Orthodontic Camouflage Management of Bimaxillary Dentoalveolar Protrusion using Four First Premolar Extractions and Differential Space Closure Mechanics: A Case Report
DOI:
https://doi.org/10.48165/ajm.2026.9.02.11Keywords:
Camouflage orthodontics, Bimaxillary dentoalveolar protrusion, Four first premolar extraction, MBT appliance, T-loop mechanics, Sliding mechanics, Anchorage controlAbstract
Bimaxillary dentoalveolar protrusion is characterized by proclination and protrusion of the maxillary and mandibular incisors despite a relatively harmonious underlying skeletal relationship. In adult patients with limited or no remaining growth potential, orthodontic camouflage using extraction therapy is an effective approach for correcting dentoalveolar protrusion while preserving the existing skeletal pattern. This case report describes the orthodontic management of a 21-year-old male with skeletal Class I malocclusion, prognathic maxilla and mandible, horizontal growth pattern, and pronounced bimaxillary incisor proclination and protrusion. The treatment involved extraction of all four first premolars followed by fixed orthodontic treatment using a 0.018-inch MBT preadjusted edgewise appliance. Maximum anchorage was reinforced using a transpalatal arch in the maxillary arch and incorporation of the second molars into the posterior anchorage units. Maxillary anterior retraction was performed using continuous T-loop mechanics, while mandibular space closure was achieved using controlled sliding mechanics. Treatment resulted in substantial correction of maxillary and mandibular incisor proclination, normalization of the interincisal relationship, maintenance of the skeletal Class I relationship and horizontal growth pattern, and improvement in dental esthetics. A stable Class I molar and canine relationship with satisfactory overjet, overbite, intercuspation, and root parallelism was achieved. The case demonstrates that careful diagnosis, maximum anchorage control, and individualized biomechanical planning can provide predictable and stable outcomes in adult patients with bimaxillary dentoalveolar protrusion.
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