Controlled Skeletal Anchorage: Clinical Case Report Solves Puzzle of Proper Anchorage to Achieve Results in Adult Patients

Dental and orthodontic treatment management of adult patients can be associated with previous dental treatments, patient neglect or genetic variations. These conditions present a challenging situation where teeth required for balanced occlusion may be altered or absent. This article presents the case of a young adult patient with a previously extracted mandibular first molar (#19) who wanted to replace it with his own teeth and avoid an implant supported crown or a three-unit bridge.

The case is interesting as it presents a 23-year-old man with an anterior crossbite, multiple diastemas in the maxilla, primarily in the anterior segment, Class III dentition on the right side, Class I dentition on the left side. Preservation of soft tissue contours was a high priority objective as well as use of a natural tooth to replace the missing molar.

In this clinical case report, the authors describe the development of a specific strategy for each arch and, if needed, each quadrant based on the movement and anchorage needed. The primary objective was to achieve control of the orthodontic movements by simultaneously creating specific movements in each area. An additional objective was to preserve the position of the maxillary central incisors in order to maintain good lip support. The authors hope readers will increase their understanding of creating a strategy of controlled skeletal anchorage and its use in adult orthodontics to achieve results that could have seemed out-of-reach previously.