Orthotown August 2018 - 38

Fig. 2. Intraoral pictures showing position of microscrew.

of premolars during the distalization process. NiTi coil springs were
activated to distalize the second molars.
After the second molars were distalized, the first molars were
distalized into Class I position. The length of the wire got shorter
during the distalization process, and the archwire in the maxillary
posterior region was changed every four months. The premolars were
distalized after the first and second molars were established in Class
I occlusion. The maxillary left molar distalized faster than the right
side because the microscrew on the right side got loose five months
into the distalization process. The oral surgeon decided to wait for
few months before placing another microscrew.
It took 10 months for first molars to get into Class I position.
After the molars were in Class I relationship, a 16x22 SS continuous
archwire was placed in the upper and lower arches and the microscrews
were removed. Class II elastics were used for a short time to establish
canines in Class I occlusion. The estimated treatment time was 24
months, but the actual treatment time was 36 months because the
patient missed several appointments because of child bearing and
delivery (Fig. 3).

Discussion

Fig. 3. Posttreatment pictures and X-rays.

38

JULY/AUGUST 2018 // orthotown.com

Many adults are seeking orthodontic treatment in pursuit of
healthy, beautiful smiles. Adult patients with complex malocclusions
also have very high expectations. A combination of all these factors
makes it important for orthodontists to offer several treatment options
to provide the best outcome.
Many factors play a role in selecting the right treatment option for
adult Class II patients. Conventionally, the orthodontic treatment of
adult Class II malocclusion patients involved either the surgery option,
the extraction option or the use of intraoral distalizers. The surgical
mandibular advancement option is the best option for patients with
a retrognathic mandible.4,5,6 However, surgery is invasive and adds
additional cost to adult patients. The risk from surgery and additional
cost of surgery could be a deterrent factor for some adult patients
seeking to correct the Class II malocclusion.
The extraction option is possible only in adult patients with
crowding and protrusive teeth. Soft-tissue thickness, facial profile and
lip incompetence are some of the factors that should be considered for
extraction treatment plan. In some patients, extraction of premolars
has caused retrusion of the lips and made the profile more concave.2
Some authors have reported difficulty in distalizing first molars with
intraoral distalizers in adult patients, because of the full eruption of second
molars, which involves the distalization of the first and second molars.
This can cause extrusion of posterior teeth, which has a countereffect
in correcting the Class II malocclusion.3 Thus, case selection and the
proper treatment plan are very important to get the best results.
Considering the facial profile, soft-tissue thickness and the
cephalometric numbers, our patient was not an ideal candidate for
surgery. Even though the ANB was 4.7 degrees, she had a well-balanced
facial profile. The extraction option was not the best choice for her,
either, because she already had dark corridors from the square arch
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