Contemporary ortho chap18 part2

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20130115 beethoven orthodontic course
textbook review
Contemporary ortho 5e
chap 18
part 2

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Contemporary ortho chap18 part2

  1. 1. CHAPTER 18Special Considerations in Treatment for Adults, 623William R. Proffit, David M. SarverAdjunctive vs Comprehensive Treatment, 624Goals of Adjunctive Treatment, 624Principles of Adjunctive Treatment, 624Adjunctive Treatment Procedures, 627Comprehensive Treatment in Adults, 637Special Aspects of Orthodontic Therapy for Adults,661
  2. 2. which is often further complicated by irregularspacing related to small or missing lateral incisors(Figure 18-20). A "diagnostic setup" is very helpfulin planning the correction of such problems. For thisAlignment of Anterior Teethprocedure, the study casts are duplicated and themalaligned teeth are carefully cut from the model,repositioned, and then waxed back onto the cast in anew position. If digital casts are available, a modernalternative is to do this on a computer screen (seeFigure14-1), and this is part of routine treatmentplanning when a sequence of clear aligners will beused in comprehensive treatment (see below). Thisallows evaluation of the feasibility of the orthodontictreatment in light of the crown and root movementsrequired, the anchorage available, the periodontal FIGURE 18-20support for each tooth, and the possible occlusalinterferences. If spacing of maxillary incisors is related to small teeth and a tooth-size discrepancy, composite buildups are an excellent The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution oftreatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient whopreparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before treatment, age 48. C and D, Redistribution of the space using aimprove the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwireThe most frequent problem is a maxillary central immediately before removal of the orthodontic appliance anddiastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil multistrand steel wire was used for initial alignment before theirregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorationsincisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to prevent partial reopening of the midline space. Surgical revision ofFor this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to thethe malaligned teeth are carefully cut from the model, patients age. H, Appearance on smile before and (I) afterrepositioned, and then waxed back onto the cast in a treatment.new position. If digital casts are available, a modern636
  3. 3. which is often further complicated by irregularspacing related to small or missing lateral incisors(Figure 18-20). A "diagnostic setup" is very helpfulin planning the correction of such problems. For thisAlignment of Anterior Teethprocedure, the study casts are duplicated and themalaligned teeth are carefully cut from the model,repositioned, and then waxed back onto the cast in anew position. If digital casts are available, a modernalternative is to do this on a computer screen (see Ortho. Closure ?Figure14-1), and this is part of routine treatmentplanning when a sequence of clear aligners will beused in comprehensive treatment (see below). This Restorations ?allows evaluation of the feasibility of the orthodontictreatment in light of the crown and root movementsrequired, the anchorage available, the periodontal FIGURE 18-20support for each tooth, and the possible occlusalinterferences. If spacing of maxillary incisors is related to small teeth and a tooth-size discrepancy, composite buildups are an excellent The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution oftreatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient whopreparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before treatment, age 48. C and D, Redistribution of the space using aimprove the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwireThe most frequent problem is a maxillary central immediately before removal of the orthodontic appliance anddiastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil multistrand steel wire was used for initial alignment before theirregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorationsincisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to prevent partial reopening of the midline space. Surgical revision ofFor this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to thethe malaligned teeth are carefully cut from the model, patients age. H, Appearance on smile before and (I) afterrepositioned, and then waxed back onto the cast in a treatment.new position. If digital casts are available, a modern636
  4. 4. which is often further complicated by irregularspacing related to small or missing lateral incisors(Figure 18-20). A "diagnostic setup" is very helpfulin planning the correction of such problems. For thisAlignment of Anterior Teethprocedure, the study casts are duplicated and themalaligned teeth are carefully cut from the model,repositioned, and then waxed back onto the cast in anew position. If digital casts are available, a modernalternative is to do this on a computer screen (see Ortho. Closure ?Figure14-1), and this is part of routine treatmentplanning when a sequence of clear aligners will beused in comprehensive treatment (see below). This Restorations ?allows evaluation of the feasibility of the orthodontictreatment in light of the crown and root movementsrequired, the anchorage available, the periodontal FIGURE 18-20support for each tooth, and the possible occlusalinterferences. If spacing of maxillary incisors is related to small teeth and a Diagnostic Setup The major indication for adjunctive orthodontictreatment to correct malaligned anterior teeth is tooth-size discrepancy, composite buildups are an excellent solution, but satisfactory esthetics may require redistribution of the space before the restorations are placed, as in this patient whopreparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before treatment, age 48. C and D, Redistribution of the space using aimprove the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwireThe most frequent problem is a maxillary central immediately before removal of the orthodontic appliance anddiastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil multistrand steel wire was used for initial alignment before theirregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorationsincisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to prevent partial reopening of the midline space. Surgical revision ofFor this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to thethe malaligned teeth are carefully cut from the model, patients age. H, Appearance on smile before and (I) afterrepositioned, and then waxed back onto the cast in a treatment.new position. If digital casts are available, a modern636
