# Nonsurgical Correction of Anterior Crossbite with Extra-Radicular Miniscrews--A Case Report
## 3 Case 2
### Treatment Progress  
After the removal of the mandibular third molars, orthodontic treatment commenced.  
The maxillary arch was bonded with Damon 2 brackets, and a 0.014-in Cu-NiTi archive was inserted as the initial archive. A custom-made bite turbo was bonded on  
\begin{table}
\begin{tabular}{c c c c} \hline \hline  & **Norms** & **Pretreatment** & **Posttreatment** \\ \hline Skeletal Analysis & & & \\ SNA (\({}^{\circ}\)) & \(81.5\pm 3.5\) & \(82.0\) & \(82.0\) \\ SNB (\({}^{\circ}\)) & \(77.7\pm 3.2\) & \(86.0\) & \(85.0\) \\ ANB (\({}^{\circ}\)) & \(4.0\pm 1.8\) & \(-4.0\) & \(-3.0\) \\ SN-MP (\({}^{\circ}\)) & \(33.0\pm 1.8\) & \(28.5\) & \(29.8\) \\ Wits (mm) & \(-2.8\pm 3.3\) & \(-12.7\) & \(-11.4\) \\ Dental Analysis & & & \\ U1 TO NA (mm) & \(3.9\pm 2.1\) & \(9.0\) & \(10.5\) \\ U1 TO SN (\({}^{\circ}\)) & \(108.2\pm 5.4\) & \(105.7\) & \(116.0\) \\ L1 TO NB (mm) & \(6.6\pm 2.8\) & \(6.5\) & \(3.5\) \\ L1 TO MP (\({}^{\circ}\)) & \(96.8\pm 6.4\) & \(82.0\) & \(72.8\) \\ FACIAL ANALYSIS & & & \\ E-LINE UL (mm) & \(-1.1\pm 2.2\) & \(-3.5\) & \(-1.5\) \\ E-LINE LL (mm) & \(0.5\pm 2.5\) & \(2.5\) & \(3.0\) \\ \hline \hline \end{tabular}
\end{table}
Table 2: Case 2, cephalometric measurements.  
the lingual surface of the mandibular left central incisors to prevent interference between the upper brackets and the mandibular dentition. Two months later, the mandibular arch was bonded with Damon 2 brackets, and a 0.014-in Cu-NiTi archive was inserted. Two TSADs (A1-J, Bio-Ray Biotech Corporation, Taipei, Taiwan), 2.0 mm in diameter and 12 mm in length, were installed at the buccal shelves of the mandible on both sides. Two 150 g NiTi coil springs were attached from the head of the miniscrews to the brackets on the mandibular amines (Figure 11). Maximilary and mandibular archwires were changed to 0.016 \(\times\) 0.025-in Cu-NiTi in the third month. One month later, the anterior crossbite was corrected to an edge-to-edge relationship. Elastomeric chains from mandibular canine to canine, combined with coil springs from the buccal shelf, TSADs to mandibular canines, were used to retract the whole mandibular dentition. Provisional crowns were fabricated on the four maxillary incisors to repair the severe incision wear from the previous malocclusion. Class I dental relationships were achieved after four months of retracting the mandibular dentition with the bilateral buccal shelf TSADs. The patient complained of lip protrusion after anterior crossbite correction, so IZC (infragyomatic crest) miniscrews were installed on both sides to distalize the whole maxillary dentition (Figure 12). Two months later, the archwires were sectioned, and the posterior segments of the archwires were removed. Up-and-down elastics (Ostrich, Ormco Co., Orange, CA, USA) were prescribed to optimize the interdigitations. After settling, all appliances were removed. The treatment duration was 12 months. The patient was satisfied with her treatment results, as documented in Figure 13. Maximilary and mandibular clear retainers were delivered, and the patient was instructed to wear the retainers full-time for the first 6 months and just at night thereafter. The retainers were renewed after the permanent prostheses were fabricated. Eight-year, three-month posttreatment records showed satisfactory stability (Figure 14).  
Figure 11: Case 2, Progressive records at (**A**) 2 nd month (**B**) 4 th month (**C**) 6 th month show the correction of anterior crossbite and Class III malocclusion.  
Figure 12: Case 2, Two upper posterior miniscrews were installed in the eighth month for the protrusion after the correction of anterior crossbite.  
Figure 13: Case 2, Posttreatment facial and intraoral photographs.