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7th World Implant Orthodontic Conference (WIOC) November 9~13, 2015, Dubai, UAE 7th World Implant Orthodontic Conference (WIOC) November 9~13, 2015, Dubai, UAE
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7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Aug 23, 2020

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Page 1: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

7th World Implant Orthodontic Conference (WIOC)November 9~13, 2015, Dubai, UAE

7th World Implant Orthodontic Conference (WIOC)November 9~13, 2015, Dubai, UAE

Page 2: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

7th World Implant Orthodontic Conference (WIOC)November 9~13, 2015, Dubai, UAE

Page 3: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Junji SugawaraSendai, Japan

Simultaneous Distalization of Bimaxillary Molars using

Miniplates for Non-Extraction Treatment

The 7th WIOC November 10-13, 2015, Dubai, UAE

Page 4: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

SAS Biomechanics

Protraction

IntrusionDistalization

Distalization

Protraction

Distalization

Intrusion

In 1992, we first started orthodontic treatment utilizing the SAS. In 1999, we developed orthodontic miniplates

specifically designed for SAS biomechanics.

1990 1995 2000 2005 2010

Class II deep bite (Distalization of Mx Molars, Intrusion of Anteriors)

Cleft lip and palate (3D Molar Movement)

Retreatment (3D Molar Movement)

Presurgical Ortho. (3D Molar Movement)

Deeply impacted molars (Traction)

Crowding (Distalization of Bimax. Molars)

Surgery First (3D Molar Movement)

How have we used SAS over time?

Class III (Distalization of Mn Molars)

Open bite (Intrusion of Mx/Mn Molars)

Page 5: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

1990 1995 2000 2005 2010

Class II deep bite (Distalization of Mx Molars, Intrusion of Anteriors)

Cleft lip and palate (3D Molar Movement)

Retreatment (3D Molar Movement)

Presurgical Ortho. (3D Molar Movement)

Deeply impacted molars (Traction)

Crowding (Distalization of Bimax. Molars)

Surgery First (3D Molar Movement)

How have we used SAS over time?

Class III (Distalization of Mn Molars)

Open bite (Intrusion of Mx/Mn Molars)

The First Bimaxillary Molar Distalization

Case

Page 6: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

YM 24-08 Initial (May 27, 2002)

Cephalometric Analysis

PatientNorm

Page 7: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Panoramic Radiograph

YM 24-08 Initial (May 27, 2002)

Wax setup modelInitial

Treatment Goal

85

3

33

Page 8: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Implantation of Orthodontic Miniplates

Y-type

L-type(Modified T-type)

Treatment Progress

Feb 12, 2003 May 7, 2003 Aug 27, 2003

Nov 26, 2003 May 13, 2004 Oct 20, 2004

Page 9: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Treatment Progress

Feb 12, 2003 May 7, 2003 Aug 27, 2003

Nov 26, 2003 May 13, 2004 Oct 20, 2004

Treatment Progress

Feb 12, 2003 May 7, 2003 Aug 27, 2003

Nov 26, 2003 May 13, 2004 Oct 20, 2004

Page 10: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Treatment Progress

Feb 12, 2003 May 7, 2003 Aug 27, 2003

Nov 26, 2003 May 13, 2004 Oct 20, 2004

YM 27-04 At debonding (Nov 24, 2004)

Page 11: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Panoramic Radiograph

YM 27-04 At debonding (Nov 24, 2004)

Page 12: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

YM 32-03 5-year follow-up (Nov 18, 2009)

YM 36-11 10-year follow-up (Jul 29, 2015)

Page 13: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Molar Distalization with SAS

3.8 mm

Sugawara J. et al. Distal movement of the maxillary molars in non-growing patients with the Skeletal Anchorage System (SAS). Am J Orthod Dentofac Orthop 126:723-33, 2006

3.2 mm

3.5 mmSugawara J. et al. Distalization of mandibular molars in adult patients with application of Skeletal Anchorage System (SAS). Am J Orthod Dentofacial Orthop 125:130-138, 2004

1.8 mm

In conclusion, the molars were predictably distalized in accordance with the individualized treatment goals, and this was without regard to patient age in non-growing patients.

3.5 mm

1.8 mm

3.8 mm

3.2 mm

1.8 mm

3.5 mm

Molar Distalization with SAS

Page 14: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Increase the Number of Non-Extraction Cases

Recent Case

Page 15: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

HY 26-05 Initial (May 30, 2012)

Cephalometric Analysis

1. CDS Analysis 2. ANB: 4.03. Wits appraisal: 1.0

PatientNorm

Page 16: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Panoramic Radiographs

HY 26-05 Initial (May 30, 2012)

CBCT

Mx

Mn

HY 26-05 Initial (May 30, 2012)

LingualLingual

Page 17: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Treatment Goal

× ×

1. Retroclination of U1: 6 mm2. Maintain U1 vertical level3. Distalization of U6: 4 mm4. Distalization of L6: 6 mm

SAS Biomechanics

L-type(Modified T-type)

Y-type

Page 18: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Mx: 16 x 22 CNA, Mn: 16 x 22 CNA passive (Sep 25, 2012)

Intrusion and Distalization of Molars

Mx: 16 x 22 CNA, Mn: 16 x 22 CNA (Dec 21, 2012)

Intrusion and Distalization of Molars

Page 19: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Mx and Mn: 14 NiTi (Feb 08, 2013)

Leveling and Aligning of Entire Dentition

Mx: 16 x 16 Elgiloy, Mn: 12 NiTi (Apr 19, 2013)

Leveling and Aligning of Entire DentitionTight Ligation with Miniplates

Page 20: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Mx: and Mn: 16 x 22 Elgiloy (Jul 02, 2013)

Detailing

Mx: and Mn: 16 x 22 CNA (Oct 10, 2013)

Detailing and Finishing

Page 21: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Mx and Mn: 17 x 25 Elgiloy (Mar 05, 2014)

Detailing and finishing

HY 28-04 At debonding (Apr 16, 2014)

Page 22: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Cephalometric Analysis

1. CDS Analysis 2. ANB: 3.53. Wits appraisal: -4.0

Panoramic Radiograph

HY 28-04 At debonding (Apr 16, 2014)

Page 23: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

CBCT

Mx

Mn

HY 28-04 At debonding (Apr 16, 2014)

Lingual Lingual

AfterBefore

Before and After4.5mm

4.0mm2.0mm

1.0mm

3.0mm 5.0mm

Page 24: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Before and After

AfterBefore

Total Treatment Time: 18.8 months

1-year follow-up (Aug 24, 2015)

Page 25: 7th World Implant Orthodontic Conference (WIOC) November 9 ... · Treatment The 7th WIOC November 10-13, 2015, Dubai, UAE. SAS Biomechanics Protraction Distalization Intrusion Distalization

Conclusion

1. We can predictably move bimaxillary molars distally at the same time in non-growing patients.

2. Since vertical control is possible with SAS, open bite is not a contraindication for molar distalization.

3. We can push the envelope of non-ext treatment by bimaxillary molar distalization.

4. CBCT is an indispensable tool to examine the alveolar housing and evaluate the extent to which the molars can be predictably distalized.