  5. 5. which is often further complicated by irregular spacing related to small or missing lateral incisors (Figure 18-20). A "diagnostic setup" is very helpful in planning the correction of such problems. For this Alignment of Anterior Teeth procedure, the study casts are duplicated and the malaligned teeth are carefully cut from the model, repositioned, and then waxed back onto the cast in a new position. If digital casts are available, a modern alternative is to do this on a computer screen (see Figure14-1), and this is part of routine treatment planning when a sequence of clear aligners will be used in comprehensive treatment (see below). This allows evaluation of the feasibility of the orthodontic treatment in light of the crown and root movementsª›®œ•Œ QuickTime˛ ©M required, the anchorage available, the periodontal °ß°®∏—¿£¡Yæπ ®”¿Àµ¯¶ππœµe°C support for each tooth, and the possible occlusal interferences. If spacing of maxillary incisors is related to small teeth and a tooth-size discrepancy, composite buildups are an excellent The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution of treatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient who preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before treatment, age 48. C and D, Redistribution of the space using a improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil multistrand steel wire was used for initial alignment before the irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5 helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to prevent partial reopening of the midline space. Surgical revision of For this procedure, the study casts are duplicated andFIGURE 14-1 Pre-Tx. Dx. Setup or Digital simulation Pre-Tx. Dx. Setup or Digital simulation the malaligned teeth are carefully cut from the model, repositioned, and then waxed back onto the cast in a the frenum was not performed, partially in deference to the patients age. H, Appearance on smile before and (I) after treatment. new position. If digital casts are available, a modern636
  6. 6. which is often further complicated by irregularspacing related to small or missing lateral incisors(Figure 18-20). A "diagnostic setup" is very helpfulin planning the correction of such problems. For thisAlignment of Anterior Teethprocedure, the study casts are duplicated and themalaligned teeth are carefully cut from the model,repositioned, and then waxed back onto the cast in anew position. If digital casts are available, a modernalternative is to do this on a computer screen (seeFigure14-1), and this is part of routine treatmentplanning when a sequence of clear aligners will beused in comprehensive treatment (see below). Thisallows evaluation of the feasibility of the orthodontictreatment in light of the crown and root movementsrequired, the anchorage available, the periodontalsupport for each tooth, and the possible occlusalinterferences. If spacing of maxillary incisors is related to small teeth and a tooth-size discrepancy, composite buildups are an excellent The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution oftreatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient whopreparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before treatment, age 48. C and D, Redistribution of the space using aimprove the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwireThe most frequent problem is a maxillary central immediately before removal of the orthodontic appliance anddiastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil multistrand steel wire was used for initial alignment before theirregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorationsincisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to prevent partial reopening of the midline space. Surgical revision ofFor this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to thethe malaligned teeth are carefully cut from the model, FIGURE 18-20 patients age. H, Appearance on smile before and (I) afterrepositioned, and then waxed back onto the cast in a treatment.new position. If digital casts are available, a modern636
  7. 7. which is often further complicated by irregularspacing related to small or missing lateral incisors(Figure 18-20). A "diagnostic setup" is very helpfulin planning the correction of such problems. For thisAlignment of Anterior Teethprocedure, the study casts are duplicated and themalaligned teeth are carefully cut from the model,repositioned, and then waxed back onto the cast in anew position. If digital casts are available, a modernalternative is to do this on a computer screen (seeFigure14-1), and this is part of routine treatmentplanning when a sequence of clear aligners will beused in comprehensive treatment (see below). Thisallows evaluation of the feasibility of the orthodontictreatment in light of the crown and root movements 16 mil steelrequired, the anchorage available, the periodontalsupport for each tooth, and the possible occlusalinterferences. If spacing of maxillary incisors is related to small teeth and a tooth-size discrepancy, composite buildups are an excellent The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution oftreatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient whopreparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before treatment, age 48. C and D, Redistribution of the space using aimprove the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwireThe most frequent problem is a maxillary central immediately before removal of the orthodontic appliance anddiastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil multistrand steel wire was used for initial alignment before theirregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorationsincisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to prevent partial reopening of the midline space. Surgical revision ofFor this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to thethe malaligned teeth are carefully cut from the model, FIGURE 18-20 patients age. H, Appearance on smile before and (I) afterrepositioned, and then waxed back onto the cast in a treatment.new position. If digital casts are available, a modern636
