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Continuous T Loop Mechanics for Bimaxillary Protrusion -A Case Report

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 International Journal of Medical Science and Applied Research (IJMSAR)
Available Online at: https://www.ijmsar.com
Volume – 4, Issue – 5, September – 2021, Page No. : 11 – 15

Continuous T Loop Mechanics for Bimaxillary Protrusion – A Case Report

1
Dr. Glodwin Antony, Private practitioner, Ernakulam, Kerala, India
2
Dr. Mithun K Naik, Senior lecturer, Department of Orthodontics, A.J. Institute of Dental Sciences, Mangalore,
Karnataka, India
3
Dr. Shetty Suhani Sudhakar, Senior Lecturer, Department of Orthodontics, A.J Institute of Dental Sciences, Mukka,
Mangalore, Karnataka, India
4
Dr. Abhinay Sorake, Reader, Department of Orthodontics, A.J. Institute of Dental Sciences, Mangalore, Karnataka,
India
5
Dr. Nishanth Shetty, Private Practitioner, Bangalore, Karnataka, India
Citation of this Article: Dr. Glodwin Antony, Dr. Mithun K Naik, Dr. Shetty Suhani Sudhakar, Dr. Abhinay Sorake,
Dr. Nishanth Shetty, “Continuous T Loop Mechanics for Bimaxillary Protrusion – A Case Report,’’ IJMSAR –
September – 2021, Vol. – 4, Issue - 5, P. No. 11-15.
Copyright: © 2021, Dr. Shetty Suhani Sudhakar, et al. This is an open access journal and article distributed under the
terms of the creative commons attribution noncommercial License. This allows others to remix, tweak, and build upon
the work non commercially, as long as appropriate credit is given and the new creations are licensed under the
identical terms.
Corresponding Author: Dr. Shetty Suhani Sudhakar, Senior Lecturer, Department of Orthodontics, A.J Institute of
Dental Sciences, Mukka, Mangalore, Karnataka, India
Type of Publication: A Case Report
Conflicts of Interest: Nil
Abstract Keywords
Bimaxillary protrusion is one of the most Bimaxillary protrusion, frictionless mechanics,
prevalent malocclusion encountered in orthodontic T loop
practice. Common treatment approach for bimaxillary Introduction
protrusion is to extract first premolar and retract Bimaxillary protrusion is proclination of both
anteriors. There are two types of space closure which maxillary and mandibular incisors. It is one of the most
are sliding and loop mechanics. Loop mechanics which prevalent malocclusion seen. A common treatment
is also called frictionless mechanics, can be either approach for bimaxillary protrusion is extraction of 1 st
segmental or continuous. Here’s a case report showing premolar and retraction of anteriors 1,2
Space closure
treatment of a male patient with bimaxillary protrusion after extraction can be done either by anterior retraction
with continuous T loop mechanics. with group A anchorage, posterior protraction with
Page 11

group C anchorage or combination of both which is

Corresponding Author: Dr. Shetty Suhani Sudhakar, Volume – 4, Issue - 5, Page No. 11 – 15
Dr. Shetty Suhani Sudhakar, et al. International Journal of Medical Science and Applied Research (IJMSAR)

group B anchorage.3Space closure stage of orthodontic malocclusion. On extraoral examination, patient had
tooth movement is achieved through two types of oval facial form, convex profile, straight divergence,
4
mechanics. One type is sliding mechanics and other one incompetent lip. On intraoral examination, patient had a
is loop mechanics. Sliding mechanics has a Angle’s class I molar relationship, Class I Canine
disadvantage of friction within the archwire bracket relationship, overjet of 3mm and normal overbite with
5
interface. Loop mechanics is also called frictionless and proclined upper and lower teeth and crowding in lower
usually preferred in group A anchorage due to anteriors (Figure 1)The panoramic radiograph showed
decreased anchorage requirement.6 Thus in this case that all teeth were present. Cephalometric analysis
report, continuous loop mechanics with T loop is used showed a Class 1 skeletal pattern with normal
as anchorage requirement is high. mandibular plane angle. The maxillary incisors were
Case Report proclined by 6mm and 35° in upper arch and 9mm and
Male patient aged 15years came to the 36° in lower arch. Patient also had a acute nasolabial
department Of orthodontics and dentofacial angle. Based on the finding, diagnosis was Angle’s
orthopaedics with the chief complain of forwardly class I malocclusion with average growth pattern and
placed upper and lower teeth. He had no significant anterior proclination and mild crowding in lower arch
medical or dental history. Patient’s father had similar

Figure 1: Pre treatment photograph

Treatment Plan
The treatment objectives for this patient were to crowding and achieve a normal soft tissue profi le and
12

maintain the molar and canine relationship, correct to maintain ideal over jet and overbite. By correcting
thebimaxillary protrusion, correct lower anterior the protrusion of maxillary and mandibular anterior
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© 2021 IJMSAR, All Rights Reserved

