2. P.33-38 Celli:CR_Celli 1/10/07 2:49 PM Page 34
Bimaxillary Protrusion Treated Without Extractions
Fig. 1 11-year-old female patient with dental and skeletal Class II mal-
occlusion and bimaxillary protrusion before treatment.
34 JCO/JANUARY 2007
3. P.33-38 Celli:CR_Celli 1/10/07 2:49 PM Page 35
Celli, Garcovich, Gasperoni, and Deli
A
A
Fig. 2 A. Patient after 26 months of treatment. B. Superimposition of cephalometric tracings before and after
treatment.
VOLUME XLI NUMBER 1 35
4. P.33-38 Celli:CR_Celli 1/10/07 2:49 PM Page 36
Bimaxillary Protrusion Treated Without Extractions
hours per day. Treatment Results the chin.9-11 This will maintain a
Seven months later, the more esthetic profile over the long
After 26 months of treat-
lower arch was banded and bond- term, especially in ethnic groups
ment, the patient showed a Class
ed, except for the four incisors. An where moderate lip protrusion is
I occlusal relationship with nor-
.016" heat-activated nickel titani- a desirable feature.
mal overbite and overjet control
um wire with bendbacks and lace- Most cephalometric and pro-
(Fig. 2). The axial inclination of
backs was used in conjunction file standards are derived from
the upper incisors was controlled,
with a lightly activated open-coil North American and northern
as shown by a 6° reduction in
spring from canine to canine. European samples of Caucasian
U1-ANS/PNS (Table 1). The
Light Class III elastics were worn patients.12-17 In recent years, how-
Class II correction was achieved
only when the headgear was in ever, researchers have begun to
mainly by maxillary retraction,
place. After 11 months of treat- develop norms for ethnic sub-
while the mandibular plane
ment, both archwires were groups that may have different
remained essentially stable,
changed to .019" ✕ .025" heat- esthetic concerns.18-23 Specifically,
despite the limited use of Class III
activated nickel titanium, still with Bowman and Johnston proposed
elastics. The lower incisor incli-
bendbacks and lacebacks. that the lips should be 2-3mm in
nation was clearly reduced; the
Further alignment was car- front of the E-plane in African
mandibular superimposition
ried out using .019" ✕ .025" stain- Americans, as opposed to 2-3mm
demonstrated that the entire arch
less steel archwires with tiebacks behind the E-plane in Cau-
was tipped back. The profile was
for torque control, followed by casians.24 In our experience, the
improved, lip prominence was
.014" Australian* wires for fin- Italian norm for lip protrusion is
reduced, the nasolabial angle
ishing. Class II elastics were used somewhere in between.
remained stable, and the facial
to optimize intercuspation. Several studies have found
convexity was reduced (Fig. 3).
that the general public associates
a fuller, more protrusive dentofa-
Discussion cial pattern with a youthful
TABLE 1 appearance. 25-27 Some authors
CEPHALOMETRIC DATA Several factors must be have stated that premolar extrac-
taken into account when planning tions cause a narrowing of the
Pre- Post- the treatment of a patient with arches, producing dark buccal cor-
treatment Treatment moderate bimaxillary protrusion. ridors in smiling28,29—although
The clinician has to consider not this view has been contradicted by
SNA 88.0° 84.5° only the outcome of treatment at recent reports.30,31 To improve the
SNB 81.0° 80.0° debonding, but also how the post-extraction smile, Zachrisson
ANB 7.0° 4.5° results will change throughout the has recommended adding buccal
SN-ANS/PNS 11.0° 11.0° growth and aging process. crown torque to lingually inclined
SN-GoGn 34.0° 35.0° While the subject is contro- canines and premolars.32
ANS/PNS- versial, excessive incisor procli- In severe skeletal Class II
GoGn 23.0° 24.0° nation has been correlated with cases, facial esthetics generally
U1-ANS/PNS 126.0° 120.0° periodontal recession and bony tend to worsen when extractions
defects.7,8 Moderate incisor pro- are performed, even if a good
L1-GoGn 106.0° 98.0°
clination, on the other hand, can occlusion is achieved.33-35 Accor-
L1-APo 5.0mm 4.5mm
improve lip support. In addition, ding to Proffit and Field, Class II
Nasolabial a slight protrusion will help bal-
angle 121.0° 121.0° ance the tendency of the profile to
Lower lip flatten due to continuing growth of *G&H Wire Company, P.O. Box 248, Green-
to E-line 5.0mm –2.0mm the nose and forward rotation of wood, IN 46142; www.ghwire.com.
g
36 JCO/JANUARY 2007
5. P.33-38 Celli:CR_Celli 1/10/07 2:49 PM Page 37
Celli, Garcovich, Gasperoni, and Deli
Fig. 3 Patient one year after treatment.
extraction treatment can result in method for controlling anchorage was designed for borderline cas-
a more prominent nose and a defi- in extraction treatment. 48 Our es of bimaxillary protrusion, in
ciency in the middle and lower results show that these mechan- which nonextraction treatment
thirds of the face.33 This was a ics can also correct a skeletal may produce more esthetic results
concern in the present case, espe- Class II relationship by means of than can be achieved with pre-
cially if mandibular growth turned maxillary growth inhibition or molar extractions.
out to be insufficient. retraction. Mandibular growth
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Bimaxillary Protrusion Treated Without Extractions
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