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Total Arch Extrusion With Skeletal Anchorage To Improve Inadequate Maxillary Incisor Display in A Case of Vertical Maxillary Deficiency

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Case Report

Total arch extrusion with skeletal anchorage to improve inadequate


maxillary incisor display in a case of vertical maxillary deficiency
Johnny J. L. Liawa; Jae Hyun Parkb; Fang Fang Tsaic; Betty M. Y. Tsaia; Wendy W. T. Liaoc

ABSTRACT

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Inadequate maxillary incisor display can negatively impact facial esthetics. Various treatment
options exist depending on the underlying cause and severity of the condition. Skeletal anchor-
age was used to extrude the maxillary dentition and rotate the mandible backward, enhancing
visibility of the maxillary incisors. An extrusion assembly was introduced to achieve orthodontic
extrusion. Use of bite raisers and interarch elastics was also discussed. Treatment results dem-
onstrated successful achievement of the treatment goals. In addition to optimal occlusion, the
patient’s facial profile improved with increased lip fullness. There was an increase in vertical
facial height, and maxillary incisor display was significantly improved, resulting in a more pleasant
smile. Two-year postretention records evidenced the stability of total arch extrusion to improve
maxillary incisor display. (Angle Orthod. 2024;94:247–257.)
KEY WORDS: Inadequate incisor display; Total arch extrusion; Skeletal anchorage; Miniscrew;
Extrusion assembly

INTRODUCTION because of vertical maxillary deficiency. This article


focuses on the application of skeletal anchorage to
Appropriate maxillary incisor display is crucial for an
extrude the maxillary dentition and rotate the mandible
esthetic smile. Inadequate maxillary incisor display is a
backward with the intent of improving the visibility of the
condition where the upper front teeth are not ade-
maxillary incisors.
quately visible during smiling or speaking, resulting in a
less attractive appearance.1,2 This can be caused by
Diagnosis and Etiology
factors such as inadequate lip support, decreased verti-
cal dimension, increased upper lip length, or a retruded A 25-year-old female patient presented with chief
maxilla. Treatment options vary depending on the complaints of malalignment and deep overbite. Upon
underlying cause and severity of the condition. Ortho- clinical examination, she displayed a short face with a
dontic treatment, orthognathic surgery, or lip reposition- concave facial profile and inadequate maxillary incisor
ing procedures may be recommended to address the display on smiling (Figures 1 and 2). During a full smile,
issue.3–6 It is challenging to attain ideal maxillary incisor there was approximately 4.2 mm of maxillary incisor
display in patients with a reduced lower facial height display with no evident facial asymmetry. Her nasola-
bial angle was slightly obtuse, with the base of her
nose tipped slightly upward. Additionally, the patient
a
Adjunct Clinical Instructor, Department of Orthodontics, had a deep labiomental fold, lower lip retrusion, and a
National Taiwan University Hospital; and Private Practice, prominent chin. No temporomandibular disorder symp-
Taipei, Taiwan.
b
Professor and Chair, Postgraduate Orthodontic Program,
toms were reported.
Arizona School of Dentistry & Oral Health, A.T. Still University, Intraoral examination showed a deep overbite of 5.3
Mesa, AZ, USA; and International Scholar, Graduate School of mm and a large overjet of 7.3 mm. The arch forms
Dentistry, Kyung Hee University, Seoul, Korea. were symmetrically square in the maxillary arch and
c
Private Practice, Taipei, Taiwan. tapering ovoid in the mandibular arch. There was an
Corresponding author: Dr Jae Hyun Park, Postgraduate
Orthodontic Program, Arizona School of Dentistry & Oral Health, arch length discrepancy of 5 mm in the maxillary arch
A.T. Still University, 5835 East Still Circle, Mesa, AZ 85206, USA and 1 mm in the mandibular arch. The depth of the
(e-mail: JPark@atsu.edu) curve of Spee was 3.7 mm. The bilateral canine and
Accepted: October 2023. Submitted: July 2023. molar relationships were both Class II.
Published Online: November 15, 2023 A panoramic radiograph revealed the presence
Ó 2024 by The EH Angle Education and Research Foundation, Inc. and impaction of the maxillary right, maxillary left,

DOI: 10.2319/070323-462.1 247 Angle Orthodontist, Vol 94, No 2, 2024


248 LIAW, PARK, TSAI, TSAI, LIAO

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Figure 1. Pretreatment facial and intraoral photographs.

