Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 722-735
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.722
Severe skeletal bimaxillary protrusion treated with micro-implants and a self-made four-curvature torquing auxiliary: A case report
Rui Liu, Wan-Bang Hou, Ping-Zhu Yang, Lin Zhu, Yong-Quan Zhou, Xia Yu, Xiu-Jie Wen
Rui Liu, Wan-Bang Hou, Ping-Zhu Yang, Lin Zhu, Yong-Quan Zhou, Xiu-Jie Wen, Department of Stomatology, Daping Hospital, Third Military Medical University (Army Military Medical University), Chongqing 400042, China
Xia Yu, Xiu-Jie Wen, Department of Orthodontics, Hospital of Stomatology, Southwest Medical University, Luzhou 646000, Sichuan Province, China
Author contributions: Liu R and Hou WB made equal contributions to this study; Liu R, Hou WB, and Wen XJ wrote the manuscript and treated the patient; Yang PZ, Zhu L, Zhou YQ, and Yu X provided advice on possible treatment strategies and gave valuable comments regarding important intellectual content of the manuscript.
Supported by National Natural Science Foundation of China, No. 81970906; and Sichuan Science and Technology Program, No. 2019YJ0689.
Informed consent statement: Written informed consent was obtained from the patient and her relative for publication. The written consent is available for review upon reasonable request.
Conflict-of-interest statement: All authors declare having no conflicts of interest regarding the treatment of this patient or the publication of this paper.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiu-Jie Wen, MD, Doctor, Department of Stomatology, Daping Hospital, Third Military Medical University (Army Military Medical University), No. 10 Daping Yangtze Branch Road, Yuzhong District, Chongqing 400042, China. wenxiujie@tom.com
Received: November 6, 2020
Peer-review started: November 6, 2020
First decision: November 20, 2020
Revised: November 23, 2020
Accepted: December 6, 2020
Article in press: December 6, 2020
Published online: January 26, 2021
Abstract
BACKGROUND

Bimaxillary protrusion is a clinically common dentofacial deformity, particularly among Chinese patients. This kind of malformation can severely affect facial esthetics and, even in mild cases, is difficult to correct without surgery. Unfortunately, many patients abandon treatment because of fear of surgery. Here, we describe a case of severe skeletal bimaxillary protrusion treated with nonsurgical orthodontic treatments, highlighting an alternative treatment option.

CASE SUMMARY

A 31-year-old woman wished to address a severe protrusion profile (approximately 8 mm overbite) and gummy smile. Cephalometric analysis and superimposition showed a severe skeletal class II pattern with a mandibular retrusion, and proclined and protrusive mandibular incisors. Panoramic radiograph showed a missing mandibular right third molar. A diagnosis of severe bimaxillary dentoalveolar protrusion was made. Taking into account the patient’s fear of orthognathic surgery, she accepted the proposed alternative treatment using micro-implants and a self-made four-curvature torquing auxiliary. The treatment allowed for maximal en masse anterior tooth retraction, proper relocation of incisors, and alleviation of the skeletal class II pattern. Esthetically, the patient’s lip protrusion was significantly decreased as was the overjet (from 10.5 mm to 1.8 mm), and the results remained stable throughout the 2-year follow-up.

CONCLUSION

Nonsurgical treatment using micro-implants and a four-curvature torquing auxiliary may benefit severe cases of skeletal bimaxillary protrusion in adults.

Keywords: Orthodontics, Bimaxillary protrusion, Micro-implants, Self-made four-curvature torquing auxiliary, Teeth, Case report

Core Tip: Nonsurgical orthodontic treatments can benefit cases of severe skeletal bimaxillary protrusion in adults who fear the traditional orthognathic surgical procedures. Success of such nonsurgical alternatives will depend on control of four key factors, namely, maximal en masse anterior tooth retraction, proper relocation of the incisors, ultimate alleviation of the skeletal class II pattern, and sufficient treatment time. Using such an approach, with micro-implants and a self-made four-curvature torquing auxiliary, we significantly decreased a patient’s severe lip protrusion and overjet, with results remaining stable through the 2-year follow-up.