Dentaltown September 2022 - 17

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Fig. 13
Fig. 14
Fig. 11
Fig. 12
Treatment options
When one wishes to present a treatment
plan for a case like this, the remaining tooth
structure can dictate what that entails. One
choice would have been to place composite
in the incisal area, but would have required
incisal reduction that was questionable and
retention/longevity would be indeterminate.
When the patient was asked, " How long
would you like the treatment to last? " he
replied, " As long as possible, " so composite
was not an option.
Crown placement alone would leave such
small abutments that retention would always
be an issue as well as cosmetic concerns,
because the patient would show a lower
incisal view with aging and the crowns would
look very short-no longer than the teeth
looked in the beginning. Crown lengthening
would be an option by some dentists, but
that would be more invasive and still leave
the possibility of endodontic concern with
2 mm of incisal reduction for crowns.
18 SEPTEMBER 2022 // dentaltown.com
Because tooth intrusion is orthodontically
possible, the patient was asked if he would
mind wearing braces for around six months.
He was open to that, so a treatment plan and
fees were presented with case acceptance.
Treatment progress
The basic procedure for orthodontic
intrusion is to leverage the teeth to be
intruded with a nickel-titanium (NiTi)
wire attached to enough posterior teeth to
serve as anchorage (Fig. 11).
In this case, the Roth brackets on the
posterior teeth were bonded at an elevation
below the teeth intended to be intruded.
The 0.018-inch round Bio-Force NiTi wire
is then active and wanting to straighten out,
thus intruding the anterior incisors.
Once intrusion took place on the
lateral incisors (Fig. 12), the second wire
(0.018-by-0.21-inch NiTi) was placed on top
of those brackets to further intrude the teeth.
The treatment time to this point was fi ve
months. Fig. 13 shows the same technique
to intrude teeth #24 and 25.
The intrusion depth was calculated
to avoid any incisal reduction for the
to-be-made three-quarter veneers. This
is an important outcome, because this
treatment was intended to be a minimally
invasive tactic to get the best outcome. At
the end of six months, the teeth were in
the desired position.
Fig. 14 presents the incisor preparation
with no incisal reduction and contacts opened
for a three-quarter wrap, thus affording as
much retention as possible. There was, in
my mind, no need to reduce the lingual
surfaces of Teeth #22-27.
Retraction was via Waterlase laser,
because I do not pack cord, and impressions
were with Impregum from a Pentamix. This
case was done with BruxZir restorations
from Glidewell, so strength was not an
issue. The case was designed with cuspid
rise and anterior disclusion.
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Dentaltown September 2022

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