and mandibular left third molars (Figure 3). The peri- while the mandibular incisors were upright (U1-SN:
odontal support appeared fine on the panoramic radio- 114.5°, L1-MP: 90.5°).
graph; no other pathological findings were noted. A Based on the findings, the patient was diagnosed
cephalometric radiograph revealed a skeletal Class I with a hypodivergent skeletal Class I relationship with
relationship (ANB: 2°) with a Class III tendency (A-Nv: a Class III tendency and vertical maxillary deficiency.
1.5 mm, Pg-Nv: 0 mm) and a hypodivergent craniofa- Additionally, the dental relationship was Class II with a
cial pattern (SN-MP: 17.0°) (Table 1). Vertical propor- deep overbite and large overjet. The main etiological
tions showed a reduced lower facial height (UFH: LFH ¼ factor for these conditions was determined to be
48.5%: 51.5%). The maxillary incisors were proclined, hereditary.

Figure 2. Pretreatment study models.

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TOTAL ARCH EXTRUSION WITH SKELETAL ANCHORAGE 249

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Figure 3. Pretreatment radiographs and lateral cephalogram.

Treatment Objectives 2. Nonextraction orthodontic treatment with skeletal


anchorage. This alternative involves using skeletal
The treatment goals for this patient included correct-
anchorage to extrude the maxillary dentition and
ing the Class II relationship to achieve optimal overjet
rotate the mandible clockwise.
and overbite, increasing the vertical dimension to har-
monize the lower face, and improving the maxillary Considering the patient’s concave facial profile and
incisor display. It should be noted that increasing the her desire to avoid surgical intervention, the option of
vertical dimension could pose stability challenges. nonextraction orthodontic treatment was selected, but it
Therefore, long-term follow-up was considered crucial was important to note that aligning the teeth without
to monitor the stability of the treatment outcome. extractions could result in protrusion. Skeletal anchorage
could be considered a potential solution to prevent the
proclincation of the maxillary anterior teeth. While extru-
Treatment Alternatives sion may appear to be a straightforward tooth movement,
Two treatment alternatives were considered for this it can be limited by factors such as occlusion, muscle
patient: force, and the original vertical dimension. Implementing
extrusion with the support of skeletal anchorage could be
1. Orthognathic surgery combined with orthodontic treat- a potential breakthrough to address these challenges.
ment. This option is recommended for achieving the Ultimately, the patient declined the surgical approach,
best possible treatment outcome with Le Fort I osteot- leaving the nonextraction orthodontic treatment with skel-
omy to move the maxilla downward and/or forward. etal anchorage as the final treatment plan.

Table 1. Cephalometric Measurements


Taiwanese Norms Pretreatment Posttreatment 2-y Retention
Skeletal Analysis
SNA (°) 81.5 6 3.5 81.0 81.0 81.0
SNB (°) 77.7 6 3.2 79.0 80.0 81.0
ANB (°) 4.0 6 1.8 2.0 1.0 0.0
SN-MP (°) 33.0 6 1.8 17.0 19.0 21.0
Dental Analysis
U1- NA (mm) 3.9 6 2.1 5.0 5.5 6.0
U1-SN (°) 108.2 6 5.4 114.5 111.5 112.5
L1- NB (mm) 6.6 6 2.8 1.5 2.5 2.5
L1-MP (°) 96.8 6 6.4 90.0 105.5 104.5
Facial Analysis
E-Line/UL (mm) 1.1 6 2.2 2.0 2.0 2.0
E-Line/LL (mm) 0.5 6 2.5 4.0 1.0 0.5

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Figure 4. Two upper posterior miniscrews were installed at the infrazygomatic crest for Class II correction. Bite raisers were bonded to the
occlusal surface of the mandibular first molars for disocclusion.

