Orthotown March 2023 - 30

MESSAGE BOARD 2
dhmjdds
Post: 3 of 15
2/4/2019
I second John's recommendation of ext UL1 and
position laterals for restoration, rather than ext U4s
then having to have an implant. Still haven't seen a
great implant, especially a solitary one, in the maxillary
anterior. And this boy would have it for possibly
60 years. I would always rather have only my natural
teeth, if possible. n
bond/veneer those teeth to make them look the
correct teeth for the spaces they are now in. So, #2
becomes #1, #3 becomes #2, and #4 becomes #3.
Pretty good idea, I think. He also sent me a journal
article that unfortunately for some of us is in Spanish
but you can see from the photos what is going on.
Pretty interesting. n
justinudm
Post: 7 of 15
fesdds
Post: 4 of 15
2/4/2019
I agree with the two other posts. That's what I would
do for my kid. n
2/19/2019
1. I think tooth #8 is the one present. I say this because
the mesial line angle tapers more toward
the center of the tooth as you go from incisal
edge to gingival margin, which is what one
would expect on a maxillary central. The distal
line angle is usually more rounded.
luciller
Post: 5 of 15
2/5/2019
I also agree with the previous posts, also considering
that the height of an implant in the upper
anterior region is not likely to be stable over a period
of more than 60 years! n
2. The gingival zenith of the present tooth is more
toward the distal, which would make me think
it's tooth #8 that's present.
Charlie, I have done what you are suggesting in
zxzxzx
Post: 6 of 15
2/19/2019
So, I discussed this case with Marco Rosa and he
sort of agreed with you guys-sort of.
I also talked with him about bone loss that might
occur as we open space for an implant. He said there
will definitely be bone loss as space is opened. But
once the space is open, the bone loss should not continue.
He sent me five articles on this. Let me know if
you want copies of the articles.
More interesting are his comments on how to deal
with the missing central incisor. I originally labeled
#8 as missing but I think it really is #9 that is missing.
BTW, can anyone confirm that based on your
knowledge of dental anatomy?
Anyway, assuming it is #9 that is missing, Marco
suggested extracting the UR4 and using the space to
shift the upper right incisors to the right to correct
the midline. Then he suggested moving the UL2,
UL3 and UL4 toward the midline and reshape/
christjl
Post: 8 of 15
2/19/2019
Charlie, I think both plans will work and your
decision will be based on your patient/parent's wishes
for restorative care. The difficulty in the Marco
solution is that you must match three teeth on one
side to the opposite three. A good restorative dentist
can hide the asymmetry. The positive of removing
the central incisor is that you have a balanced solution
and one that is symmetrical. I tend to reshape
(similar to Dr. Rosa) both the canine and the first
premolar. However, another way to look at it is the
Marco solution requires the restoration of only three
teeth. The central incisor solution requires the restoration
of six teeth.
I would look at the central very carefully. I cannot
tell from your pictures (and my computer resolution)
MARCH 2023 | 30 | ORTHOTOWN.COM
your last post. It's a long treatment time to move one
quadrant of teeth forward, but it can be done. You've
got to hope there is good hygiene. I'm sure it would
be faster with TADs but I have not used them for
this type of movement yet. n
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