  8. 8. which is often further complicated by irregularspacing related to small or missing lateral incisors(Figure 18-20). A "diagnostic setup" is very helpfulin planning the correction of such problems. For thisAlignment of Anterior Teethprocedure, the study casts are duplicated and themalaligned teeth are carefully cut from the model,repositioned, and then waxed back onto the cast in anew position. If digital casts are available, a modernalternative is to do this on a computer screen (seeFigure14-1), and this is part of routine treatmentplanning when a sequence of clear aligners will beused in comprehensive treatment (see below). Thisallows evaluation of the feasibility of the orthodontictreatment in light of the crown and root movementsrequired, the anchorage available, the periodontalsupport for each tooth, and the possible occlusalinterferences. If spacing of maxillary incisors is related to small teeth and a tooth-size discrepancy, composite buildups are an excellent The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution oftreatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient whopreparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before treatment, age 48. C and D, Redistribution of the space using aimprove the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwireThe most frequent problem is a maxillary central immediately before removal of the orthodontic appliance anddiastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil multistrand steel wire was used for initial alignment before theirregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorationsincisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to prevent partial reopening of the midline space. Surgical revision ofFor this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to thethe malaligned teeth are carefully cut from the model, FIGURE 18-20 patients age. H, Appearance on smile before and (I) afterrepositioned, and then waxed back onto the cast in a treatment.new position. If digital casts are available, a modern636
  9. 9. which is often further complicated by irregularspacing related to small or missing lateral incisors(Figure 18-20). A "diagnostic setup" is very helpfulin planning the correction of such problems. For thisAlignment of Anterior Teethprocedure, the study casts are duplicated and themalaligned teeth are carefully cut from the model,repositioned, and then waxed back onto the cast in anew position. If digital casts are available, a modernalternative is to do this on a computer screen (seeFigure14-1), and this is part of routine treatmentplanning when a sequence of clear aligners will beused in comprehensive treatment (see below). Thisallows evaluation of the feasibility of the orthodontictreatment in light of the crown and root movements 21.5 milrequired, the anchorage available, the periodontalsupport for each tooth, and the possible occlusalinterferences. If spacing of maxillary incisors is related to small teeth and a tooth-size discrepancy, composite buildups are an excellent The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution oftreatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient whopreparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before treatment, age 48. C and D, Redistribution of the space using aimprove the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwireThe most frequent problem is a maxillary central immediately before removal of the orthodontic appliance anddiastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil multistrand steel wire was used for initial alignment before theirregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorationsincisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to prevent partial reopening of the midline space. Surgical revision ofFor this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to thethe malaligned teeth are carefully cut from the model, FIGURE 18-20 patients age. H, Appearance on smile before and (I) afterrepositioned, and then waxed back onto the cast in a treatment.new position. If digital casts are available, a modern636
  10. 10. Alignment of Anterior TeethCrowded, Rotated, and Displaced Incisors As arule, spacing is the problem when maxillary incisorsneed realignment to facilitate other treatment. FIGURE 18-21Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left centrallower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are tworestorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to align the remaining teeth, or align the teeth with arch expansion andpatient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic componentalignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In this patient, aligning the lower incisors without extraction would alsoconsidered. The key question is whether the require aligning the upper incisors, but this expansion would increasecrowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as theremoving some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of the lower right central incisor. B, Mandibular occlusal view. C, Frontaltooth to provide space,8 or removing one lower view. Note the moderately deep bite and lack of overjet. The restorativeincisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of thecan be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best esthetic result and accepted a period of treatment with a fixed appliancelower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. Theappliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view after alignment. E, Frontal view. F, Smile after restoration wasappliance is more efficient and cost-effective completed.(Figure 18-21). A segment of A-NiTi wire, withstops to make it slightly advanced, usually is thebest way to bring the teeth into alignment (seeFigure 14-5). FIGURE 14-5). 637
  11. 11. Alignment of Anterior TeethCrowded, Rotated, and Displaced Incisors As arule, spacing is the problem when maxillary incisorsneed realignment to facilitate other treatment. FIGURE 18-21Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left centrallower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are tworestorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to Ext. ?patient to maintain the teeth. In some cases, align the remaining teeth, or align the teeth with arch expansion and restore the damaged one. The decision has an esthetic componentalignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In Expansion?considered. The key question is whether the this patient, aligning the lower incisors without extraction would also require aligning the upper incisors, but this expansion would increasecrowding should be resolved by expanding the arch, Inter-proximal Reductionremoving some interproximal enamel from each lip support and improve the overall facial appearance as well as the dental appearance. A, Smile before treatment, after loss of one corner of the lower right central incisor. B, Mandibular occlusal view. C, Frontalincisor. (IPR)?tooth to provide space,8 or removing one lower Expansion of a crowded incisor segment view. Note the moderately deep bite and lack of overjet. The restorative dentist sought orthodontic consultation, thinking that extraction of thecan be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best esthetic result and accepted a period of treatment with a fixed appliancelower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. Theappliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view after alignment. E, Frontal view. F, Smile after restoration wasappliance is more efficient and cost-effective completed.(Figure 18-21). A segment of A-NiTi wire, withstops to make it slightly advanced, usually is thebest way to bring the teeth into alignment (seeFigure 14-5). FIGURE 14-5). 637
