Orthotown May 2015 - (Page 28)

clinical orthodontics // message board Large Arches, Small Teeth A 15-year-old boy is presented with the chief complaint of signiﬁcant anterior spacing. How would you treatment plan? Orthotown.com > Message Boards > Clinical Topics > Clinical Orthodontics > Large Arches, Small Teeth str8nerinva Member Since: 03/12/08 Post: 1 of 6 Related Message Boards Expand the lower arch or extract mandibular Cs? Lower Arch Distorted arch form Distorted Arch Introduction Patient is a 15.6-year-old boy. Chief complaint: signiﬁcant anterior spacing (aesthetics). Problem list: Class 1 buccal segments. Signiﬁcant generalized U+L spacing: U 9.04mm L 9.15mm. Certainly some potential measurement errors, but in the ballpark of 9mm in both arches. Incisal angulation: U within normal range but could be proclined. Do not think they should be uprighted. L mild-mod upright at 88 to MP and 15 to NB. Interincisal angle: 144. Low MPA (15). Mild skeletal Class 3 tendencies: ANB -1 (78/79); Wits: -1.8mm. Short clinical crowns UR1+UL1 (Most recent center IO photo not well1> 2> focused). Incisal wear or chipping noted. Max. frenum is an issue. UR+UL 6s derotated. Late dental developer. A bit of an over-closed facial balance appearance. In my opinion, a signiﬁcant component to the overall problem is a prosthetic issue. My experience is when we try to solve prosthetic problems with orthodontics alone, the result is a lot of time spent in ortho treatment with an often less-than-optimal result. Conclusion I am most interested in how other Orthotownies would address this case. Thank you. n FEB 13 2015 tom525 Member Since: 06/18/08 Post: 2 of 6 Late dental development. Wait till the maxillary canine erupts. I use open coils in these cases to push the anterior teeth forward ﬁrst. Then I move progressively back with premolars, and then ﬁnally the molars are protracted with closing loop arches. You could use palatal implants to support the anchorage and move things along faster, if you wish. n FEB 13 2015 str8nerinva Member Since: 03/12/08 Post: 3 of 6 Using TADs to do what you described-moving the posterior forward-makes sense, but is a long haul. I would like to see some examples of cases done this way. This case is not all that rare, so hopefully someone will be able to show a case treated this way. Long-term out-of-treatment FEB 13 2015 28 Continued on p. 30 MAY 2015 // orthotown.com http://www.Orthotown.com http://www.orthotown.com/MessageBoard/thread.aspx?a=11&s=6&f=693&t=145551&g=1 http://www.orthotown.com/MessageBoard/thread.aspx?a=11&s=6&f=693&t=179356&g=1 http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown May 2015

Orthotown.com Highlights
The Benefi ts of Treatment by Twelves
Your Orthodontic Business Funnel
Industry News
TADs Experience
Poll
Case Presentation: The Next Twelve
Large Arches, Small Teeth
New Products
Overhead: What Does it Mean to a Start-up Doctor?
A Winning Combination: Stainless-Steel Mini-Screws and CBCT Simulations
Orthodontic Marketing Automation: A Look Into the Future
The More We See, The More We Know
Three Key Solutions
A Leader Inside and Outside the Practice
From San Francisco to Orlando: A Look at AAO’s Upcoming Sessions
Use of Digital Impressions in Orthodontic Fabrication
Ad Index

Orthotown May 2015