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Space closure by miniscrew-assisted mesialization of an upper third molar

and partial vestibular fixed appliance: A case report

Article in International Orthodontics · January 2022

DOI: 10.1016/j.ortho.2021.100602

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

International Orthodontics 2020; xx: xxx

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Case report
Space closure by miniscrew-assisted
mesialization of an upper third molar
and partial vestibular fixed appliance:
A case report

Mario Palone 1, Sofia Casella 1, Andrea De Sbrocchi 2, Giuseppe Siciliani 1, Luca Lombardo 1

Available online: 1. Postgraduate School of Orthodontics, University of Ferrara, Via Luigi-Borsari,

46, 44121 Ferrara, Italy
2. Private Practice, Viale I Maggio, 50, 00031 Artena, Italy

Correspondence:
Sofia Casella, Postgraduate School of Orthodontics, University of Ferrara, Ferrara,
Italy.
dott.casellasofia@gmail.com

Skeletal anchorage Summary

Tooth Movement
Technique This case report demonstrates how the use of skeletal anchorage and appropriate orthodontic
Upper molar protraction biomechanics can be used to resolve even complex cases, reducing unwanted dental movements
Adult treatment and allowing the use of a partial vestibular appliance. It describes the complete mesialization of
Orthodontic mini-implant the left upper third molar and space closure following extraction of tooth UR7, due to vertical
fracture one year after previous endodontic therapy for caries. This therapeutic choice was
conditioned by the need not to alter the good pre-existing interarch relationships, and above
all by the patient's request to be treated conservatively, and therefore not to undergo prosthetic
implant rehabilitation. The use of orthodontic miniscrews and the careful application of ortho-
dontic biomechanics, based on both direct and indirect anchorage, enabled the treatment
objectives to be achieved in a reasonable period of time with reduced treatment costs.

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https://doi.org/10.1016/j.ortho.2021.100602
© 2021 CEO. Published by Elsevier Masson SAS. All rights reserved.
1
ORTHO-100602
 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

M. Palone, S. Casella, A. De Sbrocchi, G. Siciliani, L. Lombardo

Case report
Introduction in complex cases. Specifically, the case report details the mesi-
alization of a right upper third molar and space closure following
The range of orthodontic treatment possibilities has increased previous extraction of the UR7, using a short sectional appliance
since the introduction of skeletal anchorage [1]. Temporary with minimal adverse dental effects. In addition to excellent
anchorage devices (TADs), or miniscrews, enable simplified case management, this approach provided reduced financial
management of dental anchorage, reducing the need to extend and biological costs for the patient [15].
appliances across multiple teeth and therefore the risk of
unwanted dental effects [2]. Before their introduction, ortho- Diagnosis and aetiology
dontic treatment relied on conventional mechanics that could A 30-year-old adult patient presented with the specific request
cause adverse effects, with consequent lengthening of treat- to rehabilitate the space left by the UR7, which had been
ment times [3], and in some cases more invasive treatments extracted a year earlier due to a vertical fracture occurring during
such as orthognathic surgery were required [4]. normal masticatory function, after it was endodontically and
Poor patient compliance can adversely affect treatment out- conservatively treated.
comes and prolong treatment times [5]. However, TADs reduce Extraoral clinical examination revealed a symmetrical oval face
the need for patient compliance [6]. Given their remarkable with a good distribution of the three tiers, albeit with the lower
versatility, TADs find many uses in orthodontics, allowing the third slightly reduced. The lips were competent, but the incisor
application of both orthopaedic [7,8] and orthodontic forces. exposure was slightly reduced upon smiling. The profile was
TADs are particularly suitable for pre-surgical orthodontics or for straight, and the nasolabial angle within the norm (figure 1).
straightening limited sectors of the arch due to their excellent Intraoral clinical examination revealed bilateral molar and
anchorage management potential, the reduction in the need for canine Class I relationship, with overbite and overjet in the
patient compliance, and possibility of using appliances of normal range, and coincident dental midlines. The periodontal
reduced extension [9]. biotype was thick, and both dental arches were well aligned,
The closure of post-extraction spaces in the posterior sectors is without crowding. There were diastemas mesial and distal to
one of the greatest challenges in orthodontics, mainly due to the the UR2 and UL2. The UR8 crown was tipped mesially towards
difficulty in moving the molars in a predictable way, and to the the edentulous post-extraction space, which measured about
complicated anchorage management involved. However, several 5.5 mm (figure 1).
authors have demonstrated the efficacy of sectional appliances in Panoramic radiograph showed the presence of all teeth in the
conjunction with TADs in managing complex post-extraction arches, with the exception of the UR7, with bone peaks within
space closure in the posterior sectors, stating that such an the norm (figure 2). However, apical levelling of the mesial bone
approach meets the demands of adult patients to be treated peak of the UR8 alveolus, due to the mesial crown tip of the
efficiently, aesthetically (without bulky, visible equipment), and same tooth, was radiographically evident; the interradicular
with reduced need for compliance [10,11]. Although TADs cannot distance between the UR6 and UR8 measured roughly
be considered entirely immovable during either the direct or 6.5 mm (figure 2).
indirect application of orthodontic forces [12], they certainly Cephalometric measurement highlighted a Class III skeletal
provide an adequate and satisfactory reinforcement of the relationship (ANB = 0.98, Wits = 4.2 mm) with protrusion of
anchorage [13] and these remain stable when correctly placed both jaws (SNA = 85.78, SNB = 84.88) and a hypodivergent facial
in the bone during tooth retraction and protraction phase [14]. pattern (FMA = 16.48). Both the upper (U1^PP = 120.38) and
The aim of this paper is to highlight how the careful use of lower incisors (IMPA = 100.68) appeared proclined (table I).
skeletal anchorage and appropriate orthodontic biomechanics On functional clinical examination, the patient displayed no TMJ
can yield satisfactory results in a reduced treatment time, even symptoms or functional limitation.