  12. 12. Alignment of Anterior TeethCrowded, Rotated, and Displaced Incisors As arule, spacing is the problem when maxillary incisorsneed realignment to facilitate other treatment.Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left centrallower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are tworestorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to align the remaining teeth, or align the teeth with arch expansion andpatient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic componentalignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In this patient, aligning the lower incisors without extraction would alsoconsidered. The key question is whether the require aligning the upper incisors, but this expansion would increasecrowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as theremoving some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of the lower right central incisor. B, Mandibular occlusal view. C, Frontaltooth to provide space,8 or removing one lower view. Note the moderately deep bite and lack of overjet. The restorativeincisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of thecan be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best esthetic result and accepted a period of treatment with a fixed appliancelower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. Theappliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view after alignment. E, Frontal view. F, Smile after restoration wasappliance is more efficient and cost-effective completed.(Figure 18-21). A segment of A-NiTi wire, withstops to make it slightly advanced, usually is thebest way to bring the teeth into alignment (seeFigure 14-5). FIGURE 14-5 FIGURE 18-21). 637
  13. 13. Alignment of Anterior TeethCrowded, Rotated, and Displaced Incisors As arule, spacing is the problem when maxillary incisorsneed realignment to facilitate other treatment.Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left centrallower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are tworestorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to align the remaining teeth, or align the teeth with arch expansion andpatient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic componentalignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In this patient, aligning the lower incisors without extraction would alsoconsidered. The key question is whether the require aligning the upper incisors, but this expansion would increasecrowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as theremoving some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of the lower right central incisor. B, Mandibular occlusal view. C, Frontaltooth to provide space,8 or removing one lower view. Note the moderately deep bite and lack of overjet. The restorativeincisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of thecan be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best esthetic result and accepted a period of treatment with a fixed appliancelower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. Theappliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view after alignment. E, Frontal view. F, Smile after restoration wasappliance is more efficient and cost-effective completed.(Figure 18-21). A segment of A-NiTi wire, withstops to make it slightly advanced, usually is thebest way to bring the teeth into alignment (seeFigure 14-5). FIGURE 14-5 FIGURE 18-21). 637
  14. 14. Alignment of Anterior TeethCrowded, Rotated, and Displaced Incisors As arule, spacing is the problem when maxillary incisorsneed realignment to facilitate other treatment.Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left centrallower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are tworestorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to align the remaining teeth, or align the teeth with arch expansion andpatient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic componentalignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. Inconsidered. The key question is whether the this patient, aligningupper incisors, but this expansion would increase require aligning the the lower incisors without extraction would alsocrowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as theremoving some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner oftooth to provide space,8 or removing one lower the lower right moderately deepB, Mandibular of overjet. The restorative view. Note the central incisor. bite and lack occlusal view. C, Frontalincisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of thecan be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best esthetic result and accepted a period of treatment with a fixed appliancelower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. Theappliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal viewappliance is more efficient and cost-effective after alignment. E, Frontal view. F, Smile after restoration was completed.(Figure 18-21). A segment of A-NiTi of one lower incisor !! No ext. wire, withstops to make it slightly advanced, usually is thebest way to bring the teeth into No braces on upper !! alignment (seeFigure 14-5). Only 5 month tx. time14-5 FIGURE !! FIGURE 18-21). It seems no IPR !! 637
  15. 15. Alignment of Anterior TeethCrowded, Rotated, and Displaced Incisors As arule, spacing is the problem when maxillary incisorsneed realignment to facilitate other treatment.Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left centrallower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are tworestorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to align the remaining teeth, or align the teeth with arch expansion andpatient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic componentalignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. Inconsidered. The key question is whether the this patient, aligningupper incisors, but this expansion would increase require aligning the the lower incisors without extraction would alsocrowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as theremoving some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner oftooth to provide space,8 or removing one lower the lower right moderately deepB, Mandibular of overjet. The restorative view. Note the central incisor. bite and lack occlusal view. C, Frontalincisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of thecan be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best esthetic result and accepted a period of treatment with a fixed appliancelower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. Theappliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal viewappliance is more efficient and cost-effective after alignment. E, Frontal view. F, Smile after restoration was completed.(Figure 18-21). A segment of A-NiTi of one lower incisor !! No ext. wire, with ?stops to make it slightly advanced, usually is thebest way to bring the teeth into No braces on upper !! alignment (seeFigure 14-5). Only 5 month tx. time14-5 FIGURE !! FIGURE 18-21). It seems no IPR !! 637
