Clinical management in extraction cases using palatal implant for anchorage

Correction of Class II deep overbite and dental and skeletal asymmetry with 2 types of palatal miniscrews

This case report describes the orthodontic treatment of a 31-year-old woman who had a Class II molar relationship, anterior crowding, deep overbite, maxillary dental midline deviation, vertical maxillary asymmetry, and a hyperdivergent facial pattern. The maxillary right first premolar and the left second premolar were extracted asymmetrically to correct the anterior crowding and the maxillary dental midline deviation. The maxillary molars were intruded with a midpalatal miniscrew, which helped to correct the vertical molar asymmetry and close the mandibular plane. The palatal miniscrew in the maxillary tuberosity was also used to provide anchorage reinforcement for retraction of the anterior teeth. After orthodontic treatment, dental and facial esthetics were greatly improved by treatment of anterior crowding and deep overbite, correction of the dental and skeletal asymmetry, and closure of the mandibular plane. At the 3-year follow-up, most of the treatment results had been maintained.

Computerized navigation surgery for the safe placement of palatal implants

Palatal endosseous implants are increasingly recognized as an important alternative for achieving maximal intraoral orthodontic anchorage; however, their safe surgical placement is a matter of concern. Available palatal bone is frequently limited, and erroneous drilling can damage adjacent structures. Computerized navigation surgery is an advanced surgical modality in which the surgical drill is accurately tracked and animated in real time on the radiological image of the surgical site. In implant dentistry, this surgical modality allows accurate navigation of the implant drilling procedure and increases safety and accuracy, compared with conventional dental implant surgery. This article outlines the principles of computerized navigation surgery and describes its application for the placement of palatal orthodontic implants. The merits of this approach are particularly important for patients with limited palatal bone when implant placement requires high surgical precision.