Early loss of the lower first molar may cause extrusion of the upper first molar and mesial tipping of the lower second molar. It could be locked by the mesial contour of the upper second molar, causing the door-wedge effect which impedes the intrusion of the upper first molar. Skeletal Class II malocclusion, canting, and the need for anterior retraction on the upper arch was adding space requirement and anchorage problem to the case. Treatment by using absolute anchorage would be the most efficient way to treat this case. This case report aims to show how to manage molar extrusion, bimaxillary protrusion, and occlusal plane canting using temporary anchorage devices (TADs). A 30-year-old Portuguese-Ambonese female complained about her protruded front teeth. The patient had mild skeletal Class II malocclusion, bimaxillary protrusion, occlusal plane canting, skeletal asymmetry, extruded upper first molars, missing lower first molars and upper left second premolar, crowding on the upper arch, and multiple diastemas on the lower arch. The patient had deviation when opening the mouth. The treatment was initiated by very light intrusion forces by using a power chain that crosses the occlusal side from buccal TAD to palatal TAD. Leveling the upper and lower arch was done simultaneously without including the upper first molar. The upper right first premolar was then extracted to balance the missing upper left second premolar and the anterior retraction was done using TAD as anchorage. The active orthodontic period was 23 months. The intrusion of 2.5 mm and 3.5 mm of left and right upper first molar was achieved. The facial profile and occlusal plane canting were corrected. The patient was satisfied with the result.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.