Orthotown October 2020 - 39
If I decide to go with an extraction plan, my repositions will
include unflipping the upper incisor Alpine brackets and going
into a 20x20 extra wide NiTi in the upper arch to match the
lower. If I decide to stick with the non-extraction plan, I will leave
the upper incisors flipped, reposition as needed, and stay in the
16x22 NiTi extra wide. At the next appointment, I will perform the
necessary IPR and advance to either a 16x25 SS or a 18x25 SS
archwire in the upper arch, depending on how aggressively I would
like to engage the negative torque. Through this method, I have
been quite impressed at the level of lingual crown torque that
accompanies the typical IPR space closure. I think this case is a
good example of that technique.
The upper incisors were significantly retracted to a pleasing
position. In the lower arch, it was accepted that there would be
proclination of the lower incisors in this non-extraction plan. The
goal was to try to limit it to an acceptable amount, which is, of
course, subjective. In the final photos, the lower anteriors show no
evidence of periodontal thinning or recession, and this is consistent
in retention records through 12 months posttreatment. Long-term
observation of periodontal tissues in these types of non-extraction
OT_HP_Join_Ad.indd 1
OT1020_Foster_Choices_AG_V5.indd 39
cases is key to true posttreatment success.
In the microaesthetic and miniaesthetic posttreatment
evaluation, ideal alignment, consonant smile arc and aesthetic
anterior tooth contacts make an appearance. The vertical show
of her beautiful upper incisors has increased from approximately
50% to 90%, and what a difference it makes for her smile! While
it is always hard to get a true apples-to-apples comparison with
pretreatment and posttreatment facial front smiling photos, it
does appear at least that there is a subtle reduction in soft tissue
redundancy (particularly the lower lip), likely due in part to the
slight increase in lower-third facial height, which has very slightly
opened up her "smile window."
Finally, and in the humble opinion of this "tooth-centric"
trained orthodontist, none of the aforementioned dental changes
imparted by this treatment are nearly as important to overall
aesthetics as the subtle but significant vertical change pictured
in the final facial profile photo. The balancing of facial thirds with
the slight increase to the lower third provided by this orthodontic
treatment has brought a bit more balance to highlight the natural
beauty of this woman that speaks for itself. ■
FREE FACTS, circle 16 on card
9/16/20 8:05 AM
orthotown.com \\ OCTOBER 2020
39
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Orthotown October 2020
Table of Contents for the Digital Edition of Orthotown October 2020
Orthotown October 2020 - Cover1
Orthotown October 2020 - Cover2
Orthotown October 2020 - 1
Orthotown October 2020 - 2
Orthotown October 2020 - 3
Orthotown October 2020 - 4
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