Orthotown September 2017 - 52
Some of the options available to clinicians
include limited fixed appliances, with or
without interproximal reduction, or removal
of one lower incisor if more crowding warrants it.
Case 1: Lower fixed appliances
Fig. 2a: A broken lower retainer
resulted in several teeth shifting.
Fig. 2b: A tooth-size discrepancy
and a restoration complicates the
re-treatment of lower crowding.
Fig. 2c: Casts mounted in centric relation
showed some shift forward that could be
utilized for teeth alignment.
Fig. 2d: Because there was a Co-Cr shift,
lower appliances were placed to move
teeth into the freeway space-a leveled
Curve of Spee.
Fig. 2e: A new bonded retainer was placed.
Fig. 2f: The overbite and crowding
were slightly reduced.
52
SEPTEMBER 2017 // orthotown.com
There's nothing like meeting someone at a national
orthodontic meeting whose daughter, a young adult, has
crooked lower teeth. The patient's lower fixed retainer had
come loose and-yes, you got it!-her teeth had begun to
shift. Options included doing nothing, making a spring
retainer and having her father, the marketing director for a
prominent wire company, give me some clear brackets to test.
When I encounter a tightly coupled occlusion, slight
tooth-size discrepancy resulting from a restored lateral incisor
in the maxilla, and relapse, I'm always concerned that just
aligning the teeth will force the crowding into the upper
dentition and lead to complications. This could cause the
mandible to distalize or to place pressure on the TMJ. Worse
yet, if muscle balance and function is such, spaces may open in
the upper dentition, or wear could appear in the lower. We all
know how uncomfortable that situation is and how difficult
and embarrassing it is to recover from.
Because of the tight occlusion of upper and lower incisors,
before treatment I elected to mount diagnostic casts in
addition to gathering complete diagnostic records. They
helped determine if there was a forward slide from the hinge
position into maximum intercuspation. Thankfully, there was
a forward slide with some extra overjet and room to position
the rotated teeth. This allowed for forward movement of the
incisors without trapping the lower dentition behind the upper.
The retainer was removed, braces were placed and treatment
was completed. A new bonded 3-to-3 retainer was placed and
the patient maintains regular follow-up visits to make sure
the bonded retainer stays secure.
http://www.orthotown.com
Table of Contents for the Digital Edition of Orthotown September 2017
Orthotown September 2017 - Cover1
Orthotown September 2017 - Cover2
Orthotown September 2017 - 1
Orthotown September 2017 - 2
Orthotown September 2017 - 3
Orthotown September 2017 - 4
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