)
5 (21 to 7)
(39)
6 (39)
6 3.79
64.3 6 4.38
6 4.32
66.6 6 4.64
6 5.98
54.5 6 6.59
6 4.26
57.7 6 4.66
(23 to 11)
6 (23.5 to 8.5)
(21 to 9)
4 (21 to 8.5)
(18)
2 (0.59)
(04)
1.5 (05)
6 5.02
55.1 6 5.11
6 3.75
53.6 6 3.84
6 3.69
62.9 6 3.95
6 6.27
63.9 6 6.47
6 6.83
118.0 6 7.45
6 8.99
117.4 6 9.09
6 4.69
29.8 6 4.51
6 6.32
30.4 6 6.73
6 5.47
21.7 6 5.44
6 6.56
24.4 6 6.30
6 4.82
24.5 6 4.85
6 5.96
25.1 6 6.16
P ab
PostintrusionPretreatment,
X 6 Sx [Median
(min-max)]
.273
.337
.861
.022
.414
.030
.352
.179
.303
.167
.081
.015
.670
.196
.687
.549
.019
.088
.036
.005
.660
.844
.497
.337
.790
.126
20.1
20.1
0.1
0.4
0
20.5
0.3
0.4
0.6
0.5
20.5
21
0
0
0.1
0.1
0.9
1.7
0.9
0.9
20.2
0.1
0.2
20.4
20.1
0.7
6 0.36
6 0.28
6 0.78
6 0.47
(22 to 1)
(21 to 0.5)
6 1.15
6 0.87
6 1.93
6 1.22
(25 to 1.5)
(23 to 1)
(22 to 1.5)
(20.5 to 2)
6 0.67
6 0.45
6 1.17
6 3.28
6 1.46
6 0.98
6 1.23
6 1.38
6 0.99
6 1.39
6 1.53
6 1.60
Pc
.764
.234
.264
.924
.905
.614
.311
1.000
.412
.938
.657
.234
.181
Measurements
Groups
Pretreatment,
X 6 Sx [Median
(min-max)]
Max1-HRP
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
99.1
100.1
101.6
100.0
83.5
82.7
36.0
37.7
23
22
3.5
4.5
6
3
Max1-PP
Max6-PP
Mx6-VRP, mm
Max6-PP, mm
Overjet
Overbite
I
II
I
II
I
II
I
II
I
II
I
II
I
II
6 10.78
6 13.53
6 10.77
6 13.75
6 4.89
6 3.76
6 3.57
6 3.68
(1982)
(1928)
(213)
(2.59)
(510)
(1.57.5)
Postintrusion,
X 6 Sx [Median
(min-max)]
106.1
107.9
108.3
108.9
86.8
87.0
37.2
39.1
23
22
5
5
6.5
3.5
6 6.38
6 3.84
6 6.70
6 3.80
6 4.40
6 5.18
6 4.28
6 3.34
(1989)
(1929)
(310.5)
(49)
(59)
(2.56)
P ab
.004
.063
.005
.033
.093
.006
.009
.025
.874
.047
.550
.524
,.001
,.001
PostintrusionPretreatment,
X 6 Sx [Median
(min-max)]
7.0
7.8
6.7
8.9
3.3
4.3
1.2
5.6
0
0
0.5
0.5
23
23.5
6 7.13
6 13.81
6 7.09
6 13.33
6 6.46
6 4.62
6 1.44
6 5.30
(22 to 7)
(21 to 2)
(25 to 2)
(23.5 to 3)
(25 to 21.5)
(25.5 to 21.5)
Pc
.846
.599
.654
.821
.336
.762
.960
773
Measurements
IMPA
Mand1-NB, u
Mand1-NB, mm
Mand1-VRP (cr)
Mand1-VRP(tip)
HRP-Mand1(cr)
HRP-Mand1(tip)
Mand6-VRP, mm
Mand6-MnP, u
Xi-Pm/Mand1 (cr)
Xi-Pm/Mand1(tip)
Xi-Pm/Mand1, u
Xi-Pm/Mand6, mm
Xi-Pm/Mand6, u
Groups
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
I
II
Pretreatment,
X 6 Sx [Median
(min-max)]
95
94
18.8
22.1
2.4
3.3
52.1
54.0
59.5
62.5
82.5
77.9
66
69
34.8
36.9
84.5
83.5
7.1
5.8
25
24
86
98
12
11.5
79
80
(81104)
(78111)
6 6.93
6 6.91
6 2.09
6 2.46
6 5.50
6 3.39
6 4.59
6 4.42
6 7.47
6 10.44
(6281)
(6289)
6 3.93
6 3.79
6 4.63
6 6.65
6 2.28
6 3.11
(2027)
(1932)
(7599)
(84110)
(898)
(1017)
