Orthotown September 2017 - 56
Case 5: Best not to treat
Fig. 6a: Completely restored occlusion with slight lower crowding.
Sometimes it's best to avoid trouble. After a complete dental
reconstruction short of the lower incisors, my patient's mother
presented with a deep bite, tight occlusion and absolutely no
Co-Cr shift. Without moving the upper incisors out of the
way, there was no room for the lower crowding to unravel.
Invisalign was proposed with IPR to gain room for the
treatment and align the incisors. The Curve of Spee needed to
be leveled. The patient declined and decided to receive lingual
appliances in another practice. As of this writing, treatment
has been going on for more than a year, and chipped incisor
porcelain on the upper, space issues and a vague finish timeline
have left the patient frustrated.
Conclusion
Some typical adult relapse and minor crowding situations
were documented and discussed. They included solutions
where attention to joint and occlusal function, muscular
balance and tooth-size discrepancy were in play. As described
in the "Treatment by 12s" philosophy, most treatment and
relapse situations in orthodontics involve tooth eruption and
drifting, jaw discrepancies, airway and muscular balance, and
temporomandibular function.
If you are aware of these factors, you usually can approach
treatment methodically and with minimal disappointment.n
Fig. 6b: Crowding and displaced lower cuspid
requires repositioning of the upper dentition.
Fig. 6c: No shift or room to restore lower teeth.
56
SEPTEMBER 2017 // orthotown.com
http://www.orthotown.com
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