of Connecticut. Docteur Honoris Congenital and acquired ... · and/or ISPs. Achieving optimal...

of Connecticut. Docteur Honoris

Causa (honorary doctorate in

medicine) was awarded by the

Faculty of Medicine, University of

Lille II, Lille, France. He is a Fellow

of the American College of Dentists,

a Fellow of the International College

of Dentists, a Diplomate of the

American Board of Orthodontics

(ABO), and an active member of the

Midwest Component of the Angle

Society. Dr. Roberts is Professor

Emeritus of Orthodontics at Indiana

University, Adjunct Professor

of Mechanical Engineering at

Purdue University School of

Engineering and Technology,

and Associate Professor of

Maxillofacial Implantology in

the Faculty of Medicine at the

University of Lille in France. Dr.

Roberts is active in the American

Association of Orthodontists (AAO)

as the Chairman of the Council on

Orthodontic Education; he serves

as a delegate and member of the

Board of Directors of the Great

Lakes Association of Orthodontists.

He practices orthodontics with his

son Jeffery in southeast Indianapolis

at Roberts Orthodontics.

com. Honors include US Navy

Commendation Medal with Combat

V, Isaiah Lew Memorial Research

Award - American Academy of

Implant Dentistry Foundation,

Jarabak Award for Orthodontic

Education and Research - AAO

Foundation, Salzmann Lecture –

AAO Foundation, and the Dr. Dale

Wade Award for Excellence in

Orthodontics – ABO. Dr. Roberts

has presented multiple endowed

lectures and served as a visiting

professor both nationally and

internationally.

Congenital and acquired malocclusions

may be associated with compromised

fac ia l es thet ics and aber rant

dentofacial function. Temporary

a n c h o r a g e d e v i c e s ( TA D s )

and osseointegrated implant -

supported prostheses (ISP) have

proven to be e f fec t ive , th ree

dimensional (3D) anchorage for

managing complex dentofacial

problems. Interradicular and palatal

miniscrews are effective TADs for

many orthodontic procedures, but

they may have limited potential

for t reatment of pat ients wi th

complex 3D discrepancies, such as

those associated with oligodontia,

myofunctional aberrations and/

or acquired partially edentulous

malocclusions. ISPs are not only

rel iable anchorage units, they

may be essential for establishing

bilateral posterior occlusion, which

is an essent ia l component o f

normal stomatognathic function.

Furthermore, patients with complex

malocclusions may be additionally

compromised by medica l and

periodontal problems. Efficient

dentofacial management of these

challenging malocclusions usually

requires interdisciplinary treatment

by a cl inical team, capable of

interactive surgical, restorative

a n d d e n t o f a c i a l o r t h o p e d i c

procedures. Orthodontics should

be a prospective consideration

for complex malocclusions, but it

is often is a secondary approach,

because the orthodontist may be

consulted only after the failure

of surg ica l and/or restorat ive

procedures. In the management

o f c o n g e n i t a l a n d a c q u i r e d

ma locc lus ions , o r thodon t i s ts

may be chal lenged by diff icult

clinical problems, for which there

is no reliable evidence base to

guide diagnosis and treatment.

Pred ic tab le resu l ts requ i re a

realistic application of scientific

principles. Modern concepts of

bone and per iodonta l b io logy

dictate the physiological l imits

o f osseo in tegra ted imp lan ts .

Systemic factors are defined by an

assessment of calcium metabolism,

nu t r i t i on and endoc r i no logy.

Integration of scientific principles

of surgery, wound healing and

b iomate r ia l s i s the bas is fo r

consistent success with TADs

and/or ISPs. Achieving optimal

facial esthetics, consistent with a

desirable intermaxillary occlusion,

requires a thorough diagnosis of

the morphological and functional

aspects of the malocclusion. It is

important to consider the etiology

of the problem(s) with respect

to genet ic and envi ronmenta l

mechanisms. Treatment should be

directed at eliminating the etiology of

the malocclusion. When indicated by

the interdisciplinary treatment plan,

periodontally healthy teeth can be

moved into atrophic alveolar defects

to generate new periodontium

(a l veo la r bone and a t tached

gingiva). It is usually unwise to

attempt to move teeth into alveolar

defects that have been surgically

augmented, because grafted areas

usually retain nonvital segments,

which do not respond to orthodontic

force. ISPs are more predictable

for restoring occlusion in alveolar

spaces that have received onlay

and/or sinus elevation bone grafts.

Goals for preprosthetic orthodontics

treatment are: 1. Determine the

des i red ver t ica l d imension of

occlusion (usually at the limit of lip

competence), 2. Establish bilateral

51

posterior occlusion with natural

teeth and/or ISPs, 3. Position the

mandibular incisors at the anterior

limit of the apical base, which is

usually ~2-4mm anterior to A-Pg

line, and 4. Orthodontically generate

su f f i c ien t bone and a t tached

gingiva, particularly in maxillary

anterior esthetic zone.

WIOC-15

Anticipated Benefit – Elimination Conventional Orthodontic Preparation for Orthognathic Surgery

Jorge Faber

Dr Faber is

the editor-in-

chief of Dental

Press Journal

of Orthodontics.

He holds a

PhD degree

on Biology-Morphology, and a

Master degree in Orthodontics. He

is professor of Evidence-Based

dentistry in University of Brasilia,

and serves as a reviewer for many

international journals. He is the

winner of CDABO Case Report of

the Year, for the best case report

published during 2009 in the AJO-

DO.

Conventional orthodontic-surgical

treatments for the correction of

dentofacial deformities comprise

- after diagnosis and treatment

plan - a presurgical orthodontic

stage, the orthognathic surgery per

se and the orthodontic finishing

stage. This treatment method has

also been tested by time. It has

been used for decades and proved

very effective. However, it has

limitations because when patients

decide to undergo the treatment

they have to wait for almost a year

and a half for the surgery. This is

somewhat paradoxical since many

patients who seek treatment do

so motivated by the promise of

aesthetic enhancement, despite

the treatment's primarily functional

nature. On account of this limitation,

a m o n g o t h e r s , s i n c e 2 0 0 4 I

have been using in my private

practice a treatment methodology

that ant ic ipates surgery. After

diagnosis, this protocol consists in

extensively planning all treatment

phases, installing the orthodontic

appliance, operating on the patient

and only then per forming the

actual orthodontic treatment. This

methodology anticipates the benefits

of surgery and has, therefore, been

appropriately named Anticipated

Benef i t Method. A l though the

orthodontic plan is more complex

than convent iona l t rea tment ,

surgical plans are not. Surgeons,

however, should be aware of all

orthodontic steps taken throughout

the treatment. Anticipated Benefit

also requires better communication

between orthodontist and surgeon

than in conventional treatment.

Orthodontists must feel reassured

that surgeons wi l l be ab le to

implement the treatment plan.

Surgeons , i n tu rn , mus t fee l

confident that orthodontists will

f inalize the patient's occlusion

in a relat ionship. I t should be

emphasized that Anticipated Benefit

treatment changes to the dental

relationship differ significantly from

conventional treatment. In this new

method, one type of malocclusion

is replaced by another and the

new malocclusion is subsequently

treated. In other words, due to the

typical pattern of tooth positions

in Class I I I deformi t ies, a f ter

surgery the patient will exhibit a

balanced facial appearance but

very likely combined with a Class II

malocclusion. The opposite is true

of Class II deformities. The purpose

of this lecture is to present the

rationale of this protocol.

WIOC-16

Mandibular Whole Dentition Distal Movement Using Mini Implant

Joong-Ki Lim

1993 - 2006:

Post Graduated

Course,

Graduate

School, Yonsei

University

(M.S.D., Ph.D.)

1992 - 1995:

Certificate in Orthodontics, Yonsei

University Dental Hospital

1992. 2:

Graduate from Dental College,

Yonsei University, (Diploma D.D.S.)

2003-present:

Clinical assistant professor Dept. of

Orthodontics

School of Medicine Sungkyunkwan

University Seoul, KOREA

52

Clinical assistant professor Dept. of

Orthodontics

College of Dentistry Yonsei

University Seoul, KOREA

Consulting professor Dept. of

Orthodontics

Catholic medical college, Seoul,

KOREA

Yon orthodontic clinic, Seoul,

KOREA

In Asia, there is a higher prevalence

of skeletal class III malocclusion

than the West. But there is a cultural

tendency to prefer small chin.

Therefore skeletal class III treatment

is in great demand. Traditional class

III treatment is divided into surgical

o r thodont ics and or thodont ic

camouflage which contains non-

extraction treatment using MEAW

and extract ion t reatment wi th

premolar or lower incisor extraction.

R e c e n t l y , t h e e n v e l o p e o f

orthodontic tooth movement have

been expanded dramatically owing

to in t roduct ion of or thodont ic

mini implants. And I believe that

mandibular whole dentition distal

movement is also realized without

patients' compliance for class III

treatment. For these reasons, I'm

going to make a presentation on

mandibular whole dentition distal

movement as follows.

1. The effective position of mini

implant

2. Treatment mechanics (line of

action)

3. Treatment effect and side effect

4. Indication

WIOC-17

Whole Arch Distalization

John Jin-Jong Lin

Dr. Lin is

a clinical

professor in the

Department of

Orthodontics at

Taipei Medical

University,

is a past president of the Taiwan

Association of Orthodontists, and

maintains a private orthodontic

practice.

Whole arch distalization has been

tried by using headgears, pendulum

a p p l i a n c e s , a n d r e m o v a b l e

appliances in the literature, above

methods either count on patient’

s cooperation or too complicate and

the amount of distalization usually

is limited. On the lower arch due

to dense cortical bone around the

lower molar region, distalization of

the whole arch almost impossible.

Now with the advancement of TADs

(Temporary Anchorage Devices),

whole arch distalization becomes

simple, direct and easy to use

clinically.

Sugawara's whole arch distalization

by using the mini-plate system

has revolutionized the traditional

orthodontic mechanics. It seems the

mini-plates use 2-3 mini-screws for

fixation, failure rate will be less. But

the mini-plate system has following

disadvantages: (1) I t 's a more

expensive and time consuming (2)

It's a quite comprehensive surgery,

swelling and post operation pain

are unavoidable (3) It takes another

comprehensive surgery to remove it

(4) It counts on specialist to do the

surgery.

With the recent advancement of

mini-screw technology, the author

found out that using the mini-

screw only, most of the whole arch

distalization movement can be

done. It has following advantages:

(1) Short surgical time (2) Mostly no

need for flap surgery (3) Low cost

(4) Less post operative pain and

swelling (5) The orthodontist can

do it avoids transfer communication

problem.

The author is going to present

different clinical cases including

Class I I and Class I I I t reated

w i th who le a rch d is ta l i za t ion

by using mini-screws only. 2D

cephalometrics, panorex, and 3D

cone beam CT will used to illustrate

the details.

WIOC-18

En Masse Movement of Whole Dentition Using Orthodontic Miniscrew Implant- Alveolar Housing Is the Name of the Game

Cheol-Ho Paik

Graduated

Seoul National

University

(SNU) Dental

College, Seoul,

Korea

Received

53

Orthodontic Training and PhD

course in Dept. of Orthodontics,

Dental College of Tsurumi

University, Yokohama, Japan

Visited Univ. of California in San

Francisco (UCSF) as a visiting

faculty of Dept. of Orthodontics, San

Francisco, USA

Clinical Professor, Dept. of

Orthodontics of Seoul National

University (SNU) and University of

California Los Angeles (UCLA)

Regular member of Southern

California component of Angle

Society

Private practice, SAI Orthodontic

Clinic, Seoul, Korea

Many orthodontists are faced with

difficulties when placing the incisor

teeth in an esthetically perfect

position. This is because individual

perception of beaty fluctuate with

time and the trend. With en masse

A-P tooth movement, we could treat

border line cases without extraction

and also satisfy the capricious minds

of the patient regarding the position

of the incisors. Mild to moderate

bimaxillary protrusion case is a

good candidate for this approach.

Mild to moderate crowding case can

also be an indication. For the class

Ⅲ crowding non-extraction case,

simultaneous leveling and retraction

from retromolar pad miniscrew is

preferred. Traditional 'leveling first-

retraction later' technique produces

jiggling tooth movement.

I n t he p rev ious pub l i ca t i ons

and l ec tu res , I r epo r t ed t he

classifications of the miniscrew

implant application into 4 categories,

which are the type 1 (A-P), type 2

(vertical), type 3 (transverse) and

type 4 (other). I also introduced

6 rotational directions of tooth

movement. These 6 rotat ional

directions are exactly same as

when you fly an airplane. They are

clockwise and counterclockwise

r o t a t i o n o f Ya w, P i t c h a n d

Roll. Among these 6 rotational

movements, combination of 2 or 3

can be used to move the dentition

3-d imens iona l ly to a spec i f i c

position.

Most frequently, the entire dentition

is retracted from the hooks of the

working wire to the miniscrew which

is located in the posterior buccal

gingiva. Here, avoiding soft tissue

impingement of activational ties is

important. Elastomer pulled directly

from the hook to the miniscrew

frequently impinges the soft tissue

around the canine area because

of the inherent curvature of the

alveolar bone.

When you retract the mandibular

dentition, bending of the alveolar

h o u s i n g m i g h t o c c u r . T h i s

phenomenon is possible because

of the plasticity of the thin alveolar

process compared to the thick

cort ical symphysis bone. Sti l l ,

there is a controversy whether this

type of en masse tooth movement

induce 'through bone' type tooth

movement or 'with bone' type tooth

movement. If en masse movement

of the dentition occurs solely with

the 'through bone' mode, roots can

penetrate the alveolar housing.

Alveolar housing is the name of

the game, because we move 16

to 20 roots as a whole sometimes

'through' the alveolar housing bone

and sometimes 'with' the alveolar

housing bone.

WIOC-19

Success Factors in Orthodontic Anchorage with Temporary Anchorage Devices

Kelvin Foong

Dr Kelvin Foong

received his

basic dental

degree from

the National

University of

Singapore

(NUS) in 1988, and completed

the Masters in Dental Surgery

in Orthodontics at the University

of Adelaide in 1994. He went

on to receive the Diploma of

Membership in Orthodontics from

the Royal College of Surgeons

of Edinburgh in 1996. He was

conferred the Fellowship in Dental

Surgery (without examination) in

2000 from the same college. His

research interests in surgical cleft

outcomes led to a PhD in 2005 from

NUS. He is a tenured Associate

Professor in the Department of

Preventive Dentistry, and he holds

the administrative appointments of

Vice-Dean (Academic Affairs) and

Director of the Graduate Programme

in Orthodontics at the Faculty of

Dentistry, NUS. He practices within

a large academic health center and

holds the appointment of Senior

Consultant in Orthodontics at the

National University Health System.

His clinical interests focus on the

orthodontic management of children

54

and adult patients with dento-facial

deformities. His main research

interests are in the application of

three-dimensional image processing

and visualisation techniques for the

development of accurate, patient-

specific virtual models of the teeth,

face and head. He works in close

collaboration with research partners

from Singapore, Beijing, Taipei

and Osaka in the fields of Vision

Engineering and Image Processing

to develop virtual models the face

and teeth. He brings together

the engineering techniques and

orthodontics to create solutions for

aiding clinical treatment planning

and learning.

Orthodontic anchorage derived

from temporary anchorage devices

(TADs) has opened up possibilities

o f c o r r e c t i n g m a l o c c l u s i o n s

deemed impossible previously

t o m a n a g e w i t h o u t s u r g i c a l

assistance. The correction of a

significant malocclusion depends

on critical success factors such as

(i) the selection of the appropriate

anatomical site for TAD placement,

(ii) the accurate insertion of TADs,

and (iii) the optimal application of

biomechanical principles to move

teeth. Current best evidence on the

appropriate selection of anatomical

sites will be presented together

with associated diagnostic imaging

modalities to facilitate site selection

and placement. As the placement of

TADs is technique sensitive and not

without anxiety on the part of those

placing their first few TADs, training

on the placement process is vital

to build confidence and improve

accuracy. The lecture will introduce

a computer-aided feedback process

to improving competency in TAD

insertion. A representative case mix

will also be presented to show how

skeletal anchorage has been used

with sound biomechanical principles

for tooth movement.

WIOC-20

How to improve stability, versatility, and success rates using a mini-implant system with exchangeable abutments

Benedict Wilmes

Dr. Wilmes did

a postgraduate

training in oral

surgery at the

Department of

Maxillofacial

Surgery

at University of Muenster,

Germany. He reiceived a M.S.

and a postgraduate degree in

orthodontics and dentofacial

orthopedics at the University of the

Duesseldorf, Germany. In 2004

he became Assistant Professor, in

2006 Associate Professor at the

Department of Orthodontics at the

University of Duesseldorf.

Dr. Wilmes is reviewer and

consultant of the Angle Orthodontist,

the World Journal of Orthodontics,

the Journal of Dental Research

and the German Board (DIN)

for orthodontic products. He has

held more than 100 national

and international lectures and

courses on skeletal anchorage in

orthodontics.

Dr. Wilmes was awarded the First

Prize of the German Orthodontic

Society in 2007 and the First Prize

of the European Orthodontic Society

in 2009.

Their small size allows mini-implants

to be inserted in a variety of sites.

Currently, the alveolar process is

the most preferred insertion site.

However, due to the varying bone

quality and the risk of root contact,

the survival rate of implants inserted

in the alveolar ridge still needs

improvement. Other regions, such

as the anterior palate, provide much

better conditions for mini-implant

insertion, since the amount and

quality of the available bone is far

superior. In order to utilize mini-

implants inserted in the anterior

palate, the Benefit mini-implant

system is presented. Different

types of abutments and connectors

(Beneplates) allow the construction

of versat i le and cost eff ic ient

appliances for a large variety of

clinical applications, such as:

1. molar distalization

2. molar mesialization (unilateral,

bilateral)

3. correction of arch asymmetries

4. en-masse retraction

5. molar uprighting- molar-extrusion,

-intrusion

6. alignment of retained teeth

7. rapid palatal expansion

8. Class III treatment with skeletal

anchorage

Based on a comprehensive clinical

documen ta t i on t he ra t i ona le

and practical application of this

innovative system is presented.

Utilizing mini-implants in the anterior

55

palate eliminates the risk of root

injury and takes the implants out

of the path of tooth movement.

The advanced des ign o f t he

exchangeable abutment system

provides the Orthodontist with a

Skeletal Anchorage system that is

easy to integrate in clinical practice

and allows the orthodontist to solve

problems that where difficult or

impossible to address before.

WIOC-21

Do Partial Osseointegration Based C-Implant Remain Stationary after Biocreative Therapy?

Seong-Hun Kim

Assistant

Professor,

Division of

Orthodontics,

Department

of Dentistry,

The Catholic

University of Korea, Uijongbu St.

Mary's Hospital.

A new treatment system called

"Biocreative therapy" developed

by Dr Kyu-Rh im Chung i s to

implement independent target teeth

movement while avoiding extending

unnecessary orthodontic appliances

to posterior segments during the

orthodontic treatment period. This

concept developed from the fact

that specially designed temporary

skeletal anchorage devices (TSADs)

such as partially osseointegrated

C-implants or miniplates can easily

endure multidirectional heavy forces

even when they support orthodontic

arch wires with high success rate. In

this presentation, I will introduce the

new type of C-implants, treatment

concept, and the questions whether

the C- implants are absolutely

stationary or not after BIocreative

T h e r a p y t h r o u g h s c i e n t i f i c

researches and excellent case

reports. We are definitely not related

with any other company about

Implant orthodontics, therefore we

can share more information about

current implant orthodontics field

with attendance.

WIOC-22

Implant and Host Related Considerations for the Success of Miniscrew Treatment

Om P Kharbanda

Dr. Om P

Kharbanda

is Professor

and Head,

Department of

Orthodontics

and Dentofacial

Orthopaedics, Centre for Dental

Education and Research All India

Institute of Medical Sciences,

New Delhi 110029 India. He also

serves as Adjunct Professor and

Coordinator of Centre for Medical

Education and Technology at the

same Institute. Dr. Kharbanda

has been a Visiting Professor, to

University of Sydney, Australia and

Dental School, Perth Australia. He

is currently a Visiting Professor

to University of Connecticut, USA

and Adjunct Professor Manipal

University Manipal.

Dr. Kharbanda is a postgraduate

teacher since 1986 and has

supervised more than 50 theses

in India and at University of

Sydney, Australia. His book entitled

"Orthodontics: Diagnosis and

Management of Malocclusion and

Dentofacial deformities" published

by Elsevier 2009, has become

popular in a short span of time.

Professor Kharbanda has authored/

co-authored more than 100

research papers, book chapters and

case reports in international peer

reviewed and national journals. He

has lectured in India, Asia, Middle

East, Australia, and North America.

Dr. Kharbanda is on International

Editorial Board of Am J Orthodontics

and Dentofacial Orthopaedics,

British J of Orthodontics and

Australian Orthodontic Journal.

He also serves theses journals

as a referee. Prof Kharbanda is

also Associate Editor of Journal of

Clinical Pediatric Dentistry (USA)

and Consultant Editor to the J Indian

Orthodontic Society of which he has

been a Chief Editor.

Dr. Kharbanda has been involved

with the care of cleft lip and

palate at AIIMS since 1985.

He is a recipient of the British

Commonwealth Fellowship on Cleft

Care at Manchester and Visiting

Scholar Award of the American Cleft

Palate Craniofacial Association. He

is President of the Indian Society for

Cleft Lip and Palate and Craniofacial

anomalies and Chairman of

56

INDOCLEFTCON 2010 at Delhi.

His main research interests are

Non-extraction treatment, long-term

outcome of functional appliances,

and Orthodontic root resorption,

treatment outcome in cleft patients.

He is actively involved in innovative

clinical applications of miniscrews

and related research.

Dr. Kharbanda is immediate Past

President of the Indian Orthodontic

Society and Core Committee

Member of the Asian Pacific

Orthodontic Conference to be held

in Delhi in 2012.