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

International Orthodontics 2020; xx: xxx

Case report
Figure 1
Pre-treatment extraoral and intraoral photographs

Figure 2
Pre-treatment lateral head film (a), panoramic radiograph (b) and representation of interradicular and crown distance between UR6
and UR8 (c)

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

M. Palone, S. Casella, A. De Sbrocchi, G. Siciliani, L. Lombardo

Case report
Treatment objective inch thermal NiTi wire was engaged, while a sectional archwire
As per the patient's request, the aim was to restore the eden- 0.017X0.025-inch SS was passively modelled and bonded at the
tulous site of the UR7 rapidly, and with the lowest possible palatal side in order to reinforce the dental anchorage unit [16].
biological and financial cost. The latter and the continuous metal ligature at the vestibular
side had the objective of maximizing the anchorage on these
Treatment alternatives teeth during the alignment and levelling of the UR8 (figure 3a).
In order to achieve the above objective, various treatment plans
were conceived, bearing in mind the patient's request to be
treated as conservatively as possible.
The first option, which had also been proposed to the patient
elsewhere, was to rehabilitate the post-extraction space via the
placement of a single implant-supported crown. However, due
to the mesial tip on the UR8 crown, this would have necessitated
the extraction or distalization of the UR8 in order to guarantee
adequate space for successful prosthetic implant restoration.
However, the patient rejected any such option, reiterating his
demand for a minimally invasive and less expensive therapy,
without either fixed appliances or prosthetic implant rehabilita-
tion. He also declared that he would prefer not to have the UR8
extracted.
The second therapeutic option proposed was to fit a partial fixed
prosthesis to fill the gap. Despite the low invasiveness of this
approach, it was rejected by the patient as it would have
involved prosthetic preparation of the adjacent teeth and, from
a biological standpoint, would not have been a conservative
option.
As a therapeutic alternative that would be biologically respectful
of the contiguous teeth, and would not involve either the
placement of a prosthetic implant or the extraction of the
UR8, an orthodontic treatment was proposed. The aim was to
mesialize the UR8 bodily until complete closure of the extraction
space had been achieved. This proposal took into account sev-
eral anatomical and biological factors, such as the narrow exten-
sion of the maxillary sinus, the good anatomy of the UR8 root
and crown, and the non-atrophic edentulous crest. This option
was provisionally accepted by the patient, albeit with the pro-
visos that the orthodontic appliance involved would require
minimal compliance, and not cover the full arch, instead being
limited to the sector to be treated.
By virtue of these requests, a partial vestibular fixed appliance
with miniscrew anchorage was proposed, but the patient was
informed that it could become necessary to extract the LR8 in
order to prevent premature contacts during the orthodontic
phase of space closure. The patient agreed to undergo this
treatment, accepting the need for TADs and, potentially, extrac-
tion of the LR8.

