Orthotown September 2016 - 24
clinical orthodontics // feature
A
Winning
Combination
CBCT simulations help dictate placement
of miniscrews in and near the midpalatal suture
for successful maxillary molar intrusion
P
by Dr. John Pobanz
Dr. John Pobanz has
owned and operated
Pobanz Orthodontics in
his hometown of Ogden,
Utah for 18 years.
He holds a Master of
Science in oral biology with an emphasis
on bone physiology. Pobanz completed
his dental and orthodontic training at the
University of Nebraska and is a diplomate
of the American Board of Orthodontics.
He is an associate clinical professor at
the University of the Pacific orthodontic
residency program.
24
SEPTEMBER 2016 // orthotown.com
osterior vertical maxillary excess
is a skeletal discrepancy for which
orthdontists have continually
sought a solution. This discrepancy
often results in a dolichofacial facial pattern
and an anterior open-bite malocclusion.
Traditionally, orthodontists have relied
upon extrusion of incisors with elastic wear,
which can often result in increased gingival
display and less-than-predictable stability.
Otherwise, Lefort maxillary impaction
surgery has been prescribed. The ongoing
challenge remains that many patients are
unwilling to undergo this surgery due to
risk, hospitalization and cost.
Manipulation of the posterior alveolus
through miniscrew-facilitated maxillary
molar intrusion has become a regular part of
modern orthodontic practice. We can now
correct open-bite malocclusions with reliable
stability. This article addresses the need for a
consistent protocol for miniscrew insertion in
and near the midpalatal suture using CBCT
simulations to avoid miniscrew failure.
Multiple configurations of miniscrew
anchorage have been suggested for maxillary
molar intrusion. Some authors have opted
for placement on the vertical portions of the
buccal and palatal aspects of the posterior alveolus-specifically, at interradicular insertion
sites. This protocol has some disadvantages:
The intended intrusion often results in root
collision with the interradicular miniscrews,
leading to screw failure before the full amount
of intrusion is accomplished. It also requires
four miniscrews for a single application.
Other authors have suggested that the
anatomical transition from the horizontal
portion of the palate to the vertical wall
of the posterior alveolus is a good choice
to create an anchorage point for molar
intrusion. Although this location is better
than any interradicular location, it carries
the challenge of also being the exact location
of the greater palatine neurovascular bundle,
which emerges from the greater palatine
foramen lingual to the maxillary second
molar and travels forward in this transition
area. This creates significant variability
in the depth of the skeletal concavity in
this location, as well as a corresponding
variability in the depth of the palatal tissue
http://www.orthotown.com
Table of Contents for the Digital Edition of Orthotown September 2016
Orthotown.com Highlights
Dental Hygiene— in an Orthodontic Practice?
Industry News
New Products
Monthly Poll: Bonding
Non-Sx. Plan for This Case?
A Winning Combination
Townie Talks: Transitions Q&A
Clinical Orthodontics: A Great Future in Plastics
Dolphin Imaging & Management Solutions
GORP 2016
Product Profile: Ormco
Orthotown September 2016 - Cover1
Orthotown September 2016 - Cover2
Orthotown September 2016 - 1
Orthotown September 2016 - 2
Orthotown September 2016 - 3
Orthotown September 2016 - 4
Orthotown September 2016 - 5
Orthotown September 2016 - Orthotown.com Highlights
Orthotown September 2016 - 7
Orthotown September 2016 - Dental Hygiene— in an Orthodontic Practice?
Orthotown September 2016 - 9
Orthotown September 2016 - 10
Orthotown September 2016 - 11
Orthotown September 2016 - Industry News
Orthotown September 2016 - 13
Orthotown September 2016 - New Products
Orthotown September 2016 - 15
Orthotown September 2016 - Monthly Poll: Bonding
Orthotown September 2016 - 17
Orthotown September 2016 - 18
Orthotown September 2016 - 19
Orthotown September 2016 - Non-Sx. Plan for This Case?
Orthotown September 2016 - 21
Orthotown September 2016 - 22
Orthotown September 2016 - 23
Orthotown September 2016 - A Winning Combination
Orthotown September 2016 - 25
Orthotown September 2016 - 26
Orthotown September 2016 - 27
Orthotown September 2016 - 28
Orthotown September 2016 - 29
Orthotown September 2016 - 30
Orthotown September 2016 - 31
Orthotown September 2016 - Townie Talks: Transitions Q&A
Orthotown September 2016 - 33
Orthotown September 2016 - 34
Orthotown September 2016 - 35
Orthotown September 2016 - 36
Orthotown September 2016 - 37
Orthotown September 2016 - Clinical Orthodontics: A Great Future in Plastics
Orthotown September 2016 - 39
Orthotown September 2016 - Dolphin Imaging & Management Solutions
Orthotown September 2016 - 41
Orthotown September 2016 - 42
Orthotown September 2016 - 43
Orthotown September 2016 - GORP 2016
Orthotown September 2016 - 45
Orthotown September 2016 - 46
Orthotown September 2016 - Product Profile: Ormco
Orthotown September 2016 - 48
Orthotown September 2016 - Cover3
Orthotown September 2016 - Cover4
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