Retreatment of a transfer patient with bialveolar protrusion with mini bone-plate anchorageby John E. Bilodeau

American Journal of Orthodontics and Dentofacial Orthopedics




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Retreatment of a transfer protrusion with mini bone ulate prog ecord sion n of facia type and the f

In so resented 10 common soft-tissue profiles. He found that to nd not ack and that evaluations of black profiles should be made

The patient had an unremarkable medical history. 0889-5406/$36.00

Copyright  2014 by the American Association of Orthodontists.

CASE REPORTwithout imposition of white standards. He established black norms using the esthetic lines of Steiner, Holdaway, and Ricketts.


Private practice, Springfield, Va.

The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported.

Address correspondence to: John E. Bilodeau, 1429 Harvest Crossing Dr,

McLean, VA 22101; e-mail,

Submitted, August 2011; revised and accepted, November 2013.cated if the skeletal discrepancy warrants it.

The question often raised is how much convexity should be reduced. Peck and Peck1 studied the concept of beauty as related to the white profile. They found people who were deemed attractive. Their profiles were compared with the standards of Steiner, Holdaway, and Ricketts. Sushner concluded that black profiles were significantly more protrusive than white profiles,http:/ 506l profile. A common treatment approach for this of malocclusion is to extract teeth in the midarch retract the anterior teeth. This approach reduces ullness of the lips and decreases the facial convexity. me patients, an orthognathic procedure can be indiFarrow et al,4 using photographs that were altered depict different levels of bialveolar protrusion, fou that black Americans prefer a straighter profile, but necessarily a “white” profile.

Sushner5 studied 100 lateral photographs of blis characterized by flaring of the maxillary and mandibular anterior teeth, protrusion of the lips, and a convex both black and white orthodontists preferred a straighter profile with good facial balance and mild convexity.John E. Bilodeau

Springfield, Va

A 40-year-old black woman, with pretorqued, preang chief concerns of missing teeth and her orthodontic areas in both the maxilla and the mandible. After r retreated with the extraction of 3 premolars. Her protru

The facial change was evident due to the reductio 2014;146:506-13)

Transfer patients sometimes pose a dilemma. Doesthe accepting orthodontist follow the original treat-ment plan? Or, after reviewing the transfer records and having a frank discussion with the patient, does he or she change the treatment plan? If this is the scenario, it must be made absolutely clear to the patient that the previous treatment plan was not “wrong,” but rather that it was a plan that was not working or did not work.

This black woman (age, 40 years 1 month) had been wearing appliances for 13 months. She had bialveolar protrusion with flaring of both the maxillary and the mandibular anterior teeth, protrusion of the lips, facial strain, and a convex facial profile. She desired a facial change—reduction of the protrusion.

The American black facial pattern is diversified, but one common facial type is bialveolar protrusion, which/ with bialveolar -plate anchorage d appliances on the maxillary teeth, transferred with ress. She had bialveolar protrusion and edentulous s were made and her desires assessed, she was was reduced and all edentulous spaces were closed. the protrusion. (Am J Orthod Dentofacial Orthop that the public prefers a slightlymoreprotrusive facial profile than customary orthodontic standards would dictate.

They stressed the importance of the public's opinion and stated that the “ultimate source of our esthetic values should be the people, not just ourselves (orthodontists).”

Foster2 studied profile preferences with silhouettes.

The groups included black, white, and Chinese subjects who were art students, general dentists, and orthodontists. The results indicated that the groups shared a common esthetic standard for the posture of the lips that was within 1 to 2 mm. All groups were consistent in assigning fuller lips for younger ages. For adults, a straight profile was preferred.

Thomas3 surveyed black and white orthodontists using soft-tissue profile tracings of photographs that rep-Her dental history showed the loss of the maxillary left

Bilodeau 507second premolar and the mandibular second molars. She had a Class I dentition with bialveolar protrusion and was wearing a preangulated, pretorqued appliance on her maxillary teeth, and only the mandibular first molars were banded in the mandibular arch. Prior orthodontic records were requested, but only panoramic and cephalometric radiographs were received. The patient's chief concerns were her “missing teeth and her orthodontic progress.” The primary etiology was heredity.


The facial photographs and intraoral photographs (Fig 1) demonstrate the convex facial profile. The patient could not close her lips without mentalis strain.

The dental casts (Fig 2) showed an Angle Class I occlusion. Themaxillary left second premolar and themandibular second molars were missing. All third molars were present. There were edentulous areas in the maxillary left second premolar and the mandibular second molar areas. The maxillary left second molar was extruded into themandibular left secondmolar's edentulous space.

Fig 1. Pretreatment facial an

American Journal of Orthodontics and Dentofacial OrthopedThe panoramic radiograph (Fig 3) shows that all teeth were present except the maxillary left second premolar and the mandibular second molars. The mandibular third molars were mesioaxially inclined into the edentuluous space that was created by the missing mandibular second molars. There was bone loss on the maxillary anterior teeth.

The cephalogram and its tracing (Fig 4) illustrate an ANB angle of 4. The SNA angle of 85 confirmed the maxillary procumbancy. The FMA was 20. The facial height index was 0.75.6 The IMPA angle of 115 and an interincisal angle of 96 reflect proclination of the mandibular and maxillary incisors. The Z-angle of 45 confirmed a protruded soft-tissue overlay7; however, the Wits measurement of 0 mm reflected no alveolar imbalance.8,9 McNamara's nasion Frankfort perpendicular suggested bialveolar protrusion.10