Simultaneous Intrusion and Retraction of Migrated Periodontal Upper Incisors with Mini-Implants: A Case Report

Case Report

J Dent App. 2014;1(2): 29-32.

Simultaneous Intrusion and Retraction of Migrated Periodontal Upper Incisors with Mini-Implants: A Case Report

Andre Wilson Machado1*, Renato Parsekian Martins2 and Emanuel Braga3

1Associate Professor, Department of Orthodontics, Federal University of Bahia, Salvador, Brazi

2Private practice and part-time adjunct faculty of the orthodontics graduate pro- gram, UNESP, São Paulo State University, Araraquara School of Dentistry, Araraquara, São Paulo, Brazil

3Associate Professor, Department of Orthodontics, Federal University of Bahia, Salvador, Brazil

*Corresponding author: Andre Wilson Machado, Av. Araújo Pinho, 62, 7° andar, Faculdade de Odontologia da Universidade Federal da Bahia, Salvador/BA, Brazil, Cep: 40.110-150

Received: June 23, 2014; Accepted: July 30, 2014; Published: Aug 02, 2014


With the increased number of adult patients seeking treatment, orthodontists routinely encounter patients with advanced periodontitis. These situations are a challenge to the clinician since it is difficult to establish anchorage due to the reduced bone support. Thus, the use of skeletal anchorage for these clinical conditions has proved to be an excellent alternative. This case report demonstrates the use of mini-implant anchorage for 'en masse' simultaneous intrusion and retraction of maxillary anterior teeth in a 55-year-old male patient with a Class II deep bite malocclusion with advanced periodontitis. Acceptable occlusion and esthetic results were achieved demonstrating that mini-implants are useful in enhancing anchorage in patients with bone loss associated with severe periodontal disease.

Keywords: Orthodontics; Tooth intrusion; Bone anchor; Loss of periodontal insertion


A common sequel of periodontal disease is the loss of bone support and, sometimes, the loss of posterior teeth. This condition, in the long term, will increase masticatories load on the anterior teeth leading to migration, elongation, spacing and protrusion of the incisors [1]. The literature describes several techniques for the solution of these problems such as the intrusion of anterior teeth and space closure [1-7].

In patients with active periodontal disease, orthodontic treatment is contraindicated because it may accelerate tissue breakdown [8]. However, it is clearly indicated in cases where the disease is controlled, despite the presence of periodontal sequelae, such as bone loss and gingival recession [9,10]. It is also believed that with the orthodontic treatment the patient may not experience additional loss of bone support [9,10]. Moreover, the loss of alveolar bone results in a shifting of the tooth's center of resistance apically, and the forces acting on the teeth will commonly cause tipping [11]. Therefore, orthodontic treatment should use light forces with appropriate mechanical control [2-5,12].

Another important aspect is that in those periodontal patients, planning should take into account that posterior teeth may not be used as anchorage units [2,12]. In such cases, skeletal anchorage comes as an excellent alternative since it provides adequate force control, reduces treatment time and does not require patient cooperation [4,13-15]. Furthermore, this approach has proved to be more effective than other traditional alternatives in some orthodontic movements such as incisor intrusion [16,17].

In order to obtain stationary near-to-absolute anchorage, zygoma ligatures [1], dental implants [18], miniplates [4] and mini-implants [2,5,15] have been extensively used. Of those alternatives, the latter are an excellent alternative to enhance orthodontic mechanics with some advantages: easy insertion and removal, low cost, immediate loading and simpler placement surgery at numerous anatomic locations [13- 15]. This approach has been widely described and studied but there have been few case reports on the correction of migrated and spaced incisors in patients with severe adult periodontitis [2,5]. Moreover, their use to achieve a genuine segmented simultaneous intrusion and retraction of incisors in a periodontal patient has not been addressed in the literature. This technique uses segmented arches to intrude and retract the upper incisors and similarly to other orthodontic mechanics, an adequate posterior anchorage control is needed [19].

The goal of this case report is to draw the attention of orthodontists to the possibility of adapting the segmented simultaneous intrusion and retraction of incisors mechanics in periodontal patients with mini-implant anchorage.

Case Report


A 55-year old male patient had a chief complaint of spacing and protusion of the upper incisors. He had a history of severe periodontal disease and was treated over an eleven-month period with deep scaling and root planning, followed by regular periodontal maintenance. Bone grafting in the right upper premolar region was tried twice with no success, and even though the patient had widespread bone loss, oral hygiene was adequate and there was no gingival bleeding on probing. No signs of temporomandibular joint disorder were noted and there was no underlying medical condition.

The patient exhibited a symmetric face within normal standards, but a close-up assessment, however, revealed an unpleasant smile with protrusive, spaced and elongated upper incisors and root exposure (Figure 1).