Class III Malocclusion

Treatment of Maxillary Transversal and Sagittal Deficiency with the Use of Miniscrews: An Update

Benedict Wilmes

Dr. Wilmes did a postgraduate training in oral surgery at the Department of Maxillofacial Surgery at University of Muenster, Germany. Subsequently, he received a postgraduate degree in orthodontics and dentofacial orthopedics at the University of the Duesseldorf, Germany. In 2013 he became Professor at the Department of Orthodontics at the University of Duesseldorf. Dr. Wilmes has published more than 100 articles and textbook chapters. He is reviewer of numerous journals including the American Journal of Orthodontics and Dentofacial Orthopedics and the Angle Orthodontist.

Dr. Wilmes has held more than 250 lectures and courses in 50 different countries all over the world. His primary interest is in the area of non-compliant and invisible orthodontic treatment strategies (TADs, lingual orthodontics and aligner). Dr. Wilmes was awarded the First Prize of the German Orthodontic Society in 2007 and the First Prize of the European Orthodontic Society in 2009.

Lecture Description

Morphological features of skeletal class III Malocclusion may comprise mandibular prognathism, maxillary retrognathism or a combination of both. Sagittal orthopaedic forces to protract the maxillary complex were commonly applied to the upper dental arch. This approach incurred well-known side effects such as proclination of the upper front teeth, bite opening, mesial movement of the lateral segments, and constriction of unerupted canines. New skeletal anchorage concepts involving surgical mini-plates or mini-implants have been developed to address these problems. Directing orthopaedic forces directly into the bony structures of the midface promised a significant reduction of dental side effects as well as an enhancement of skeletal response. To further increase orthopaedic treatment effects, some maxillary protraction protocols include rapid maxillary expansion (RME) in order to stimulate the midface sutures. RME can be carried out purely bone-borne or with a combination of dental and skeletal anchorage using mini-implants in the anterior palate (Hybrid-Hyrax). In recent years, the orthodontic specialty continues to make significant advances with the development and incorporation of various digital technologies. The objective of this lecture is to illustrate also the full digital process including custom fabrication of CAD-CAM insertion guides and 3D printing of metallic mini-implant supported appliances.

Learning objective

To identify the optimum workflows for correction of maxillary deficiency
To identify optimum insertion sites in the palate