Treatment progress Figure 3

A partial vestibular fixed appliance (DB metal brackets, Leone Delivery of partial vestibular fixed appliance
SPA, Sesto Fiorentino, Florence, Italy) was bonded to the UR4 a: with 0.016 NiTi and 0.017X0.025-inch SS lingual retainer
and UR5 and a molar tube to the UR6 and UR7 (Legend LP Tube, b: with 0.019X0.025-inch NiTi archwire after one month of therapy
GC Orthodontics Europe GmbH, Breckerfeld, Germany). A 0.016- c:0.019X0.025-inch SS archwire, after two months of therapy

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

International Orthodontics 2020; xx: xxx

Case report
Figure 4
Periapical radiograph after miniscrew insertion on interradicular
palatal site between the UR5 and UR6
Figure 6
Sagittal and occlusal view of archwire bends performed on the
0.019X0.025-inch SS during space closure

After about 4 weeks, a 0.019X0.025-inch NiTi wire was the LR8. To prevent this hindering the mesialization of the
engaged in order to continue the alignment and levelling tooth in question, the latter was extracted, as foreseen in the
of UR8 (figure 3b). Its partial alignment and levelling led to planning phase.
a slight increase in the bite, caused by premature contact After about 1 month, a 0.019  0.025-inch SS archwire was
between its palatal cusp and the mesiovestibular cusp of inserted to finish the levelling of the tooth; the wire was

Figure 5
Delivery of sectional 0.017X0.05-inch SS arch wire that connects the palatal surface of the UR6 and the head of the palatal miniscrews
a: First application of orthodontic forces delivered on both vestibular and palatal sides through the elastic chain
b: Progress of space closure phase, after 4 months of active working phase

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

M. Palone, S. Casella, A. De Sbrocchi, G. Siciliani, L. Lombardo

Case report
Figure 7
Progress of active space closure biomechanics
a: after 8 months of active working phase
b: after 10 months. Premature contacts and incongruence at occlusion occurred

Figure 8
Addition of a lingual button on tooth UR4
a: palatal force applied UR4
b: representation of biomechanics on the sectional archwire system, with its clockwise rotation with centre of rotation at tooth UR6, palatal force on both UR4 and UR5 and
vestibular force applied on UR8
c: after two months, the counter-clockwise rotation of the system has been resolved

modelled to remain passive at the convertible tube on the between the UR5 and UR6 (figure 4). A 0.017  0.025-inch
UR6, which presented a 148 distal offset prescription SS archwire was modelled to connect the bracket-shaped
(figure 3c). The UR8 was fully levelled within the following miniscrew head to the palatal surface of the UR6, and was
2 months of therapy. fixed to both sides using flowable composite (LoFlow
At the end of that phase, an orthodontic miniscrew (Spider Gradia Direct, GC Orthodontics Europe GmbH, Breckerfeld,
Screw K1 long neck, 1.5 mm  8 mm, HdC, Thiene, Italy) Germany). This system made it possible to indirectly anchor
was manually inserted in an interradicular palatal site the UR8 [17].