  16. 16. Alignment of Anterior TeethCrowded, Rotated, and Displaced Incisors As arule, spacing is the problem when maxillary incisorsneed realignment to facilitate other treatment.Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left centrallower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are tworestorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to align the remaining teeth, or align the teeth with arch expansion andpatient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic componentalignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. Inconsidered. The key question is whether the this patient, aligningupper incisors, but this expansion would increase require aligning the the lower incisors without extraction would alsocrowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as theremoving some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner oftooth to provide space,8 or removing one lower the lower right moderately deepB, Mandibular of overjet. The restorative view. Note the central incisor. bite and lack occlusal view. C, Frontalincisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of thecan be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best esthetic result and accepted a period of treatment with a fixed appliance Crimped stoplower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. Theappliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal viewappliance is more efficient and cost-effective after alignment. E, Frontal view. F, Smile after restoration was completed.(Figure 18-21). A segment of A-NiTi wire, withstops to make it slightly advanced, usually is thebest way to bring the teeth into alignment (seeFigure 14-5). FIGURE 14-5).FIGURE 14-5 637
  17. 17. Alignment of Anterior TeethCrowded, Rotated, and Displaced Incisors As arule, spacing is the problem when maxillary incisorsneed realignment to facilitate other treatment.Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left centrallower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are tworestorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to align the remaining teeth, or align the teeth with arch expansion andpatient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic componentalignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. Inconsidered. The key question is whether the this patient, aligningupper incisors, but this expansion would increase require aligning the the lower incisors without extraction would alsocrowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as theremoving some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner oftooth to provide space,8 or removing one lower the lower right moderately deepB, Mandibular of overjet. The restorative view. Note the central incisor. bite and lack occlusal view. C, Frontalincisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of thecan be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best esthetic result and accepted a period of treatment with a fixed appliancelower arch is to be treated, the esthetics of the on both arches, after which the incisorOpenbecoil first Crimped stop would restored. Theappliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal viewappliance is more efficient and cost-effective after alignment. E, Frontal view. F, Smile after restoration was completed.(Figure 18-21). A segment of A-NiTi wire, withstops to make it slightly advanced, usually is thebest way to bring the teeth into alignment (seeFigure 14-5). FIGURE 14-5).FIGURE 14-5 637
  18. 18. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce asatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be thefinal aligner in a sequence (though this may be too flexible FIGURE 18-22to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right laterala fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C,retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners andcan provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
  19. 19. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce asatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be the Neither stripping norfinal aligner in a sequence (though this may be too flexibleto be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral incisor extraction shoulda fixed appliance is removed, a canine-to-canine clipretainer, or a bonded fixed retainer. 10 incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C, Mandibular occlusal. The plan was extraction of the primary incisor and be undertaken without a Stripping the contact points of the teeth to remove enamelcan provide space for alignment of mildly irregular lower closure of the extraction site, using a series of Invisalign aligners and bonded attachments to produce the necessary rotation and root movement. diagnostic setup.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After FIGURE 18-22 noted that the maxillary right canine was not eight aligners it was tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
  20. 20. on overjet, overbite, posterior intercuspation, and esthetics.9 In severe crowding, removing one lower incisor and using the space to align the other three incisors can produce a satisfactory result and can be managed with clear aligner Alignment of Anterior Teeth therapy if bonded attachments are part of the treatment plan (Figure 18-22). The treatment time and difficulty, whatever the type of appliance, put this at or across the border of comprehensive treatment. Neither stripping nor incisor extraction should be undertaken without a diagnostic setup to verify feasibility. Remember that stretched gingival fibers are a potent force for relapse after rotations have been corrected, and that good long-term stability may require a fiberotomy (see Chapter 16). Whether clear aligners or a fixed appliance was used, retention is necessary until restorative or other treatment is completed. This can be the final aligner in a sequence (though this may be too flexible to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C, retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement. incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard- sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F, intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used along one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners, managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completion time and 18-22FIGURE difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.) stripping nor incisor extraction should be undertaken without a diagnostic setup to verify feasibility. 637
