Innovative Dental Midline Correction by En Masse Arch Derotation via Miniscrews

Aim: Unilateral premolar extraction is one of the more complex and controversial orthodontic treatment modalities and may lead to adverse sequelae such as midline deviation, occlusal canting, transverse discrepancies, and arch asymmetry. Managing these complications-especially in retreatment cases-can be biomechanically challenging and sometimes unattainable using conventional mechanics. This case report aims to introduce an innovative temporary anchorage device (TAD)-supported jig for comprehensive dental arch yaw correction, midline correction, and occlusal cant leveling in an orthodontic retreatment case.Case Presentation: A 28-year-old female presented with a non-consonant smile arc, asymmetric dental arches, and leftward dental midline deviation following previous unilateral extraction of the upper and lower first premolars. Clinical and cephalometric evaluations revealed a 2-mm midline deviation and a 4º left-sided occlusal cant. Treatment involved a customized TAD-supported mesialization jig placed in the left maxillary vestibule to derotate the entire maxillary arch from left to right. After maxillary arch derotation, the same jig was converted to a stable anchorage unit for mandibular midline correction using asymmetric Class II elastics.Results: Active treatment was completed within 24 months. All treatment objectives were achieved, including complete midline correction, crossbite resolution, occlusal cant leveling, and arch alignment. After 2 years of retention, the occlusion and esthetics remained stable, and patient satisfaction was excellent.Conclusion: The TAD-supported jig for total maxillary arch derotation provided a conservative, effective, and predictable solution for correcting complex dental arch yaw discrepancies and midline deviation. This innovative approach expands the scope of non-invasive orthodontic retreatment strategies and enhances both functional and esthetic outcomes.