D e n ti s t r y ISSN: 2161-1122 Dentistry Mostafa et al., Dentistry 2018, 8:2 DOI: 10.4172/2161-1122.1000472 Open Access Research Article Voume 8 • Issue 2 • 1000472 Dentistry, an open access journal ISSN: 2161-1122 *Corresponding author: Amr Ragab El-Beialy, Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Oral and Dental Medicine, Cairo University, 11 El-Saraya Street, Manial, Cairo, Egypt, Tel: (+2)01006607277; E-mail: amr.elbeialy@dentistry.cu.edu.eg Received December 05, 2017; Accepted February 26, 2018; Published March 05, 2018 Citation: Mostafa YA, El-Beialy AR, Tarraf NE, Nada RM, Heidar AM, et al. (2018) The Amalgamated Technique. Dentistry 8: 472. doi:10.4172/2161-1122.1000472 Copyright: © 2018 Mostafa YA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The Amalgamated Technique Yehya Ahmed Mostafa 1 , Amr Ragab El-Beialy 1* , Nour ElDin Tarraf 2 , Rania M Nada 1 , Ahmed Mostafa Heidar 1 and Amr Zahran 3 1 Department of Orthodontics and Dentofacial Orthopedics, Cairo University, Egypt 2 Department of Orthodontics, Sydney University, Australia 3 Department of Periodontology, Cairo University, Egypt socket according to the method described by Liou and Huang1. Te distraction devices were cemented and activated several turns until some resistance was felt. Te transpalatal arch was placed and a three-piece intrusion arch fabricated for simultaneous intrusion and retraction. A nickel-titanium coil spring or elastic chain was attached between the distal extension of the anterior segment and the mini-screw to initiate anterior retraction (Figure 3)[ 6-10]. Te patients were instructed to activate the distraction device four quarter turns per day and were followed up every three days. When the canines were sufciently retracted (distracted) the distraction devices Keywords: Orthodontics; Shortening treatment time; Amalgamated technique; Periodontal ligament distraction; Miniscrews; Corticotomy- facilitated orthodontics Te Technique Te candidates for the technique were examined clinically and those who met the inclusion criteria were informed of the procedure, potential benefts, risks, and complications, and a signed consent from the patient or patient’s parent was obtained. Inclusion criteria • Class II div 1 malocclusion • Class I bimaxillary protrusion • Class II canine relation • Maxillary canines centered within the alveolar bone For the sake of discussion, the technique can be divided into three stages; canine retraction by periodontal ligament distraction, anterior segment retraction and intrusion by corticotomy and mini-screw anchorage, then the fnal detailing of occlusion. In actual practice, the three stages are superimposed. For the frst stage, bands were ftted on the canines and frst molars and alginate impressions made for the fabrication of the distraction devices. Te latter were soldered to the canine and molar bands making sure that the line of action of the distraction device is parallel to the dental arch from the occlusal and facial views. A 36 mil transpalatal arch was adjusted to passive ft into palatal sheaths on the frst molar bands. Te distraction devices were tried in and brackets (American Orthodontics Master Series 22 slot) placed on the incisors. Te second molars were banded. Leveling and aligning to 17 × 25 stainless steel archwires was carried out. Te patients were then scheduled for extraction [1-5]. On the day of extraction, the mini-screws were placed into the alveolar bone mesial to the frst molar (Figure 1). Labial and lingual muco-periosteal faps were refected from canine to canine, and root- circumscribing grooves were scored in the labial and lingual alveolar bone using a #2 round bur under copious irrigation. Whenever possible, corticotomy perforations were also made (Figure 2). A resorbable grafing material was mixed with clindamycin and sterile saline into a wet-sand like consistency and placed onto the labial and lingual cortical plates. Te faps were re-positioned and sutured. Ten, the frst premolars were extracted and grooves made inside the extraction Abstract In the last decade of the preceding century, orthodontic practice witnessed the reporting of periodontal ligament distraction for rapid canine retraction1, the use of mini screws for anchorage 2-9, and the resurrection and refnement of corticotomy –facilitated orthodontics 10-15. These methods added aspects of strength to routine clinical practice. It has been hypothesized that, by “amalgamating” conventional fxed orthodontic treatment with the aforementioned techniques, it would be possible to produce a “layered” treatment regimen that maximizes the patients’ beneft. The advantages of the new techniques should theoretically cancel out the drawbacks of routine fxed treatment (long duration, enamel lesions, root resorption, anchorage problems). This article describes the evolution and clinical application of a new technique, The Amalgamated Technique Figure 1: Intra-oral photograph showing mini-screw placed mesial to frst molar.