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Mini-implants Options · View
Frank
Posted: Monday, March 13, 2006 12:35:00 PM
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Drs. Boyd and Cho:
I would like to know which locations for mini-implants would be best to protract both the maxillary and mandibular dentition? I am thinking about cases that were treated a long time ago by extraction and were misdiagnosed nonextraction cases or borderline extraction cases that resulted in dished-in profiles.
FB
Ron Redmond DDS
Posted: Tuesday, March 14, 2006 3:23:00 PM
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Dear Frank,
I contacted Dr. Heon Jae Cho at the University of Pacific for an answer to your question. He has had the most experience with mini-implants of those I know.
His answer:

Dear Dr. Redmond,
We have exact the same cases that he explained in the question. This is what we did.
We moved upper and lower anterior teeth (from bicuspids to bicuspids)
into more preferred position, first. We used molars as anchorage to this tooth movement without mini-implants. Once we had good incisor positions, we placed mini-implants between cuspid and bicuspid. We started molar protraction using mini-implants as anchorage.
We did not finish those cases here at Pacific, but we do have good progress so far.
I hope this helps you to answer the question.
Thank you,
Heon Jae

I hope this helps. Dr. Cho's recommendation is an innovative approach to repositioning the maxillary and mandibular dentition forward.
Best regards,
Ron Redmond, DDS, MS, FACD
Frank
Posted: Thursday, March 16, 2006 10:14:00 AM
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Dear Dr. Redmond,
Thanks for your help with my question about implants and dished-in profiles. If possible, could you ask Dr. Cho if he would consider this approach as a viable mechanical approach? Could you place a large implant such as a 1.5 or 1.6mm implant in the posterior palate and use a transpalatal arch activated to protract the maxillary dentition, as opposed to the usual distalizing mechanics? After this is accomplished, then use Class II elastics or springs to advance the mandibular dentition using the maxillary dentition and implant for anchorage. Or, alternatively, place the palatal implant in the anterior of the palate and use springs or chain to protract the maxillary dentition and eventually protract the mandibular dentition. These two approaches would require the use of a single implant rather than four implants, and in the second approach, no TPA. Also, could both arches be advanced simultaneously? I guess the question I am really asking is if this is asking for too much anchorage to be provided by a single implant? I would appreciate any thoughts about this.
Thanks,
Frank Burrell
Ron Redmond DDS
Posted: Friday, March 17, 2006 3:17:00 AM
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Dear Frank,
Your recent reply is sufficiently detailed to make me think you should e-mail directly with Dr. Heon Jae Cho. He is currently at the Department of Orthodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, and can be reached through e-mail: hcho@Pacific.edu. I'm certain Dr. Cho will be able to answer your detailed questions. It will help if you use my name in your correspondence with Dr. Cho.
Good luck!
Ron Redmond, DDS, MS
Ron Redmond DDS
Posted: Monday, March 20, 2006 2:29:00 PM
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Here is the response to Frank from Dr. Heon Jae Cho:

My humble opinion is that I think you can use one palatal mini-implant and TPA to bring the maxillary dentition forward, and
then use Class II elastics to bring the mandibular dentition forward. My suggestion to you is you need to used rigid wire for the TPA (.036" instead of .030"), and you can deliver protraction forces either in the palate or in the archwire. Maybe both! I used to place many midpalatal mini-implants to intrude molars with TPAs. In that situation, I used 1.5 or 1.6mm-diameter mini-implants.
You can be as creative as you like. This is my feeling about mini-implant orthodontics.
I hope this information helps you a little.
Dr. Heon Jae Cho
charlie ruff
Posted: Sunday, April 9, 2006 8:09:00 PM
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What bothers me about the responses is that no one has finished a case of the type described using the mechanics described. While we can all try to be creative in our thinking with the options of mini-implants, I as a practioner realize that real life is not school, if you understand my drift. This patient has already been treated orthodontically once and now is in the process of being treated a second time. To read the responses, this is not a slam dunk by any means, and one of the reasons may be mini-implants. They are easy to place and easy to remove; in fact, sometimes they remove themselves, and therein is the problem.
I don't believe you can depend on them nearly as much as we would like (I've personally placed 50+ mini-implants). The case under discussion involves an informed consent issue for the patient and parents. There are real choices here. One of them is whether this is still an orthodontic case or would it be better treated ortho surg, or ortho pros. In my humble experience of 25 years, the cases that I've done best with are those cases in which I tried to treat orthodontic problems orthodontically and sought help from surgeons and prosthodontists when appropriate.
This patient could be treated with ortho and jaw surgery or ortho to open spaces with real implants placed for all the spaces opened mesial to the first molars (assuming that to be the treatment plan). If the parents insisted on no surgery and no prosthodontics, then I would be thinking of what can I do that is predictable, not educated guesswork. For the lower arch, this means a retromolar implant as described by Dr. Eugene Roberts. Plenty of published material on this. On the upper arch, you have several choices: miniplates at the piriform rim to protract the maxilla with headgear, or perhaps a Schaumann midpalatal implant to use for absolute anchorage.
Remember to charge an appropriate fee for this case.
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