This presentation will deal with

our experience and research in

the treatment of severe cases of

malocclusion where orthodontic

anchorage has been reinforced with

miniscrews. Presentation will also

dwell upon implant related and host

related factors that are responsible

fo r the success o r fa i l u re o f

miniscrews. The observat ions

will be supported with research

re la t ing to bone dens i t y and

biochemical markers of peri-implant

inflammation. Findings of FEM

analysis relating screw design with

stresses on bone architecture will

be discussed to propose alternate

designs.

Till end of 2009 So we have placed

56 miniscrews with bracket head (all

of same design and manufacturer)

in 17 patients treated for correction

of Class I severe bidental protrusion

or Class II division 1 malocclusion.

All these patients had maximum

anchorage requirements. After

leveling and alignment, miniscrews

were p laced in max i l la ry and

mandibular buccal interradicular

bone for en masse retraction of six

anterior teeth. The first molars were

reinforced with miniscrews through

0.017 "X 0.025" SS wire designed

to connect additional first molar

tube with implant bracket head. It

also served as a stop between the

molar and miniscrew. Attaching

miniscrew to molar provided an

additive anchorage effect with least

direct dynamic forces on implants.

Experience with clinical success,

protocols and treatment stages will

be discussed. With experience we

designed a special implant guide Jig

generation I and II which helps in

accurate placement of miniscrew in

X, Y and Z axis along with desired

angulations of placement.

Research on anchorage efficacy

of miniscrew implants showed that

the mesial movement of maxillary

molars during en masse retraction

was found to be as little as 0.14 ±

0.38 mm which was significantly

less compared to matched sample

where anchorage was supported

with transpalatal arch. Miniscrew

supported anchorage certainly

provided better horizontal, vertical

and rotational anchorage control

and thereby improved treatment

outcome which is more relevant in

vertical facial types.

Primary implant stabi l i ty is an

important factor for successful

treatment in such situations. Various

factors have been reported to be

affecting miniscrew stability. One

such factor is bone density at the

implant site. We aimed to evaluate

bone density at area of interest

in maxi l la and mandible using

advanced software using CT scan.

Its association with clinical stability

of miniscrews was researched.

The study sample of 10 patients

showed that the buccal in ter-

radicular bone in the area of second

premolars and first molars in maxilla

and mandible were suitable for

miniscrew placement. Bone density

found within the range does not

seem to have a direct relationship

with implant failures. Peri-implant

i n f lammat ion and p rocedura l

inaccuracies during miniscrew

placement appear detrimental to

implant stability.

Research to find out best implant

des ign , wh i ch cou ld p rov ide

maximum benefit with minimum

stresses on bone miniscrews of 3

different designs are being tested

in 3 different situations on bone

simulated material. The study in

progress aims to analyze and

compare the stresses generated

in bone with simulated forces of

different angulations and force

values. This study will give us a

clear perspective on the stress

pat terns and guide to c l in ical

protocol and manufacture implant

design that is likely to be most

successful.

This presentation will be supported

with clinical case reports, clinical

research data and laboratory

research findings on miniscrews

being carried out at All India Institute

of Medical Sciences in collaboration

with Indian Institute of Technology at

New Delhi, part of the above studies

is supported by Indian Council of

Medical Research, New Delhi.

57

WIOC-23

The Different Wonders of Mini Screw Implant – An Adjunct to Orthodontic Treatment Mechanics

Dennis C. Lim

College:

1984 – 1990:

University of the

East Ramon

Magsaysay

College of

Dentistry

Post Graduate in Orthodontics

(masteral degree):

1994 – 1996:

University of the Philippines, Manila

Further Studies in Orthodontics:

Jan 1998 – May 1999:

Kanagawa Dental College, Japan

Training:

Dec 1990 - Jul 1991:

Externship Program in Oral Surgery

UP- Philippine General Hospital

Teaching Experience:

2008 - present:

Professorial lecturer Graduate

Program in Orthodontics University

of the East

2008 – present:


Program in Orthodontics Manila

Central University

1999 – 2003:


Program in Orthodontics University

of the Philippines

1999 – 2006:

Director and Professorial Lecturer

Graduate Program in Orthodontics

College of Dentistry, Baguio City

Malocclusions come in different

forms and orthodontists are faced

with a dilemma as to how to deal

with such problems. Often times,

orthodontists just treat with different

treatment mechanics hoping to be

able to correct the malocclusions.

With the advent of mini screw

implants, correction of diff icult

cases are achievable. Mini screw

implant can now serve as an

added accessories in helping the

orthodontists perform a better

treatment solutions in order to

satisfy the growing needs of the

patients. This lecture will show

d i f fe ren t cases l i ke openb i te

malocclusion, uprighting of molars,

anterior retraction using mini screw

implants.

WIOC-24

Working out an Altered Strategy for Extraction Based on Skeletal Anchorage System

Jang Yeol Lee

Director,

Smileagain

Orthodontic

Center, Seoul,

Korea

Clinical

Professor, Dept.

of Orthodontics, Yonsei University,

Seoul, Korea

Clinical Professor, Dept. of

Orthodontics, Samsung Medical

Center, Seoul, Korea

Visiting scholar, Dept. of

Orthodontics, University of North

Carolina, USA

Associate Fellow, University of

Warwick, United Kingdom

Dr. Lee is currently co-director

of the Smileagain orthodontic

center in Seoul, Korea. He is

Clinical Professor in Department

of Orthodontics, Yonsei University,

Seoul, Korea and also Clinical

Professor in Department of

Orthodontics, Samsung Medical

Center, Sungkunkwan University,

Seoul, Korea and Associate Fellow

in the Department of Orthodontics,

University of Warwick, UK.

He received his dental and

orthodontic education at Yonsei

University, Seoul, Korea and

completed his master and Ph. D

degrees in the same school. Dr.

Lee is also a visiting scholar in the

department of orthodontics, school

of dentistry at the University of North

Carolina, USA.

He has treated many adult patients

focusing on esthetics and his

clinical interests includes applied

biomechanical principles relates

to lingual orthodontics, mini-

screw orthodontics and functional

orthognathic surgery for Cl III

patients. Dr. Lee has given many

lectures on various topics about

mini-screw orthodontics and lingual

orthodontics over the last few years

in AAO, Australian Orthodontic

Congress, World Society of Lingual

Orthodontic Congress, Asian-

Pacific Orthodontic Conference,

International Orthodontic Congress,

Asian Implant Orthodontic

Conference and Korean Association

of Orthodontists Congress. He also

58

has organized minscrew and lingual

courses in many countries such as

UK, Australia, Mexico, Philipines,

Taiwan, Vietnam, China and

Morocco.

Dr Lee was the Secretary General

of the 4th Asian Implant Orthodontic

Conference in Seoul, 2005 and he

was also the Secretary General

of the organizing committee in

the 1st World Implant Orthodontic

Conference held in 2008.

Mini-screws have changed not

only the paradigm of orthodontic

treatment itself but also the detail

strategy for treatment planning.

It comes so natural because the

characteristics of tooth movement

under skeleta l anchorage are

d i f f e r e n t w i t h c o n v e n t i o n a l

o r thodont ics and we need to

understand them correctly. Various

types of tooth movements that have

been considered difficult for so long

can now be possible through this

skeletal anchorage system and

different view of diagnosis would be

required.

Under skeletal anchorage system,

the rate of non-extraction might

have been raised and the pattern of

extraction could have been altered

to gain the space for patients having

crowding or lip protrusion. It has

been considered not only from the

horizontal aspect also from vertical

aspects. Furthermore challenges

for controlling molars of edentulous

a rea have changed the to ta l

treatment planning as well. So it is

time to look back and need to make

sure if it would be appropriate what

we are doing.

In this presentation, retrospective

review of the changed pattern

for extraction and the long-term

stability will be discussed. Also

cons iderat ions for an a l tered

strategy for extraction under skeletal

anchorage system will be suggested

with various clinical cases.

WIOC-25

Biomechanical Principles Applied to Implant Orthodontics: Achieving High Therapeutic Efficiency

Noriaki Yoshida

Professor

and Chair,

Department of

Orthodontics

and Dentofacial

Orthopedics

Nagasaki

University Graduate School of

Biomedical Sciences

Vice Dean, Nagasaki University

School of Dentistry

1980-1986:

DDS from Nagasaki University

School of Dentistry, Japan

1990-2000:

Instructor, Department of

Orthodontics, Nagasaki University

School of Dentistry

1992-1994:

Research fellow, Department of

Orthodontics and Dentofacial

Orthopedics, Free University Berlin,

Germany

1994:

Research fellow, Humboldt

University, Germany

2000-2001:

Assistant Professor, Department of

Orthodontics, Nagasaki University

School of Dentistry

2001-present Professor and

Chair, Department of Orthodontics,

Nagasaki University School of

Dentistry

2005:

Visiting Professor, Orthodontics,

Division of Craniofacial Sciences

and Therapeutics, University of

Southern California, USA

Orthodontic treatment combined

with implant anchorage system has

been widely applied to the patients

having various malocclusions.

In fact, the implant anchorage is

found to contribute much to speedy

and eff icient orthodontic tooth

movements, and hence a reduction

of treatment period. However,

biomechanical principles associated

with implant anchorage are still

unknown. There are a lot of clinical

questions we should address. How

can we achieve a desired type

of tooth movement through the

minimum course without round-

tripping? How can we prevent a

bowing effect or bite deepening

during space closure in extraction

treatments? How does the line

of action of a force in relation to

the center of resistance of a tooth

affect the type of tooth movement?

What length of power arms, what

level of implant anchorage or what

combination of those mechanical

p a r a m e t e r s i s i n d i c a t e d f o r

controlled tooth movement and so

on.

Control of anterior tooth movement

59

is essential for the orthodontists

to achieve an individually planned

treatment goal. Sliding mechanics in

combination with implant anchorage

has become more and mo re

popular. The use of power arms

attached to the archwire enables

one to readily achieve controlled

movement of anterior teeth.

In this presentation, the optimal

loading condition for achieving the

desired type of tooth movement

du r i ng space c losu re , wh i ch

was analyzed on the basis of

b i o m e d i c a l e n g i n e e r i n g a n d

biomechanical approach such

as in-vivo measurement of initial

tooth displacement, finite element

method and 3D-scanned dental cast

analysis, will be discussed.

Next, we have investigated the

relationship between mechanical

p a r a m e t e r s a n d a n a t o m i c a l

parameters determining how the

tooth will move. It is concluded

that an optimal loading condition

should be back-calculated from the

location of the center of resistance.

The method for estimating optimal

mechanical condition associated

with anatomical variables and its

clinical application will also be

discussed.

1. A l t e r n a t i v e A p p l i c a t i o n s ;

(deepbite, arch leveling, Class II

with extraction, Class II without

extraction).

2. Elective Applications; (insufficient

dental anchorage, asymmetric

anchorage conditions, hostile

biomechanical conditions).

The Alternative applications are

indicated in cases in which the use

of Tad's could optimize and simplify

the whole treatment, in order to

perform orthodontic movement

avoiding the adverse effects of the

anchorage forces. They represent

the most common orthodont ic

malocclusion such as Class II

treatment and deepbite; in this

case, the use of Tads can be useful

to obtain in a more predictable

way some specif ic orthodontic

movements but not fundamental

ones.

The Elect ive appl icat ions, are

represented by clinical conditions

in which the use of miniscrews

could represent a factor influencing

the kind of treatment plan, not

only an auxiliary device to simplify

treatment. These malocclusions are

less common such as ectopic teeth,

periodontal patients or asymmetric

space closure. The insertion of

Tads in this case can be the key

to change the treatment choice

and a way to perform orthodontic

m o v e m e n t s o t h e r w i s e n o n

achievable.

By following the biomechanical

coherence concepts, it is possible

to select the right kind (length,

diameter, and head) of miniscrews

for every clinical condition, avoiding

over treatment, and with the ideal

biomechanical ratio.

WIOC-26

Ideal Applications of T.A.D.s in Orthodontics: A Biomechanical Point of View

Aldo Giancotti

University of

Rome "La

Sapienza"

School of

Dentistry: Rome

- Italy

DDS - July 1984

University of Ferrara - Italy

Orthodontics Certificate October

1996

The use of TADs in Orthodontics

can be considered a useful and

sometimes unavoidable auxiliary

device in several clinical conditions.

Through orthodontic literature their

use has been widely documented

in several scientif ic and above

all clinical papers, but it's not so

common to f ind a rational and

logical application of TADs from

a biomechanical point of view. In

some clinical reports, orthodontic

mechanics is not highly defined,

therefore lacking logical ratio. Other

clinical cases show that patient

consideration regarding the number

of miniscrews really necessary

to obtain the desired outcome is

missing. The aim of this lecture is

to illustrate the ideal biomechanical

indications for using Tads, according

to biomechanical principles. We can

simplify Tads applications into two

different categories:

60

WIOC-27

Available Sites and Biomechanic Needs in the Use of Miniscrews: Limits and New Possibilities

Dott. B. Giuliano Maino

Graduate in

Medicine and

Dentistry; Post

Graduate in

Orthodontics

at Cagliari

University;

Post Graduated clinical training in

Orthodontics at Boston University.

Private Practice in Orthodontics in

Vicenza.

Visiting Professor of Orthodontics at

Parma University, Ferrara University,

Insubria University.

Lecturer in Orthodontics in Italy,

Europe and USA; Author and Co-

author of 3 books and more then 90

scientific papers.

Active member of A.S.E. (the Angle

Society of Europe);

Active member of S.I.D.O. (Italian

Society of Orthodontics);

International Member of A.A.O.

(American Association of

Orthodontics);

Elected President of Italian

Academy of Orthodontists;

Past President of S.I.Te.Bi.

(Italian Society of Bidimensional

Technique);

Member of E.O.S. (European

Orthodontic Society);

Certified of Excellence in

Orthodontics I.B.O. (Italian Board of

Orthodontics) and E.B.O. (European

Board of Orthodontics);

Past President of A.S.I.O. (Italian

Association of Specialists in

Orthodontics);

Active member of S.I.d.P. (Italian

Society of Periodontology).

When treating malocclusion by

us ing min iscrews as ske le ta l

ancho rage , i t ' s adv i sab le t o

place the miniscrew in the ideal

place in order to obtain the best

biomechanical force system.

M a n y t i m e s t h e a n a t o m i c

limitations force the clinician to

place miniscrews in sites that are

less favourable for an optimal

biomechanics or to apply miniscrews

in sites that are not easy to reach.

Th is l ec tu re w i l l p resen t the

combined use of Self Ligating

Miniscerws and Power Plates to

improve these limitation and provide

an optimal Biomechanical system

applying miniscrews in the easier

and most available insertion sites.

This combination offer the possibility

to get over the conventional limits

and improve the versatility of the

miniscrew skeletal anchorage.

WIOC-28

Fact & Fallacy of Skeletal Anchorage in Orthodontics

Hee-Moon Kyung

Dept. of

Orthodontics,

School of

Dentistry

Kyungpook

National

University,

Daegu, Korea

1981.3-1983.2:

Orthodontic training, Kyungpook

University Hospital

1986,5 – present:

Full time instructor, Professor

School of Dentistry, Kyungpook

National University,( KNU)

1991,4 - 1992,3:

Visiting Professor, Department of

Orthodontics, Faculty of Dentistry,

Osaka University, Japan

1996.1-1997.12:

Visiting & Clinical Associate

Professor, Department of


The University of British Columbia,

Canada

2001.1-2003.1:

Dean, College of Dentistry,

Kyungpook National University

2003.10-2008.10:

Vice president of World Society of

Lingual Orthodontics

2004.10-present:

Chairman, Department of

Orthodontics, School of Dentistry,

Kyungpook National University,

2007.11-2010.04:

President, Korean Association of

61

Lingual Orthodontists

2010.04-present:

Active member of Angle East

Society

Control of anchorage is one of

the most important aspects of

orthodontics. There are times when

absolute anchorage or maximum

anchorage condition is needed

which have a high "resistance

t o d i s p l a c e m e n t " . H o w e v e r,

considering Newton's Third Law that

an applied force can be divided into

an action component and an equal

and opposite reaction component,

it is almost impossible to achieve

absolute anchorage condi t ion

where reaction force is producing

no movement at all especially with

intraoral anchorage. Thus extraoral

anchorage is traditionally used to

reinforce anchorage. However, the

use of extraoral anchorage demand

full cooperation of patient as well as

24 hours of continues wears which

cannot be done. Actually, patient

compl iance is considered the

"Achilles heel" of controlled tooth

movement in traditional mechanics.

Therefore, it is extremely difficult

to do orthodontic treatment without

compromising anchorage.

In an effort to maximize anchorage

while reducing the dependence

on patient cooperation, skeletal

anchorage, such as prosthetic

implants and mini-plates, has been

used as orthodontic anchorage.

However, prosthodontic implants

and mini-plates are not as efficient

for orthodontic treatment due to

their bulky size and high cost. Thus,

smaller diameter microimplants

were developed to provide better

treatment efficiency as compared

to the bulkier and more costly

prosthetic implants. Nowadays,

orthodont ic microimplants are

a common too l used in da i l y

orthodontic treatment to control

ancho rage w i t hou t t he need

for pat ient compl iance. Many

orthodontists, however, still hesitate

t o u s e t h e m b e c a u s e o f t h e

perceived dangerous side effects

such as root injury.

There are many sizes & kinds of

microimplants in the market. Some

orthodontists may be confused

when choosing the proper size of

microimplants. Additionally, there

are still many controversies about

microimplant anchorage. These

inc lude immedia te & de layed

loading of orthodontic force, small

& big s ize implants, coated &

machined implants, self-tapping and

self-drilling methods, topical and

injection anesthesia, success rates

between maxilla and mandible and

suitable initial torque forces etc.

To p i c s t o b e c o v e r e d i n t h e

presentation include comparisons

of the different types of skeletal

a n c h o r a g e d e v i c e s a n d t h e

above controversies based on the

experience and literature evidence.

The presentation will also show

why microimplant anchorage is not

dangerous even it is placed by the

orthodontists themselves.

WIOC-29

An Effective Treatment Strategy for High Angle Protrusion Cases

Johnny Joung-Lin Liaw

DDS, dental

department,

National Taiwan

University

MS, Graduate

institute of

dental and

craniofacial science, Chang Gung

University

Director, Beauty Forever Orthodontic

Clinic

High angle cases or so-cal led

backward rotators tend to have a

typical long face and retruded chin.

Their molars tend to be extruded

during orthodontic treatment and

to increase the lower anter ior

facial height which makes the face

even longer and the chin more

retruded. Therefore, the vertical

control to avoid molar extrusion

or even active molar intrusion is

very critical for the success of high

angle case treatment. Openbite

treatment with TADs to intrude

posterior teeth has become an

established treatment strategy.

However, the high angle cases with

normal or deep bite do not respond

well as the openbite cases with

simple posterior teeth intrusion.

To achieve active vertical control

for maximal profile improvement

with more chin projection, anterior

62

intrusion would be necessary to

avoid the incisor impedance during

the counterclockwise rotation of the

mandible. The author would like

to explore the combined intrusion

& retraction force system set up

with the posterior and anterior

miniscrews to be an effect ive

treatment strategy for high angle

protrusion cases.

WIOC-30

Rationale of Mini-Implants Application in Vertical Problems

Young-Chel Park

2002 – present:

Professor,

Dept. of

Orthodontics,

College of

Dentistry,

Yonsei

University, Seoul, Korea

2008 – present:

President, World Implant

Orthodontic Association

2004. 8 - 2008.7:

Dean and Professor, College of

Dentistry, Yonsei University, Seoul,

KOREA

2002 -2004:

Director, Dental Hospital, Yonsei

University

1992 - 2002:

Professor and Chairman, Dept. of

Orthodontics,

College of Dentistry, Yonsei

University

1998 -1999:

Visiting Professor, Dept. of

Orthodontics

University of British Columbia,

Vancouber,, CANADA

1984 - 1985:

Visiting Assistant Professor, Dept. of

Orthodontics

University of Connecticut, U. S .A.

As mini implants as orthodontic

anchorage gets to be a more routine

part of orthodontic practice, we try

to make their use as predictable

as possible. This means a need for

more evidence in its use.

This presentation will discuss the

rationale of mini-implants application

in vertical problems. The evidence

of molar intrusion in skeletal open

bite and facial asymmetry correction

will be demonstrated. The long term

retention data after molar intrusion

will also be introduced.

In add i t ion , the ra t iona le fo r

increasing the stabil i ty of mini

implants will be suggested.

1. Evidence of molar intrusion with

mini implants

Open bite correction by molar

intrusion

Asymmetry correction by molar

intrusion

Biologic reaction during and after

molar intrusion

Long term retention data after

molar intrusion

2. Rationale for increasing the

stability of mini implants

3. Effective use of mini implants

on the conventional orthodontic

concepts

WIOC-31

Ultimate Vertical Dimension Control Using Implant Anchorage for Long Face Partly Edentulous Patients

James Cheng-Yi Lin

Clinical

Assistant

Professor,

School of

Dentistry,

National

Defense

Medical University, Taipei, Taiwan

Consultant Visiting Staff, Dept. of

Orthodontic & Craniofacial Dentistry,

Chang-Gung Memorial Hospital,

Taipei, Taiwan

Director, Dr. James Lin & Associates'

Orthodontic & Implant Center.

Nowadays orthodontists can apply

the TADs to control the vertical

d imension for long face adul t

patients very easily and almost

without compromising the treatment

outcome.

But, how to control the vertical

dimension if a cl inician face a

hyperdivergent adult with partial

edentulous problem?

Clinically, if a long face patient with

partial edentulous problem, usually

some cruc ia l and chal lenging

situations may accompany such as

overerupted teeth, tipping teeth, and

so on. All these situations may not

only jeopardize the future restorative

spaces, but also make patient's

63

profile getting worse while clinicians

want to restore the dentition.

So, this presentation will highlight

the followings:

1. What is the major treatment

concern for this type of patient?

2. What TADs can help for this type

of patient?

3. What are the roles of dental

implants for this type of patient?

