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J Pio 2010 08 002
J Pio 2010 08 002
J Pio 2010 08 002
available at www.sciencedirect.com
Clinical contribution
Marino Musilli a,c,∗ , Marco Marsico b,c , Annalisa Romanucci b,c , Francesco Grampone b,c
a DDS, Specialist in Orthodontics, Private practice in Naples/Salerno
b DDS, Private practice in Naples
c Private practitioners Biomech Study Group
a r t i c l e i n f o a b s t r a c t
Article history: Starting from a segmented approach, the Authors propose 3 different methods of using mini
Received 3 June 2009 screws during the process of molar uprighting. The first UPG is performed by placing a mini
Accepted 29 June 2010 screw in the retromolar area and by applying an elastic chain loaded between the screw and
the molar.The second UPG is made by placing a screw in the retro molar area and by using
Keywords: a small cantilever which is active during intrusion and uprighting.The third UPG is made
Biomechanics by using a miniscrew placed a few millimeters mesial to the molar to control the vertical
Cantilevers force produced by the uprighting with a long cantilever to the frontal teeth.To assist in the
Mini screws understanding of the different clinical indications, the biomechanical differences between
Molar uprighting these three systems are analyzed.
Segmented approach © 2010 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.
∗
Corresponding author: via Luigi Cacciatore 57 - 84124 Salerno, Italy.
E-mail address: marinomusilli@hotmail.com (M. Musilli).
1723-7785/$ – see front matter © 2010 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.
doi:10.1016/j.pio.2010.08.002
progress in orthodontics 1 1 ( 2 0 1 0 ) 166–173 167
3. Results
Fig. 6 – Final rx with 37 uprighted, distal miniscrew and an
In all three methods, the UPG was easily managed but there are implant in the site of 36.
significant biomechanical differences between them in terms
of effectiveness, type of movement and clinical indications.
The first movement (Figs. 5–7), an UPG of about 15◦ , is real-
ized in 5 weeks. The dental movement was made in a relatively
short time, because there was an uncontrolled tipping 12 real-
ized by using a single force on the crown.
In this way, even if the cantilever starts from the labial surface
of the molar, there are no vestibular or lingual proclinations.
The space opening is decreased in comparison to the previ-
ous mechanisms, but in both systems it is possible to perform
uprighting by using only one screw and a bracket on the molar,
without adding any other teeth.
Fig. 9 – Occlusal view of 37 with a small cantilever from the The third movement (Figs. 12–21), an UPG of about 18◦ in
tooth to the screw, distal to the molar: at the beginning. both molars, is realized in 9 weeks.
170 progress in orthodontics 1 1 ( 2 0 1 0 ) 166–173
Fig. 13 – Lateral view of UPG of 46 with a long cantilever, Fig. 15 – Occlusal view of UPG of 37 and 46 with a long
from the molar to the anterior teeth, and a screw mesial cantilever, from the molars to the anterior teeth, and a
to the molar: at the beginning. screw mesial to the molar: at the beginning.
4. Discussion
Fig. 16 – Lateral view from the Panoramic Radiograph of 36 and 47 at the beginning.
progress in orthodontics 1 1 ( 2 0 1 0 ) 166–173 171
Fig. 20 – Lateral view from the Panoramic Radiograph of 37 and 46, three months later the end. The movement on 37 and 46
is generated by the cantilever that from the auxiliary tube goes to the anterior teeth. From the basic tube of 46 starts a
connection wire for 47.
On both sides the screws are mesial and a legature wire is braided and tightened between the screws and the molar mesial
crest. At the end of the uprighting the 37 is stopped with a stainless steel sectional between 37, the screw and the 35.
