Orthotown July/August 2019 - 20
message board
Cannot Retain Anterior
A patient on her fourth trip around is still showing signs of misalignment,
and this Townie is asking the community for advice on future treatments
ToddS96
Member Since: 01/09/15
Post: 1 of 10
This adult patient presented to me in 2010 for treatment regarding misaligned #8 and #9.
Both are porcelain crowns. She had gone through prior orthodontic treatment twice.
Aug. 26, 2010
Oct. 11, 2012
I aligned the teeth. The general dentist did some
minor perio work and replaced the crowns. I placed
a bonded palatal retainer 2-2.
May 23, 2019
Over the years, the bonded retainer has loosened
several times, probably due to impact from the deep
bite and limitations in bond strength to porcelain.
Here we are now. The patient is not satisfied and
would like additional treatment. I cannot seem to
keep a bonded palatal retainer here. I am thinking
about a short course of Invisalign, and leaving the attachments in place indefinitely on #8 and
#9, along with Invisalign retainers. Any thoughts? Thank you in advance. ■
5/28/2019
zxzxzx
Member Since: 02/28/03
Post: 2 of 10
My approach in cases like this is to:
1. Euthanize the patient after the retreatment is complete. That generally works well.
2. Or euthanize the teeth. After retreatment, extract the UL1 and do an implant.
It will not move.
Sorry for the humor. I'm in a strange mood. ■
5/28/2019
davidharnick
Member Since: 08/28/02
Post: 3 of 10
Hi. Unfortunately, we all probably have similar cases. What I would do is Invisalign with
significant upper IPR. It appears you aligned the teeth but they were flared some. I am better
planning with 3D than trying to guess and remember to do IPR with fixed. I would also minimize
the extrusion of UL1 and intrude the others. The smile arc police will come after me! Having
long-term attachments on crowns doesn't seem like an answer to me. Cheers, David. ■
5/28/2019
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