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

International Orthodontics 2020; xx: xxx

Case report
In addition, a mesially-opened hook was modelled at the As the correction progressed, a gingivectomy was performed
gingival end of the stabilization sectional. This would favour to ensure perfect adaptation of the soft tissue near the
the application of an orthodontic mesialization and intrusion closing space, and traction from the palatal side was elimi-
force from the palatal side, after positioning a metal button on nated once the UR8 had been sufficiently intruded. Figure 5b
the lingual surface of the UR8. In the same phase, occlusal shows the progress 4 months after the start of the active
build-ups were placed on the mesiopalatal cusp of the UR6 to phase.
release the arches and facilitate the biomechanics used. They During the entire active phase, a mesial root-tip bend was first
were also placed on tooth UL6, accepting the risk of unwanted created and then gradually increased in order to facilitate bodily
extrusion of the posterior teeth in the remaining quadrants, mesialization of the UR8, counterbalancing the mesial coronal
which would be minimal considering the patient's hypodiver- tilt moment caused by the closing mechanics of the vestibular
gence and the short timeframe of the planned correction elastic chain. Also, to counteract the mesial rotation of this tooth,
(figure 5). The mesial bodily translation force on the UR8 on the transverse plane, a slight toe-in bend was performed
was obtained through the use of elastic chains on both ves- (figure 6).
tibular and palatal sites. The force applied palatally also pos- After a further 4 months of traction, complete mesial
sessed an intrusive component to correct the verticality of this translation of the UR8 had almost been achieved. At this
tooth and avoid unwanted occlusal interference. This biome- point, so as not to worsen the combined adverse effect of
chanics also had the objective of averting mesial rotation of distal rotation and vestibularization observed on the
the UR8 (figure 5a). right upper premolars, generated due to the traction forces
applied vestibularly, the last 1.5 mm of residual space was
closed only with a chain stretched from the UR6 to UR8
(figure 7).
Ten months after the start of traction, the space closure was
achieved. The occlusal build-ups were removed, and premature
contacts were observed at the level of the palatine cusp of the
UR4 and the vestibular cusp of the UR7 with their respective
lower teeth (figure 8).
Despite the use of TAD to reinforce the anchorage, the closing
mechanics had created unwanted counter-clockwise rotation
of the entire sectional, with the centre of rotation at the level
of the tooth connected to the miniscrew, and consequent
vestibularization of the UR4 and UR5 and lingualization of
the UR8. To correct this interference, a lingual button was
applied to the UR4, and a palatal force applied to it (figure 8a).
The application of this force on the mesial end of the sectional
had the objective of correcting the observed rotation of the
system on the horizontal plane, thereby eliminating the pre-
mature contacts and allow good posterior intercuspation
(figure 8b).
Two months after the application of this force, the counter-
clockwise rotation of the sectional had been corrected
(figure 8c), and the premature contacts issue resolved. Hence,
the vestibular appliance was debonded, the interradicular
Figure 9 miniscrew on the palatal side removed, and the UR6 and
Debonding of vestibular fixed appliance, TAD removal and fitting UR8 were splinted on the vestibular side by means of an
of 0.017X0.025-inch SS vestibular fixed retainer on the UR6 and appropriately modelled 0.017  0.025-inch SS sectional wire
UR8 (figure 9).

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

M. Palone, S. Casella, A. De Sbrocchi, G. Siciliani, L. Lombardo

Case report
Treatment results
After a total treatment time of 15 months, all treatment goals
had been achieved with good anchorage control. The post-
extraction space of the UR7 had been totally closed thanks to
the bodily mesial translation of the UR8, maintaining the har-
mony of the dental arches, the correct values of overjet and
overbite, and the bilateral molar and canine Class I (figure 10).
The posterior marginal ridges in the first quadrant had been well
aligned (figure 11).
The post-treatment periapical and panoramic radiographs
reveal excellent root parallelism, no signs of bone or apical
resorption, and a restoration of the bone peaks at the level Figure 11
of the UR8. Good posterior marginal ridge alignment and post-treatment
intra-oral periapical radiograph

Figure 10
Post-treatment extraoral and intraoral photos

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

International Orthodontics 2020; xx: xxx

Case report
Figure 12
Post-treatment X-rays and tracings
a: lateral head radiography
b: superimpositions of tracings superimpositions of the tracings on the cranial base, on the maxilla and the mandible
c: panoramic radiography

Superimposition of the cephalometric tracings highlight the no significant variation with respect to the pre-treatment values
good anchorage control, mediated by the support of the ortho- (table I).
dontic miniscrews, albeit with slight distal movement of the Figures 13 and 14 show the progress of the correction of the
UR6. There was no major change in the patient's divergence, UR8 from both occlusal and palatal views. One-year check-
despite the placement of occlusal builds-up for a period of about up highlighted the excellent maintenance of the results
10 months (figure 12). Post-treatment cephalometry revealed obtained.

