Objective: How to intrude severely overbite 8mm incisors without surgery and how to achieve minimum overjet with missing lower incisors
Case: My 27 year patient with a chief complaint of her braces for 10 years without any development. She has developed an unattractive smile. The panoramic xray reveals temporomandibular disorder with signs and symptoms because of too much retrusive position of her mandible. Her dental and cephalometric examination was found to be having skeletal Class 2 malocclusion and deep bite along upper and anodontia of 2 central incisors in lower anterior region. She had increased maxillomandibular plane angles and decreased lower anterior facial height, suggesting a hypodivergent growth pattern with proclined upper anteriors and upright lower anteriors. Soft tissue profile indicated a convex profile with retrusive and incompetent lips. Treatment involved extraction of uppers first premolars to unravel the crowding and intrude the anterior teeth. Technique used Roth 0.022 bracket slot differential anchorage system to close the extraction space, retract and intrude anterior teeth using 2 TADs of 1.7 x 8mm implant self-drilling screws placed between maxillary 1st bicuspid and first molar. Results: There is minimum overbite and overjet of 2mm with pleasant smile. Her lower two bicuspids became her cuspids since there is anodontia of lower lateral incisors. We have achieved and Class 1 cuspid relation with good centric relation.
Discussion and Summary: It is possible to intrude severely overbite and achieve minimum overjet without surgery thru the use of 2 screws placed between maxillary 1st bicuspid and first molar and retract anterior thru differential anchorage technique.