ORTHODONTICS: Bimaxillary Protrusion Treated with Insignia® System Customized Brackets and Archwires

Correction of moderate-to-severe bimaxillary protrusion is challenging, particularly without orthognathic surgery and/or temporary anchorage devices(TAD). This case presents a 4-first-premolar extraction treatment of a 12-year-old boy with a chief complaint of lip protrusion.

The diagnostic evaluation revealed a convex profile, steep mandibular plane angle, bimaxillary flared incisors and protrusive lips, deep bite, and deep curve of Spee.

The orthodontic treatment was accomplished with a customized appliance (Insignia® system), including the self-ligating brackets and progressive archwires, constructed by reverse engineering from a 3D digital set-up. Extraction spaces were successfully closed in all four quadrants in 13 appointments over 19 months without using TAD supplemented anchorage. The facial profile and occlusion have been significantly improved.

The 3 keys to success of bimaxillary protrusion treatment with digitally engineered mechanics are precise estimation of anterior torque compensations, appropriate use of auxiliaries, and careful adherence to the recommended archwire sequence. With correct treatment planning, the outcomes are enhanced by minimal treatment adjustments, and decreased treatment time.