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

M. Palone, S. Casella, A. De Sbrocchi, G. Siciliani, L. Lombardo

Case report
TABLE I
Pre-treatment and post-treatment cephalometric measurements.

Measurements Norm Pre-treatment Post-treatment

SNA (8) 82.0 85.7 85.8

SNB (8) 80.0 84.8 85.2

ANB (8) 2.0 0.9 0.9

Wits (mm) 0.0 4.2 3.6

Maxillary Skeletal (A-Na Perp) (mm) 1.0 2.2 2.2

Mand. Skeletal (Pg-Na Perp) (mm) 2.0 4.6 4.6

FMA (MP-FH) (8) 26.0 16.4 17.2

MP – SN (8) 33.0 22.8 23.7

Palatal-Mand Angle (8) 28.6 13.2 14.3

Palatal-Occ Plane (PP-OP) (8) 10.0 3.4 4.3

Mand Plane-Occ Plane (8) 18.6 9.8 10.0

U1-APo (mm) 6.0 4.6 4.3

L1-APo (mm) 1.0 2.0 2.0

U1 – Palatal Plane (8) 110.0 120.3 119.8

U1 – Occ Plane (8) 59.0 55.4 56.8

L1 – Occ Plane (8) 72.0 69.7 70.0

IMPA (8) 95.0 100.6 100.0

Upper lip (mm) 8.0 4.3 5.2

Lower lip (mm) 2.0 4.2 4.1

A: Point A; B:Point B; S: Sella; N: Nasion; Wits: AO-BO: perpendiculars from points A and B onto the occlusal plane; Na Perp: Plane perpendicular to Frankfurt Plane passing through
point Nasion (Na), Pg: Pogonion, SN: Sella-Nasion Plane, MP: Mandibular plane; FH: Frankfurt plane; U1: Upper central incisor, L1: Lower central incisor; IMPA: incisor mandibular
plane angle.

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

International Orthodontics 2020; xx: xxx

Case report

Figure 13
Progress of space closure mechanics during treatment
a: on palatal view
b: on occlusal view

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

M. Palone, S. Casella, A. De Sbrocchi, G. Siciliani, L. Lombardo

Figure 14 Case report

Post 1-year extraoral and intraoral photographs after one year. Good posterior marginal ridges alignment on occlusal view and palatal
view after one year

Discussion seems particularly advantageous when there are healthy adja-

Orthodontic closure of post-extraction spaces in the presence of cent teeth that can be moved orthodontically to close a post-
healthy adjacent teeth is a valid therapeutic option, but com- extraction space, as in the case described above.
plex. With proper planning and execution, this treatment can Indeed, Silveira et al. reported that the replacement of missing
provide excellent aesthetic and functional outcomes, obviating teeth with prosthetic crowns appears to result in worse peri-
the need for prosthetic implant rehabilitation [18]. This option odontal conditions than the orthodontic closure of such spaces

