|Year : 2020 | Volume
| Issue : 1 | Page : 23-25
Simplified upper molar intrusion with modified interim Goshgarian-type palatal archSimplified upper molar intrusion with modified interim Goshgarian-type palatal arch
Raj Kumar Maurya1, Sanjay Manohar Londhe2, Atul Bali3
1 Department of Orthodontics, ADC (R & R), New Delhi, India
2 Dte Gen Dental Services, New Delhi, India
3 O/o DGDS, IHQ of MoD, New Delhi, India
|Date of Submission||17-Dec-2019|
|Date of Acceptance||02-Jan-2020|
|Date of Web Publication||31-Jan-2020|
Raj Kumar Maurya
ADC (R & R), New Delhi - 110 010
Source of Support: None, Conflict of Interest: None
Surgical-orthodontic management of hyper divergent skeletal Class III malocclusions is often confronted with clinical challenges. Overeruption of the maxillary second molars during longer presurgical orthodontic decompensation phase usually results in occlusal interferences which hinder the setting of desired postsurgical occlusion in preparation for model surgery. Here, a simple, yet effective interim modification of conventional Goshgarian-type transpalatal arch is proposed which can be effectively used to intrude over erupted molars during orthodontic treatment.
Keywords: Intrusion, orthodontics, transpalatal arch
|How to cite this article:|
Maurya RK, Londhe SM, Bali A. Simplified upper molar intrusion with modified interim Goshgarian-type palatal archSimplified upper molar intrusion with modified interim Goshgarian-type palatal arch. J Dent Def Sect. 2020;14:23-5
|How to cite this URL:|
Maurya RK, Londhe SM, Bali A. Simplified upper molar intrusion with modified interim Goshgarian-type palatal archSimplified upper molar intrusion with modified interim Goshgarian-type palatal arch. J Dent Def Sect. [serial online] 2020 [cited 2020 Jul 2];14:23-5. Available from: http://www.journaldds.org/text.asp?2020/14/1/23/276401
| Introduction|| |
Hyper divergent skeletal Class III malocclusions with a combination of maxillary retrognathism and mandibular prognathism pose an orthodontic-orthognathic challenge to the clinician. In such cases, banding of the second molars is usually deferred till the late phases of presurgical orthodontic decompensation to prevent further hinge opening of the mandible and consequent lengthening of the lower face. However, in severe Class III cases with a prolonged preparatory presurgical orthodontic phase, overeruption of upper second molars may result in marginal ridge discrepancies in the vertical plane between the upper first and second molars [Figure 1]. Such occlusal interferences pose a hindrance in setting the desired postsurgical occlusion with at least three-point contact during model surgery. Various methods have been proposed in literature for molar intrusion, i.e., mini-implant-supported, conventional, and modified transpalatal arch and Nance buttons and modified biomechanics.,,,
|Figure 1: Intraoral right and left lateral views showing over erupted upper second molars|
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This article describes a modified interim Goshgarian-type palatal arch (MIGPA) which is simple to fabricate and may be effectively used to intrude over erupted molars during orthodontic treatment.
| Appliance Fabrication and Application|| |
The palatal arch was fabricated using a rigid 0.036” stainless steel wire with a distally oriented single central round loop parallel to the long axis of the first molars. Two sections of 0.038” stainless steel wire ending into J-hooks (in line with the second molars to be intruded) were soldered on either side of the central loop. A 3-mm long NiTi closed coil spring (150 g; GAC Inc.,) was used to apply a force of 100 g on the right side and a closed elastic power chain (Rocky Mountain Orthodontics Inc., Denver, CO) applied a force of 80 g on the left side [Figure 2]. The chain was made taut by twisting and was further secured by a building up the mesiolingual cusp with composite resin to prevent its slippage. Since in this case, the degree of intrusion required on either side was not similar, the amount and method of force application used on the right and left sides were different.
To effectively control the direction of tooth movement, bilateral J hooks were used to apply force parallel to the tooth's long axis. Toward the completion of intrusion, a step-up bend with palatal root torque was placed in the sectional wire on the buccal aspect, mesial to second molars to eliminate rotational moments.
Three months later, substantial intrusion had occurred [Figure 3]. The mesial marginal ridges of the maxillary second molars were level with the distal marginal ridges of the maxillary first molars [Figure 4].
|Figure 3: Intraoral right and left lateral views showing substantial upper second molar intrusion|
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|Figure 4: Depiction of favorable changes: Top row (1 and 2)-before intrusion, and bottom row (3 and 4)-after intrusion|
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| Discussion|| |
Various complex and invasive modalities adopted for the correction of over erupted molars include corticotomy with the use of repelling rare-earth magnets, miniscrews, implants, zygomatic wires, and skeletal anchorage.,, Significant grinding of an over erupted tooth usually necessitates the ensuing need of endodontic treatment.
The modified palatal arch precludes the need for above-mentioned expensive and cumbersome appliances and offers advantages of ease of fabrication with simple mechanics. A combination of a buccal fixed appliance and MIGPA helps provide a balanced force system for the effective intrusion of molar, as reported by Gupta et al., Kumar et al., Durgekar and Nagaraj.,,, The present modification, however, carries the advantage of keeping the force close to the center of resistance hence providing true intrusion. It prevents tipping and buccal or palatal overhanging of the affected and adjacent teeth.
| Conclusion|| |
The MIGPA is a simple, noninvasive, and inexpensive appliance which can be successfully used to intrude supra erupted maxillary molars, at the same time providing the benefits of patient comfort and reduced chairside time.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gujar A, Rani MS, Durgekar SG. Combination of expansion and orthognathic surgery in a severe hyperdivergent skeletal Class III malocclusion. APOS Trends Orthod 2016;6:312-8. [Full text]
Enacar A, Pehlivanoglu M, Akcan CA. Molar intrusion with a palatal arch. J Clin Orthod 2003;37:557-9.
Park YC, Lee SY, Kim DH, Jee SH. Intrusion of posterior teeth using mini-screw implants. Am J Orthod Dentofacial Orthop 2003;123:690-4.
Kravitz ND, Kusnoto B, Tsay PT, Hohlt WF. Intrusion of overerupted upper first molar using two orthodontic miniscrews. A case report. Angle Orthod 2007;77:915-22.
Park HS, Jang BK, Kyung HM. Maxillary molar intrusion with micro-implant anchorage (MIA). Aust Orthod J 2005;21:129-35.
Gupta A, Kannan S, Gupta G, Goyaliya A, Kaul A, Garg N. A modified transpalatal arch with sleeve. J Indian Orthod Soc 2013;47:112.
Kumar ND, Krishna BR, Shamnur N, Mithun K. Modified transpalatal arch for molar intrusion. J Int Oral Health 2014;6:88-9.
Nainani JT, Sunil G, Krishna Nayak US, Mathew NR, Saidath K. Molar intrusion with a modified transpalatal arch: A case report. JulyAugust 2012;4:9-11.
Durgekar S, Nagaraj K. Modified transpalatal arch for molar intrusion. Int J Orthod Milwaukee 2012;23:59-61.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]