Maxillary Protraction Using Intentional Ankylosis of Primary Canines- Case Report

Objectives: In Class III cases caused by mid-facial deficiency or maxillary retrusion, the treatment of choice is maxillary advancement. Since protraction of the maxilla is done via a tooth borne device, part of the Class III correction is dental by nature. The use of intentionally ankylosed deciduous teeth as absolute anchorage for maxillary protraction in humans was first described by Shapiro & Kokich (1984). An ankylosed tooth serves as a natural biocompatible implant, and thus the forces applied will produce skeletal changes rather than tooth movement. Method: The treatment was performed on a 9 year-old patient who arrived at the clinic and was diagnosed as skeletal and dentoalveolar Class III. She presented a retrognathic maxilla, anterior and posterior cross bite and disharmony of the profile. Following local anesthesia, the maxillary primary canines were extracted and the pulps were extirpated, filled with calcium hydroxide and sealed. The periodontal ligament was scraped off and the canines were subsequently repositioned and cemented in a Rapid Palatal Expansion (RPE) device, which was also cemented to the upper first permanent molars. Patient was prescribed with antibiotics. Results: Three months after the procedure, the RPE was activated and protraction of the maxilla was initiated by means of elastics from the RPE to a face mask. Patient compliance was excellent, and a progressive improvement was noted in both dental relationship and profile harmony. No dental side effects were noted. 6 months after treatment, the result achieved is stable. Conclusion: The use of intentionally ankylosed primary teeth as means of achieving absolute anchorage for skeletal correction in Class III cases due to a retrognathic maxilla, has advantages of achieving skeletal correction without unwanted side effects.