Treatment Progress curve of Spee, the mandibular archwire was switched


to a 0.016 3 0.022-inch SS archwire.
A modified Alexander prescription fixed-bracket sys-
In the 9th month, two buccal shelf miniscrews (2.0 3
tem was employed for this treatment. The slot sizes of
17 mm, A1-P, Bioray Biotech) were installed bilaterally
the anterior teeth (canine to canine) were 0.018-inch,
between the mandibular first and second molars, slanted
whereas the slot sizes of the posterior teeth were forward (Figure 5). Elastomeric chains were attached
0.022-inch. Two miniscrews (2.0 3 10 mm, A1-P, Bio- from the terminal molars to the heads of the buccal shelf
ray Biotech Corp., Taipei, Taiwan) were inserted bilat- miniscrews to protract the entire mandibular dentition to
erally at the infrazygomatic crest (IZC) 2 weeks after address the Class II dental relationship further.
initial bonding to distalize the maxillary canines on a To enhance the display of the maxillary incisors, two
0.014-inch copper-nickel-titanium (Cu-NiTi) archwire. anterior miniscrews (1.4 3 8 mm, A1-V, Bioray Biotech)
Bite raisers were placed on the occlusal surfaces of were placed between the maxillary central and lateral
both mandibular first molars immediately after initial incisors on both sides in the 14th month (Figure 6). Two
bonding of the mandibular arch to avoid bracket inter- cross tubes (2 mm in length, 0.022 3 0.025-inch, Ortho
ference (Figure 4). By the 4th month, the entire maxil- Technology Inc, Tampa, FL, US) were inserted along
lary arch was retracted with IZC miniscrews and the maxillary archwire and positioned where extrusive
elastomeric chains for Class II correction on the forces were to be applied. The extrusion assembly con-
0.016 3 0.022-inch stainless steel (SS) archwire. In sisted of a 0.016 3 0.022-inch SS wire as a guide bar
the 6th month, after achieving the desired flattened featuring a circular loop at the top. A stopper was placed

Figure 5. Two slanted buccal shelf miniscrews were installed for protraction of the mandibular molars.

Angle Orthodontist, Vol 94, No 2, 2024


TOTAL ARCH EXTRUSION WITH SKELETAL ANCHORAGE 251

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Figure 6. Design of maxillary incisor extrusion with TSADs. (A) Bilateral interradicular miniscrews between maxillary central incisors and
lateral incisors. (B) Close-up view of the extrusion assembly. (C) The cross-tube joins the archwire and guiding bar for the open coil spring.
(D) The guiding bar connects the miniscrew and archwire and accommodates the open coil spring. (E) A crimpable stop prevents the coil
spring from slipping into the circular part that wraps around the head of the miniscrew. (F) A segment of NiTi open coil spring to generate the
extrusive force. NiTi indicates nickel-titanium.

along the guide bar, just below the circular loop. Addi- Subsequently, the bite raisers were removed, and short
tionally, a segment of NiTi open coil spring (light, Ormco interarch elastics were employed to settle the occlusion.
Corp., Orange, Calif), slightly longer than the distance Unfortunately, noticeable relapse was observed in maxil-
between the stopper and the vertical tube of the cross lary incisor display (Figure 7).
tube, was inserted around the guide bar. The treatment approach was based on the previous
To install the extrusion assembly, the guide bar was study on redirecting mandibular growth through the clock-
inserted into the vertical tube of the cross tube, with wise rotation of the maxillomandibular complex with ortho-
the circular loop hooked around the interdental minis- dontic dentoalveolar height development.7 In the 25th
crew. Flowable composite resin was applied to secure month, two anterior miniscrews were inserted again bilat-
the attachment, preventing irritation. An inward bend erally between the maxillary central and lateral incisors,
was made at the tail of the guide bar to control the while two posterior miniscrews were placed between the
desired amount of extrusion while also avoiding disar- maxillary second premolars and first molars (Figure 8).
ticulation of the extrusion assembly and irritation of the These miniscrews served as anchors for the extrusion
oral mucosa. The open coil spring could be reacti- assemblies, which were used for a period of five months
vated by adding flowable composite resin beneath the to extrude the entire maxillary dentition. The extrusion
crimpable stoppers. assemblies and miniscrews were removed in the 30th
The maxillary incisor display showed significant month of treatment. After a total of 32 months of active
improvement 2 months after the initiation of treat- treatment, all appliances were removed. Vacuum-formed
ment (Figure 7). The extrusion assembly was then clear retainers were delivered for full-time wear during the
discontinued, and the anterior miniscrews were removed. first 6 months, followed by nighttime use thereafter.

Figure 7. Maxillary incisor display at different stages: (A) Pretreatment, (B) 15th month, and (C) 25th month. Images demonstrate the
improvement achieved after using the anterior extrusion assembly for a period of 2 months. However, it also reveals the subsequent relapse
that occurred after discontinuing use of the extrusion assembly.

