The February 2024 Volume 13 Issue 1 of the Journal of the World Federation of Orthodontists (JWFO) presented a range of studies and reviews that reflect the evolving landscape of orthodontics. As a key publication for orthodontic professionals, the JWFO—published quarterly by Elsevier and accessible to WFO members—provides cutting-edge research and insights to bridge clinical practice and academic research. Under the guidance of Dr. Vinod Krishnan, this issue offers a deep dive into recent advancements and treatment approaches that address both complex malocclusions and innovative anchorage systems. Below, we summarize the highlights from February’s articles, designed to inspire continued learning and application for orthodontic clinicians, researchers, and students worldwide. For a closer look at the full articles, abstracts, and visuals, visit the JWFO website.
- Changing Orthodontic Mechanics with Temporary Anchorage Devices
- Anterior Open Bite Correction via Molar Intrusion: Diagnosis, Advantages, and Complications
- Biomechanical and Clinical Considerations in Deep Bite Treatment Using Temporary Skeletal Anchorage Devices
- Orthodontic Treatment Approach for Open Bite in Idiopathic Condylar Resorption (ICR) Patients
- Orthodontic Considerations in Hypodivergent Craniofacial Patterns
- Current status of the biomechanics of extra-alveolar miniscrews
- Nonextraction Treatment of Anterior Open Bite with Distalization and Intrusion
Changing Orthodontic Mechanics with Temporary Anchorage Devices
Vinod Krishnan
This article highlights the transformative impact of Temporary Anchorage Devices (TADs) in orthodontics. Over the past two decades, TADs have become essential tools for managing complex malocclusions by reducing the reliance on patient compliance and allowing for more precise and effective tooth movements, particularly in vertical malocclusion cases. Despite success rates that lag behind dental implants, TADs offer orthodontists new biomechanics to address challenging cases with minimal invasiveness. This issue of the Journal of the World Federation of Orthodontists (JWFO) compiles insights from experts on the biomechanics of TADs, covering topics from site selection and force systems to case studies demonstrating TAD applications.
Key Highlights:
- Enhanced Treatment Options: TADs expand the range of orthodontic treatments, enabling effective management of difficult malocclusions without relying on fixed appliances alone.
- Critical Success Factors: Parameters like placement angle, proximity to roots, and patient factors (e.g., smoking, diabetes) significantly affect TAD success.
- Biomechanics in Focus: Proper selection, positioning, and understanding of TAD biomechanics are crucial for achieving optimal results and minimizing unwanted effects.
- Expert Contributions: Articles cover various applications of TADs, including molar intrusion for open bite correction, deep bite management, and strategies for hypo-divergent facial patterns.
- Case Studies: Real-world applications demonstrate the successful use of TADs in treating complex cases such as anterior open bites and cases involving idiopathic condylar resorption.
Anterior Open Bite Correction via Molar Intrusion: Diagnosis, Advantages, and Complications
Yoon Jeong Choi, Heeyeon Suh, Jung Jin Park, Jae Hyun Park
Published online: January 06, 2024
Anterior open bite (AOB) can be effectively treated nonsurgically through molar intrusion using temporary skeletal anchorage devices (TSADs). By inducing counterclockwise rotation of the mandible, this technique reduces anterior facial height, improves lip competency, and advances chin position. TSADs have transformed AOB treatment by allowing efficient tooth movement and minimizing patient compliance challenges. Success requires a thorough diagnosis, precise planning, and balanced TSAD placement to ensure forces are applied evenly. Overcorrection and diligent periodontal monitoring are critical to securing long-term stability and maintaining incisal overlap post-treatment. This approach offers a valuable alternative to surgery, reducing the invasiveness and risk associated with more conventional methods.
Highlights:
- Counterclockwise Mandibular Rotation: Molar intrusion corrects AOB by rotating the mandible, enhancing facial aesthetics.
- Precise Diagnosis Essential: Effective planning depends on assessing occlusal plane, skeletal discrepancies, and vertical excess.
- Overcorrection Strategy: Overcorrection and close periodontal monitoring are key to achieving stable, lasting results.
- Advantages Over Surgery: Enables effective AOB correction with less invasiveness and lower risk.
- Complications to Monitor: Includes potential for relapse, periodontal challenges, and minor aesthetic scarring.
Biomechanical and Clinical Considerations in Deep Bite Treatment Using Temporary Skeletal Anchorage Devices
Jae-Soo Kim, Jae Hyun Park,Sungsu Heo, Jong-Moon Chae
Published online: January 03, 2024
Correcting deep bite, a challenging vertical malocclusion, can be efficiently achieved through the use of temporary skeletal anchorage devices (TSADs). TSADs offer a modern solution for intruding anterior teeth without the negative side effects of traditional methods, which often relied on insufficient anchorage, leading to undesirable tooth movement. Successful deep bite treatment with TSADs requires careful attention to incisal exposure at rest, proper placement of the TSADs for adequate interradicular bone support, and an understanding of the biomechanics involved to ensure controlled and effective tooth movement. This approach provides clinicians with a more stable, patient-compliant alternative that maintains facial aesthetics and improves long-term outcomes.
Highlights:
- Simple and Efficient Intrusion: TSADs facilitate straightforward and controlled intrusion of anterior teeth, minimizing unwanted movement.
- Esthetic Considerations: Incisal exposure at rest is a key factor in deciding which teeth to intrude.
- Biomechanical Precision: Proper CR (center of resistance) location is essential to achieve ideal biomechanics and avoid tipping.