172 progress in orthodontics 1 1 ( 2 0 1 0 ) 166–173
Fig. 21 – Lateral view tracing of UPG of 37 and 46 with superimposition. On both sides, the black line is the initial position
and the red line is the final position. The superimposition is applied on the Panoramic Radiograph and the mandibular
canal, the external oblique ridge and the lower border of the mandible are chosen as reference points.
but it is less when compared to both options. During rota- - clinical, surgical and anatomical consideration on the screw
tion, the friction between the wire and the molar tube brakes insertion;
the crown movement, reducing distal tipping. The indications - radicular molar resorption connected with individual fac-
for this system are molar UPG with less space opening and tors or forces applied.
considerable vertical control. As before, the entire appliance
consists of the screw and molar tube, and no other addi- Riassunto
tional appliances are required. Here the space necessary to
Gli autori propongono 3 differenti metodi per realizzare un movi-
the screw position is less because the distal molar rotation is
mento di uprighting (UPG) con miniscrew, usando come meccanica
less.
di riferimento quella a doppia leva, tipica della tecnica dell’arco seg-
The third system uses the same long cantilever, from
mentato. Nel primo UPG la minivite è posizionata in zona retromolare
the molar to the anterior teeth, as the double cantilevers
ed il movimento è generato da una catenella elastica posizionata tra
mechanisms that generate extrusion and molar rotation and
la vite stessa ed il molare.
intrusion of anterior teeth. Intrusion, coherent with the ther-
Nel secondo caso la minivite è sempre localizzata in zona retromolare,
apy, doesn’t permit use of a second cantilever. Therefore, a
ma lo spostamento è prodotto da una leva attiva in intrusione ed UPG
miniscrew, used by indirect anchorage, is required to control
molare.
the vertical force on the molar (Figs. 4,12,13,14).
Nel terzo caso l’UPG è realizzato grazie ad una lunga leva che dal
To prevent extrusion, we lock the molar with a double
molare si dirige ai denti anteriori, mentre la minivite, posizionata
metallic ligature wire .010 braided and tightened between the
pochi mm mesialmente al molare, viene utilizzata per il controllo
screw and the molar crest, with a vertical trajectory, but with-
della componente estrusiva.
out limiting the molar rotation. In this way the molars can
I tre sistemi di UPG sono state analizzati in dettaglio dal punto di
have a root movement. Sometime we can observe a crown
vista biomeccanico, al fine di evidenziare le differenze e le relative
movement around a chord of a circle, where the legature is the
indicazioni.
radius and the hole on top of the screw is the center of rotation.
Within these restraints, most of times the molar starts to
Résumé
distoinclinate with a light intrusion and then reaches the UPG
with radicular movement (Fig. 21). The third system is indi- Sur la base d’une approche segmentée les auteurs proposent 3 méth-
cated when there is no space distal to the molar for screw odes différentes d’utilisation de mini-vis pendant le processus de
insertion, a UPG without mesial space opening, when it is redressement de dents molaires. La première méthode se réalise à
necessary, and good vertical control. l’aide d’une mini-vis dans la région rétromolaire en appliquant une
chaînette élastique mise en charge entre la vis et la molaire.
La deuxième méthode porte sur la mise en place d’une vis dans la
5. Conclusions région rétromolaire et sur l’utilisation d’un petit cantilever activé
pendant l’intrusion et le redressement.
The appropriate method for molar UPG must be determined
La troisième méthode prévoit l’utilisation d’une mini-vis placée à
in each particular case but an appropriate force system using
quelques millimètres, côté mésial, par rapport à la dent molaire dans
miniscrews, as direct or as indirect anchorage, is a simple and
le but de contrôler la force verticale venant du redressement avec un
an effective method of UPG. All the systems are easy to apply
long cantilever jusqu’à la dent frontale.
and it is possible to significantly reduce treatment time and to
Les différences biomécaniques se dégageant des trois méthodes sont
minimize patient discomfort.
analysées pour mieux maîtriser les indications cliniques.
The possibility to unload the side effect on the screw per-
mit the elimination of dental anchorage and the possibility of
Resumen
unwanted movement of the anchorage unit.
As in any technique, even here there are some general lim- Fundamentándose en un enfoque segmentado los autores presentan
itations: 3 métodos diferentes de utilización de minitornillos en el proceso de
progress in orthodontics 1 1 ( 2 0 1 0 ) 166–173 173
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