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Trends ORTHO TRIBUNE | JUNE & JUly 20106 movement of the tooth (or teeth) is possible. • Space closure in the molar region (e.g., to avoid the need for prosthetic measures). Premature loss of the primary molars has not yet been eradicated despite all the advances made in prophylactic treatments. There may be a need for appropri- ate therapy, particularly in cases in which the adjacent teeth are not carious (Fig. 6a–c). What should the patient be offered: implants, bridges or space closure treatment? With a view to the realistic long-term prognosis for the anchorage teeth, conservation of the surviving natural teeth and the minimization of the effects on the existing materials, a prosthetic solution would not appear to be appropriate. The basic concept of restorative dentistry — first destroy, in order to reconstruct — is frequently not the best solution. Let us assume that the strategy adopted is to mesialize tooth #27, in order to compensate — using a natural method — for the loss. The skeletal anchorage means that undesirable side effects, such as reciprocal space closure, are avoided. Only a few elements (brackets, springs, etc.) are needed to support the mesial movement. The treatment remains invisible to the casual observer, while in comparison with the stated alterna- tives, it is very cost-effective and provides for a high level of con- servation of the natural elements. The prognosis for the long-term preservation of the natural teeth is very good. Vertical tooth displacement Any displacement of the teeth along the vertical axis can present a cos- metic and/or functional problem. The solution is extrusion or intru- sion using skeletal anchorage. This technique is very simple to imple- ment and very cost-effective. Extrusion Extrusion using miniscrews may be used for single teeth (Figs. 7a–c) and for groups of teeth (Figs. 8a, b). Trauma had caused the intrusion of tooth #22 (Figs. 7a–c). The tooth was returned to its original position within three months by means of the indirect anchorage of tooth #23 to a mini- screw using a straight wire appli- ance. In the case of a bite that exposed tongue and bone (Figs. 8a, b), the approach adopted was to provide transverse expansion and extrusion of the anterior teeth. Intermaxillary rubber traction braces connected to miniscrews in the lower jaw were used. If the braces had been connected to the lower anterior teeth, undesir- able extrusion of these would have resulted (every action has an equal and opposite reaction). Because of the small root surface, this process would have occurred in a much shorter space of time than in the case of the upper anterior teeth. The opposing bone in the lower jaw prevented this undesirable reactive effect. Intrusion This open bite with extrusion of the tongue (Figs. 9a, b) was treated by means of intrusion of the molars and consequent caudal rotation of the maxilla. Miniscrews were inserted in the first and second quadrants in each case between the canine and the first premolar. A Titanol Uprighting Spring (FORESTADENT) was attached to the capstan of the miniscrew, and the screw was set to intru- sion. There was even some over- correction of the positioning of the first molars on both sides after five months’ intrusion, resulting in clo- sure of the frontal bite. Conclusions It may be necessary for therapists to overcome logistical and emotional barriers before they can begin to employ miniscrews, but it is only when they are used that their versa- tility becomes apparent. Miniscrews make our routine work that much simpler. They enhance the efficiency and effec- tiveness of many dental appliances, resulting in an overall improvement in treatment quality. OT (Editorial note: A complete list of references is available from the publisher. This article first appeared in Dental Tribune Asia Pacific, Vol. 7, No. 4, 2009. The next edition of Ortho Tribune will feature “Part IV — More clinical examples.” All pho- tos were provided by the authors.) Figs. 7a–c: Extrusion of a single tooth. Viable lateral incisor following intrusion due to trauma (a). Miniscrew with indirect anchoring of the canine and straight arch technique, in order to extrude tooth #22 (b). Status after three months (c). Figs. 6a–c: Space closure in the region of the upper laterals. Baseline situation: Teeth #25 and #27 are free of caries (a). Using miniscrews (OrthoEasy, FORESTADENT), it is possible to provide ‘invisible’ treatment (b). Very few ele- ments are required for mesialization (c). Figs. 8a, b: Extrusion in order to close an open bite caused by tongue thrust, with deterioration of the upper jaw. The aim was to extrude the upper frontals over the miniscrew in the lower jaw (a). Status after 12 months (b). Figs. 9a, b: Intrusion in order to close a tongue and skeletal open bite. Intrusion of the molars was effected using a Titanol Uprighting Spring (FORESTADENT) (a). Status after six months (b). Dr. Björn Ludwig Am Bahnhof 54 56841 Traben-Trarbach Germany Phone: +49 (654) 181-8381 Fax: +49 (654) 181-8394 E-mail: bludwig@kieferorthopaedie-mosel.de About the authorOT f OT page 5 6a 7a 8a 9a 8b 9b 6b 7b 6c 7c