Orthodontic traction of impacted mandibular premolars through buccal-shelf mini-implant supported cantilever springs: A case series.

The management of impacted mandibular premolars, often requiring orthodontic traction to preserve teeth, is frequently complicated by the lack of precise three-dimensional control in conventional traction techniques, which can lead to prolonged treatment, iatrogenic damage, or failure. This case series demonstrates the efficacy of a novel approach utilizing buccal-shelf mini-implants as skeletal anchorage for customized cantilever springs in the orthodontic traction of impacted mandibular premolars. Three patients with varying impaction patterns (a 34-year-old male with tooth 35, an 11-year-old female with teeth 33 and 34, and a 21-year-old male with tooth 44) were treated. Following a combined tunnel and lateral window surgical exposure, a button was bonded onto the impacted tooth. A two-loop stainless steel cantilever spring, supported by a buccal-shelf mini-implant, was engaged via an elastic chain to apply controlled traction. This system allowed for dynamic adjustment of the force vector during treatment. Successful orthodontic traction of all impacted premolars was achieved, followed by final alignment with fixed appliances. The technique provided enhanced control over tooth movements in all three dimensions, improved traction efficiency, minimized occlusal interference, and avoided the need for complex biomechanics. The Buccal-shelf Mini-implant Supported Cantilever-spring (BMSC) is a reliable and effective method for managing impacted mandibular premolars.