Severe skeletal bimaxillary protrusion treated with micro-implants and a self-made four-curvature torquing auxiliary: A case report

BACKGROUND Bimaxillary protrusion is a clinically common dentofacial deformity,particularly among Chinese patients.This kind of malformation can severely affect facial esthetics and,even in mild cases,is difficult to correct without surgery.Unfortunately,many patients abandon treatment because of fear of surgery.Here,we describe a case of severe skeletal bimaxillary protrusion treated with nonsurgical orthodontic treatments,highlighting an alternative treatment option.CASE SUMMARY A 31-year-old woman wished to address a severe protrusion profile(approximately 8 mm overbite)and gummy smile.Cephalometric analysis and superimposition showed a severe skeletal class II pattern with a mandibular retrusion,and proclined and protrusive mandibular incisors.Panoramic radiograph showed a missing mandibular right third molar.A diagnosis of severe bimaxillary dentoalveolar protrusion was made.Taking into account the patient’s fear of orthognathic surgery,she accepted the proposed alternative treatment using micro-implants and a self-made four-curvature torquing auxiliary.The treatment allowed for maximal en masse anterior tooth retraction,proper relocation of incisors,and alleviation of the skeletal class II pattern.Esthetically,the patient’s lip protrusion was significantly decreased as was the overjet(from 10.5 mm to 1.8 mm),and the results remained stable throughout the 2-year followup.CONCLUSION Nonsurgical treatment using micro-implants and a four-curvature torquing auxiliary may benefit severe cases of skeletal bimaxillary protrusion in adults.

Prevalence of Bimaxillary Protrusion: A Systematic Review

Objective: This study aimed to systematically review current relevant literature on the prevalence of bimaxillary protrusion. Materials and Methods: The electronic databases PubMed, Medline, Scopus, Google Scholar and the Cochrane Library were searched using specific inclusion criteria to obtain applicable articles. References from included studies were also examined. Results: Three articles were identified that met the inclusion criteria. Prevalence of bimaxillary protrusion ranged from 3.7% to 68.8% in different populations reported in the literature examined. GRADE assessed overall confidence was deemed to be very low. Conclusion: These results show that the prevalence of bimaxillary protrusion varies greatly between races and geographic regions. The Trinidad and Tobago population has a high prevalence of bimaxillary protrusion.

Extraction treatment of an adult patient with severe bimaxillary dentoalveolar protrusion using microscrew anchorage

Bimaxillary dentoalveolar protrusion is one of the most prevalent malocclusion in Asian population.Traditionally, orthodontic treatment often involves the extraction of four first premolars and demands the least amount of anchorage loss, therefore headgear used to be an unavoid- able fate of these patients. Nowadays, along with the development of implant anchorage, more and more patients have benefited from the implant-aided orthodontic treatment, even escaped from orthognathic surgery. However, for extremely severe cases, orthodontists seem to still have to face the limitation of orthodontic treatment and turn to surgeons for cooperation. In this case, we will see how dramatic changes happened on an adult patient with severe bimaxillary dentoalveolar protrusion malocclusion after the orthodontic treatment with microscrew implants as the temporary skeletal anchorage with the patient＇s written informed consent,