Create Better Balance: Finding A Solution to Distalization of Maxillary Arch in an Adult Patient Including Use of Temporary Anchorage Devices

One of the many orthodontic challenges that many practitioners experience is the management of Class II patients. A Class ll classification is given to patients with a prognathic maxilla and a normal mandible, an average maxilla and a retrognathic mandible, or a prognathic maxilla and a retrognathic mandible. The solutions for these problems may include orthodontic treatment to create a better balance between the two arches with the objective of achieving an esthetic and functional relationship between the arches and with a proper relationship to the facial soft tissues. Sometimes, it is advisable or necessary to include a surgical component in addition to the orthodontics which may be as simple as placing a temporary anchorage device (TAD), extraction of teeth, or as complex as orthognathic surgery. Part of the dilemma is the difficulty of distalization of the teeth in the upper arch without opening the bite in a wedge fashion. Another potential problem is an anterior displacement of the mandibular incisor area that may also include the alveolar bone component due to use of the mandibular arch as the anchorage unit. Some patients have also reported pain in the joint area due to use of intermaxillary arch forces.¹