- Optimal TSAD Placement: Correct positioning ensures sufficient interradicular bone support, enhancing treatment success.
- Comprehensive Approach Needed: Both clinical and biomechanical considerations are essential for effective deep bite correction with TSADs.
Orthodontic Treatment Approach for Open Bite in Idiopathic Condylar Resorption (ICR) Patients
Gye Hyeong Lee, Jae Hyun Park, Young Guk Park, Danal Moon, Sang Mi Lee
Published online: December 28, 2023
Effective orthodontic treatment for patients with idiopathic condylar resorption (ICR) requires initial stabilization of the temporomandibular joint (TMJ) to prevent further condylar deterioration and ensure a stable mandibular position before commencing active tooth movement. This case study highlights a combined treatment approach that uses a stabilization splint, anteroposterior lingual retractors (APLR), and temporary skeletal anchorage devices (TSADs) to address open bite and improve facial aesthetics.
Key Points:
- TMJ Stabilization: The stabilization splint ensures a stable mandibular position, critical in ICR patients due to joint instability. Stabilization minimizes TMJ load and prepares for orthodontic movement.
- Orthodontic Camouflage: APLR and TSADs facilitate maxillary posterior teeth intrusion and anterior teeth retraction, achieving mandibular counterclockwise rotation, which improves occlusion without invasive surgery.
- TMJ-Friendly Mechanics: Careful biomechanics and minimal TMJ loading prevent adverse impacts on the TMJ, providing a stable outcome for both dental and skeletal improvements.
Orthodontic Considerations in Hypodivergent Craniofacial Patterns
Johnny J.L. Liaw, Jae Hyun Park
Published online: January 02, 2024
Hypodivergent craniofacial patterns, often associated with a deep bite and a low mandibular plane angle, present unique challenges in orthodontics. Patients with these patterns typically have robust masticatory muscles, square faces, and strong occlusal forces, which can complicate treatment. For such cases, a nonextraction approach, supported by skeletal anchorage with temporary skeletal anchorage devices (TSADs), is generally recommended to maintain vertical dimension. Additionally, total arch extrusion of the maxillary dentition can improve maxillary incisor display and facial esthetics without surgical intervention. This approach emphasizes stability, functionality, and esthetics while addressing the distinctive biomechanical requirements of hypodivergent cases.
Highlights:
- Nonextraction Approach with TSADs: Supports a balanced treatment for hypodivergent patterns, avoiding vertical dimension reduction.
- Extra-Alveolar TSADs for Total Arch Distalization: Effective placement at infrazygomatic crest and buccal shelf for efficient distalization.
- Total Arch Extrusion: Enhances maxillary incisor display, improving facial esthetics and maintaining stability.
- Deep Bite Correction Strategies: Combination of posterior extrusion and anterior intrusion to counter strong occlusal forces.
- Balanced Facial Proportions and Stability: Focused on maintaining vertical dimension with noninvasive techniques.
Current status of the biomechanics of extra-alveolar miniscrews
Marcio Rodrigues de Almeida
Published online: December 27, 2023
Extra-alveolar (E-A) miniscrews have transformed orthodontic treatment, offering a reliable anchorage method that minimizes root damage risk and eliminates interference with tooth movement along the dental arch. Positioned outside the traditional inter-radicular zone, E-A miniscrews, especially in areas like the infrazygomatic crest and buccal shelf, enable orthodontists to execute complex movements such as total arch distalization, molar intrusion, occlusal plane adjustments, and midline correction in a single, streamlined process. By carefully designing the force application through adjustable hook heights and mini-implant positioning, clinicians can achieve targeted biomechanical outcomes. These innovations have expanded treatment possibilities, providing greater control over both skeletal and dental malocclusions when using fixed appliances or clear aligners.
Highlights:
- Advantages of Extra-Alveolar Miniscrews: These miniscrews reduce root damage risk and allow free mesiodistal tooth movement.
- Enhanced Biomechanical Control: Proper application of biomechanical principles enables precise control over dental and skeletal corrections, particularly in complex cases.
- Single-Step Arch Distalization: E-A miniscrews support efficient total arch retraction, allowing significant distalization in one step.
- Force System Design: The force vector is adjustable through hook height and implant positioning, enabling targeted movements like molar intrusion or incisor extrusion.
- Success in Integration with Clear Aligners: E-A miniscrews can be combined with aligners to achieve predictable movements without relying heavily on patient compliance.
Nonextraction Treatment of Anterior Open Bite with Distalization and Intrusion
Kyoshi Tai, Steven Park, Andre Weissheimer, Yasumori Sato, Sercan Akyalcin
Published online: December 26, 2023
In a case of anterior open bite (AOB) with crowding, nonextraction orthodontic therapy successfully addressed both vertical and sagittal concerns through the combined use of palatal appliances and temporary anchorage devices (TADs). The treatment involved distalizing and intruding the maxillary posterior teeth using palatal anchorage, with additional mandibular distalization achieved via Class III elastics. This approach not only corrected the open bite and overjet but also resulted in favorable profile changes and maintained stability at a five-year follow-up, showcasing the efficacy of nonextraction treatments for AOB in patients seeking non-surgical, minimal-extraction options.
Highlights:
- Successful Nonextraction Open Bite Correction: AOB corrected effectively without the need for tooth extraction.
- Efficient Distalization and Intrusion: Palatal appliances distalized and intruded maxillary posterior teeth, while maintaining patient occlusion and facial aesthetics.
- Stability Post-Treatment: At the five-year follow-up, occlusion and facial profile remained stable, reflecting the long-term success of this approach.
