Orthodontic mesialization of third molars using a t-shaped palatal indirect anchorage device for posterior dentition rehabilitation: a case report and literature review

Abstract

Background: Adolescents with posterior tooth loss face clinical challenges due to skeletal immaturity that precludes implant placement leading to masticatory dysfunction, diminished quality of life, and progressive alveolar atrophy. To address this issue, a literature review was conducted to identify potential interventions. However, a critical evaluation of these strategies revealed limitations within current treatment approaches. Based on these findings, an innovative biomechanical protocol was established for third molar mesialization, incorporating a customized T-shaped palatal indirect anchorage device (T-PIAD) to achieve precise three-dimensional spatial control. Case presentation: This case report details the orthodontic management of a 16-year-old male with multiple posterior tooth loss. A bone-conservation protocol was implemented through maxillomandibular molar mesialization using a customized T-PIAD. The 36-month treatment achieved complete edentulous space closure via third molars protraction, with no significant complications. Post-treatment stability was confirmed through 24-month follow-up observations. Conclusions: T-PIAD-assisted orthodontic mesialization of third molars demonstrates promising potential in addressing posterior tooth loss among adolescent patients, providing a biologically compatible alternative to prosthetic replacements during craniofacial development phases.