4. How to deal with such complicated

situations without compromising

the treatment outcome?

WIOC-32

Minimalism in Orthodontics Using FRC and TAD

Kwangchul Choy

Educations

D.D.S. Yonsei

Univeristy

M.S. Graduate

School, Yonsei

University

Ph.D.

Graduate School Yonsei University

Experiences

Residency, Dept of Orthodontics,

Yonsei University, Research Fellow

University of Connecticut Health

Center

Visiting Professor, University of

Connecticut Health Center

Associate Professor, Yonsei

University

Private practice, Veritas

Orthodontics

After the introduction of TAD, the

control of reactive force became

m u c h m o r e c o n v e n i e n t , a n d

clinicians were able to discover

numerous ways of orthodontic

tooth movement. The fundamental

protocol of traditional treatment

mechanics, however, has remained

unchanged.

Time has passed since the FRC

(Fiber Reinforced Composite) has

been introduced to the industry

and field of prosthetic dentistry. Its

light yet strong physical properties

have shown similarities to that of

stainless steel, bringing it forward

as a desirable material in the field of

orthodontics.

FRC can be used in many ways in

orthodontics: splinting the active unit

for En Masse movement or splinting

the reactive unit for distributing

the stress uniformly along the

anchorage unit, supplementary to

TADs.

In the ac t i ve un i t , En Masse

movement can be performed by

splinting the teeth through the

usage of FRC rather than stiff

wires. Also the number of brackets

can be dramatically reduced.

In the reactive unit, reactive forces

can be evenly distributed along

the anchorage teeth effectively

by splinting them using FRC. The

leveling stage can be omitted and so

called undisturbed anchorage can

be obtained. TADs can reinforce the

anchorage in such circumstances.

Through FRC and TAD, many

u n n e c e s s a r y o r t h o d o n t i c

attachments may be reduced. FRC

allows us to perform major tooth

movement in the initial stage of the

treatment rather than the leveling

and alignment that does take place

in the classic methods. In other

words, it is possible to change the

traditional protocol of orthodontic

treatment, even bringing aesthetic

benefits of FRC through labial

appliance.

WIOC-33

Innovation of Implantation Method and Instruments in Self-Drilling Screw to Achieve Highly Success Rate

Junji Ohtani

Assistant

professor

Department of

Orthodontics

and Craniofacial

Developmental

Biology,

Graduate School of Biomedical

Sciences,

Hiroshima University

2001:

Faculty of Dentistry, Aichi-Gakuin

University

Awarded the degree of DDS in

dentistry

2005:

Department of Orthodontics and

Craniofacial Developmental Biology,


Sciences, Hiroshima University

Awarded the degree of PhD,

supervised by Professor Kazuo

Tanne

2007-present:

Assistant professor


Craniofacial Developmental Biology,


Sciences, Hiroshima University

64

In recent clinical orthodontics, mini-

screws available for establishing

an absolute anchorage for tooth

movement on the alveolar and jaw

bones have been focused on.

We first examined various factors

relevant to the success rate of mini-

screw to be used self-drilling screw,

demonstrating in animal experiment.

We revealed that the twisting torque

during mini-screw implantation

is the most important factor. The

tensile strength test and bone-

implant contact ratio (B/I ratio) were

significant greater when the using

of optimal twisting torque than when

over 15Ncm. Moreover, the tensile

strength and B/I ratio exhibited no

significant changes during healing

period of 56 days.

Based upon these in vivo studies,

it was clarified that when we implant

mini-screw with appropriate twisting

torque, cortical bone exhibited a

close contact with screw surface.

That is to say, we should maintain

appropriate twisting torque during

screw implantation to achieve highly

primary stability. Moreover, if we

will be able to implant mini-screw

without excessive destruction in

cortical bone area, we may load

immediately after implantation

because of the results of bone

condition during healing period.

Next, in a cl inical survey, we

inves t iga ted in to appropr ia te

twisting torque in each implantation

site for patients. As a result, it was

demonstrated that the magnitude

of twisting torque revealed highly

success rate, was different at each

implantation site except palatal bone

site. From these clinical outcomes,

we intend to control twisting torque

during screw implantation according

to each implantation site. Therefore,

we have been developed newly

hand driver to control rotation speed

and twisting torque. I would like to

show the detail of our implantation

concept considered with twisting

torque by using torque controllable

hand driver. By the innovation of

designed implantation method in

Hiroshima University hospital, the

great success rate was revealed.

Some of interest ing point wi l l

be shown in this presentation,

asking valuable opinions from the

audience.

WIOC-34

The Hybrid Orthodontic Treatment System (HOTS)

Tomio Ikegami

Honorary

Clinical

Associate

Professor,

Faculty of

Dentistry,

The University

of Hong Kong

EDUCATION

1967-1974:

Doctor of Dental Surgery; Kyushu

Dental College. Kokura, Kitakyushu,

Japan

1981-1983:

Certificate of Dental Specialty

(Orthodontics); Tufts University

School of Dental Medicine, Boston,

Massachusetts 02111, U.S.A.

1988:

Master of Science Degree

(Orthodontics); Tufts University

School of Dental Medicine, Boston,

Massachusetts 02111, U.S.A.

PROFESSIONAL CAREER

1984- Private:

practice in orthodontics

1990- Diplomate; The American

Board of Orthodontics (A.B.O.)

2001- 2009- President of the Japan

MEAW Technique and Research

Foundation

2006- Specialist in Orthodontics;

Japanese Orthodontic Society

(J.O.S.)

2007- Honorary associate professor;

Hong Kong University School of

Dentistry

For the treatment of first premolar

extraction cases with edgewise

mechanics, the traditional methods

of retracting the six anterior teeth

are: 1) initial retraction of the two

canines followed by the retraction

of the four incisors (i.e., two-step

retraction); or, 2) moving all six

anterior teeth lingually together

(i.e., en masse retraction). Each

method has its advantages and

disadvantages. The former method

has an advantage when retracting

the canines; they can travel along

the alveolar trough which is located

between the labial and l ingual

cortical bone in the narrow canine

area. This method though requires a

longer treatment time because each

separate retraction can take as long

as six months to complete. In the

latter method, it is advantageous

that the full retraction is able to be

started earlier than in the former

method, but the direction of the

canine retraction might not be as

favorable because the canines are

retracted rather straight backwards

65

i n t e r f e r i n g w i t h t h e l i n g u a l

cortical bone, which may cause

unfavorable damage to both the

canine roots and the lingual cortical

bone. This interference will also

cause prolonged treatment time

consequently. What is needed now

is an efficient treatment system that

achieves predictable outcomes with

a shorter treatment time, without

being dependent upon pat ient

compliance.

Three advances in the f ield of

orthodontics have led to the creation

of a new treatment system for first

premolar extraction cases: 1) the

Micro Implant Screw (MIS); 2) the

Dual Dimension Wire (DDW) which

has an anterior rectangular portion

and a round posterior portion; and,

3) the Multiloop Edgewise Arch

Wire (MEAW) which is a 0.016" x

0.022" stainless steel rectangular

wire with multiple L-loops. Since

this new system combines these

three devices with a new treatment

concept, it is named the Hybrid

Orthodontic Treatment System

( H O T S ) . H O T S e n a b l e s t h e

simultaneous but separate retraction

of the canines (along the round

portion) as well as the four incisors

(with the rectangular portion) without

depending upon patient compliance.

This presentation elaborates on the

HOTS and illustrates its use with a

case report.

WIOC-35

Mini - Implants-an Adjunct to Everyday Orthodontic Practice

Shalene Kereshanan

Lt. Col. Dr

Shalene

works as a full

time single

orthodontic

operator within

the dental

department of the main military

hospital in Kuala Lumpur. Dr

Shalene received her Bachelor of

Dental Surgery from the University

of Wales, College of Medicine

in 1999. She later obtained her

Membership of Faculty of Dental

Surgery, Royal College of Surgeons

of England (2005); Master in

Dental Science (Orthodontics)

(Cardiff, 2007) and Membership

in Orthodontics, Royal College of

Surgeons, Edinburgh (2007). Her

clinical interests include self-ligating

brackets, root resorption and adult

orthodontics.

Min i - implants, TADs or bone

screws as they are known to

many are the current flavour of

the day in Orthodontics. This brief

presentation will share some of

the applications of mini-implants in

everyday orthodontic practice in a

busy single operator orthodontic unit

within the main Malaysian Armed

Forces Hospital in Kuala Lumpur

and discuss some of the problems

encounte red fo r the average

Malaysian patient.

WIOC-36

Treatment Strategy Using TADs for adult Class III Malocclusions

Shingo Kuroda

Associate

Professor

Department of

Orthodontics

and Dentofacial

Orthopedics,

The University

of Tokushima Graduate School of

Oral Sciences

1996:

Graduate school, Faculty of

Dentistry, Osaka University, Japan

(D.D.S.)

2000:

Graduate school, Graduate School

of Dentistry, Osaka University,

Japan (Ph.D).

2000-2008:

Assistant Professor, Department

of Orthodontics and Dentofacial

Orthopedics, Okayama University

Graduate School of Medicine,

Dentistry and Pharmaceutical

Sciences, Japan.

2007-present:

International review board member

of American Journal of Orthodontics

and Dentofacial Orthopedics.

2008-present:

Associate Professor, Department

of Orthodontics and Dentofacial

Orthopedics, The University of

Tokushima Graduate School of Oral

66

Sciences, Japan.

2009-present:

Visiting researcher, Laboratory

for the Study of Calcified Tissues

and Biomaterials, Department of

Stomatology, Faculty of Dentistry,

Université de Montréal, Canada.

Temporary anchorage devices

(TADs) have evolved as a main

stream orthodontic technique in

the past decade, since they can

provide absolute anchorage without

patient cooperation. Especially,

miniscrew anchorage is currently

in vogue because they are quite

useful for various orthodontic tooth

movements with minimal anatomic

l imitat ion on placement, lower

medical cost, and simpler placement

with less traumatic surgery.1, 2

In the treatment of adult mild to

moderate Class III malocclusions,

TADs are quite useful compared

to the t rad i t iona l o r thodont ic

mechanics such as Class III intra-

maxillary elastics and a high-pull

J-hook headgear to the mandibular

arch, because they can provide

group distalization of mandibular

arch without any counteraction and

require no patient's cooperation.3

Re t romo la r a rea i s the mos t

suitable place for TAD insertion

and it should be the first choice

in Class III treatment.4 If there is

inadequate attached gingiva in the

area, interradicular alveolar screws

can be placed between the second

premolar and first molar or between

the first and second molars.5

In the t rea tmen t o f C lass I I I

malocclusions with severe skeletal

discrepancies, combined treatment

with orthognathic surgery and

tooth movement with TADs offers

several advantages. TADs could

facilitate the surgical procedures

and make the pre- and post-surgical

orthodontics simpler.6

Conclusively, TADs enhance the

quality of Class III treatment, and

this new treatment strategy can

dramatically change orthodontic

diagnosis and treatment results in

Class III malocclusion.

WIOC-37

Treatment of High-Angle Class II Cases Using Implant Anchors

Yasoo Watanabe

Dr. Watanabe

graduated from

the Faculty

of Dentistry,

Hiroshima

University

in 1979 and

received PhD degree from same

school. He served as an assistant

professor at the Department of


Hiroshima University. Currently,

he maintains a private practice

in orthodontics in Fukuyama,

Hiroshima, Japan.

Now that implant anchors have

become part of orthodontic practice,

we orthodontists have come to study

the applicability of implant anchors

in solving not only anteroposterior

problems but also transverse and

vertical problems in the process of

treatment planning.

A m o n g c a s e s w i t h v e r t i c a l

problems, h igh-angle Class I I

cases can be considered as a good

indication for orthodontic treatment

us ing implant anchors, which

permit the tooth movements that

are not possible with conventional

orthodontic appliances, such as

the intrusion and extrusion of the

entire dental arch. The mandible

r o ta tes coun te r c l ockw i se as

the poster ior occlusal vert ical

dimension is reduced with the

use of implant anchors, allowing

correction of vertical skeletal and

dentoalveolar problems typical of

these cases as well as horizontal

problems. Resultant facial esthetic

and func t iona l improvements

seem to open new possibilit ies

for orthodontic treatment. This

p r e s e n t a t i o n c o v e r s v a r i o u s

problems associated wi th the

treatment of high-angle Class II

cases by showing their treatment

courses. While different types of

implant anchor systems available,

cases treated with an extra-alveolar

anchor system will be presented.

67

WIOC-38

Combining No-Compliance and Skeletal Anchorage Strategies for Efficient Class II Treatment

Cesare Luzi

Dental degree

at the University

of Rome "La

Sapienza".

Postgraduate

degree in

Orthodontics at

the University of Aarhus, Denmark,

where he obtained the Speciality

in Orthodontics and the Master of

Science Degrees. Founder and

first President of the European

Postgraduate Students Orthodontic

Society (EPSOS). Active member

of SIDO (Italian Society of

Orthodontics). Member of the EOS

(European Orthodontic Society)

and ASIO (Italian Association of

Specialists in Orthodontics). Winner

of the Houston Research Award of

the European Orthodontic Society

(Vienna 2006) and of the First Prize

Award for Clinical Research of the

Italian Orthodontic Society (Florence

2006). Private practice in Rome,

Italy, limited to orthodontics.

Class I I treatment has greatly

evolved with the introduction of

no -comp l iance sys tems. The

possibility of eliminating the variable

of patient collaboration together

with the use of fixed devices opens

to more predictable results with

shorter treatment times. No matter

whether the clinician chooses to

distalize upper molars, advance

the mandible, or extract teeth to

correct class II malocclusions, no-

compliance solutions are today

avai lable. Al though extremely

e f f i c i e n t , t h e m a i n p r o b l e m

associated with no-compliance

systems is anchorage control. Fixed

devices which have the purpose

of distalizing upper molars have

shown to produce intra-arch loss of

anterior anchorage, while fixed bite-

jumping devices of any kind have as

a main side effect the proclination of

lower incisors, which can minimize

the skeletal effects of such type

of treatment. Furthermore, if the

decision to extract in the upper

arch to correct class II relationships

is taken, the control of maximum

p o s t e r i o r a n c h o r a g e c a n b e

difficult to obtain with conventional

anchorage systems. Recent ly

ske le ta l ancho rage dev i ces ,

especial ly mini- implants, have

revolutioned daily clinical practice

allowing absolute anchorage control.

The insertion protocol of mini-

implants is so easy and quick that

it takes only some minutes to the

orthodontist himself without requiring

any other specialist. Extraction

cases can now be planned with

maximum anchorage control, while

class II no-compliance systems,

either for molar distalization or bite

jumping devices for mandibular

advancement, can be used in

association with temporary skeletal

anchorage devices el iminating

any possible anchorage loss. This

opens a new frontier in class II

treatment allowing more efficient

resul ts wi th shorter t reatment

times and predictable treatment

protocols. Class II no-compliance

treatment strategies and the rational

association of temporary skeletal

anchorage devices for absolute

anchorage control will be analyzed

in order to optimize orthodontic

treatment.

WIOC-39

State of the Art of Brazilian Miniscrews

Hideo Suzuki

MSc at

University

of Camilo

Castelo Braco –

Campinas, Sao

Paulo

PhD at St.

Lepoldo Mandic Research Center-

Campinas, Sao Paulo

Professor in the Department of

Orthodontic, St Leopoldo Mandic

Research Center- Campinas, Sao

Paulo

The aim of this presentation is to

provide an overview of the currently

stands in regards to Brazi l ian

orthodontic miniscrews, showing

the miniscrews recently available

in the market considering their

characteristics such as size, shape,

diameters, lengths, surface and

resistance as well as their success

rates and clinical application as

auxiliary anchorage during various

type of tooth movement as intrusion,

uprigthing, retraction, distalization,

etc.

68

WIOC-40

Benefits of Implant Anchors

Shigeru Murai

Lecturer at

department of

orthodontics,

Hokkaido

Medical care

University

Executive

Secretary of JAAO(2010)

1975 graduated at dentistry of Iwate

medical college.

1975 Worked as oral surgeon at

Sapporo Medical College

1980 Lecturer at department of

orthodontics, Hokkaido Medical care

University.

1982 Chief at Dentistry and Oral

surgery of Hakodate Municipal

Hospital

1985 Founded Mihara orthodontic

office

The convent iona l op t ions fo r

orthodontic anchorage control are

either extraoral or intraoral, i.e.,

headgear, maxil lary protrusive

appliance (MPA) or inter-maxillary

elastics.

There a re many p rob lems in

Japan with Implant Anchors. But

the number of orthodontists who

use implants like SAS (Skeletal

Anchorage Sys tem) and TAD

(Temporary Anchorage Device) are

increasing.

One reason is that patients don't

need to wear extra oral anchorage

and inter-maxillary elastics.

The other reason is that orthodontists

can advance treatment for automatic

and fast teeth movement. In private

o r thodon t i c o f f i ces , we have

limitations using implant anchors.

As a private office orthodontist, I try

to decrease headgear and shorten

the treatment period. Recently TAD

is used mainly in Japan, which can

adapt easily to many cases.

However the length of the screw

pin is usually 8-15 mm, so when

the screw pin is located near the

tooth root, its resorption or inhibition

of tooth movement are possible,

therefore I try to insert the screw

pin as far away from the root as

possible. Doing this, however,

causes many other problems.

In order to avoid side effects of the

screw pin, I set it where there are

no tooth roots like palatal area and I

prefer using free friction bracket and

apply other many techniques.

I will talk about my experience

of us ing Implant Anchors, my

philosophy regarding them and

present many case studies from

my practice as an oral surgeon and

orthodontist.

WIOC-41

The Micro Implant Pearl Concept

Korrodi Ritto

Dr. Korrodi

Ritto graduated

in dentistry in

1988. Received

the PHD degree

in 1997. The

title of Specialist

in orthodontics was obtained in

1998. He works in private practice

at Mouzinho Albuquerque 115 1º,

2400-194 Leiria, Portugal.

He is the inventor of the Ritto-

Appliance. He wrote more than

70 articles in orthodontic journals

around the world, and displayed

many clinic tables and posters

at AAO, EOS, and Portuguese

Societies.

The cor rec t ion o f the tongue

thrust should be an integral part of

treatment in orthodontics.

The awareness of the problem of

muscular dysfunction involving the

dentition has been a grave problem

for orthodontists for many decades.

The improper tongue thrust is

reinforced with each succeeding

feeding. Sometimes the degree

of malocclusion or malformation

depends upon the severity of the

tongue thrust problem.

I t mus t be remembered t ha t

although the muscles of the tongue,

including the root of the tongue and

muscles of the floor of the mouth,

are the most important group of

muscles that we contend with, other

muscles, including the lips and

cheeks, are of great importance as

well.

THE GOAL of the treatment with the

micro implant pearl is to bring about

normal function of those muscles

surrounding the dentition that takes

part in the masticatory process and

deglutition. To make the treatment

easier and the results more stable,

regardless of what we use, either

fixed or removable or functional

methods, the cause must be dealt

with and eliminated.

This condition of swallowing dysfunction

is corrected by reinforcement of the

exercise prescribed to bring about a

new pattern of swallowing.

69

WIOC-42

Orthodontic Treatment Using Mini-Screw Anchorage for Patients withTemporomandibularJoint Dysfunction

Teruko Takano-Yamamoto

Department of

Orthodontics

and Dentofacial

Orthopedics,

Tohoku

University

Graduate

School of Dentistry,

Education and Degrees:

1969-1975:

Osaka University, Faculty of

Dentistry

JAPAN – D.D.S.

1975-1981:

Osaka University, Faculty of

Dentistry

JAPAN – Ph.D. (Orthodontics)

Occupation:

1976-1979:

Instructor of the Department of

Orthodontics, Osaka University,

Faculty of Dentistry

1979-1982:

Instructor of Department of Calcified

Tissue and Biochemistry, Osaka

University, Faculty of Dentistry

1982-1992:

Instructor of the Department of

Orthodontics, Osaka University,


1992-1995:

Assistant Professor of the

Department of Orthodontics, Osaka

University, Faculty of Dentistry

1995-1997:

Professor and Chair of the

Department of Orthodontics,

Tokushima University, Faculty of

Dentistry

1997-2006:

Professor and Chair of the


Okayama University Dental School

2006-2009: Professor and Chair

of Division of Orthodontics and

Dentofacial Orthopedics, Tohoku


Dentistry

In the recen t years , demand

for treat ing adult pat ients has

g rea t l y inc reased, who o f ten

suffer f rom temporomadibular

jo int dysfunct ion(TMD). There

are some reports describing the

relationships between malocclusion

and jaw function. During jaw border

movements, compared with normal

occlusion individuals, the patients

wi th mandibular prognathism,

unilateral posterior crossbite or

anterior open bite have limited

condylar motion range. Therefore,

using a six-degrees-of freedom jaw

tracking system, we are recording

the condylar movement during

lateral excursive jaw movement and

mastication in adult patients. As a

results, it is confirmed that functional

changes in the gnatho log ica l

system are achieved following the

improvements of malocclusion in

orthodontic treatment and that TMD

symptoms also disappear.

Recent ly, mini-screws ut i l ized

as an orthodontic anchorage for

the treatment with multi-bracket

a p p l i a n c e h a s b e e n w i d e l y

accepted among orthodontists.

For more than ten years, we have

aggressively used the titanium

screw as a stationary anchorage in

orthodontic treatment and evaluated

the clinical usefulness of mini-

screw as orthodontic anchorage.

Especially, the possible amount

of tooth movement of incisors and

molars using implant anchorage

has changed in both horizontal

and vertical directions compared to

conventional orthodontic anchorage.

As cases of both canted occlusal

plane and anterior open bite have

vertical problem, we used mini-

screw anchorage for vertical control

of the molars for such patients with

TMD.

We will discuss the characteristics

of diagnosis, treatment planning,

and treatment outcome in the use

of mini-screws as an absolute

anchorage for patients with TMD.

And successful vertical correction

with skeletal anchorage will be

discussed. The goal of orthodontic

treatment is to improve the patient’

s life by enhancing dental and jaw

function and dentofacial esthetics.

