Titanium screw anchorage for correction of canted occlusal plane in patients with facial asymmetry

Introduction: Facial asymmetry is a major complaint of orthodontic patients. In those with severe facial asymmetry, combination treatment of LeFort I osteotomy and mandibular surgery was commonly used. This article demonstrates the usefulness of titanium screws for orthodontic anchorage to intrude the molars in 2 patients with facial asymmetry and canted occlusal plane. Methods and Results: The first patient was a woman, aged 29 years 6 months, with mandibular protrusion and canted occlusal plane; she was treated with molar intrusion and intraoral vertical ramus osteotomy. During presurgical orthodontic treatment, a titanium screw was implanted in the zygomatic process, and the molars were intruded for 6 months by using an elastic chain of 200 g. After intrusion, the molars were intruded 3.0 mm, and the canted maxillary occlusal plane was improved. The second patient was a young man, aged 16 years 5 months, with mandibular deviation and canted occlusal plane; he was treated with a combination of titanium screw anchorage and intraoral vertical ramus osteotomy. A miniscrew was implanted in the alveolar bone, and the orthodontic load began immediately after placement surgery by using an elastic chain. After 5 months of intrusion, the molars had been intruded by 3.0 mm. Conclusions: Compared with 2-jaw surgery, this method of molar intrusion is less invasive, involves less psychological stress, is less expensive, and results in less postoperative discomfort. Therefore, treatment with titanium screws for molar intrusion to correct a canted occlusal plane could become a new treatment strategy for patients with facial asymmetry.