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252 LIAW, PARK, TSAI, TSAI, LIAO

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Figure 8. (A) In the 25th month of treatment, four interdental miniscrews were inserted between the maxillary central and lateral incisors and
between the second premolars and first molars bilaterally to extrude the maxillary dentition to improve the incisor display at smile. (B) 4
months later, the length of open coil springs demonstrated significant dental extrusion of the maxillary arch.

Treatment Results of the patient’s smile. Crown length increased signifi-


cantly during extrusion as the gingiva did not fully follow
Occlusion was successfully corrected to achieve a
the extrusive tooth movement.
Class I dental relationship, accompanied by optimal
Cephalometric superimpositions revealed several
overjet and overbite (Figures 9 and 10). The previously
key changes in the dental and skeletal relationships
concave profile became straighter with an enhancement
(Figures 11 and 12):
in lip support, resulting in a fuller appearance. Addition-
ally, vertical facial proportions showed some improve- 1. Maxillary incisors: The forward movement of the max-
ment and a better display of the maxillary incisors. This illary incisors by 1.3 mm, accompanied by 3.6 mm
improvement in incisor display contributed to a more of extrusion, improved the maxillary incisor display
pleasant smile, significantly enhancing overall esthetics significantly.

Figure 9. Posttreatment facial and intraoral photographs.

Angle Orthodontist, Vol 94, No 2, 2024


TOTAL ARCH EXTRUSION WITH SKELETAL ANCHORAGE 253

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Figure 10. Posttreatment study models.

2. Maxillary first molars: The maxillary first molars 6. Mandibular plane rotation: Extrusion of the maxil-
exhibited distalization of 1.5 mm and extrusion of lary dentition rotated the mandible clockwise and
2.8 mm, which may have contributed to an increase increased the mandibular plane by 2.0° (SN-MP:
in the vertical dimension. 17.0° to 19.0°).
3. Mandibular incisors: Relative intrusion of the man-
dibular incisors was noted with proclination by
DISCUSSION
10.5° (IMPA: 90.0° to 100.5°) and 4.0 mm intrusion
at the incisal edge. Additionally, the mandibular Theoretically, vertical dimension has been considered
incisors moved forward by 4.3 mm. as being genetically determined and unchangeable due
4. Mandibular first molars: The mandibular first molars to the influence of muscular forces.8,9 Any increase in
experienced distalization of 1.8 mm and extrusion the vertical dimension can result in relapse over time. In
of 1.3 mm, contributing significantly to an increase cases where esthetic improvement is desired without
in the vertical dimension, specifically in the lower resorting to orthognathic surgery involving downward
anterior facial height by 3.0 mm. grafting of the maxilla, clinicians are now exploring the
5. Occlusal plane rotation: There was significant possibility of increasing the vertical dimension through
clockwise rotation of the occlusal plane by 7.5° orthodontic extrusion with the assistance of skeletal
(SN-OP: 8° to 15.5°). anchorage.

Figure 11. Posttreatment radiographs and lateral cephalogram. The Pretreatment cephalogram is traced as dotted lines.

Angle Orthodontist, Vol 94, No 2, 2024


254 LIAW, PARK, TSAI, TSAI, LIAO

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Figure 12. Cephalometric superimposition showed a great amount of total arch extrusion in maxillary dentition and significant mandibular inci-
sor intrusion, which resulted in clockwise rotation of the occlusal plane and mandible. Treatment effects remained stable at 2-year follow-up.

Orthodontic extrusion of the maxillary incisors in such incisor display is to consider total arch extrusion of the
situations can be challenging, as the extruded maxillary maxillary arch, effectively increasing the vertical dimen-
incisors may interfere with the mandibular incisors, sion. It is worth noting that the stability of molar extrusion
impeding the desired extrusion.1–3,10 While improve- might be more reliable than incisor extrusion. Extruding
ments in maxillary incisor display can be achieved tem- the maxillary molars to a certain extent creates addi-
porarily, there is a tendency for relapse due to occlusal tional interarch spaces, allowing for extrusion of the
forces. One possible strategy for enhancing maxillary maxillary incisors.

Figure 13. Facial and intraoral photographs at 2-year follow-up.

