Comparison of treatment outcomes between skeletal anchorage and extraoral anchorage in adults with maxillary dentoalveolar protrusion.

INTRODUCTION: The goal of this retrospective cephalometric study was to compare orthodontic outcomes in patients with maxillary dentoalveolar protrusion malocclusion treated with extraoral headgear or mini-implants for maximum anchorage.

MATERIALS: Forty-seven subjects with Angle Class II malocclusion or Class I bimaxillary dentoalveolar protrusion were treated by retracting the maxillary dentoalveolar process by using the extraction space of the bilateral maxillary first premolars. Two anchorage systems were used. Group 1 (n = 22) received traditional anchorage preparation with a transpalatal arch and headgear; group 2 (n = 25) received mini-implants (miniplates, miniscrews, or microscrews) for bony anchorage. Pretreatment and posttreatment lateral cephalograms were superimposed to compare the following parameters between groups: (1) amount of maxillary central incisor retraction, (2) reduction in maxillary central incisor angulation, (3) anchorage loss of the maxillary first molar, (4) movements of the maxillary central incisor and first molar in the vertical direction, and (5) changes in skeletal measurements representing the anteroposterior and vertical jaw relationships.

RESULTS: The skeletal anchorage group had greater anterior tooth retraction (8.17 vs 6.73 mm) and less maxillary molar mesialization (0.88 vs 2.07 mm) than did the headgear group, with a shorter treatment duration (29.81 vs 32.29 months). Translational movement of the incisors was more common than tipping movement, and intrusion of the maxillary dentition was greater, in patients receiving miniplates than in those receiving screw-type bony anchorage, resulting in counterclockwise rotation of the mandible and a statistically significant decrease in the mandibular plane angle. Cephalometric analysis of skeletal measurements in patients with low to average mandibular plane angles showed no significant difference between groups, although greater maxillary incisor retraction and less mesial movement of the first molar were noted in the mini-implant group. In patients with a high mandibular plane angle, those receiving skeletal anchorage had genuine intrusion of the maxillary first molar and reduction in the mandibular plane angle, whereas those receiving headgear anchorage had extrusion of the maxillary first molar and an increase of mandibular plane angle. In contrast to the posterior movement in the headgear group, anterior movement of Point A was noted in the mini-implant group.

CONCLUSIONS: In both the anteroposterior and vertical directions, skeletal anchorage achieved better control than did the traditional headgear appliance during the treatment of maxillary dentoalveolar protrusion. Greater retraction of the maxillary incisor, less anchorage loss of the maxillary first molar, and the possibility of counterclockwise mandibular rotation all facilitated the correction of the Class II malocclusion.