The implant anchorage makes it

possible to enlarge orthodontic

scope morphologically, functionally

and facial esthetically in treatment

of patients with malocclusion, and to

bring a revolution in the orthodontic

paradigm.

70

WIOC-43

Treatment of Temporomandibular Joint Disorders Using Miniscrew Anchorage

Masato Kaku

Education

April, 1989,

Entrance into

Okayama

University

Dental Schoool

(2-5-1 Shikata-

Cho, Okayama City, 700-8525,

JAPAN)

March, 1995, Graduation from

Okayama University Dental School

(Doctor of Dental Surgery)

April, 1995, Entrance into Hiroshima

University Graduate School

of Biomedical Sciences (1-2-3

Kasumi, Minami-ku, Hiroshima City,

734-8553, Japan)

March, 1999, Graduation from

Hiroshima University Graduate

School of Biomedical Sciences

(Doctor of Philosophy)

Work Experience

April, 1999~, Clinical Associate,

Orthodontics, Hiroshima University

Dental Hospital

Current position: April, 2000~,

Assistant Professor, Department

of Orthodontics and Craniofacial

Developmental Biology, Hiroshima


Biomedical Sciences

September, 2003~August, 2004,

Visiting professor, Department of

Orthodontics, College of Dentistry,

University of Florida

Temporomandiblar joint disorder

(TMD) is defined as a collective

te rm embrac ing a number o f

c l in ica l problems that involve

the mast ica tory muscu la ture ,

t he t emporomand ibu la r j o i n t

(TMJ) and associated structure.

It is characterized by the clinical

presentation: pain in the mastication

muscles and TMJ, limited range of

mandibular movement, joint sounds

described as clicking or crepitus.

Studies showed a multifactorial

etiology of TMD, with malocclusion

be ing a po ten t ia l r i sk fac to r.

Previous reports also indicated

that malposition of the mandibular

condyle relative to the glenoid

fossa may be one of the important

causes of TMD and that orthodontic

t r e a t m e n t a n d a n a n t e r i o r

repositioning splint are effective for

TMD with retropositioned condyle.

Skeletal 2 malocclusion cases

with a steep mandible are difficult

to treat because of their vertical

growth pattern. If the orthodontist

does not take the abnormal growth

pattern into consideration, patient’

s lower facial height will increase

and the profile will be getting worse.

Moreover, certain types of skeletal 2

malocclusion with retroposition and

posterior rotation of the condyle may

lead to TMD more frequently than

other malocclusions. Therefore,

th is k ind of pat ient should be

treated carefully. Miniplates and

miniscrews are now frequently used

for establishing absolute anchorage

for orthodontic tooth movement.

Surgical invasion is minimal during

miniscrew insertion compared to

placement of miniplates because

mucosa should be cut and a flap

is required. Although a number of

case reports using mini-screws

to maintain vertical control in the

maxi l la have been publ ished,

there is no information on a TMD

t rea tmen t us ing m in i sc rews .

We present the reproduction of

centric condyle positioning and

stable occlusion by intrusion of

posterior dentoalveolar region using

miniscrew anchorage.

WIOC-44

Handling Breathing-compromised Cases using Mini-Implants

Eung-Kwon Pae

Associate

Professor,

UCLA School of

Dentistry

Director of the

Orthodontics

and Dentofacial

Orthopedics Residency Program

Molar intrusion has been considered

one o f t he mos t cha l l eng ing

orthodontic tooth movements, which

often requires rather aggressive

t reatment modal i t ies such as

surgical interventions when severe.

Although the orthognathic surgeries

are ind icat ive and very much

beneficial for such severe cases,

recent advancements in mini-

implants have made difficult tasks,

such as intruding molars 5-6 mm,

appear trivial. Thus, surgeries can

be avoided in such cases if one

uses mini-implants with a meticulous

71

treatment plan. However, open-

bite malocclusions compounded

with breathing problems are still

challenging, not because of the

difficulties in biomechanics, but

because of the chal lenges in

diagnosis and treatment plan. It

should be emphasized that al l

treatment efforts for intruding molars

must begin by being diagnosed as

an airway-compounded openbite

case. Here, a novel interpretation

of old data rooted in respiratory

physiology is introduced. What

cephalometric measurements would

indicate breathing difficulty? What

benefits could be expected from

three-dimensional imaging data?

Further, a new application of mini-

implants to minimize side-effects of

orthodontic-orthopedic appliances

will be introduced.

WIOC-45

A Significance of Molar Intrusion in the Treatment of Open Bite with Vertical Skeletal Discrepancy: Treatment Strategy Derived from the Etiologic Consideration

Kazuo Tanne

Professor,

Department of

Orthodontics

and Craniofacial

Developmental

Biology,

Hiroshima


Biomedical Engineering

1985-1987:

Visiting Professor, University of

Connecticut

School of Dentistry (Chief: Prof.

Charles J. Burstone)

1987-1993:

Lecturer, Department of

Orthodontics, Osaka University


1993-2002:

Professor and Chairman,

Department of Orthodontics

Hiroshima University Faculty of

Dentistry

2000-2004:

Dean, Hiroshima University Faculty

of Dentistry

2002-present:

Professor, Hiroshima University


Sciences

2004-present:

Vice Director, Hiroshima University

Hospital

Director, Medical and Social

Cooperating Center, Hiroshima

University

In Japan, edgewise technique,

originally developed by Dr. Angle

E.H., was introduced in 1960’s.

For more than 30 years since the

introduction, open bite has been

treated with edgewise techniques

through the combined mechanisms

to move the molars to the anterior

direction leading to autorotation of

the mandible after teeth alignment

into the extraction spaces and

to extrude the anterior teeth by

use of vertical elastics. However,

we experienced in daily practice

that such approach has a couple

of shortcomings such as a high

frequency of relapse and root

resorption in the anterior teeth.

In general, open bite is induced

b y v a r i o u s o r a l h a b i t s , a n d

nasopharyngeal disturbances from

nasal and pharyngeal diseases.

In order to elucidate the cause-

and-effect re lat ionship, nasal

or pharyngeal obstruction was

established in growing monkeys.

As a result of morphometric and

electrophysiologic studies, it is

demonstrated that such respiratory

obstruction surely induces mouth

breathing and Class II open bite.

As the mechanisms, it is shown

that onset of moth breath ing,

reduction of masticatory muscle

ac t i v i t y, masse te r musc le i n

particular, vertical displacement

of the molars and the surrounding

alveolar bone and backward and

downward rotation of the mandible

are indicated as the causes of Class

II open bite. It is thus confirmed that

vertical control of the molars and

the alveolar bones is a key to the

correction of Class II open bite.

From these considerations, MEAW

technique was introduced by Dr.

Kim to aim molar intrusion without

produc ing anter ior ex t rus ion.

However, according to our recent

survey, the prevalence of root

resorpt ion is very high, in the

anterior teeth in particular, and

thus a certain treatment modality

has been h igh ly an t i c ipa ted .

Recently, various types of micro-

implant anchorage (MIA) have

been developed to reinforce the

anchorage for tooth movement and

to intrude and/or distalize the molars

more easily than before without

affecting the anterior teeth. Thus,

72

treatment strategy for open bite has

been changed drastically. Currently,

more optimal or excellent outcomes

of open bite treatment can be

achieved by use of MIA.

In this lecture, these changes in

treatment techniques are presented

in addition to treatment cases with

MIA.

WIOC-46

Tough Impacted Teeth Made Easy

Chris H. Chang

Dr. Chris Chang,

an ABO certified

orthodontist,

received his

PhD degree

in bone

physiology and

Certificate in Orthodontics from

Indiana University in 1996. Dr.

Chang published over 30 articles

and book chapters on several topics

including management of impacted

cuspids, suture expansion, and

self-ligating system. In addition,

He is a professional instructor and

lectures on a wide range of topics,

including the Damon system,

OrthoBoneScrews, excellent

finishing, clinic management and

effective presentations in Taiwan

and around the world. As a publisher

of News & Trends in Orthodontics,

he has been actively involved

in the design and application of

orthodontic bone screws. His most

recent focus of practice is to apply

orthodontic bone screws to the

treatment of the impacted cuspids.

Deeply impacted teeth are difficult

to treat because they require an

outward, backward and downward

force system. The use of orthodontic

bone screws, combined with a 3-D

lever arm, provides an excellent

solution. Six complicated impacted

cases will be presented. Key steps

of treating for impacted teeth will

also be discussed with photos

and videos to ensure participants

have a thorough understanding. All

important tips will also be reviewed

in details. After this presentation,

you r ab i l i t y t o hand le t ough

impacted teeth will never be the

same.

Learning Objectives:1. Gain a complete understanding

of treating impacted teeth with

orthodontic bone screws.

2. Be ab le to des ign mu l t ip le

mechanic force systems for

various types of impacted teeth.

3. Adopt an easy method to perform

surgical procedures for impacted

teeth.

4. Lea rn how to f ab r i ca te an

effective 3-D lever arm as an aid

to orthodontic bone screws.

WIOC-47

Four-Dimensional Total Arch Movement -Possibilities and Limitations

Kee-Joon Lee

Education

Mar. 1998 –

Feb. 2004:

Graduate

school, College

of Dentistry,

Yonsei

University, Seoul, Korea (Ph.D)

Mar. 1995 - Feb. 1997 Graduate

School, College of Dentistry,

Yonsei University, Seoul, Korea

(M.S.)

Mar. 1988 - Feb. 1994:

College of Dentistry, Yonsei

University, Seoul, Korea (D.D.S.)

Professional experience

Mar 2008 – present:

Associate professor, Dept. of



Mar 2004 – Feb 2008:

Assistant professor, Dept. of



July 2002 – Feb 2004:

Visiting scholar, Dept.of

Biochemistry, School of Dental

Medicine

University of Pennsylvania, USA

May 2001- July 2002:

Lecturer, Dept. of Orthodontics,

College of Dentistry,


Mar. 1998 - Apr. 2001:

Medical officer(Captain)

Chang-Dong Military Hospital

73

74

Mar. 1994 - Feb. 1998:

Intern & Resident

Dept. of Orthodontics, Yonsei

University Dental Hospital, Seoul,

Korea

It is now evident that the TADs

may induce predictable movement

of single tooth, teeth segment

and even the total arch in various

directions. So far the perception of

the arch and/or tooth movement

using the TADs has been rather

static, in that the time factor has

not been considered. What if the

growth is combined with the tooth

movement? The range of growth

modif ication is normally larger

than the range of orthodontic tooth

movement, as illustrated in the

"envelop of discrepancy". Hence

a proper manipulation of growth

using TADs may lead to greater

treatment changes than any static

tooth movement in the non-growing

patients. In this presentation, the

differences between the three-

dimensional and four-dimensional

t o t a l a r ch movemen t w i l l be

introduced.

1. Three-dimensional total arch

movement

Tooth movement can be induced

in A-P, vertical and transverse

direct ions. However, due to

the lack of growth, the range

of movement is restricted by

anatomic barriers. Therefore

t he r a t i ona le o f t o t a l a r ch

movement should be differentially

understood in each dimension

and treatment plans should be

strategically established based

on the purpose of the treatment.

Cautions regarding the tooth

movement wi l l be explained

according to results in the animal

models.

2. Four-dimensional tota l arch

movement

Growth may help or hinder the

t reatment depending on i ts

direction and residual amount,

which have been shown to be

largely unpredictable. In order to

maximize the treatment outcome,

the orthodontists need to select

a good time point for proper

intervention. A guideline for the

proper intervention including the

time and the insertion sites for

miniscrews, with special attention

to the hyperdivergent Class II, will

be given.

Although the concept of growth

modification has been recruited for

decades, specific protocols may be

reestablished based on the theories

and clinical evidences. Overall, time,

anatomic characteristics and post-

treatment stability of the treatment

are to be integrated for the best

treatment outcome.

WIOC-48

Management of Lower 3-Incisors by Using Orthodontic Miniscrew

Eric Liou (劉人文)

Department of

Orthodontics

and Craniofacial

dentistry

Chang Gung

Memorial

Hospital

Taipei, Taiwan

Human teeth are always symmetric

in number between the right and

left dentition for a proper function

and esthetics. Although it causes

no problem in chewing function,

the feature of lower 3- inc isor

has problems in esthetics and a

narrower anterior transverse arch

dimension. The most common

feature of lower 3-inciosr clinically

is missing one of the incisors with

one of the lower central incisors

positioning in the center of lower

d e n t i t i o n . T h e c o n v e n t i o n a l

orthodontic treatment modalities for

the lower 3-incisor include regaining

an edentulous space orthodontically

for the missing incisor, and then

restoring the edentulous space with

a prosthesis, such as a crown &

bridge, Maryland bridge, or with a

dental implant. The advantages of

this treatment modality are that the

upper and lower dental midlines

could be coordinated and the

anterior transverse arch dimension

c o u l d b e r e s u m e d a f t e r t h e

orthodontic treatment. Especially in

young individuals, the disadvantage

of this treatment modality is the

prosthesis or dental implant which

is not natural and physiological.

Another treatment modality is the

extraction of one of the incisors

and c losure of the ext ract ion

space orthodontically to make the

number of incisors even on both

sides so that the upper and lower

dental midline could coordinated.

However the problem of a narrower

anterior transverse dimension is left

unsolved. Without extraction of any

incisors and enamel reshapping

of one of the lower canines, this

presentation aims to solve the

problems of lower 3-incisor by using

orthodontic miniscrew to rotate and

shift the entire lower dentition to

either right or left side, so that the

upper and lower dental midlines

could be coordinated, and the

anterior transverse arch dimension

could be resumed at the same time.

75

TAO Oral Presentations

Clinical Group

No. 01

Treatment of Skeletal Class III Malocclusion with Anterior Openbite with Skeletal Anchorage System應用骨性錨定治療三級異常咬合合併前牙開咬病例

Li-Fang Hsu (徐儷芳), Emily

Yi-Min Liu (劉怡敏), Fong-Lan

Chan (詹鳳蘭), Jane Chung-

Chen Yao (姚宗珍), Yi-Jane

Chen (陳羿貞)

國立臺灣大學醫學院附設醫院牙科部

齒顎矯正科、國立臺灣大學牙醫專業

學院臨床牙醫學研究所

三級異常咬合合併前牙開咬的患

者，除了上顎後縮或下顎前突等顎間前

後關係的異常之外，常伴隨有以下幾項

特徵：過多的上下顎後牙齒槽垂直方向

生長、上顎咬合平面角度較小、下顎的

咬合平面角度較大、下顎角點角度較

大、下顎平面開展度較大，及較大的前

下顏面高等等。在這類患者的治療方向

可分為手術及非手術兩方面來討論。在

較輕微的患者，可使用迷你骨釘或迷你

骨板作為骨性錨定，將上下顎過度挺出

的後牙進行壓入，使下顎骨做逆時針旋

轉以解決前牙開咬的問題；但下顎骨逆

時針旋轉亦可能造成骨性三級異常咬合

的外觀更趨於不利，所以在較嚴重的患

者，我們應考慮配合雙顎的手術治療以

利開咬及骨性三級異常咬合的改正。

本案例之患者為二十八歲女性，

主訴為前牙開咬及咬合不正，在過去

曾有顳顎關節症的病史，因經過數年

追蹤目前已趨於穩定，故前來進行矯

正諮詢與治療。經臨床檢查發現患者

正面觀下顏面垂直比例較長，前牙有

約三釐米的垂直開咬，側面觀有上顎

齒槽前突，鼻唇角小於九十度及閉唇

不全的問題。根據臨床檢查及側顱分

析診斷為骨性三級咬合異常合併高下

顎平面角，安格氏三級咬合異常合併

前牙開咬。患者希望能以非手術方式

至改善咬合問題。我們也考量到患者

的下顎前突程度並不嚴重，於是在下

顎骨拔除兩顆根管治療過的第二大臼

齒，將第三大臼齒往近心移動取代第

二大臼齒，並在上顎雙側種植頰側迷

你骨板及顎側迷你骨釘，下顎雙側後

牙頰側也種植迷你骨釘，協助進行上

下顎後牙區的垂直控制及壓入；同時

將上下顎齒列向遠心移動以改正過於

傾斜的前牙角度。此病例經兩年七個

月時間完成治療，成功關閉前牙開

咬，達到雙側安格氏一級咬合；治療

後患者閉唇不全的問題也因而改善，

上下顏面比例變得更為和諧美觀，顳

顎關節的狀態也持續維持穩定，本次

報告將分析其治療效果並探討此類患

者的治療策略及機械力學應用。

No. 02

Nonsurgical Orthodontic Correction of Anterior Openbite in an Adult Case前牙開咬之非手術性矯正成人病例

Yi-Sheng Chen (陳易聖), Ar-

Ting Wang (王亞婷), Wen-

Chung Chang (張文忠), Jane

Chung-Chen Yao (姚宗珍)




前牙開咬，常會造成病人心理，

功能，健康上的影響。在進行臨床的

診斷及治療時，可能的致病因素，

像是吸手指，口呼吸，吐舌頭，顳顎

關節疾病等等⋯，皆須先詳查在已

控制之下矯治。對於有前牙開咬現

象的病人，傳統治療方法主要是開

刀的方式，以勒福一型截骨術進行

上顎的後方向上嵌塞動作（posterior

impaction），進而使下顎可以產生

逆時鐘旋轉，使前方門牙產生接觸並

減小可能過長的前顏面高度，解決開

咬問題，但手術的風險，金錢，副作

用仍是病人考量的要點。目前，由於

使用矯正植體治療的穩定發展，對於

此類的病人，在適當的條件下，也能

用這種較保守的手段能達到類似的治

療效果。

本病例是一個27歲的女性，來

本院的主訴為前牙開咬，發音困難和

不易咬斷食物。病人自述有顳顎關節

病史，有接受過咬合板治療。經臨床

檢查發現，病人側面觀為突臉型，下

頜平面角過度開展，且下巴明顯後

縮。口內除了前牙開咬，還伴隨齒列

擁擠，上頜後牙橫向空間不足，與下

頜為錯咬關係，第一大臼齒呈現一級

咬合關系。上頜先利用Hass腭弓擴

張裝置撐寬上顎，器改正後牙錯咬關

系後，在上下頜雙側後牙區，放置迷

你骨釘及骨板裝置，使上頜後牙區積

極的向上壓入（intrusion），下頜則

作垂直方向的控制，以期病人下頜作

逆時針方向的旋轉，改善前牙開咬，

建立良好的一級咬合關系。治療後，

病人的側面觀呈直臉形，下巴變的

較為，顏面外觀改善，且有良好美觀

之穩定咬合。

No. 03

微創下巴術達到三贏的局面 - 牙矯及整外兩科合作

Sok-Heng Chin (陳淑賢), 湯月碧

渾然天成整形外科診所、台大醫院

背景

下巴後縮是牙矯及整形醫師常見

的外觀缺憾。如何避免大手術而以微

創方式達到最好的效果一直是兩科常

常面臨的挑戰。

目的及目標

希望結合整外及牙矯的專科來達

到最好的外觀，最美的笑容，達到病

人、牙矯及整形“三贏”的局面。

材料及方法

整形外科醫生使用各式材質，配

合微創精細之手術技巧及特別的審美

觀下達到最佳、最自然的結果。

結果

超過8年以上，使用微創方式成

功矯正了無數嚴重至輕微之下巴後

縮。此方法不僅傷口小、疼痛少、恢

復快，外觀非常渾然天成，而且也摸

不出來，且手術的併發症也極少，所

以術後滿意度很高。

結論

此微創下把手術對於病人的正面

和側面的效果都很卓越，為病人、牙

矯及整形醫師帶來“三贏”的局面。

微創下巴術不止改變了病人的臉型，

連台灣民眾在乎的氣質也會改變。

No. 04

Orthodontic Combined Orthognathic Surgery Treatment in Angle Class II Malocclusion Patient - A Case Report矯正配合正顎手術治療安格氏第二類咬合 - 病例報告

Hui-Yi Chen (陳慧怡), Frank

Hsin-Fu Chang (張心涪), Eddie

Hsiang-Hua Lai (賴向華)




In adults with severe mandibular

retrognathia, compromise or camouflage

treatment is frequently used to

reduce the distance of mandibular

advancement. However, it may have

many adverse effects to nasolabial

angle or lip support. Bilateral sagittal

split osteotomy (BSSO) mandibular

advancement is the ideal treatment

plan of these patients. When rigid

internal fixation was introduced,

great optimism was expressed,

and several authors considered

mandibular advancement to be a

very stable procedure. This 19 year-

old female with chief complaint

of mandibular retrognathism and

dental crowding came to our dental

clinic in 2007. Extraoral examination

revealed apparent mandibular

retrognathia. Hyperdivergent profile

and acute nasolabial angle was

found. In the intra-oral examination,

dental crowding and deep curve of

Spee, which indicated large space

deficiency. She was treated by

orthodontic treatment combined

orthognathic surgery. Four bicuspid

ex t rac t ion was done to leve l

and align the teeth without too

much incisor flaring effect which

may worsening her nasolabial

angle. Later Bilateral sagittal split

osteotomy (BSSO) mandibular

advancement combined genioplasty

was done to improve her chin

projection. Patient exhibited good

profile and smile after treatment.

In post operation one-year follow

up, now obvious skeletal change

suggested good stability of this

treatment.

