After my last post, I got so many kind messages so I want to start by thanking everyone who took the time to private message me, to tell me how useful they find these blog posts!
So, that said, lets get on with todays case walk through:
I got a simple Class 2 Div 2 Incisal relationship case here, the canines are 1/2 unit class 2 – this is the kind of case that any GDP who has been on a simple ortho course can tackle.
The overjet is going to increase as the centrals tip forward, and if the patient is happy with this, then thats great!
If your patient is not cool with this idea, then things get a bit more complex. Luckily, in this case, my patient wanted a quick fix before her wedding (she gave me about 9 months to do it), and she didn’t like the laterals. She didn’t want a visible brace, and aligners were not the preferred option, so we did this one with a lingual fixed.
So with a lingual brace, the biggest problem (and a common one) is that the bracket on the UR2 will not bond.
This means the first objective of this mission is to get things aligned enough so that I can bond that tooth up. This is what I did first:
So the photo on the left is the preop, the right is at the first review (around 6 weeks after).
There has definitely been some movement.
For this kind of brace, the brackets are passive for this wire size (12niti). This means that the wire is loose in the bracket, and can easily slide out of one side.
In the area of the UR2, there is excess wire that has been bent into a loop, and there are blobs of composite that stop the wire from escaping through the brackets.
This creates a spring, helping to expose the palatal surface of the UR2.
Anyway, I was getting impatient and bored, so I changed the mechanics at the next visit:
So the picture on the right is the second review.
Instead of composite stops, I have now changed them to crimpable stops (1), and placed them further apart. The overall principle is the same as before.
The bit marked in blue is a powerchain going from the labial of the UR2 to the UR3 bracket (2). This helps to derotate the UR2, while the wire is tipping the centrals forward.
This worked beautifully!
So now, the bracket is on, it should be plain sailing, just work through the wire sequence, and we should end up with a perfect result!
The problem is that I didn’t check the set-up of this case before I bonded up!
Here are pictures of the set up, and the ‘final result’
Now, the clinical result looks like the set up – so there is no problem with the brace! But I didn’t check the keslings, otherwise I could have sent it back for adjustments before bonding up!
So the laterals are still not fully corrected. I have two options:
- Debond and finish with clear aligners
- Try to be a hero and do some wire bending.
Because I am a hero, I chose option 2. And started to talk to the patient about composite bonding to ‘finish things off!’
The wire bends are in blue, and I have drawn on an exaggerated (blue) wire to show the bends more clearly. I have learned that for a lingual brace, the bends need to be TINY!
The desired tooth movement is in black.
The end result:
As always the end result could be improved slightly with a little gum contouring – but thats the beauty of looking over your cases – you always learn how you could improve things!
These days I talk to my patients a lot more about gum contouring post ortho.
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