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

International Orthodontics 2020; xx: xxx

Case report
[15]. Furthermore, although dental implants are now associated The biomechanics described involved the use of a partial fixed
with very high survival rates [19] these are certainly lower than vestibular appliance, anchored by means of a miniscrew in an
those of natural teeth. This is because, being equipped with a interradicular palatal site. The miniscrew provided indirect
periodontal ligament, natural teeth have both better ability to anchorage at the level of the UR6, in a similar way to that
dissipate masticatory forces than dental implants [20] and pro- described in the lower arch by Derton et al. [10].
prioceptive capacity [21], which are protective factors in the The treatment goals were achieved within an acceptable time-
long term. These biological considerations are particularly valid frame, without the need for patient compliance, and meeting
when the patient is a young adult, with a long life ahead of his demand for aesthetic treatment. That being said, some
them. precautions were necessary to counteract mesial tipping of
Although it is therefore an advisable choice, the orthodontic the crown and mesial rotation of the tooth to be moved. These
closure of edentulous spaces via bodily mesialization of the included both tip-back and toe-in bends and the application of
posterior teeth is not easy to manage or implement. The main lingual mesialization forces [30].
difficulty lies in the management of the anchorage, which It should be noted, however, that despite the use of skeletal
would conventionally require an appliance bonded to as many anchorage, the control of reaction forces was not absolute.
teeth as possible in order to effectively dissipate the collateral Indeed, orthodontic miniscrews should not be considered
counteractive forces. However, some young and adult patients completely immovable, as reported by Liou et al. [12]. This
refuse the use of visible, full-length appliances, and instead led to occlusal interference after removal of the resin build-
request to be treated as aesthetically as possible [22]. In such ups. Nonetheless, it was possible to overcome this issue by
cases, miniscrews can provide support for dental anchorage, accurately diagnosing the problem.
thereby enabling the use of partial orthodontic appliances to In conclusion, with appropriate biomechanics, it was possible to
attain complicated dental movements such as bodily mesializa- close the space of an edentulous maxillary site measuring about
tion of the posterior teeth [10]. 6 mm, which in the diagnostic phase was considered to be
Baik et al. argued that protraction of the posterior teeth in the achievable, considering that in adults it is possible to close
absence of crowding or labial protrusion can be a valid thera- edentulous spaces of up to and over 10 mm [31].
peutic option and, in such cases, the use of skeletal anchorage is The result was bodily mesial translation of the UR8, without
particularly indicated [23,24]. The success rate of these cases obvious signs of root resorption or gingival recession, which are
seems to be greater in the maxillary arch, as there is a reduced possible side effects of this biomechanics. The favourable out-
amount of cortical bone [25], and a lower tendency to post- come was maintained by means of a fixed splint in the vestibu-
extractive bone resorption of the crest over time [26], as com- lar area as advised by some authors [32].
pared to the mandibular arch. All this leads to a higher rate of
dental movement during the protraction of the posterior teeth in
the maxilla than in the mandible [27]. However, some consid-
Conclusion
erations regarding the anatomy of the lower floor of the maxil- Skeletal anchorage combined with a partial vestibular fixed
lary sinus and the roots of the teeth to be moved must be made: appliance is a technique that can provide optimal closure of
thus, compared with other teeth, the maxillary posterior teeth posterior extraction spaces. With proper diagnosis and proper
have a complex anatomical structure and are closely related to treatment planning, functional posterior occlusion that is stable
the sinus [28]. In the presence of a very low and pneumatized over time can be achieved.
maxillary sinus, the use of light and continuous forces is partic- Funding: there were no sponsors for the publication of this case report.
ularly indicated, while the resistance to movement will be The research was entirely funded by the experimenters.
greater [29].
Author Contributions: management of clinical case: Mario Palone.
This clinical case shows how a case of posterior edentulism can Conception and design of the treatment: Mario Palone and Luca Lombardo.
be resolved after careful prognostic evaluation in a relatively Drafting the manuscript: Sofia Casella and Mario Palone.
short time via orthodontic repositioning of an upper third molar, Revising the manuscript critically for important intellectual content: Luca
Lombardo, Mario Palone, Andrea De Sbrocchi and Giuseppe Siciliani.
with appropriate crown and root shape, into the extraction space Approval of the version of the manuscript to be published: Luca Lombardo,
of an upper second molar. The maxillary sinus was not exces- Mario Palone, Giuseppe Siciliani and Andrea De Sbrocchi.
sively pneumatized, and the edentulous crest showed no sig- Disclosure of interest: the authors declare that they have no competing
nificant signs of atrophy. In addition, the anatomy of the UR8 interest.
was considered good.

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 To cite this article: Palone M, et al. Space closure by miniscrew-assisted mesialization of an upper third molar and partial vestibular
fixed appliance: A case report. International Orthodontics (2022), https://doi.org/10.1016/j.ortho.2021.100602

M. Palone, S. Casella, A. De Sbrocchi, G. Siciliani, L. Lombardo

Case report
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