【Chris Chang Ortho】442.

Bimaxillary Protrusion Treated with Insignia® System Customized Brackets and Archwires

Abstract

Correction of moderate-to-severe bimaxillary protrusion is challenging, particularly without orthognathic surgery and/or temporary anchorage devices(TAD). This case presents a 4-first-premolar extraction treatment of a 12-year-old boy with a chief complaint of lip protrusion. The diagnostic evaluation revealed a convex profile, steep mandibular plane angle, bimaxillary flared incisors and protrusive lips, deep bite, and deep curve of Spee.

The orthodontic treatment was accomplished with a customized appliance (Insignia® system), including the self-ligating brackets and progressive archwires, constructed by reverse engineering from a 3D digital set-up. Extraction spaces were successfully closed in all four quadrants in 13 appointments over 19 months without using TAD supplemented anchorage. The facial profile and occlusion have been significantly improved.

The 3 keys to success of bimaxillary protrusion treatment with digitally engineered mechanics are precise estimation of anterior torque compensations, appropriate use of auxiliaries, and careful adherence to the recommended archwire sequence. With correct treatment planning, the outcomes are enhanced by minimal treatment adjustments, and decreased treatment time.
摘要

治療中重度的雙顎前突極具挑戰性，如果不採用手術及暫時性錨定裝置的情況下，難度更高。本案例是一位主訴上下唇突出的12歲男孩，以拔除四顆第一小臼齒的方式來治療雙顎前突。診斷評估為側面輪廓突出，mandibular plane 角度偏大，上下門牙角度過度唇傾，上下唇突出，深咬，且具有明顯的curve of Spee。本案例使用客製化的矯正裝置系統 Insignia® 進行治療，此系統是經過3D數位設定確立治療計劃後，再特製的自鎖式矯正器及序列性矯正線。經過13次診療，歷時19個月，本案例成功將4個拔牙空間關閉，且治療過程中沒有使用暫時性錨定裝置。病人原本突出的側面輪廓及咬合，皆獲得明顯的改善。

使用數位化矯正裝置成功治療雙顎前突有三個關鍵：1. 精準預測前牙矯正所需的torque補償，2. 在適當時機使用輔助裝置，3. 依循系統建議的矯正換線順序。在正確的治療計劃設定下，使用數位化矯正裝置能減少矯正過程中需要調整的次數，縮短整體治療時間，更有效率的達到理想治療效果。

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