(1383)
(7094)
Postintrusion,
X 6 Sx [Median
(min-max)]
99
97
27.7
27.8
4.1
4.6
52.3
53.6
61.8
64.0
83.9
79.8
69
72
36.0
36.9
86.3
75.8
5.6
5.0
23
24
90
93
12
12.5
82
71
(89117)
(88112)
6 9.09
6 5.08
6 2.08
6 1.99
6 6.26
6 4.86
6 5.02
6 5.09
6 6.68
6 10.08
(6382)
(6490)
6 4.49
6 4.01
6 5.96
6 9.46
6 2.37
6 2.84
(1926)
(1829)
(77107)
(86108)
(916)
(1019)
(7398)
(5591)
P ab
.010
.008
,.001
.002
,.001
.010
.796
.670
,.001
.035
.053
,.001
.001
.002
.009
.972
.103
,.001
,.001
.013
,.001
.011
,.001
.019
1000.000
.010
.116
.003
PostintrusionPretreatment,
X 6 Sx [Median
(min-max)]
7
8
8.9
5.7
1.7
1.3
0.2
20.4
2.3
1.5
1.4
1.9
2.5
3
1.2
20.01
1.8
27.7
21.5
20.8
22
21
9
8
0
0.5
3
29
(28 to 20)
(22 to 14)
6 5.24
6 5.29
6 0.78
6 1.59
6 2.62
6 2.54
6 1.74
6 2.27
6 2.45
6 1.60
(15)
(05)
6 1.34
6 1.56
6 3.69
6 5.83
6 0.58
6 1.10
(23 to 21)
(23.5 to 0.5)
(115)
(25 to 11)
(285 to 2.5)
(20.5 to 3)
(25 to 85)
(218 to 3)
Pc
.614
.131
.487
.626
.319
.607
.801
.058
,.001
.087
.139
.169
.125
,.001
Measurements
E plane-upper lip
E plane-lower lip
Upper lip-VRP
Lower lip-VRP
Nasolabial angle
Labiomental angle
Groups
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
Group
I
II
I
II
I
II
I
II
I
II
I
II
Pretreatment,
X 6 Sx [Median
(min-max)]
24
22.5
24.2
22.5
80.8
83.4
74.3
78.0
101.8
109.5
93.5
105.2
(29 to 3)
(26 to 21)
6 4.02
6 1.65
6 5.60
6 5.33
6 4.85
6 5.47
6 15.36
6 14.67
6 20.97
6 26.20
Postintrusion,
X 6 Sx [Median
(min-max)]
24
23
23.1
21.7
80.7
83.4
76.2
79.6
101.2
110.0
94.6
104.2
(29 to 4)
(25 to 21)
6 3.63
6 1.58
6 6.60
6 6.08
6 6.26
6 5.82
6 14.50
6 14.95
6 19.80
6 26.06
P ab
.608
1.000
,.001
.014
.869
1.000
.004
,.001
.675
.641
.110
.340
PostintrusionPretreatment,
X 6 Sx [Median
(min-max)]
0
0
1.1
0.8
20.1
0.0
1.9
1.6
20.6
0.5
1.1
1.0
(22 to 2)
(21 to 2)
6 0.89
6 1.01
6 1.64
6 2.17
6 1.95
6 1.15
6 4.52
6 3.47
6 2.41
6 3.63
Pc
.579
.419
.920
.629
.533
.087
DU, O
ZSOY
AYDOG
774
less patient dissatisfaction. In two recent studies15,16 it
was shown that pure upper incisor intrusion could be
achieved using a segmental arch to the incisors when
it is supported by two mini-implants that are placed
between the lateral and canine teeth. However,
nowadays treatment of deep bite via upper incisor
intrusion is questioned as a result of the potential
negative effects on smile esthetics. With this in mind,
the present study aimed to investigate the effects of
TAD-supported lower incisor intrusion and to compare
these effects with those achieved using a conventional-mechanics, intrusion utility arch.