本病例為一下顎後縮之骨性二

級患者，並合併有齒列擁擠的問題；

治療上以正顎手術合併下頷骨整形術

取代傳統代償性齒顎矯正治療。術式

為雙側矢狀劈開使下顎前移，並以迷

你骨板固定。術後患者顏面外觀得到

良好改善並且咬合功能較術前理想。

並且由於堅性內固定術技術之進步使

76

得手術後的穩定性大符增加，在矯正

後仍維持良好的顎間關係。

No. 05

Gingival Graft Surgery and Orthodontic Correction of Anterior Crossbite in an Adult Class III Malocclusion三級咬合異常成人病例的前牙錯咬矯正與牙齦移植術

Shu-Yin Chao (趙書瑩), Kuan-

Yen Peng (彭冠諺), Min-Chih

Hung (洪銘志), Yi-Jane Chen

(陳羿貞)




成人矯正治療前，牙周狀況的

檢查是極為重要的項目，例如牙周囊

袋深度、牙齒搖動度、牙齦萎縮程度

等等。其中牙齦萎縮之可能原因包

括：反覆的牙周組織發炎、牙周組織

太薄、牙齒排列異常、不當的潔牙方

式、年齡增長。牙齦萎縮的治療首先

應教導患者正確的潔牙方式，再考

慮是否須進行牙齦移植術（gingival

graft surgery）。矯正牙齒移動可能

會加重或減緩牙齦萎縮狀況，例如牙

齒向唇側移動往往會造成唇側牙齦萎

縮問題更趨嚴重；因此事先預測矯正

治療中牙齒移動的方向，將有助於決

定牙齦手術的最佳時機。依各種病例

的不同需要，牙齦移植術可能在牙齒

矯正治療前、治療中或治療後進行。

本病例報告患者為一位40歲男

性，主訴為前牙錯咬，臨床檢查發現

病人側貌為輕微凹形臉，下顎平面角

較小，下臉部較短。口內檢查發現輕

微齒列擁擠的情形（上顎空間不足

4mm、下顎不足2mm），垂直覆咬

6mm、水平覆咬-3mm，正門牙為錯

咬，臼齒為安格式三級咬合關係，下

正門牙的唇側牙齦嚴重萎縮。因考量

牙周狀況故治療計劃為在矯正治療前

於下正門牙先進行牙齦移植術，改善

牙周狀況；再進行上顎齒列矯正治

療，經過九個月，下顎門牙區牙周狀

態穩定後，才開始下顎的齒列矯正治

療；藉由將上顎門牙向唇側傾斜來改

善前牙錯咬。治療後門牙咬合關係達

到理想的水平及垂直覆咬，下門牙牙

周狀況在矯正治療中及治療後都維持

良好。

No. 06

Nonsurgical Treatment of Skeletal Class II Malocclusion with Anterior Open Bite Resulted from Temporomandibular Joint Osteoarthiritis以非手術方法治療骨性二級咬合異常合併前牙開咬及顳顎關節炎病例

Hsuan-Yi Hsiao (蕭琁憶), Yuan-

Yi Tung (童元釔), Joung-Lin

Liaw (廖炯琳), Yunn-Jy Chen

(陳韻之), Jane Chung-Chen

Yao (姚宗珍)




治療骨性二級咬合異常合併前

牙開咬的病例，可以考慮以正顎手

術方式處理，但若想單純以齒列矯

正方式治療，藉由臼齒壓入（molar

i n t rus ion），減少後牙齒槽高度

（posterior dental height），來解

決前牙開咬問題，依照傳統非手術

矯正治療方式，是很難達成的。並

且許多前牙開咬病人，還合併有顳

顎關節問題（temporomandibular

disorder），更增添了矯正治療的複

雜度及難度。

本病例報告的患者是一位2 3

歲年輕女性，被診斷患有顳顎關

節炎（ temporomandibular joint

osteoarthiritis），主訴為前牙開咬。

臨床口外檢查發現，患者無明顯顏面

不對稱，顏面部下三分之一較長，上

顎門牙中線無偏移，側面觀下巴明顯

後縮、鼻唇角大於90°；口內觀可以發現，水平覆咬6 mm，垂直覆咬

- 3 mm，上下顎齒列輕微擁擠，上

下門齒角度有齒性代償情形。根據臨

床檢查及測顱分析，診斷為骨性二級

咬合異常合併下顎後縮，安格氏二級

咬合異常合併前牙開咬。因病人拒絕

正顎手術治療方式，因此治療計畫為

拔除上顎第一小臼齒，配合使用上顎

頰側迷你骨板，顎側迷你骨釘，以保

守性治療進行上顎後牙壓入，改善前

牙開咬，並進行上顎前牙後退，改善

過大的水平覆咬。患者歷經兩年一個

月的矯正治療，成功改善咬合關係、

咀嚼功能，並增進顏面美觀。在矯正

治療完成後，病人持續回診追蹤。於

第四個月回診時發現，水平覆咬及垂

直覆咬皆有輕微變化，伴隨顳顎關節

及咬肌酸痛現象，在症狀治療後，目

前仍持續追蹤中。

本報告將對如何利用骨性錨定裝

置--非手術方式，治療二級咬合異常

合併前牙開咬病例，及其治療後穩定

度做一探討。

77

No. 07

Traditional Orthodontic Treatment of an Adult Skeletal Class III Malocclusion with Anterior Crossbite前牙錯咬骨性三級異常咬合成年病例之傳統矯正治療

John Siu-Lung Tse (謝兆隆),

Chih Liang Ho (何志良), Yi-

Jane Chen (陳羿貞)




前牙錯咬伴隨骨性三級異常的

病患，造成原因可能是由於上顎生長

不足或下顎生長過度、或兩者同時兼

俱。在外觀上常會出現中臉部後縮或

下巴前突的側面輪廓；口內則常見有

上下前牙錯咬、前牙角度出現代償特

徵，導致病人在咬合功能與顏面美觀

上的缺陷。成年患者前牙錯咬的治療

主要是依病患的主訴為首要考量，治

療前須分析其骨性差異之嚴重程度以

訂定適合的治療計劃，程度輕微及尚

未有太多齒性代償情況者，可採用非

手術性的傳統齒顎矯正方式治療，若

前牙錯咬伴隨存在著咬合干擾及下顎

功能性偏移者，在治療上的效果通常

較好；但骨骼性差異大，且出現大幅

度齒性代償情形時應採用正顎手術合

併傳統齒顎矯正方式治療。本病例報

告的患者主訴是牙齒排列不整。臨床

檢查顯示其側面觀有下顎稍為前突的

情形，但鼻唇角接近直角，沒有嘴

唇不易閉緊或微笑時笑齦的情形，

上下唇在美觀線E-line之內；同時發

現大約1 mm的CO-CR偏差。口內檢

查發現上齒列空間不足4.0 mm，下

齒列空隙1.0 mm，前牙為-1.5 m錯

咬，垂直覆咬為6.0 mm，雙側犬齒

與第一大臼齒皆呈現安格式一級咬

合關係。在側顱分析中得知：ANB

為-2.5°、SN-FH為6.5°、SN-MP

為27°，U1-SN為89.5°、L1-MP

為80°、U1-L1為163°、U1-NP為

-3 mm，可知上下顎前牙角度較往舌

側傾斜、內倒，而下顎前牙出現輕微

代償性的現象。本病例採取不拔牙的

傳統矯正治療方式，在上顎後牙放上

玻璃離子材料將咬合墊高，將深咬打

開以便使上顎前牙往外推、下顎前牙

做下壓與後拉。藉著改變上下前牙的

角度、降低二者之間的夾角而改正前

牙錯咬，同時增進上下齒列橫向寬度

之協調性，以建立良好穩定的咬合接

觸，本報告將特別著重討論病例診斷

及治療過程中的生物機械力學考量。

No. 08

Molar Body Movement with Mini-Implant - Case Report利用迷你植體進行大臼齒之整體移動 - 病例報告

Shiau-Lee Liew (劉曉麗), Yi-

Jyun Chen (陳易駿), Chia-Tze

Kao (高嘉澤)

中山醫學大學附設醫院齒顎矯正科

臨床上，喪失第一大臼齒的病

例，傳統矯正治療不容易將第二大臼

齒往近心做整體移動，因此常面臨錨

定不足的問題。而對於顏面不對稱，

下顎中線偏移的骨性第三類咬合不正

病例，會增加治療的困難程度。

患者為17歲的女性，主訴為臉

部不對稱及覺得臉太長。臨床上檢查

發現她的外觀呈現直臉型，人中有疤

痕，下顎前突，下巴往左偏移；口內

檢查發現相對於上顎中線，下顎中

線往左側偏移約4mm，#16有很大的

銀粉填補物，#36缺失，#34#35之

間有空隙，前牙呈現反咬的咬合情

形，水平覆蓋約-4mm，垂直覆蓋約

-2mm，臼齒及犬齒都是安格式三級

咬合關係。診斷為骨性下顎前突，安

格式第三級咬合不正。

治療計畫為拔除#14，#24，

#16，使用固定矯正裝置，利用迷你

植體將#37近心移動後，進行正顎手

術改善下顎前突問題。治療結果，患

者臉部不對稱與上下顎中線偏移問題

大幅改善，下顎骨經手術成功後縮

11.5mm，前牙水平與垂直覆蓋恢復

正常值，#37整體近心移動取代#36

以減少患者在術後贗復的治療。

No. 09

Treatment of Angle's Class II div. 1 by Fix Appliances Combined with Mini-Implant合併迷你植體以固定矯正器治療安格氏第二類第一型態不正咬合

Hsu YingChi Hsu (許瑛祺),

Chia-Tze Kao (高嘉澤)

中山醫學大學附設醫院牙科部齒顎矯

正科

針對齒性上顎前突之咬合不正，

傳統式治療常輔以其他錨定如TPA或

是Headgear，往往會存在有其上顎

前牙後退量不足的不穩定性以及可能

78

會延長治療時間等不可預測性。本病

例為探討以迷你植體輔助治療安格氏

第二類第一分類咬合不正患者，女性

X歲病人主訴為暴牙以及齒列擁擠，

希望盡速改善。經矯正初次檢查發現

其上顎門齒前突（Overjet）嚴重達

12mm，下顎齒列擁擠，中度深咬，

治療計畫為拔除雙側上顎第一小臼齒

並輔以迷你植體（最強錨定），利用

滑動機制（Sliding mechanism）將

上顎前牙後縮，治療結果為上顎前牙

成功向後向上移動，大幅改善咬合關

係與外觀，治療時間總共花費90週。

No. 10

Orthodontic Compensatory Correction of a Class III Malocclusion in Patient with a Rapid Palatal Expander (RPE) and Protraction Face Mask and Mini-Implant - A Case Report以上顎快速擴張器及面弓和迷你植體代償性矯正治療第三類骨性異常咬合之病例報告

Yun-Ting Chen (陳筠婷), Chia-

Tze Kao (高嘉澤), Hoi-Shing

Luk (陸開盛)

中山醫學大學附設醫院牙科部、中山

醫學大學牙醫學系

病例報告為一位11歲六個月

的男性，伴隨骨性三級異常咬合

（Class III skeletal malocclusion）

和上頜牙弓長度不足的病例報告。計

畫以不拔牙及非手術方法來治療。第

三類異常咬合的矯正以快速顎擴張器

（Rapid palatal expander）和上頜

前方牽引面弓（Maxillary protraction

facial-mask）將上頜向前方牽引刺

激生長以增加上頜牙弓長度，並利用

迷你植體（mini-implant）作為下顎

錨定將牙齒往後退，進而達到安格

式 I級咬合功能和改進的骨骼關係。

結論：於適當時機使用快速顎擴張器

（Rapid palatal expander）和上頜

前方牽引面弓（Maxillary protraction

facial-mask）可有效的刺激顎骨生

長，合併使用迷你植體於下顎，可進

而改善上下顎骨及咬合關係。

No. 11

混合牙列期之不拔牙病例報告

Hui-Lan Chang (張慧蘭)

普愛牙齒顎矯正牙科診所

我們分析12個病例年齡分別為

8到11歲的混合齒列期，以不拔牙的

方試成功的完成了矯正治療。分為

Class II病例，使用E's space，HG，

Elastics，removable appliance和

fixed appliance並加上顎骨發育以達

成理想治療結果。另外Class III病例

除了使用E's space外，再加上RPE

或removable appliance和 elastics來

配合治療，最後以fixed appliance來

完成治療，均能達成理想結果。

這12個病例顯示早期治療不管

使用何種矯正裝置，均可縮短fixed

appliance的治療時間。並且一些需

拔牙病例在早期治療下可以不用拔

牙。mandible生長對class II的病例

尤其有很大的幫助，不管在profile或

咬合上都有很大的進步。

12個病例在長期觀察4-8年甚至

20年下，除class III 臉型外觀跟著

生長發育外，但咬合均能達到理想

class I關係，且這種好的上下牙弓間

咬合關係甚至可以抑制下顎牙床過

度生長將咬合控制到成年後。在研

究中發現上前牙與NA距離和下前牙

與NB距離均能在早期治療中達到標

準。且12個病例在長期觀察下均無

復發，咬合也沒有往太多不好的方向

生長。證明早期治療是不拔牙及穩定

性高的一個重要因素。

No. *

Initial Cleft Severity Is Related to Maxillary Growth in Patients with Complete Unilateral Cleft Lip and Palate陳坤智教授獎學金得獎論文

Yu-Ting Chiu (邱鈺婷)1, Yu-

Fang Liao2, Philip KT Chen3

Craniofacial Center, Chang Gung

Memorial Hospital, Taipei, Taiwan

and College of Medicine, Chang

Gung University, Taoyuan,Taiwan

An Attending Staff in Craniofacial

Orthodontic Department1

Assistant Professor in Craniofacial

Orthodontic Department2

Associate Professor and Chief of

Craniofacial Center3

Background and PurposeInit ial cleft severity in patients

with complete unilateral cleft lip

and palate (UCLP) varies. This is

reflected in the sizes of the cleft

79

and the palate. The purpose of this

retrospective study was to establish

whether a relat ionship existed

between the cleft severity at birth

and the growth of the maxilla.

MethodsMaxillary dental casts of 29 infants

wi th non-syndromic complete

UCLP were used to measure the

sizes of the cleft and the palate.

The later growth of the maxilla was

determined using cephalometric

r ad iog raphs t aken a t age 9 .

Statistical analysis was performed

using multiple linear regression.

ResultsThe results showed a relationship

between the cleft area and the

maxil lary protrusion (SNA, p <

0.05). Also, there was a relationship

between the palate area and the

maxillary width (J-J`, p < 0.05).

ConclusionsThese data suggest that in patients

with complete UCLP there is a

significant relationship between the

initial cleft severity and the maxillary

growth. Patients with a small cleft

area have a more protruded maxilla

than those with a large cleft area.

Patients with a large palate area

have a wider maxilla than those with

a small palate area.

No. *

Changes in the Morphology of Mandibular Symphysis Secondary to Pre-Surgical Dental Decompensation in Class III Malocclusion本會雜誌「九十八年度研究論文類最佳論文獎」

Yu-Ching Wang (王聿靖),

I-Ming Tsai, Hui-Ling Chen

Department of Orthodontics, Chang

Gung Memorial Hospital, Taiwan

The purpose of this study is to

evaluate the changes in morphology

of mandibular symphysis in Class

III malocclusion after pre-surgical

dental decompensation. Thirteen

patients underwent orthognathic

surgery to correct Class III skeletal

and dental malocclusions. The

d e n t a l d e c o m p e n s a t i o n w a s

indicated for these patients to gain

greater setback amount of bilateral

sagittal split ramus osteotomy. The

morphology was assessed through

lateral cephalograms obtained

initially and preoperatively. After pre-

surgical dental decompensation,

the sagittal discrepancies were

maintained. There was statistically

significant lower incisor proclination,

and both the FMIA and IMPA

approximated the norms. When the

mandibular incisors were labially

inclined, the thinner cancellous

bone was characterized by the

decreased width between B to B’

point. The symphyseal height and

total height were greater after dental

decompensation due to orthodontic

tooth movement affect ing the

position of the alveolar landmark

such as malv point (midpoint of

anterior alveolus). Therefore, we

must pay attention to the boundary

l i m i t f o r t o o t h m o v e m e n t i n

presurgical dental decompensation

for subjects with lingual inclination

of the mandibular incisors and the

thin cancellous bone.

本研究的目的是以測顱X光片分

析安格列氏三級咬合的病患在術前

矯正治療後，其下顎骨聯合的形態變

化。有13位要接受正顎手術的三級

咬合病患，為使下顎經雙側矢狀劈開

術能獲得更大的後退量，必須先以矯

正治療改善下顎門牙角度。經由治療

開始前及術前測顱X光片的比較可以

得知：術前矯正將下顎門牙向唇側傾

斜，使其與下顎骨的角度趨於正常，

此移動會使下顎骨聯合的B點寬度變

窄、骨聯合高度及骨聯合總體高度增

加。因此在進行術前矯正時，需注意

下顎骨聯合的厚度與下顎門牙的移動

量，避免將牙齒移動到齒槽骨之外。

80

Research Group

No. 01

An Animal Study of Applying Amniotic Membrane Matrix for Root Coverage Surgery應用人類羊膜輔助牙根覆蓋之動物實驗模式研究

Kuan-Yen Peng (彭冠諺), Man-

Ching Cheng (鄭曼菁), Hao-

Hueng Chang (章浩宏), Jane

Chung-Chen Yao (姚宗珍), Yi-

Jane Chen (陳羿貞)

國立台灣大學醫學院附設醫院牙科部

齒顎矯正科、國立台灣大學牙醫專業

學院牙醫學系暨臨床牙醫學研究所

齒顎矯正裝置改善咬合不正的

治療過程中，有時可能對牙齒造成不

可逆的牙齦萎縮現象。嚴重牙齦萎縮

會引起不美觀及牙根敏感症狀，以牙

根覆蓋手術覆蓋暴露牙根是解決上述

問題的最佳選擇。羊膜為胎膜的最內

層，除了含有許多生長因子，細胞外

間質也含有大量膠原蛋白，因此羊膜

適用於做為細胞生長支架及傷口敷

料，且被證實可以加速傷口癒合。本

研究之目的為評估羊膜應用於牙根覆

蓋手術之可能性，特別是羊膜對於牙

周組織傷口癒合的影響以及是否具有

促進牙周組織再生的作用。本研究初

期實驗以三隻小獵犬的上下顎第三門

齒、上下顎第二、第三、第四小臼齒

及上顎第一小臼齒為實驗對象，在實

驗牙齒上切除部份牙周組織製造5毫

米之骨缺損及牙齦萎縮，一個月後進

行牙根覆蓋手術。進行牙根覆蓋手術

時，以實驗動物右側牙齒為實驗組，

在牙根覆蓋手術中多覆蓋一層羊膜；

而左側同名牙齒則為對照組，雖執行

牙根覆蓋手術但未放置羊膜。於牙根

覆蓋手術後的第三天、兩星期、一個

月、兩個月、六個月，將動物犧牲並

進行組織切片觀察。臨床評估項目包

括牙周囊袋深度、牙齦萎縮量及邊緣

牙齦發炎程度；組織切片形態分析及

量化則包括牙周組織再生情況、牙齦

覆蓋高度、上皮高度及厚度等等。

本研究結果發現：羊膜於傷口癒合初

期，具有降低發炎反應、增加牙根覆

蓋後傷口區域的血管數量等促進組織

癒合作用，且同時有利於牙齦邊緣的

表皮細胞往牙齒冠部方向移行生長。

雖然組織學形態觀察顯示羊膜具有促

進牙周組織癒合的潛力，實驗組的牙

周組織再生量、牙齦覆蓋量、上皮厚

度等組織形態測量值高於未貼附羊膜

的對照組，但二組之差異未達統計學

上顯著性。

No. 02

Effect of Cryoprotectant Equilibration Time and Contact Surface Area under Novel Magnetic Freezing Technology on Dental Pulp Tissue Cryopreservation磁性冷凍下冷凍保護劑浸泡時間與牙髓組織接觸面積對冷凍保存效益之影響

Benson Chao-Hsuan Sun (孫

釗炫), Vivian Wei-Chung Yang

(楊維中), Sean Sheng-Yang

Lee (李勝揚)

台北市立萬芳醫院齒顎矯正科

IntroductionCurrent tooth bank cryopreservation

protocol was f i rst designed to

preserve periodontal l igament

viabil ity for dental replantation

purpose. Recent technological

a d v a n c e m e n t h a s e n a b l e d

extraction of dental pulp stem cell

for application in regenerative

medicine. This advancement calls

for the importance of long term

denta l pu lp cryopreservat ion.

E ffec t ive c ryopreservat ion o f

denta l pu lp t i ssue is d i f f i cu l t

due to surrounding dental hard

tissue which makes ineffective

c r y o p r o t e c t a n t p e r m e a t i o n

and pro longed cryoprotectant

equilibration time. The aim of this

study was to determine the optimal

post-thaw dental pulp tissue viability

with/without magnetic freezing

after exposure to cryoprotectant at

different times (15, 30 or 60 min)

and at different concentrations (5 or

10%) of dimethyl sulfoxide (DMSO).

MethodEight weeks old Wistar rat incisors

are used as study subject. Rat

anterior incisor pulp chamber is

inherited with one opening end,

hence pulp non-exposed group

means one opening end and pulp

exposed group means no hard

t issue covering. Pulp exposed

groups and pulp non-exposed

groups are individually equilibrated

with respective「5% DMSO」or

「10% DMSO」cryoprotectant.

Equilibration times are 15, 30 or

60 minutes. After cryoprotectant

equilibration, temperature is lowered

81

by magnetic / nonmagnetic freezing

then stored in -150℃ freezer for

1wk. Post-thaw teeth / pulp are

examined by two methods: (1)

Histological structure analysis (H &

E) (2) Explant viability test.

ResultThis study has demonstrated the

effectiveness of using magnetic field

to promote vitrification, maintaining

post thaw pulp tissue morphology

and viability. Removing dental hard

tissue is an alternative mean for

improving pulp tissue viability. Under

magnetic field, using 5% DMSO

with 15 min equilibration time is

ideal cryopreservation condition for

dental pulp tissue preservation.

ConclusionThis study provides an improved

cryopreservation condition for dental

pulp tissue preservation.

