Orthodontic considerations in the treatment of bimaxillary protrusion with anterior subapical osteotomy.

Severe bimaxillary dentoalveolar protrusion, a dentofacial deformity prevalent among Asians, can be easily addressed with the use of anterior subapical osteotomies in conjunction with extraction of a tooth in each quadrant. Presurgical orthodontic preparation for anterior subapical osteotomy includes intra-arch (leveling, alignment, and derotations) and interarch (sagittal, vertical, and transverse) objectives. The procedure requires careful attention to the use of segmental orthodontic mechanics and surgical arch wires, in conjunction with surgical splints and rigid osteosynthesis. The controlled use of training box and vertical elastics postsurgically and the proper choice of retainers have greatly facilitated the achievement of a good and stable end result.