Orthodontic and surgical treatment of a patient with complex dentofacial deformity associated with OSAHS, using skeletal anchorage devices: miniplates and mini-implants

Gustavo ZANARDI

Objective: The purpose of this article was to report the clinical case of a patient with complex dentofacial deformity, associated with asymmetric malocclusion, with deviation of the lower midline, absence of maxillary incisors and with posterior crossbite, in addition to severe respiratory disorders, characterized by Obstructive Sleep Apnea and Hypopnea (OSAHS), confirmed by sleep polysomnography. Case report: During orthodontic preparation, two miniplates were installed in the maxilla and an expanded transpalatal bar and crossed intermaxillary elastics were used to expand the maxillary arch, uncross the bite and create space for upper anterior implants. Mechanics were used with closed NiTi springs supported on the miniplates to distalize the entire maxillary arch and correct Class II malocclusion. In the mandibular arch, it was decided to install a mini-implant in the distal of the tooth #37, used indirectly as anchorage, and the extraction of tooth #35 and retraction of the anterior teeth was performed with correction of the deviation of the lower midline of about 5mm, until it was coincident with the midline of the chin. After adequate orthodontic preparation, orthognathic surgery was performed with bi-maxillary advancement, rotation of the occlusal plane in a counterclockwise direction and advancement and vertical reduction of the chin. After the surgery, the case was finished with rectangular stainless-steel arches, finishing bends and heavy intermaxillary elastics for intercuspation. It was decided to remove the appliance for the patient to carry out the next stages of oral rehabilitation treatment with grafts, implants and prostheses, as well as occlusal adjustment and replacement of existing restorations. The proposed objectives were achieved, both in the aesthetic aspect, as well as in the occlusal and functional aspects. There was an improvement in apnea, with the result of the new sleep polysomnography with an apnea-hypopnea index = 0, that is, without apnea episodes. The patient was very satisfied with the result obtained, mainly due to the facial and respiratory changes that occurred. Conclusion: It is concluded, based on the description of this clinical case, that the association of orthodontic preparation performed with the aid of skeletal anchorage (miniplates and mini-implants), orthognathic surgery and orthodontic finishing with intermaxillary elastics and finishing bends is adequate for the solution of the problems presented, aiming to obtain a more harmonious face, breathing and occlusion at the end of the treatment.

Keywords: Malocclusion. Esthetics. Orthodontic-surgical treatment. Dentofacial deformity. Skeletal anchorage.

How to cite: Zanardi G. Orthodontic and surgical treatment of a patient with complex dentofacial deformity associated with OSAHS, using skeletal anchorage devices: miniplates and mini-implants. Clin Orthod. 2021 Jun-Jul;20(3):133-48.

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