No. 03

Bone Thickness of Infrazygomatic Crest and Buccal Shelf for Orthodontic Implant Placement顴下及頰棚矯正骨釘施打位置骨厚度之測量

Chia-Li Chen (陳佳立), Po-Jung

Chen (陳柏融), Sou-Hsin Kuang

(况守信), Jin-Jong Lin (林錦榮),

Yong-Kie Wong (黃穰基)

國立陽明大學牙醫學系碩士班齒顎矯

正組

目的

分析上顎顴下（infrazygomatic

crest）及下顎頰棚（buccal shelf）矯

正骨釘較常施打位置的骨厚度，以及

與周圍解剖構造的相關距離，並且尋

找安全的施打角度，以利臨床醫師施

打矯正骨釘時，有一個參考的藍圖。

實驗材料及方法

存取近藤悅子齒顎矯正診所2008

年之牙科電腦斷層（CB MercuRay,

Hitachi medical corporation, Tokyo,

Japan）影像資料，從中選取20~40

歲之成人病患並篩選符合納入條件之

資料，使用三維影像重建及測量軟體

（ImplantMax Version 4.0），進行影

像重組後，測量上顎顴下區域之頰

側骨厚度和矯正骨釘施打的骨深度，

並且測量最大安全角度；測量下顎頰

棚區域之頰側骨厚度、傾斜角度以及

最大安全角度；各測量區域皆分別測

量兩個高度，包括距離齒槽脊4mm和

6mm高度。

結果

顴下矯正骨釘施打之骨深

度，無論是距離齒槽脊4mm或6mm

高度，第二小臼齒與第一大臼齒間

顯著比其他區域厚（4mm高度：

8.1±2.2mm；6mm高度：6.6±2.1mm）；顴下區域矯正骨釘施

打位置頰側骨厚度，第二大臼齒近心

頰側處（4mm高度：3.6±1.0mm；

6mm高度：3.3±1.0mm）顯著大於

第一大臼齒近心頰側處；顴下區域

矯正骨釘施打最大安全角度，第二大

臼齒近心頰側顯著大於第一大臼齒近

心頰側，6mm高度處顯著大於4mm

高度處。

頰棚區域，頰側骨厚度之測量，

由第一大臼齒近心頰側處（4mm高

度：1.3±0.4mm；6mm高度：1.6

±0.7mm）至第二大臼齒遠心頰側

處（4mm高度：6.5±1.4mm；6mm

高度：7.3±1.5mm），逐漸增加；

頰棚之傾斜程度，第一大臼齒區域

（7.7±5.3°）顯著比第二大臼齒區域（38.2±10.9°）陡峭；頰棚區域

矯正骨釘施打最大安全角度，第二大

臼齒近心頰側顯著大於第一大臼齒近

心頰側，6mm高度處顯著大於4mm

高度處。

結論

施打矯正骨釘於上顎顴下區

域，建議放置於第二小臼齒與第一大

臼齒之間、第一與第二大臼齒之間或

第二大臼齒近心頰側處；施打矯正骨

釘於下顎頰棚區域，建議放置於第一

大臼齒遠心頰側至第二大臼齒近心頰

側區域。

No. 04

Biomechanical Comparison of Orthodontic Mini-Implant between with Single Thread and with Dual Thread- A Finite Element Analysis有限元素法比較單螺紋與雙螺紋矯正迷你植體之生物機械性質

Hao-Ming Chiu (邱浩銘)

台北榮總

研究目的評估單螺紋與雙螺紋矯正迷你植

體在不同骨條件下之骨應力及初級穩

定度。

研究材料與方法以有限元素法分析，在相同水平

施力、六組不同皮質骨與海綿骨厚度

的骨塊模型中，單螺紋與雙螺紋矯正

迷你植體之骨應力、接觸面滑動距離

與植體頂端水平位移。水平施力大小

為2牛頓；六組不同的骨塊模型包含

兩種皮質骨厚度，分別為0.5公厘、

1.5公厘；三種海綿骨厚度，分別為皮

82

質骨厚度之0、1/2、1倍。骨組織所

受之應力以平均等效應力（von Mises

stress）代表，植體之初級穩定度是

以植體與骨組織接觸面之滑動距離以

及植體頂端之水平位移量評估。

結果骨組織最大應力方面：最大值

97.60 MPa出現在皮質骨0.5公厘，沒

有海綿骨的狀況。在較差的皮質骨方

面（0.5公厘皮質骨）：單螺紋植體的

最大應力值較相同骨條件的雙螺紋植

體高（除0.5公厘皮質骨、0.5公厘海

綿骨這組以外）。在一般皮質骨方面

（1.5公厘皮質骨）：單螺紋植體的最

大應力值與雙螺紋植體的最大應力值

相差不大。不論是單螺紋植體或是雙

螺紋植體，0.5公厘皮質骨組別的最大

骨應力值都較相對應1.5公厘皮質骨組

別大，顯示皮質骨對骨應力有顯著的

降低。在較差的皮質骨之下，單螺紋

植體會因為海綿骨厚度的增加而減少

骨組織的最大應力，雙螺紋植體並不

會。在一般的皮質骨方面，單、雙螺

紋植體對於骨組織的應力都不會因海

綿骨的厚度增加而減少。

從骨表面應力值發現：近心側受

壓迫的骨組織應力值都較遠心側高。

單螺紋植體的圖形為單峰且應力高度

集中的情形，雙螺紋植體為雙峰且應

力較均勻分布的情形。切面骨組織應

力分佈發現：單螺紋植體遠心側的骨

組織應力會過度集中於皮質骨下表

面，雙螺紋植體遠心側的骨組織應力

值上下表面的分佈較均勻。

植體的滑動距離方面：最大

值，37.82μm，出現在皮質骨0.5公

厘，沒有海綿骨的情形。在較差的皮

質骨狀況：單螺紋植體的滑動距離

（37.82μm）較相同骨條件的雙螺

紋植體（1.99μm）高。在一般皮質

骨之下：單、雙螺紋植體的滑動距離

相差不大。不論是單螺紋或是雙螺紋

植體，皮質骨對滑動距離有顯著的降

低。在較差的皮質骨方面，單螺紋植

體會因為海綿骨厚度的增加而減少滑

動距離，而雙螺紋植體並不會。在一

般的皮質骨方面，單、雙螺紋植體植

體都不會因為海綿骨厚度的增加而減

少滑動距離。

在植體的頂端水平位移方面：

最大值，181.84μm，出現在皮質骨

0.5公厘，沒有海綿骨的情形。在較

差的皮質骨之下：單螺紋植體的頂端

水平位移（181.84μm）較相同骨條

件的雙螺紋植體（70.07μm）高。

在一般的皮質骨之下：單螺紋植體的

頂端水平位移與雙螺紋植體的位移相

差不大。不論是單螺紋植體或是雙螺

紋植體，皮質骨對頂端水平位移有顯

著的降低。在較差的皮質骨，單螺紋

植體會因為海綿骨厚度的增加而減少

頂端水平位移，而雙螺紋植體並不

會。在一般的皮質骨方面，單、雙螺

紋植體都不會因海綿骨的厚度增加減

少頂端水平位移。

討論在0.5公厘皮質骨條件之下，雙

螺紋矯正迷你植體可以將水平施力轉

移到遠離受力方向的骨組織上，骨組

織所受最大應力較單螺紋植體低並且

使骨組織應力分佈較均勻。在1.5公厘

皮質骨條件之下，雙螺紋矯正迷你植

體與單螺紋矯正迷你植體的應力差距

不大。皮質骨的影響方面，皮質骨的

厚度對於兩種植體的骨組織應力皆有

顯著的降低。在海綿骨的影響方面，

單螺紋植體在0.5公厘的皮質骨之下，

海綿骨厚度的增加會明顯減少骨組織

的應力。但是雙螺紋植體在0.5公厘的

皮質骨之下，海綿骨厚度的增加並不

會明顯減少骨組織的應力。不論是單

螺紋植體或是雙螺紋植體，在1.5公厘

的皮質骨之下，海綿骨厚度的增加不

會影響骨組織的應力。

接觸面的滑動距離與植體頂端水

平位移是評估立即受力植體初級穩定

度的目標參數。其結果與骨組織應力

分析的結果一致。顯示雙螺紋植體的

初級穩定度不論是由骨組織應力及初

級穩定度來看都是較理想的。

結論在骨條件較差的區域：上顎竇部

分或是拔牙區域，可以使用雙螺紋矯

正迷你植體以降低骨組織最大應力以

及增加植體之初級穩定性。在一般骨

條件區域，單螺紋植體與雙螺紋植體

的骨組織最大應力以及植體之初級穩

定度沒有顯著差異。

No. 05

The Effects of Bonding Position for Impacted Dilacerated Incisor: FEA以有限元素分析法解析黏著位置對阻生彎曲門齒之療效

Chuan-Yang Chang (張川陽)1,3,

Bo-I Chuang (莊柏逸)2, Lin-

Ching Chiu (邱琳晶)3, Yen-Nien

Chen (陳彥年)3, Hsiu-Ming Hsu

(許修銘)1, Jia-Kuang Liu (劉佳

觀)1, Chih-Han Chang (張志涵)3

成大醫院口腔醫學部1、國立成功大

學資訊工程研究所2、國立成功大學

醫學工程研究所3

由於上顎門齒對美觀的影響相

當大，一旦換牙時間過久，父母與孩

童皆易察覺而尋求治療，根據文獻指

出，上顎正中門齒則為頰側阻生牙中

發生率第二高。依據阻生牙本身狀況

之不同，臨床上會有不同的治療方

式，包括：拔牙、矯正治療、手術治

療或手術暴露合併矯正牽引皆是可能

的治療計畫。對於高位阻生的牙根彎

曲門牙的治療方式，則未有定論，如

果選擇手術暴露合併矯正牽引方式來

保留牙齒，則二階段手術是臨床常採

用的治療方式。成大醫院矯正科於多

年前，觀察到不同之矯正器黏著位置

可以得到不同的臨床效果。本研究

採用有限元素分析法來研究不同黏

著位置對牙齒之生物力學影響。依

據研究結果顯示，新的黏著位不論

在治療初期或治療中期，皆能夠產

生較大的牙冠切緣位移（0.002879

mm / 0.0020325 mm治療初期；

0.0028794 mm / 0.0018872 mm治

療中期）。綜合研究結果與臨床觀

察，新的黏著位置確實能夠得到良好

的臨床療效，是治療此類患者可採行

的治療方式。83

Research Group

No. 01

Cephalometric Craniofacial Characteristics with Different Types of Tooth Missing in Patients with Unilateral Cleft Lip and Palate不同類型先天性缺牙之單側唇裂患者其側顱型態之特性

Ting-Ting Wu (吳婷婷)1,3, Ellen

Wen-Ching Ko (柯雯青)1,3, Lun-

Jou Lo (羅綸洲)2, Chiung-Shing

Huang (黃炯興)1,3

Department of Craniofacial

Orthodontics, Chang Gung

Memorial Hospital at Taipei1;

Department of Plastic and

Reconstructive Surgery, Craniofacial

Center, Chang Gung Memorial

Hospital at Linkou, Chang Gung

University College of Medicine,

Taoyuan, Taiwan2;

Graduate Institute of Craniofacial

and Oral Science; College of

Medicine, Chang Gung University,

Taoyuan, Taiwan3

Background and PurposePatients with cleft have a markedly

higher frequency of congenital

missing permanent teeth when

c o m p a r e d w i t h t h e n o r m a l

population. The association of the

missing teeth and cleft were not only

the approximate anatomic position

and timing of facial development,

but also the genetic factors.

The a im of th is re t rospect ive

investigation was to determine

whether a corre lat ion ex is ted

between the different types of

tooth missing and the craniofacial

characteristics in patients with

unilateral cleft lip and palate.

MethodConsecutive patients with non-

syndromic unilateral cleft lip and

palate born between 1994 and 1995

were enrolled in the study. All of

the patients were treated with the

same protocol in the same hospital.

The patients were divided into the

following four groups according

to different type of tooth missing:

A group that is no missing teeth,

a group missing one maxil lary

lateral incisor, a group that missing

one maxillary lateral incisor and

one maxillary second premolar

or missing two maxillary lateral

incisors, and one that missing two

maxillary lateral incisors and one

second maxillary premolar. Lateral

and posteroanterior cephalograms

o f a l l pa t ien ts a t age 9 were

analyzed by using 15 skeletal and

6 dentoalveolar measurements.

S imple l inear regress ion was

used to compare cephalometric

craniofacial characteristics in the

four groups.

ResultsSignificant findings were shorter upper

and total anterior facial height (p=0.02

and 0.007, respectively), decreased

mandibular plane angle (p<0.001),

increased SNB (p=0.019) with

increased number of missing teeth.

ConclusionsThe different type of tooth missing in

the maxilla in patients with unilateral

cleft lip and palate has the effect on

the vertical dimension in the anterior

facial height. When the number

of missing teeth increased, the

anterior facial height decreased and

the mandible rotated upward and

forward.

No. 02

Gingivoperiosteoplasty Outcome for Treatment of Alveolar Clefts in Patients with Unilateral Cleft Lip and Palate牙齦骨膜修補術於單側唇裂患者之治療結果：骨生成與牙周骨支持

Yi-Chin Wang (王依靜), Yu-

Fang Liao (廖郁芳), Kuo-Ting

TAO Outstanding Junior Doctor/Investigator Competition

84

Chen (陳國鼎)

Craniofacial Center, Chang Gung

Memorial Hospital, Taoyuan,

Taiwan; Chang Gung University,

Taoyuan, Taiwan

台北長庚紀念醫院顱顏齒顎矯正牙科

Background & PurposeThe role of gingivoperiosteoplasty

in closure of the alveolar cleft

remains controversial. The aim

of this study was to evaluate the

gingivoperiosteoplasty outcome

in terms of bone production and

periodontal bone support in patients

with unilateral cleft lip and palate.

MethodsIn th is prospect ive study, the

postoperative cone beam computed

tomographic (CBCT) scans of

22 children (mean age: 9.3±0.8

years) with complete unilateral

cleft lip and palate who underwent

gingivoperiosteoplasty at the time

of primary lip repair were analyzed.

Bone production within the alveolar

cleft and periodontal bone support

fo r c le f t -ad jacen t tee th were

analyzed.

ResultsFifteen children did not require

secondary alveolar bone grafting.

Bone volume was greater on the

palatal and coronal sides of the

alveolar cleft than the buccal and

nasal sides (p < 0.05). Periodontal

bone support for the cleft-adjacent

teeth was more on the coronal part

of their roots than the apical part (p

< 0.05).

ConclusionThe resu l t s sugges t tha t the

C B C T i m a g i n g s y s t e m i s

suitable for clinical assessment

o f g i n g i v o p e r i o s t e o p l a s t y .

Gingivoperiosteoplasty results in

bone of less quantity on the nasal

side of the alveolar cleft. Sixty-

eight percent of patients who have

undergone gingivoperiosteoplasty

avoid the need for secondary

alveolar bone grafting.

No. 03

Physiological Mechanisms of the Postoperative Accelerated Orthodontic Tooth Movement after Orthognathic Surgery正顎手術後齒列矯正加速現象之骨生理探討

Alice H.L. Shen (沈心嵐), Eric

Jein-Wein Liou (劉人文)

長庚醫院顱顏矯正牙科

PurposeClinically we have observed the

phenomenon of postoperatively

accelerated or thodont ic tooth

m o v e m e n t i n p a t i e n t s w h o

had orthognathic surgery. This

phenomenon lasts for a period

of 3 to 4 months. However the

underlying mechanisms of this

phenomenon have not been well

studied yet. The purpose of this

prospective cl inical pi lot study

was to study the postoperative

changes in bone physiology and

metabolism and the corresponding

responses in dentoalveolus such

as the changes of tooth mobility.

Materials and Methods: Twenty-

two consecutive adult patients who

had 2-jaw orthognathic surgery

were included in this study. The

serum alkaline phosphotase (ALP)

and C-terminal telopeptide of type I

collagen (ICTP), and the Periotest

tooth mobility of the maxillary and

mandibular incisors were examined

preoperat ively, and 1 week, 1

month, 2 months, 3 months, and

4 months postoperatively. The

data were analyzed statistically.

Results: Both of the tooth mobility

of the maxillary and mandibular

incisors and ICTP signif icantly

increased from 1 week to 3 months

postoperatively, and then decreased

to their preoperative level in the

4th month postoperatively. The

changes of the tooth mobility were

significantly in correspondence

with the changes of ICTP. The ALP

significantly increased from the first

to fourth month postoperatively, but

it was not significantly correlated

to the changes of tooth mobility.

Conclus ion: The or thognath ic

surgery triggers a 3 to 4 months

of higher osteoclastic activities

and metabol ic changes in the

dentoalveolus postoperatively,

which possibly accelerates the

postoperative orthodontic tooth

movement.

85

No. 04

Three-Dimensional Evaluation of Pharyngeal Airway after Bimaxillary Surgery for Skeletal Class III Deformities

Yuh-Jia Hsieh (謝育佳), Yu-

Fang Liao (廖郁芳)



Memorial Hospital, Taipei, Taiwan;

College of Medicine, Chang Gung

University, Taoyuan, Taiwan

長庚紀念醫院台北院區

ObjectiveThe purpose of this study was to use

cone-beam computed tomography

(CBCT) to examine the volumetric

changes in the pharyngeal airway

after bimaxillary surgery for skeletal

Class III deformities.

MethodsIn th is prospect ive study, the

pharyngeal airways of 40 adults

who underwent bimaxillary surgery

for skeletal Class III were assessed

on CBCT before surgery and

> 6 months after surgery. The

airway was segmented using a

semiautomatic region growing

method with a fixed Hounsfield

threshold value. Airway volumes

o f v e l o p h a r y n x , o r o p h a r y n x

and hypopharnx were analyzed

separately, as was the total airway

volume.

ResultThe airway volumes of velopharynx,

oropharynx and hypopharnx did not

change significantly after bimaxillary

surgery (p > 0.05), as did the total

airway volume (p > 0.05).

ConclusionsThis study suggests that although

the mandible moved backward after

bimaxillary surgery, physiologic

adaptation could occur to preserve

the airway capacity after sagittal

compression. CBCT was valuable

in determining the effects of jaw

surgery on pharyngeal airway

dimensions.

No. 05

Submucosal Injection of Platelet Rich Plasma Accelerates Orthodontic Tooth Alignment黏膜下注射富含血小板血漿加速矯正牙齒排列移動

Grace Ya-Ying Teng (鄧雅音),

Eric Jein-Wein Liou (劉人文)

長庚醫院顱顏齒顎矯正科

PurposeSubmucosal injection of platelet

r i ch p lasma (PRP) inc reases

the osteoclast numbers, activity,

and decreases the alveolar bone

density in rats. The purpose of

this clinical trial was to assess the

effects of submucosal injection

of PRP on the rate of orthodontic

tooth alignment. Methods: A total

of 41 patients who had maxillary

and mandibular anterior crowding

were included in this clinical study.

The control group consisting of 24

patients received no submucosal

injection of PRP, and the PRP group

consisting of 17 patients received

a single application of submucosal

injection of autogenous PRP in the

buccal and lingual mucosa of the

maxillary and mandibular anterior

teeth in the beginning of orthodontic

tooth alignment. The concentration

of PRP was 7~10 t imes of the

basel ine platelet count, and i t

was injected immediately after its

preparation. For each patient, the

irregularity index of the anterior

crowding and the treatment time

for solving the anterior crowding

by a sequence of NiTi wires until

a 17X25 TMA archwire could be

fully engaged were recorded. The

rate of tooth alignment between

the control and PRP groups was

then assessed by the change of

irregularity index per month and

analyzed by non-parametric statistic

analysis. Results: The change of

irregularity index per month in the

maxillary dentition was 2.54±1.16

mm/month in the control group

and was 3.85±2.71 mm/month

in the PRP group, and the PRP

group was significantly (p<0.01)

faster than the control group. In the

mandibular dentition, it was 2.00±1.37 mm/month in the control group

and 3.07±2.51 mm/ month in the

PRP group, and the PRP group was

significantly (p<0.05) faster than

the control group. Conclusion: The

submucosal injection of autogenous

PRP accelerates orthodontic tooth

alignment.

86

No. 06

Magnetic Cryopreservation on Mesenchymal Stem Cells Derived from Dental Pulp磁性冷凍對牙髓間葉幹細胞之冷凍保存研究

Guo-Wei Huang (黃國維),

Vivian Wei-Chung Yang (楊維

中), Sheng-Yang Lee (李勝揚)

台北市立萬芳醫院

A r e l i a b l e m e t h o d f o r t h e

c r y o p r e s e r v a t i o n o f h u m a n

mesenchymal stem cells (MSCs)

which are capable of self-renewal

and mult iple differentiations is

needed for regenerative medicine or

tissue engineering. A cryoprotectant

and a cooling system are required

for stem cell preservation. Very

rapid cooling enables vitrification

w h i c h i s t h e c r e a t i o n o f a n

amorphous glassy solid from a liquid

to avoid ice crystal formation which

may injure cells. However, high-

concentration of cryoprotectants

can be chemically toxic to cells. A

magnetic cryopreservation method

using a program freezer with a

magnetic field was established by

ABI corporation. This method has

been successfully used to preserve

human periodontal ligament cells

for teeth banking and tooth re-

implantation. The objective of this

study was to test whether this

program freezer can be used for the

cryopreservation of dental pulp stem

cells (DPSCs), an MSC population

exhibiting high proliferation rate and

multiple differentiation potentials.

In addition, we determined whether

this method can reduce the need for

a cryoprotectant and preserve the

characteristics and differentiation

ability of DPSCs. For this purpose,

we compared the post-thawed

v i ab i l i t y, seed ing e f f i c i ency,

proliferation rate, expression of

MSCs markers and differentiation

ability of human DPSCs subjected

to magnetic cryopreservation and

those subjected to conventional

slow-freezing. The post-thawed

viability, seeding efficiency, and

proliferation rate after magnetic

cryopreservation with a serum-

free cryopreservat ion medium

containing 3% dimethyl sulfoxide

were found to be superior to those

after conventional slow -freezing. In

addition, magnetic cryopreservation

preserved the abi l i ty of post-

thawed DPSCs to express MSC

markers and induce osteogenic and

adipogenic differentiations. Thus,

magnetic cryopreservation may be

a reliable and effective method for

the cryopreservation of DPSCs and

other MSCs.