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TOTAL ARCH EXTRUSION WITH SKELETAL ANCHORAGE 255

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Figure 14. 2-year postretention panoramic radiograph and lateral cephalogram. The posttreatment cephalogram was traced as a dotted line.
The cephalometric superimposition showed good stability.

In this case report, orthodontic extrusion was achieved provide interincisal clearance proves to be a more effi-
through an extrusion assembly anchored on interdental cient approach when feasible.
miniscrews. The guide bar of the extrusion assembly Another important consideration when using bite rais-
was custom-made by the clinician chairside. Extrusive ers is the influence of muscle force. Patients with a low
force was generated by de-activating a light open coil mandibular plane angle often exhibit greater muscular
spring segment of NiTi, around 100 gm. forces, leading to a common occurrence of posterior
To achieve effective extrusion of the maxillary inci- tooth intrusion when bonded with bite raisers, while the
sors, it was crucial to ensure the appropriate interin- rest of the dentition undergoes extrusion.11,12 To address
cisal clearance in overjet and overbite. To provide this, one potential approach would be to adjust the loca-
necessary interincisal clearance for the maxillary inci- tion of the bite raisers on the extruded molars in an alter-
sors to extrude, posterior bite raisers can be employed nating fashion to alleviate intrusion of those teeth.
to hinge the mandible backward. If there had been In cases where patients present with a low mandibular
contraindications for increasing facial height, intrusion angle and inadequate maxillary incisor display, injection
of the mandibular incisors could have been consid- of Botulinum toxin type A into the masseter muscle is
ered. However, the rate of intrusion is generally slower often considered.13 This can be a potential solution to
than that of extrusion. Therefore, using bite raisers to address challenges posed by strong occlusal forces and

Figure 15. Evaluation of the treatment effect and stability on maxillary incisor display after extrusion with TSADs at different stages. (A)
Pretreatment; (B) 2 months after maxillary anterior extrusion; (C) 9 months after maxillary anterior extrusion; (D) Posttreatment; (E) 2-year
follow-up. TSADs indicates temporary skeletal anchorage devices.

Angle Orthodontist, Vol 94, No 2, 2024


256 LIAW, PARK, TSAI, TSAI, LIAO

Figure 16. A flap was reflected to remove the broken tip of the miniscrew.

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avoid reintrusion after extrusion as much as possible. follow-up period. Throughout treatment and follow-up,
Since the effects of muscle paralysis resulting from injec- no symptoms or signs of complications were observed.
tions typically last approximately 6 months, repeated Upon reflection of the flap, it was observed that the frac-
injections may be necessary to maintain desired out- tured portion of the miniscrew had been wedged into the
comes over time. periodontal ligament space of the right maxillary lateral
In addition, interarch vertical elastics can be incisor. A high-speed round diamond bur was used to
employed to promote extrusion of the remaining remove a small amount of alveolar bone surrounding the
dentition that was initially out of occlusion due to the fracture segment. Then the fracture segment was care-
presence of bite raisers. This technique allows for fully removed by counterclockwise rotation using a
comprehensive and uniform extrusion throughout Weingart plier (Dentaurum GmbH & Co. KG, Ispringen,
the entire dentition, resulting in positive treatment Germany). Fortunately, no further complications were
outcomes. However, using interarch vertical elastics
observed after the removal of the miniscrew. It is impor-
highly depends on patient compliance with the treat-
tant to avoid contact with the roots of the incisors when
ment protocol.14
inserting interdental miniscrews in the future.
During the initial attempt to extrude the maxillary
incisors, some improvement in their display was
observed. Unfortunately, there was a relapse during CONCLUSIONS
the treatment process. Subsequently, a simultaneous • This case report demonstrated the successful use of
extrusion approach for the maxillary incisors and skeletal anchorage and total arch extrusion to improve
maxillary molars was adopted.7,15 This strategy resulted maxillary incisor display and enhance facial esthet-
in a more stable enhancement in the display of the ics in a patient with vertical maxillary deficiency.
maxillary incisors over 2 years (Figures 13–15). The Treatment goals were achieved with extrusion
total arch extrusion technique is applied to the poste- assemblies anchored with miniscrews.
rior and anterior regions of the maxillary arch, allow- • The patient’s occlusion was corrected, and signifi-
ing for extrusion of the entire maxillary dentition cant improvements were observed in her facial profile,
through use of a labial archwire in the bracket slots.
lip support, vertical facial proportions, and maxillary
The interarch elastics were not used much in this
incisor display.
reported case. • Stability of the total arch extrusion was evidenced
The extrusive forces exerted tended to rotate the
through 2-year postretention records.
maxillary posterior teeth toward the palate. It is advan- • Further research and larger-scale studies are war-
tageous to introduce some expansion in the maxillary
ranted to validate findings of this case report.
archwire with palatal root torque or using a transpalatal
arch. By controlling the extent of maxillary incisor extru-
sion more than that of the maxillary molars, it was pos- REFERENCES
sible to achieve clockwise rotation of the occlusal
1. Opdebeeck H, Bell W. The short face syndrome. Am J
plane, which not only improved the maxillary incisor dis- Orthod. 1978;73:499–511.
play and smile arc but also contributed to good occlu- 2. Spear F. Diagnosing and treatment planning inadequate
sion and stability. tooth display. Br Dent J. 2016;221:463–472.
During the second round of maxillary incisor extrusion, 3. Turley PK. Orthodontic management of the short face
one miniscrew fractured during insertion (Figure 16).16 patient. Semin Orthod. 1996;2:138–152.
However, it was decided not to remove the fractured 4. van Otterloo JdM, Tuinzing D, Kostense P. Inferior positioning
miniscrew immediately to maintain the planned biome- of the maxilla by a Le Fort I osteotomy: a review of 25 patients
chanics and, instead, it was addressed during the with vertical maxillary deficiency. J Maxillofac. 1996;24:69–77.

