Speedy surgical-orthodontic treatment with temporary anchorage devices as an alternative to orthognathic surgery

Introduction: We describe a new type of corticotomy-assisted orthodontic treatment called speedy orthodontics for treating severe anterior protrusion in adults. Once medullary bone is deformed after corticotomy, recovery to its original dimension is impossible if the greenstick fractured bone is ossified as it was deformed. Speedy orthodontics describes a protocol to allow movement of dental segments over a shorter time by using a corticotomy and an orthopedic force with temporary anchorage devices. Methods: After proper diagnosis and treatment planning, the maxillary first premolars are removed, and then a corticotomy is performed to outline a block of bone around the maxillary anterior teeth under local anesthesia. An interval of 2 weeks is optimal between the labial and lingual corticotomy for sufficient healing and less patient anxiety. The maxillary anterior teeth are fixated into a single unit with the specially designed lingual retractor. A retraction force of 500 to 900 g per side is applied to the lingual retractor and the C-palatal plate placed in the midpalatal area. After anterior bone segment retraction, finishing is performed with full fixed appliances. Results: Correct overbite and overjet, facial balance, and improvement of lip protrusion were obtained in adults with protrusion treated by speedy orthodontics. Conclusions: This new type of treatment mechanics can be an effective alternative to orthognathic surgery in adults with protrusion. (Am J Orthod Dentofacial Orthop 2009;135:787-98)