No. 07

The Influence of Bracket Types, wire Alloys, and Different Oral Environment Condition on Frictional Resistance評估矯正托架型式、矯正線材質及不同口腔環境條件對摩擦阻力的影響

Chen-Jung Chang (張禎容),

Chuan-Yang Chang (張川陽),

Tzer-Min Lee (李澤民), Jia-

Kuang Liu (劉佳觀)

國立成功大學醫學院口腔醫學研究所

ObjectiveThe aim of this study is to assess

the frictional resistance generated

by various types of bracket, wire

alloys, and different amount of tooth

mal-alignment with a customized

experimental model in the dry and

wet states. Materials and methods:

We constructed a customized

model to assemble five brackets

and the bracket in the middle could

be displaced 5 mm gingivally in

order to simulate the clinical “high-

canine” situation. We tested three

types of bracket (conventional twin

bracket: omni-arch® with O-ring,

active self-ligation bracket: Clippy®

, and passive self-ligation bracket:

Damon 3MX® & Axis®), two types

of archwire material (0.014” A-NiTi

& 27℃ Copper-NiTi), and bracket

87

displacement in amount of 0 and 3

mm. Frictional tests were carried out

at room temperature in the dry and

wet ( artificial saliva ) states. The

surface characteristics of bracket

slot were examined with scanning

electron microscopy before and

after frictional test. Results: 1) The

frictional force was proportional to

the amount of tooth mal-alignment

in either dry or wet states. 2) In

0-mm tooth mal-alignment condition,

both passive self-ligation bracket

and active self-l igation bracket

exhibited very small to no frictional

force. However, in 3-mm tooth mal-

alignment condition, passive self-

l igat ion bracket showed lower

frictional force when compared

with active self-ligation bracket and

conventional bracket. 3) In dry state

and 3-mm tooth mal-alignment

c o n d i t i o n , 2 7℃ C o p p e r - N i Ti

archwires generated lower frictional

force than A-NiTi archwires when

coupled with self-ligation bracket.

4) The frictional resistance is higher

in the wet state than the dry state.

5) For SEM observation, the slot

angles of conventional brackets

showed wearing surfaces after

frictional test.

No. 08

Regulation of MMP-3 Promoter in Mouse Osteoblasts under Cyclic Compression Force Stimulation under Cyclic Compression Force Stimulation週期性機械力刺激對於MMP-3基因啟動子在老鼠骨母細胞內的調控

Shu-Chun Tsai (蔡淑珺), Hui-

Jen Tsai (蔡慧貞), Chu-Yin

Weng (翁竹音), Chih-Ching

Liao (廖志清), 曾國榮, Kang-

Yee Wang (王剛毅), Chun-Ting

Lu (呂俊霆), Chung-Chen Jane

Yao (姚宗珍)




Bone resorption in compression

area during orthodontic treatment

was found to be closely related

t o t h e e x p r e s s i o n o f m a t r i x

metalloproteinases-3 (MMP-3),

one of the members of matr ix

metalloproteinases family (MMPs).

Previously, we have found that

MMP-3 could be up-regulated by

mechanical compression in human

osteoblasts. In order to ver i fy

whether the gene response induced

by compression in human cells

will be recapitulated cross species

in mouse, 1% cyclic compression

force for 4, 8, 24 hours was applied

to mouse osteoblast-like MC3T3-E1

cells grown in a 3D collagen gel to

mimic the physiologic environment.

The results of real-time PCR of

MMP-3 gene express ion and

l uc i f e rase ac t i v i t y o f human

MMP-3 promoter showed MMP-3

expression changed in a t ime-

dependent manner. There was no

significant increase of MMP-3 unless

the duration of cyclic compression

force reached 24 hours. The dual

luciferase analysis was used to

identify possible signaling pathways

of MMP-3 promoter regulation. The

p38 inhibitor (SB203580) and PI3-K

inhibitor (LY 29400) were found to

down-regulate the activity of MMP-3

promoter. Thus we concluded that

MMP-3 gene expression in mouse

MC3T3-E1 cells was up-regulated

by 1%, 24 hours cyclic compression,

and so was the transfected human

MMP-3 promoter. And the p38和

PI3-K pathways possibly involved

for the mechanical st imulated

expression of MMP-3 promoter.

Therefore , the mechanism of

mechanical stimulation to induce

this degradation enzyme for bone

remodeling is preserved across

species. Further work can be pursuit

in animal studies to optimize the

condition for fastening the rate of

bone remodeling during orthodontic

treatment.

88

Clinical Group

No. 01

Correction of Class II Hyperdivergent Facial Pattern Using Temporary Anchorage Device利用骨性錨定有效治療骨性二級不正咬合合併高下顎平面角

Ya-Ting Wang (王亞婷), Hui-

Jen Tsai (蔡慧貞), Jenny Zwei-

Chieng Chang (張瑞青)


National Taiwan University Hospital,

Graduate Institute of Clinical

Dentistry, School of Dentistry,

National Taiwan University, Taipei,

Taiwan




The development of temporary

anchorage dev ice (TAD) has

marked the beginning of a new

era in orthodontic history. Tooth

movements such as poster ior

absolute intrusion and total arch

distalization are enabled with the

aid of TADs; while orthognathic-like

treatment effects may be achieved.

In this clinical report, a 30-year-old

female with generalized periodontitis

was diagnosed with skeletal Class II

(combined maxillary protrusion and

mandibular retrognathism) and high

mandibular plane angle (SN-MP＝46∘). She had a 10 mm overjet at

centric relation with a 4 mm CO-

CR discrepancy. Orthognathic

surgery was proposed for correction

of the skeletal discrepancy but

was rejected by the patient. Our

treatment plan thus shifted to a

non-surgical treatment plan which

included extraction of maxillary

lateral incisors and third molars with

bilateral bony anchorages installed

for anterior retraction and posterior

intrusion. The total treatment time

was 2 years and 3 months. Facial

esthet ics was much improved

with maxillary anterior retraction

and maxillary posterior intrusion

accompanied by a 4-degree of

mand ibu la r counterc lockwise

rotation. Ideal overjet and overbite

w e r e a c h i e v e d a n d C O - C R

discrepancy was eliminated. The

treatment effects and advantage

of TADs wil l be evaluated and

discussed in this report.

No. 02

Orthodontic Correction of Anterior Openbite in Skeletal Class II Malocclusion骨性二級咬合異常病例的前牙開咬矯正與追縱

Jiun-Hao Lin (林俊豪), Lien-

Chii Wang (王簾綺), Wen-Pei

Wong (汪文琲), I-Ling Hong (洪

義玲), Jane Chung-Chen Yao

(姚宗珍)




前牙開咬發生的原因很多，包含

了顳顎關節障礙、不良的口腔習慣、

顎骨垂直生長量過長等情形。對於患

者而言，前牙開咬除了影響發音，對

於患者的咀嚼功能和美觀更是一大困

擾。在矯正治療方面，除了戒除舌頭

的不良習慣之外，更需要針對病因配

合正確的矯正治療計畫，才能達到良

好及穩定的治療結果。

本病例報告患者為一位21歲女

性，主訴為前牙開咬及發音困難。臨

床檢查後發現患者屬於骨性二級咬

合，下平面角較大。口內檢查發現前

牙開咬，垂直覆咬為-6mm，臼齒為

安格式一級咬合關係。治療計畫為拔

除第一、二、四象限的第一小臼齒以

及關閉原有左下第一大臼齒缺牙空

間；並且在上下兩側後牙區域放置骨

釘及骨板以進行後牙臼齒壓入以改善

前牙開咬問題。治療後達到理想的水

平及垂直覆咬，咬合狀況在治療後和

後續追蹤都維持良好。發音問題上由

復健科診治，接受語言治療後情況已

有改善。

No. 03

Treatment of Bilateral Impacted Maxillary Canine with Unilateral Transposition of Lateral Incisor and Canine- A Case Report兩側犬齒阻生合併單側側門牙與犬齒錯位之病例報告

Pi-Huei Liu (劉必慧), Cheng-

Tsung Huang (黃丞聰), Chih-

Ching Liao (廖志清), Stella

Ya-Hui Yang (楊雅惠), Jenny

89

Zwei-Chieng Chang (張瑞青),

Eddie Hsiang-Hua Lai (賴向華)




牙齒錯位是指兩個相鄰的牙齒

發生位置互換的情況，而牙齒錯的常

發生在上顎犬齒的位置。臨床上如果

要把錯位的牙齒移到原始的位置，需

要讓牙齒移動、卻又不影響到鄰牙，

因此是相當有挑戰性的，操作不慎則

有可能會傷到鄰牙或是周圍的支持組

織。

本病歷為一罕見上顎單側側門齒

與犬齒完全錯位之年輕女性，在經過

42個月的矯正治療中，利用了許多

的牽引裝置，小心的移動牙齒，使得

單側的側門齒與犬齒完全錯位得以改

正，且在治療完成後一年之追蹤仍維

持良好之咬合關係。

治療完全錯位牙齒的方式有(1)

將牙齒維持在錯位之位置，(2)將牙

齒移動到原來的自然位置，(3)拔掉

單顆或兩顆錯位之牙齒，很多因素都

會影響到治療計畫的決定，重要的應

該要是在與病人溝通後，制定一個對

病人最有利的治療計畫。

No. 04

Orthodontic Treatment Combined with Two-Jaw Orthognathic Surgery for ClassⅢ Malocclusion - A Case Report矯正合併正顎手術治療第三級不正咬合之病例報告

Yi-Shiou Chen (陳怡秀), Lien-

Chi Wang (王簾綺), Chi-Ying

Huang (黃繼瑩), Yi-Jane Chen

(陳羿貞)




針對還有生長潛力之安格式第二

級異常咬合的病患，通常需要矯形合

併矯正來治療。本病例報告一位下顎

後縮的二級異常咬合患者，治療前手

骨分析顯示處於生長加速階段中期，

以全口固定式矯正器合併固定式功能

性矯正裝置，經過兩年多的治療，前

牙達成良好的水平覆咬及垂直覆咬，

並使後牙建立在穩定的齒列安格式一

級咬合，同時下顎後縮的臉型也獲得

改善。

No. 05

Combined Fronto-Facial Monobloc Distraction Osteogenesis and Orthognathic Surgery in a Patient with Crouzon Syndrome - A Case Report

Yi-Hsuan Chen (陳怡璇)1, Ellen

Wen-Ching Ko1, Philip Kuo-

Ting Chen2, Chiung Shing

Huang1


Craniofacial Dentistry1

Department of Cosmetic Surgery

and Craniofacial Center2

Chang Gung Memorial Hospital,

Taipei, Taiwan ROC

Crouzon syndrome f requent ly

a s s o c i a t e s w i t h s y n d r o m i c

craniosynostosis, which is a rare

craniofacial anomaly involving

p rematu re fus ion o f mu l t i p le

c ran ia l su tu res . Subsequen t

craniofacial skeletal discrepancy

and clinical orofacial features may

occur in the facial bone. These

particular orofacial features include

brachycephaly, hyperterlorism,

orbital protosis, hypoplastic maxilla,

and anterior crossbite. Patients with

Crouzon syndrome require multiple

reconstructive surgical maneuvers

at various stages of development.

In this case report of an 18-year-

old male patient with Crouzon

syndrome, complaining of poor

facial profile, eye protrusion and

bad occ lus ion due to severe

underdevelopment of midface. He

had not undergone through any

surgery before. After distraction

osteogenesis (DO), the frontal

bone and mid-face was advanced

forward: The supraorbital region

was advanced 15 mm forward; the

midface demonstrated a forward

advancement of 17 mm, 22 mm and

23 mm at Orbitale, anterior nasal

spine, and A point respectively.

The downward movement was

2~3 mm at the maxil lary level.

After consolidation of DO, he was

then treated by edgewise fixed

appliance combined with two-jaw

orthognathic surgery. Maxillary

LeFort I osteotomy was conducted

to correct occlusal plane canting,

and mandibular bilateral sagittal

split advancement and genioplasty

were performed to achieve proper

facial profile and dental occlusion.

After 26 months of treatment results

in an excellent correction of his

whole midface and mandible as well

90

as satisfactory dental occlusion.

Timing of suitable treatment options

to correct Crouzon syndrome will be

discussed in this report.

No. 06

Dental and Skeletal Correction of Möbius Syndrome - A Case ReportMöbius syndrome的病人做齒顎矯正的臨床病歷報告

Yea-Ling Yang (楊雅玲)1,

Eellen Wen-Ching Ko1, Yu-Ray

Chen2, Chiung Shing Huang1


Craniofacial Dentistry1

Department of Cosmetic Surgery

and Craniofacial Center2

台北長庚顱顏矯正科

IntroductionMöbius syndrome is defined as

combining congenital bi lateral

facial and abducens nerve palsies.

Continued clinical observations

led to the realization that such

concurrent cranial nerve VI and VII

palsies were also associated with

various craniofacial, cardiothoracic,

endocrinologic, and developmental

disorders.

It occurs in one of every 50,000

live births, and affects boys and

girls equally. Many patients have

a foreshortened upper l ip with

exposed incisors and experience

oral incompetence, poor articulation.

The clinical findings associated

with the bilateral facial nerve palsy

during infancy include incomplete

eye closure during sleep, drooling,

and difficulty sucking. With ensuing

development, a classic emotionless

"mask-like facies" is noticed, with

an inabil ity to produce a facial

expression.

Case reportA 26-year-old female presented

with Möbius syndrome. She came

to department of orthodont ics

in Taipei Chang Gung Memorial

Hospital, and complained of her

excessive exposure front teeth. She

had skeletal Class II malocclusion

with anterior open bite. Her chin

deviated to left side and lip closure

was incompetent. After evaluation,

she underwent orthognathic surgery

and orthodontic treatment. Surgical

techniques for correct ion her

skeletal problems included maxillary

LeFort I osteotomy impaction and

setback; bi lateral sagittal spl i t

osteotomies setback; genioplasty

advancement and reduction.

The two-year fo l low up a f te r

treatment indicated that the surgical

outcome and occlusion were stable.

DiscussionPatients with Möbius syndrome had

a hyperdivergent face, and a more

posterior positioned mandible with

a less prominent chin. The surgical-

orthodontic correction could only

solve the underlying skeleto-dental

disposition. Further, soft tissue

surgery and nerve graft would

be needed to restore the forward

movement of facial muscles.

No. 07

Treatment of Skeletal Class III with Anterior Open Bite through Skeletal Anchorage以骨性錨定治療骨性三級分類合併前牙開咬之病例報告

Steven Wang (王凱隆), Eric

Jein-Wein Liou (劉人文)

林口長庚醫院矯正科

BackgroundIntrusion of molars and upward

rotation of mandible with temporary

anchorage devices (TADs) is one

of the modalities in treating anterior

open bite. However, a Class III

anterior open bite could not be

treated only through intrusion of

molars due to the upward rotation

of mandible worsens the chin

prominence. Purpose: The purpose

of this case report is to report the

treatment strategy for Class III

anterior open bite by using TADs in

a 23 yeas old female patient. Case

report: The anterior open bite was

5 mm from the 2nd premolar to 2nd

premolar, the molar and canine

relationship was Class III, and the

ANB angle was -1°. After the initial

leveling and alignment, miniscrews

were inserted bilaterally in the

infrazygomatic crests of maxilla and

the buccal shelves of mandible for

the intrusion of maxillary molars

and en masse retraction-intrusion

91

of the entire mandibular dentition.

Although the anterior open bite was

improved after a few months of

treatment, the Class III facial profile

did not improve. The treatment

strategy was then changed to en

masse retraction-intrusion of the

entire mandibular dentition and

extrusion of the maxillary anterior

teeth by using a pair of extruding

lever arms for a downward and

backward rotation of mandible. The

anterior open bite was then further

improved, the buccal occlusion was

achieved in Class I, and the facial

profile was improved specially the

chin prominence. Conclusion: A

Class III anterior open bite could be

treated successfully by using TADs

in the mandible for the en masse

retraction-intrusion of the entire

mandibular dentition and extrusion

of the maxillary anterior teeth by

using a pair of extrusion lever arms

for preventing the upward and

forward rotation of mandible and

worsening of the chin prominence.

No. 08

Correction of Anterior Open Bite Malocclusion - A Case Report 矯治前牙開咬之病例報告

Yang Wei-Min (楊瑋民), Hui-

Ling Chen (陳慧玲)

林口長庚齒顎矯正科

Severe anterior open bite is a

d i f f icu l t problem to correct in

orthodontic treatment. In adults,

treatment of severe anterior open

bite consists mainly of surgically

repositioning the maxilla or the

mandible. A case report of a Class I

malocclusion with an anterior open

bite by extraction of four premolars

without surgery. The prognosis was

good and without relapse.

No. 09

The Use of Miniscrew, HPJH and Autotransplantation in a Class I Malocclusion以骨釘和頭帽治療一級咬合不正合併自體齒移植之病例報告

Yin-Tai Chen (陳英代), Yu-

Ching Wang (王聿靖)

林口長庚醫院矯正科

Autotransplantation can be defined

as the transplantation of embedded,

impacted or erupted teeth from

one site to another in the same

individual into extraction sites

or surgically prepared sockets.

Cost effectiveness is the obvious

advantage of this procedure which

enables the utilization of a tooth that

is non-functional to be transferred to

a functional position to replace a lost

tooth. This case report describes

the use of autotransplantation as

part of an orthodontic treatment

plan where there was loss of a

lower second molar tooth. A female

patient, age 27 years, complained

of the difficulty of lip closure was

diagnosed as Class I malocclusion

with bimaxillary protrusion and

diastema. Upper second premolars

and lower right second molar were

extracted due to extensive decay.

Two miniscrews were implanted

between upper first molars and

second premolars to retract the

upper anterior teeth. The J-hook

headgear was used to distalize

the lower arch. The upper left third

molar, which had restoration and

secondary caries, was transplanted

i n t o t h e s u r g i c a l l y p r e p a r e d

lower second molar socket. After

completion of root-canal treatment,

the transplanted third molar showed

normal periodontal healing with

absence of infection, ankylosis but

mild root resorption. The retraction

of upper arch and the distalization

of lower dentition, to correct the

patient's initial complaint of l ip

protrusion, was completed in 38

months. The transplanted tooth

remained functional throughout.

The transplantation of a third molar

is seen as a promising treatment

a l t e rna t i ve t o rep lace a l os t

permanent tooth, and to restore

aesthetics and function.

No. 10

Treatment of Anterior Crossbie with Upper Second Premolar Impactions - A Case Report前牙錯咬合併上顎第二小臼齒阻生之治療 - 病例報告

Chih-Yu Lin (林芝瑜), Li-Hsiang

92

Lin (林利香)

萬芳醫院牙科部齒顎矯正科、台北醫

學大學牙醫學系

臨床矯正治療上，當遇到患者有

前牙錯咬問題者，常伴隨有上下顎骨

骼前後方向的異常狀態。本病例報告

中，提出一前牙錯咬合併有上顎雙側

第二小臼齒阻生的個案，外觀上有下

顎前突的問題；經討論決定採取不拔

牙的治療計劃，藉由固定式矯正裝置

與配合口內顎間橡皮筋之運用，改善

咬合關係，並使得阻生小臼齒得以順

利萌發。治療後，齒列呈現良好一級

咬合關係；外觀上，下顎突出趨於正

常。本病例報告之治療方式，於處理

患者的前牙錯咬時，期能做為臨床醫

師之參考。

93

No. 01

Effects of Low Intensity Laser Therapy over Mini-Screw Success Rate

Aguinaldo Garcez

Center of Research and Post-

graduation SaoLeopoldo Mandic

The success rate of miniscrews

when used as temporary orthodontic

anchorage is relatively high, but

some factors could affect its clinical

success such as inf lammation

around the miniscrew. Low Intensity

Laser Therapy has been widely

used for biostimulation of tissue and

wound healing specially for its anti-

inflammatory effects. The purpose

of this study was to evaluate the

effect of low intensity laser therapy

over the miniscrew success rate.

Five Landrace's pigs received

50 mini-screws on buccal side in

mandible and on palate in maxilla.

All the miniscrews were immediately

loaded with 250 gf and the right

side were irradiated with a 780nm

diode laser with 70 mWs for 1

minute (Dose = 34 J/cm2) the left

side was used as control group.

The miniscrews were photographed

and analyzed clinically every week

to determine their stability and

presence of local inflammation.

After 3 weeks histological analysis

and fluorescent microscopy was

performed to compare the laser side

and the control side. The clinical

results showed a success rate of

60% for control group and 80% for

laser treated group. The histological

analysis and fluorescent microscopy

d e m o n s t r a te d t h a t t h e l a se r

group had less inflammatory cells

than control group and the bone

neoformation around mini-screw

was more intense. Low intensity

laser therapy increased the success

rate of orthodontic minicrews,

probably due to anti-inflammatory

effect and bone stimulation.

No. 02

Labial and Lingual Bracket with or without Miniscrew

Toru Deguhi１, Terao F１,

Sugawara Y2, Kataoka T2,

Yamashiro T2, Takano-

Yamamoto T1

Division of Orthodontics, Tohoku


Dentistry1

Department of Orthodontics

and Dentofacial Orthopedics,

Okayama University Graduate

School of Medicine, Dentistry and

Pharmaceutical Sciences2

IntroductionIn recent years, patients seeking

for orthodontic treatment have

been increasing, especially in adult

patients. In adult patients, aesthetic

factor is important when starting the

orthodontic treatment. Furthermore,

one of the problems in adult patients

is that they often do not like to wear

extraoral appliances and elastics

which is required in controlling

anchorage. Thus, the use of lingual

appliance for aesthetic reason and

the use of miniscrew for controlling

anchorage without the need of

patient cooperation may be the

solution for shortcoming of adult

cases. However, lingual appliance

has been known to often result in

increased vertical dimension (bite

plane effect), and/or decreased

axial inclination of maxillary incisors.

