Orthotown September 2020 - 48
Treating missing teeth
We commonly see missing teeth, whether congenitally missing
or extracted, and it's nice to be able to offer options to patients,
particular younger ones with congenitally missing posterior teeth.
For many of these cases, we offer the solution of TAD placement
and space closure with maximum anchorage.
For cases with missing teeth, TADs are placed anterior to the
edentulous area and used as indirect anchorage by tying with a
stainless steel ligature distally to the adjacent tooth. A NiTi closing
spring is then used to close the space. This is a simple and effective
way to maintain anchorage and close space for missing teeth.
Especially in cases with congenitally missing premolars, where
the primary molar is not a long-term viable option, TADs are a
great option in young patients to use as anchorage and close spaces
by protraction.
Fig. 33
Fig. 34
Fig. 35
Fig. 36
Fig. 37
Fig. 38
Fig. 39
Fig. 40
Fig. 41
Fig. 42
Fig. 43
Fig. 44
EXAMPLE: MISSING PREMOLARS
The patient (Figs. 33 and 34) is bonded initially, but the retained
primary teeth are not bonded. Arch wire progression is completed;
once the stainless steel wire is placed, the primary teeth are extracted
and TADs are placed mesial to the edentulous area and indirectly
tied to use as anchorage. Extraction is held until space is ready to
close to take advantage of the regional acceleratory phenomenon
to aid in efficient space closure. A NiTi closing spring is then used
from a post on the arch wire around the distal on the wire distal to
the tooth adjacent to the edentulous area. The space is then closed
(Figs. 35 and 36). A wire tie is placed to ensure space closure is
maintained without continuous use of elastic chain (Figs. 37 and 38).
Treating deep bite correction
Correction of severe deep bites can be challenging, particularly
among adult brachiocephalic individuals. For this reason, we
supplement treatment with the use of TADs to aid in correction of
the deep bite.
If the lower cuspid to cuspid needs intrusion, two TADs are
placed and initially tied with elastic thread in light wires. Once
stainless steel wires are placed, power chain is used to continue
intrusion. If only lower incisors need intrusion, one TAD is placed
in the midline to aid in correction.
EXAMPLE 1: DEEP BITE ADULT INTRUSION
OF LOWER CUSPID TO CUSPID
In cases where the deep bite consists of over-eruption of the lower
3-3 (Figs. 39 and 40), 1.6-by-6mm TADs are placed between the
lower 2/3s bilaterally to aid in opening the bite (Figs. 41 and 42).
EXAMPLE 2: DEEP BITE ADULT INTRUSION
OF LOWER INCISORS
For deep bite cases in which just the lower incisors are extruded
(Fig. 43), a single TAD is placed between the lower 1s (Fig. 44).
48
SEPTEMBER 2020 // orthotown.com
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Orthotown September 2020
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