Dr. Shetty Suhani Sudhakar, et al. International Journal of Medical Science and Applied Research (IJMSAR)

teeth, the lip incompetence would be eliminated, and aligning were carried out with the help of copper niti
the acute nasolabial angle would be improved. Thus it wires. Alignment was completed within 5 months.
was decided upon extraction of first premolars and Continuous T loop was fabricated with 17x25 TMA
anterior retraction with group A anchorage. Space wire where the loop was placed towards the posterior
closure can be bought about by sliding or loop segment as group A anchorage was necessary in this
mechanics. Loop mechanics was preferred in this case case. Alpha and the beta arm were of same length.
as it have better anchorage control and less friction. It Passive continuous T loop with reduced posterior
was decided upon continuous T Loop arch wire with segment was fabricated as shown in figure 2 and
17x25 TMA wire. activate every 6 week by pulling the wire distal to 2 nd
Treatment Progress molar and cinching by 2mm.This procedure was
Maxillary and mandibular first molars were repeated until the extraction space was closed. After 9
extracted. All teeth were bonded and banded with 0.022 months of retraction of the maxillary and mandibular
PEA MBT prescription bracket. Initial levelling and anterior teeth, the extraction space was closed.

Figure 2: Treatment progress

After 16 months of treatment, the fixed Treatment Results

appliance was removed with proper over jet and The post treatment facial photographs showed
overbite and Class 1 molar relationship. Fixed retainers marked improvement of the facial profile, and the
and Hawley’s appliance in maxillary and mandibular patient’s smile improved. Maxillary and mandibular
13

arches for retention. anterior teeth protrusion were corrected, and a Class I
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© 2021 IJMSAR, All Rights Reserved

Dr. Shetty Suhani Sudhakar, et al. International Journal of Medical Science and Applied Research (IJMSAR)

molar relationship and over jet and overbite was NB plane decreased from 36° to 28°. The movement of
maintained (Figures 3). The upper incisors to NA plane the maxillary and mandibular incisors contributed to
had decreased from 35° to 22° and the lower incisors to correction of the soft tissue profile, and mentalis strain.

Figure 3: Post treatment photograph

Discussion
Space closure can be carried out by either retraction of anteriors with minimal anchorloss.
sliding mechanics or loop mechanics.4 Loop mechanics Reduction of proclination also lead to reduction in lip
have several advantages such as reduced friction, lesser protrusion thus, improving soft tissue profile. As the
anchorage requirement.6 Thus in our case, loop main concern of the patient to seek treatment was
mechanics was used for space closure. esthetics, patient was very happy with the results
Till date various loop configurations have been attained. Thus with this method we were able to attain
described for space closure. Some of the designs have structural balance, functional efficiency and esthetic
more advantages over the other.6 T loop has a higher harmony.
M/F ratio and delivers more constant force over a large References
deactivation span than vertical loop.7Due to the depth of 1. Farrow AL, Zarrinnia K, Azizi K. Bimaxillary
the vestibule, the orthodontist is limited to how high the protrusion in black Americans—an esthetic
loop can be made. In order to overcome this problem, a evaluation and the treatment considerations.
wire, such as a T-loop, can be added horizontally. Thus American Journal of Orthodontics and Dentofacial
in this case T loop was used for space closure With Orthopedics. 1993 Sep;104(3):240-50.
14

continuous T loop arch wire we were able to attain full

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Dr. Shetty Suhani Sudhakar, et al. International Journal of Medical Science and Applied Research (IJMSAR)

2. Diels RM, Kalra V, DeLoach N Jr, Powers M,

Nelson SS. Changes in soft tissue profile of
African-Americans following extraction treatment.
Angle Orthod. 1995;65(4):285-92
3. Rajcich MM, Sadowsky C. Efficacy of intraarch
mechanics using differential moments for achieving
anchorage control in extraction cases. American
Journal of Orthodontics and Dentofacial
Orthopedics. 1997 Oct;112(4):441-8.
4. Nanda R. Biomechanics and Esthetic Strategies in
Clinical Orthodontics, St. Louis: Elsevier Saunders;
2005.
5. Graber LW, Vanarsdall RL, Vig KW. Orthodontics
Current Principles and Techniques, 4th ed. St.
Louis: Elsevier Mosby; 2005.
6. Siatkowski RE. Continuous arch wire closing loop
design, optimization, and verification. Part I. Am J
Orthod Dentofacial Orthop 1997;112(4):393-402.
7. Burstone CJ. The segmented arch approach to space
closure. Am J Orthod. 1982;82(5):361–3784.

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