Severe bimaxillary dento-alveolar protrusion with dental anterior open bite treated with absolute anchorage – a case report

Bimaxillary dento-alveolar protrusion is one of the most prevalent malocclusions in the Asian population.¹ Traditionally, orthodontic treatment often involves the extraction of four first premolars² and the use of headgear for anchorage conservation, which requires maximum patient co-operation.³ Anchorage loss often leads to incomplete treatment results and further produces an extension of orthodontic treatment period.⁴ Adult patients in particular often desire that their treatment be completed in as short a period as possible and reject the prescribed use of headgear because of aesthetic and social concerns The recent introduction of temporary anchorage devices (TADs)⁵ such as titanium screws and mini-plates, provides clinicians with an alternative anchorage system instead of the conventional extra-oral appliances that depend on patients' co-operation. The TAD system has been shown to provide effective anchorage^6,7,8,9,10 to obtain en masse retraction of anterior teeth without loss of anchorage. In extremely severe cases, however, orthodontists still face the limitations of purely orthodontic treatment and opt for orthognathic surgery. This article demonstrates the treatment of an adult patient with severe bimaxillary protrusion and dental anterior open bite, treated with mini-implants as the temporary skeletal anchorage aid, producing dramatic improvement.