Therefore, in this study, we have

compared the orthodontic clinical

outcome between labial and lingual

appliance, and also between with or

without the use of the miniscrew in

extraction cases.

Materials & MethodsTotal of 48 cases (Labial without the

use of miniscrew: LaN, n=12, Labial

with the use of miniscrew: LaI, n=12,

Lingual without miniscrew: LiN,

n=12, Lingual with miniscrew: LiI,

n=12) with extraction of maxillary

and mandibular premolar extraction

cases were used. Cephalometric

analysis and occlusal indices (peer

assessment ra t ing: PAR, and

objective grading system: OGS)

were used to compare the clinical

outcome among groups.

ResultsNo s ign i f icant d i f ference was

observed in any of the analyzed

pre-treatment cephalometric and

WIOC Oral Presentations

94

occlusal indices among groups.

From the post-treatment analysis,

significantly decreased SN-U1 was

observed in LaI compared to LaN,

indicating more anterior retraction.

Significantly increased PP/U6 was

observed in LiN compared to LaI,

indicating extrusion of molars.

Furthermore, significantly decreased

PTM-U6/NF was observed in LaI

and Li I compared to LaN and

LiN, indicating the difference in

anchorage value depending on the

use of miniscrew. Significantly better

torque control and worse control

in root angulation was observed

in the lingual groups by the OGS

evaluation

ConclusionIn conclusion, different characteristics

of labial and lingual appliance was

indicated by the cephalometric

and occlusal evaluation, and these

features should be considered

during the orthodontic treatment.

No. 03

TADs for Total Arch Movement: Miniimplant vs. Miniplate

Jeong-Sub Lee

Department of Orthodontics, Wonju

Christian Hospital, Yonsei University

Miniscrew implant as TAD is being

a routine application in the modern

orthodontic office. However, the

failure rate is not negligible, and

the stability is not predictable. Inter-

radicular miniscrew implant in

itself could be an obstacle during

orthodontic treatment especially in

the progress of molar distalization

and protraction. On the other hand,

miniplate shows relatively high

success rate, less risk of damaging

t h e n e i g h b o r i n g a n a t o m i c a l

structures, no interference in the

progress o f too th movement .

H o w e v e r, f l a p s u r g e r i e s a r e

needed for insertion and removal

of miniplate, and accompanied by

discomforts of post-surgical swelling

and inflammations of soft tissue

around miniplates. The lecture will

illustrate how we select temporary

anchorage device and insertion site

for movement of whole dentition,

and present simplified miniplate

w i th c l in i ca l and h is to log ica l

examinations.

No. 04

En Masse Distalization with an iPanda

Eduardo Yugo Suzuki

Department of Orthodontics, Faculty

of Dentistry, Chiang Mai University

D is ta l i za t ion o f the max i l la ry

molars is an important treatment

option for the correction of Class

II malocclusions. Conventional

approaches to d is ta l iz ing the

maxillary molars include the use

of extra- or intra-oral devices.

However, the esthetic and social

c o n c e r n s o f h e a d g e a r w e a r

for molar distal ization and the

u n d e s i r a b l e a n c h o r a g e l o s s

with the use of intraoral molar

distalizing devices has stimulated

several investigators to evaluate

the possibility of using miniscrew

implants as anchorage devices.

To overcome such di ff icul t ies,

t he au tho rs have deve loped

a s i m p l i f i e d a n d i n n o v a t i v e

distalization appliance that allows

the effective use of midpalatal

miniscrew implants, the indirect

Palatal miniscrew Anchorage and

Distalization Appliance (iPanda).

The iPanda is easily connected to

and removed from the midpalatal

min iscrews and a l lows e i ther

maximum anchorage or distalization

of the maxillary molars, or both in

succession. Therefore, the purposes

of this study are to introduce the

clinical application of the newly

developed iPanda in a series of

treated patients and to describe the

dental and skeletal effects obtained

with this innovative technique.

No. 05

Dentoskeletal and Soft Tissue Treatment Effects of Two Different Methods for Treating Class II Malocclusions

Madhur Upadhyay


Sciences, School of Dental

Medicine, University of Connecticut

Objectives: Moderate to severe

Class II malocclusions can not

only cause esthetic and functional

problems but can also lead to

psychological problems of varying

intensity depending on the amount

95

of anterior-posterior discrepancy

and its interaction with the related

soft tissue structures. Although

there are severa l methods of

t r ea t i ng such ma locc l us i ons

(extractions,distalization,function

al appliances etc), the final goal

is always to provide acceptable

esthetics and stability. The purpose

of this clinical-cephalometric study

was to examine the dentoskeletal

and soft tissue treatment effects of

maxillary anterior teeth retraction

with mini-implant (MI) anchorage

in young adults having Class II

Division I malocclusion undergoing

extraction of only the maxillary

first premolars in comparison with

pat ients undergoing treatment

with a non-extraction approach i.e.

using a fixed functional appliance.

Methods: 35 patients (mean age

16.5±3.2 years,overjet ≥ 6mm)

were assigned to group 1(G1):

correction of overjet with MIs as

anchor units, or group 2 (G2): where

fixed functional appliances were

used. Dentoskeletal and soft tissue

changes were analyzed on lateral

cephalograms taken before and after

the correction of overjet. Statistical

analyses were performed using the

Student’s paired and unpaired‘t

tests.’ Kolmogorov-Smirnoff tests

and Q-Q plots were used to assess

the normality of the data Results:

A statistically significant increase

was noted in the facial vertical

dimensions in G2, but the variables

i n G1 showed no s ign i f i can t

differences (P>0.05). Extrusion and

mesialization of the lower molar was

noted in G2, whereas G1 showed

distalization (anchorage gain) and

intrusion of the upper molar. Facial

convexity angle, nasolabial angle,

and lip protrusion did not show any

significant differences. Conclusions:

Both the treatment approaches

provided adequate decompensation

o f t he ma locc lus ion bu t had

minimum effect on the skeletal

discrepancy. There was a dramatic

improvement in the facial esthetics

in both the groups however the

different treatment methods used

in the two groups did not yield any

significant soft tissue differences.

However the treatment time was

significantly less with fixed functional

appliances.

No. 06

Identifying Individuals with Higher Risk of Root Dehiscence during Mandibular Retraction Using TADs

Sabarinath V.P

Chang Gung Memorial Hospital

Objective – Temporary anchorage

devices (TADs) permit greater

amounts of anter ior retract ion

w i t h n o a n c h o r a g e l o s s ,

however ind iv idual var ia t ions

of root dehiscence exist on the

pressure side alveolar reactions.

U n f o r t u n a t e l y , o u r c u r r e n t

knowledge toward this individual

variation in response to orthodontic

force is limited. We hypothesized

that individual underlying bone

turnover reflects the severity of

l ingual root dehiscence during

anterior retraction. The purposes

of this pilot study were to examine

the changes in mandibular anterior

a lveolar bone wi th min iscrew

orthodontics and correlate the

changes with serum based markers

of bone turnover. Methodology –

Twelve adult dentoalveolar Class

III subjects with anterior cross bite

treated using miniscrew assisted

mandibular retraction were included

in the study. Serum levels of Alkaline

phosphatase (ALP), an enzyme

released during bone formation,

and carboxyterminal cross-linking

telopeptide of bone collagen (CTX),

a metabolite during bone resorption,

were obtained before treatment (T0).

Additionally CBCT images were

obtained at T0, immediately after

debonding (T1) and at least one

year post debonding (T2). Alveolar

bone thickness and the lingual

root dehiscence at T0, T1, and

T2 were measured at the middle

and apical thirds of the mandibular

incisors. The changes of alveolar

bone thickness and root dehiscence

at T0-T1 were correlated to the

serum levels of ALP and CTX at

T0 by partial correlation analysis

(p<0.05). Results –The alveolar

bone thickness remained largely

unchanged at the apical third, while

the thickness at the middle third

showed a significant decrease of

1.0 -1.5 mm after anterior retraction

(T0-T1). The changes of alveolar

thickness at the middle third showed

a significant inverse relationship

to the pre-treatment serum levels

of CTX (r = -0.896) and ALP (r =

- 0.686) respectively. The lingual

root dehiscence was 2.0-3.5 mm

at the apical and 3.0-4.0 mm at

the middle third respectively after

96

anterior retraction. The lingual root

dehiscence at middle third showed

a significant direct relationship to

CTX (r = 0.735) and inversely to

ALP (r = - 0. 778). The thickness at

the middle third showed significant

partial recovery of 0.7 – 0.9 mm

in the retention period (T1-T2).

Conclusions – Individual underlying

bone resorption/ formation activity

re f lec ts the sever i t y o f bone

thickness reduction and lingual

root dehiscence of the mandibular

anter ior alveolus dur ing TADs

assisted orthodontic treatment,

although the alveolar bone showed

partial improvement in the retention

phase.

No. 07

Severe Gummy Smile and Class II Correction by Using Miniscrews

Yi-Hung Shih (石伊弘), Johnny

Joung-Lin Liao

恆美牙醫診所

A 22- year-old female came to

our cl inic asking for help. She

hoped we can improve her facial

esthetics, including lip protrusion,

lip incompetence and gummy smile.

After thorough clinical evaluation,

she was diagnosed as a skeletal

class II, high angle, 100% deepbite,

maxillary protrusion and mandibular

retrusion case. Bilateral molar

relationships showed complete class

II. Besides, upper right 2nd premolar

missing caused upper dental midline

deviated to right 3mm. Her gummy

smile was due to overgrowth of

premaxilla. Furthermore altered

passive eruption caused short

clinical crowns and increased the

amount of gummy smile.

Extraction treatment plan combined

with the use of miniscrews was

indicated to correct her protrusion,

lip incompetence and crowding

relief. Two posterior miniscrews

were planed to achieve maximal

upper arch retraction and correct

class II molar relationship to class I.

Two anterior subapical miniscrews

were planed to correct gummy

smile and achieved bite opening.

Esthetic crown lengthening surgery

was suggested after completion of

orthodontic treatment to achieve

ideal crown proportions and esthetic

demand.

In this case, anterior subapical

miniscrews provided reliable and

stable anchorage for anter ior

i n t r us i on ; t he re fo re , we can

improve her 100% deepbite and

reduce gummy smile successfully.

However, upper posterior screws

f a i l e d s e v e r a l t i m e s d u r i n g

treatment, so we inserted another

m in isc rews in hard pa la te to

gain more reliable anchorage for

maxillary retraction and finally we

can finish the occlusion in class I

molar relationship. Upper posterior

min iscrews seems unre l iab le

depends on patient's bone quality.

Miniplates and palatal miniscrews

serve as alternatives of sources of

anchorage.

A f t e r 3 y e a r s a n d 1 m o n t h s

treatment, we improved patient’

s facial esthetics successfully,

especial the gummy smile and lip

protrusion. The patient reduced

het lip incompetence and got more

harmonious appearance in the end.

No. 08

Determined Features for a Satisfactory Facial Profile in Class III Camouflage Orthodontic Treatment with Miniscrew Anchorage

Emma Yuh-Jia Hsieh (謝育佳),

Eric Jein-Wein Liou


Craniofacial Dentistry, Chang Gung

Memorial Hospital, College of

Medicine, Chang Gung University,

Taoyuan, Taiwan

ObjectiveThis study aimed to study the

determined features in Class III

patients who would be beneficial

for a satisfactory facial profile after

camouflage orthodontic treatment

with miniscrew anchorage.

MethodsThis retrospective study consisted

of 20 Taiwanese adults with Class

III borderline malocclusion (13

female, 7 males) who underwent

orthodontic camouflage treatment

with miniscrew anchorage. For

each patient, standard photographs

o f l a t e r a l f a c i a l p r o f i l e a n d

cephalometric films were taken

be fo re and a f te r o r thodon t i c

treatment for soft tissue analyses.

The pat ients were judged and

divided into groups of satisfactory

or un-satisfactory facial profile by an

97

experienced panel of orthodontists

according to patient's post-treatment

facial profi le. Wilcoxon singed

rank test was used to examine the

treatment changes. Mann-Whitney U

test was used to compare the inter-

group post-treatment differences,

and logistic regression analysis was

used to determine the association

between the pretreatment facial

features and the post-treatment

facial profile.

ResultsThe Wilcoxon singed-rank test

showed the treatment significantly

increased the mentocervical angle,

nasolabial angle, Z angle, and

significantly decreased the facial

angle in all the patients. However,

these changes were not significantly

different between the groups of

satisfactory and un-satisfactory

facial profile. The logistic regression

analysis revealed the patients with

the soft tissue Pogonion locating

behind the subnasale perpendicular,

a greater pre-treatment facial

convexity (more than 3 degrees),

and a smaller labiomental angle

(less than 150 degrees) prior to

treatment significantly correlated to

a satisfactory facial profile after the

camouflage orthodontic treatment

with miniscrew anchorage.

ConclusionA Class III patient with features of

the soft tissue pognion locating

behind the subnasale perpendicular,

a greater facial convexity, and a

smaller labiomental angle would be

beneficial for a satisfactory facial

profile after camouflage orthodontic

treatment with miniscrew anchorage.

No. 09

Use of Miniscrew Anchorage to Enhance Efficiency of Scissors-Bite Correction

Ting-Ting Wu (吳婷婷)1, Wen-

Ching Ko2



Memorial Hospital at Taipei1



Memorial Hospital at Taipei2

Total buccal crossbites can be

ex t remely d i fficu l t to cor rec t ,

n o m a t t e r w i t h s u r g e r y a n d

orthodontics. In most pat ients

with in- locking crossbites, the

maxillary teeth erupt past their

mandibular antagonists, creating

severe occlusal difficulties. The

critical procedures for scissors-bite

correction are intruding and palatally

tipping the upper molar when it is

both extruded and buccally flared,

and buccally uprighting the lower

molar when it is lingually tipped.

With the conventional approaches to

correct the scissors-bite, extrusion

of the molars and repetitive bonding

failure are frequently occurred.

Using miniscrew as direct skeletal

anchorage can correct the scissors-

bite efficiently.

Two young female adults with

unilateral posterior buccal crossbite

and Angle Class I malocclusion

were treated with fixed appliance,

miniscrew and bite block.

Miniscrews were inserted into the

palatal region of the upper molar

and buccal region of the lower

molar to provide the anchorage for

intrusion and palatal / buccal tipping

of the molars simultaneously. Local

treatment with fixed appliance was

applied in the area of scissors-bite.

Bite block was added on the lower

molar of the contralateral side.

Because the bite block eliminated

occlusal interference, the scissors-

bite could be corrected effectively

within a short time. Anchorage and

vertical control were taken care of

with miniscrew.

The combined use of miniscrew and

local fixed appliances enhances

efficiency of molar scissors-bite

correction.

No. 10

Treatment of Class II Division 1 Malocclusion by TADs

Alice Hsin-Lan Shen (沈心嵐),

Eric Jein-Wein Liou


Craniofacial Dentistry, Chang Guan

Memorial Hospital, Taipei, Taiwan

This 16-year-old female presents

with Class II Division 1 subdivision

right malocclusion, complicated

by gummy smile, large mandibular

plane angle and the mandibular

right first molar missing. Treatment

consisted of 4 temporary anchorage

devices (TADs) application and

extraction of bilateral the maxillary

first premolars and the mandibular

left first premolar. A very favorable

r e s u l t w a s a c h i e v e d d u e t o

98

reduction of gingival display and

the mandibular plane angle was

decreased successfully.

No. 11

Nanoporous Structures of an Anodized Orthodontic Miniscrew

Yueh-Tse Lee (李岳澤)1, Eric

Jein-Wein Liou1, Hsin-Jay

Wu2, Li-Ling Huang2, Sinn-

Wen Chen2


Craniofacial Dentistry, Chang Gung

Memorial Hospital, Taipei, Taiwan1

Department of Chemical

Engineering, National Tsing Hua

University, Hsin-Chu, Taiwan2

Anodization is a surface treatment

process that fo rming a ox ide

layer on a meta l l i c anode. I t

h a s b e e n s u c c e s s f u l l y u s e d

to e lect rochemical ly a l ter the

surface properties and to improve

osseo in tegra t ion o f t i tan ium-

based dental implants. Dental

implants need a complete and

p e r m a n e n t o s s e o i n t e g r a t i o n

for their stabil ity. On the other

hand, orthodontic miniscrews are

used as temporary anchorage

devices for various orthodontic

t reatment requirements. They

need an "optimal" and temporary

osseointegration to sustain their

stability during orthodontic loading

and also to remove easily at the

end of or thodont ic t reatment .

The purpose of this study was to

analyze the surface morphologies

a n d m i c r o s t r u c t u r e s o n a n

orthodontic miniscrew so that the

osseointegration is optimal for

both clinical durability and ease of

removal. Anodization was carried

out at constant voltages varied from

5 to 20 V for predetermined reaction

time in various types and different

concentration electrolytes. After

anodization, the color changes of

the miniscrews could be observed

w i th ba re eyes . The su r face

morphologies and microstructures

of the miniscrews were examined

using scanning electron microscopy

(SEM) and optical microscopy.

The compositions of the surfaces

were determined using Auger

electron microscopy (AEM). The

thickness of the reaction layer

was determined using AEM. The

anodized miniscrews displayed

va r i ous co lo rs w i th d i f f e ren t

anod iza t ion parameters . The

anodized sur face was main ly

titanium oxide. With the addition

of fluoride ions in the electrolytes

and anodizing at lower voltages for

longer anodization time, nano-sized

tubes can be successfully fabricated

on the surfaces of miniscrews.The

annealing effect could maintain the

nanoporous structures and increase

the thickness of oxide layer. The

nanoporous structures could be

beneficial to the osseointegration of

orthodontic miniscrews.

No. 12

An Easy Method to Correct Gummy Smile and Anterior Teeth Lingual Root Torque with TADs

Jiann-Chyou Chang (張箭球)1,

Hsin-Chung Cheng1,2, Wei-Nan

Wang1,2, Chien-Lun Peng1,2,

Ching-Huei Horng1

Division of Orthodontics,

Department of Dentistry, Taipei

Medical University Hospital1

School of Dentistry, College of Oral

Medicine, Taipei Medical University2

Maxillary Protrusive cases were

often found with gummy smile

and deep overbite , especially in

Angle Class II Div. I malocclusion

patients. Gummy smile correction

is difficult by traditional methods,

so that most of the cases must

be treated combined with surgical

impaction of upper arch. Bicuspids

extraction and then anterior teeth

retraction, whatever en-mass or two

stage retraction can make lip more

retrude and get good E-Line angle.

But more l ingual crown tipping

and less teeth body movement

usually make it worse when smiling.

TADs Intrusive Methods (TIM)

are very easy to make better root

torque control when anterior teeth

retraction and deep bite correction.

Only TADs and power chain are

used, so patients wil l be more

comfortable and no compliance

headgear was required.

99

No. 13

Temporary Anchorage Device (TADs) and Its Craniofacial Orthodontic Applications - A Case Report

Prasad Koteswara NKK

Faculty of Dental Sciences, Sri

Ramachandra University

Background and purpose Patients with clefts of lip alveolus

and palate need complex and long

lasting orthodontic therapy. The

possibility of Orthodontic anchorage

is of ten l imi ted by congeni ta l

absence of teeth, disturbed skeletal

growth or failing compliance with

the use of extraoral anchorage

appliances.With the the advent of

the temporary anchorage devices

(TADs) in orthodontics the clinicians

were able to add this innovative

method as one of their clinical

strategies and thus were able to

minimize the re surgeries and

also modify the surgeries thus

producing absolute anchorage.

This Paper deals with various

applications of TAD s in patients

with cleft lip and palate and other

applications. Presentation includes

slides showing pre treatment, intra

and post treatment pictures and

temporary anchorage placement.

The purpose of this presentation is

to report this treatment technique

and discuss its application with

various case reports.

Main objectives of this presentationT h e b i o l o g i c a l p r i n c i p l e s o f

t empora ry anchorage dev ice

(TADs) in conjunction with cleft lip

and palate treatment is reviewed.

Clinicians will be able to add this

innovative method as one of their

clinical strategies and thus minimize

the potential re operation.

No. 14

Survival Analysis for Mini-Implants: A Retrospective Investigation of 379 Cases in Taiwan

Tzu-Ying Wu (吳姿瑩)1, Cheng-

Hsien Wu2, Shou-Hsin Kuang3

Orthodontic department in Taipei

VGH / Yang-Ming University1

Oral and maxillofacial department in

Taipei VGH / Yang-Ming University2

Orthodontic department in Taipei

VGH / Yang-Ming University3

The purpose of this study was to

evaluate the factors influencing

success rate of orthodontic mini-

implant in Asia patients. Methods:

In total, 379 self-tapping (A1,Syntec

Scientific Co, Taipei, Taiwan) mini-

implants from 2006 to 2009 were

included in the retrospective survival

study. Factors associated with mini-

implant failure were identified by

Kaplan-Meier survival curves.

ResultsThe cumulative survival rates were

90% at 8 weeks and 80% at one

year. The Kaplan- Meier log rank

test indicated significant differences

in 3 explanatory variables: soft

tissue (kerainized, non-keratinized),

dental related position (extradental,

i n t e r d e n t a l ) a n d a g e . C o x

proportional hazards regression

indicated that mini-implant placed at

non-keratinized tissue area did not

show higher risk than keratinized

area. And age <30 showed a higher

risk of mini-implant failure.

ConclusionMini-implant can be statistically

used as orthodontic anchorage.

However, when mini-implant are

placed in a younger patient, special

caution is needed.

No. 15

A Clinical Evaluating the Potential Failure Factors of TADs

Tai-ting Lai (賴泰廷)

Taipei Mackay Memorial Hospital,

Taipei, Taiwan

Anchorage control in edgewise

treatment is an important factor

affecting treatment results. In the

traditional approaches such as

headgear and intraoral elastics

are used to reinforce anchorage,

but it is difficult to obtain stationary

anchorage even when the patients

show exce l l en t coope ra t i on .

Temporary anchorage devices

(TADs) have been utilized as an

anchor in orthodontic treatment

recently. However, they have a high

failure rate.

100

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