Angle Orthodontist, Vol 94, No 2, 2024


TOTAL ARCH EXTRUSION WITH SKELETAL ANCHORAGE 257

5. Talei B. The modified upper lip lift: advanced approach with different facial types. Am J Orthod Dentofacial Orthop.
deep-plane release and secure suspension: 823-patient 2000;118:63–68.
series. Facial Plast. 2019;27:385–398. 12. El-Bokle D, Abbas NH. A novel method for the treatment of
6. Paik C-H, Park K-H, Park JH. New orthopedic and orthodon- Class II malocclusion. Am J Orthod Dentofacial Orthop.
tic treatment modality for adult patients with skeletal Class 2020;158:599–611.
III malocclusion with insufficient maxillary incisor exposure. 13. Mu€cke T, Löffel A, Kanatas A, et al. Botulinum toxin as a
AJO-DO Clinical Companion. 2021;1:22–30. therapeutic agent to prevent relapse in deep bite patients.
7. Loca-Apichai P, Liou EJ-W. Redirecting mandibular growth J Maxillofac. 2016;44:584–589.
through orthodontic dentoalveolar height development in
14. Derton N, Derton R, Perini A. Forced eruption with minis-
growing patients with Class III malocclusion undergoing
crews; intra-arch method with vertical elastics versus intra-
maxillary orthopedic protraction. Am J Orthod Dentofacial
arch method using the Derton-Perini technique: two case
Orthop. 2022;162:510–519.
reports. Int Orthod. 2011;9:179–195.

Downloaded from http://meridian.allenpress.com/angle-orthodontist/article-pdf/94/2/247/3333048/i1945-7103-94-2-247.pdf by guest on 09 August 2024


8. Bloom D, Padayachy J. Increasing occlusal vertical dimen-
sion—Why, when and how. Br Dent J. 2006;200:251–256. 15. Atsawasuwan P, Hohlt W, Evans CA. Nonsurgical approach
9. Abduo J, Lyons K. Clinical considerations for increasing occlu- to Class I open-bite malocclusion with extrusion mechanics:
sal vertical dimension: a review. Aust Dent J. 2012;57:2–10. a 3-year retention case report. Am J Orthod Dentofacial
10. Paolone MG, Kaitsas R. Orthodontic-periodontal interac- Orthop. 2015;147:499–508.
tions: orthodontic extrusion in interdisciplinary regenerative 16. Kadioglu O, Bu €yu
€kyilmaz T, Zachrisson BU, Maino BG.
treatments. Int Orthod. 2018;16:217–245. Contact damage to root surfaces of premolars touching min-
11. Ueda HM, Miyamoto K, Saifuddin M, Ishizuka Y, Tanne K. iscrews during orthodontic treatment. Am J Orthod Dentofa-
Masticatory muscle activity in children and adults with cial Orthop. 2008;134:353–360.

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