Retreatment of an orthognathic camouflaged case by total lower arch mesialization using temporary anchorage device

Abstract

Mandibular tooth extractions for camouflage treatments in borderline Class III patients may
end up with unpleasing esthetic results which may lead the patient seeking further complicated
retreatments. In this case report, we presented a patient’s retreatment with a combined orthodontic
and orthognathic surgery treatment plan. The treatment strategy involved an innovative temporary
anchorage device (TAD)‑based method for total mandibular arch mesialization instead of space
reopening for first lower premolar replacement with implants. In the current case report, orthognathic
management of a Class III adult female is discussed. The patient had a history of an esthetically
unsuccessful previous camouflaged orthodontic treatment with two lower premolar extractions.
She was prepared for orthognathic surgery using an innovative custom‑made sliding jig based on
miniscrews for total mandibular arch mesialization with the aim of dental arch decompensation.
After gaining the optimal dental arch discrepancy, the patient had orthognathic surgery (maxillary
advancement and mandibular setback and advancement genioplasty). Total mandibular dental arch
mesialization with the aim of dental arch discrepancy preparation was successfully conducted using
TADs. By means of the innovative miniscrew‑anchored sliding jig, the patient’s satisfactory esthetic
and occlusal results were obtained in 22 months. With innovative application of the miniscrews,
more practical and reasonable alternatives are available to replace conventional and complicated
treatment plans such as space reopening for implants in patients with unsuccessful previous
orthodontic therapies.
Key Words: Anchorage, orthodontics, orthognathic, retreatment