The amount of interradicular bone available for miniimplant placement was investigated by Schnelle et al.18
using panoramic radiography and by Poggio et al.19
using volumetric dental tomography. According to the
results of both studies, the amount of mandibular bone
thickness decreases toward the anterior area, and
mandibular interradicular areas were not considered
safe zones. Twenty-six implants were inserted in the
present study group, and four of these showed mobility
during intrusion (92.4% success). As the intrusion was
about to be completed, two of these mobile implants
were still loaded and the other two were replaced. In
addition to bone quality, different factors, such as the
geometry of the implant, the operators skill and
experience, and insertion technique, determine the
success of an implant.20 Three of the mobile implants
were on the right side of the patient. The probable
reason for these failures may be the operators ease
(or difficulty) of placement on one side. Schnelle et al.18
and Hu et al.21 advised placement of implants of the
smallest diameter and length in these risky areas in
order to achieve stability. In this study, if higher force
levels were used, the success rate might have been
different.
The dentofacial effects that were achieved were
similar in both of the groups. The mean amount of
overbite decrease was 3 mm for the implant group and
3.5 mm for the utility arch group, which was similar
between the groups. The vertical and sagittal mandibular incisor movement showed only minimal differences, which were not statistically significant between the
groups. The sagittal movement of the incisor tip was
2.3 mm in the implant group and 1.5 mm in the utility
arch group. When this movement is interpreted, it
should be kept in mind that the initial cephalometric
records were taken at the beginning of treatment, not
at the beginning of intrusion. A minimal amount of
protrusion is expected during segmental leveling of
incisors. Vertical movement of the center of resistance
was 1.9 mm in the implant group and 1.4 mm in the
utility arch group. Several studies2124 have found
various amounts of lower incisor intrusion (1.02
3 mm) with conventional mechanics. In these studies
Angle Orthodontist, Vol 81, No 5, 2011
775
15. Polat-Ozsoy O, Arman-Ozcirpici A, Veziroglu F. Miniscrews
for upper incisor intrusion. Eur J Orthod. 2009;31:412416.
16. Saxena R, Kumar RS, Upadhyay U, Naik V. A clinical
evaluation of orthodontic mini-implants as intraoral anchorage for the intrusion of maxillary anterior teeth. World J
Orthod. 2010;11:346351.
17. Shroff B, Yoon WM, Lindauer SJ, Burstone CJ. Simultaneous intrusion and retraction using a three-piece base
arch. Angle Orthod. 1997;67:455461.
18. Schnelle MA, Beck FM, Jaynes RM, Huja SS. A radiographic evaluation of the availability of bone for placement of
miniscrews. Angle Orthod. 2004;74:830835.
19. Poggio PM, Incorvati C, Velo S, Carano A. Safe zones: a
guide for miniscrew positioning in the maxillary and
mandibular arch. Angle Orthod. 2006;76:191197.
20. Park HS, Jeong SH, Kwon OW. Factors affecting the clinical
success of screw implants used as orthodontic anchorage.
Am J Orthod Dentofac Orthop. 2006;130:1825.
21. Hu K, Kang M, Ki T, Kim K, Kim H. Relationships between
dental roots and surrounding tissues for orthodontic
miniscrew installation. Angle Orthod. 2009;79:3745.
22. Gordon JB. Lower Incisor Intrusion in Low Mandibular Plane
Angle, Deep Bite Cases [masters thesis]. Los Angeles,
Calif: University of CaliforniaLos Angeles; 1997.
23. Greig DGM. Bioprogressive therapy: overbite reduction with
the lower utility arch. Br J Orthod. 1983;10:214216.
24. Dake ML, Sinclair PM. A comparison of the Ricketts and
Tweed type arch levelling techniques. Am J Orthod Dentofac Orthop. 1989;95:7278.
25. Shimatsu M. Determination of the center of resistance of
mandibular anterior arch segments. Orthod Waves. 2008;
67:95107.
26. McNamara JA Jr. Utility arches. J Clin Orthod. 1986;20:
452456.