  21. 21. on overjet, overbite, posterior intercuspation, and esthetics.9 In severe crowding, removing one lower incisor and using the space to align the other three incisors can produce a satisfactory result and can be managed with clear aligner Alignment of Anterior Teeth therapy if bonded attachments are part of the treatment plan (Figure 18-22). The treatment time and difficulty, whatever the type of appliance, put this at or across the border of comprehensive treatment. Neither stripping nor incisor extraction should be undertaken without a diagnostic setup to verify feasibility. Remember that stretched gingival fibers are a potent force for relapse after rotations have been corrected, and that good long-term stability may require a fiberotomy (see Chapter 16). Whether clear aligners or a fixed appliance was used, retention is necessary until restorative or other treatment is completed. This can be the final aligner in a sequence (though this may be too flexible to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C, retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement. incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard- sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F, intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used along one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners, managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completion time and 18-22FIGURE difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.) stripping nor incisor extraction should be undertaken without a diagnostic setup to verify feasibility. 637
  22. 22. on overjet, overbite, posterior intercuspation, and esthetics.9 In severe crowding, removing one lower incisor and using the space to align the other three incisors can produce a satisfactory result and can be managed with clear aligner Alignment of Anterior Teeth therapy if bonded attachments are part of the treatment plan (Figure 18-22). The treatment time and difficulty, whatever the type of appliance, put this at or across the border of comprehensive treatment. Neither stripping nor incisor extraction should be undertaken without a diagnostic setup to verify feasibility. Remember that stretched gingival fibers are a potent force for relapse after rotations have been corrected, and that good long-term stability may require a fiberotomy (see Chapter 16). Whether clear aligners or a fixed appliance was used, retention is necessary until restorative or other treatment is completed. This can be the final aligner in a sequence (though this may be too flexible to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C, retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement. incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard- sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F, intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used along one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners, managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completion time and 18-22FIGURE difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.) stripping nor incisor extraction should be undertaken without a diagnostic setup to verify feasibility. 637
  23. 23. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce asatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be thefinal aligner in a sequence (though this may be too flexibleto be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right laterala fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C,retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners andcan provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
  24. 24. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce asatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be thefinal aligner in a sequence (though this may be too flexibleto be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right laterala fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C,retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners andcan provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
  25. 25. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce asatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be thefinal aligner in a sequence (though this may be too flexibleto be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right laterala fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C,retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners andcan provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
  26. 26. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce a Inter-arch Tooth Size Discrepancysatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be thefinal aligner in a sequence (though this may be too flexibleto be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right laterala fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C,retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners andcan provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
  27. 27. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce a Inter-arch Tooth Size Discrepancysatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be thefinal aligner in a sequence (though this may be too flexibleto be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right laterala fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C,retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners andcan provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
  28. 28. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce a Inter-arch Tooth Size Discrepancysatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be thefinal aligner in a sequence (though this may be too flexibleto be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right laterala fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C,retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners andcan provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
  29. 29. on overjet, overbite, posterior intercuspation, and esthetics.9In severe crowding, removing one lower incisor and usingthe space to align the other three incisors can produce a Inter-arch Tooth Size Discrepancysatisfactory result and can be managed with clear alignerAlignment of Anterior Teeththerapy if bonded attachments are part of the treatment plan(Figure 18-22). The treatment time and difficulty, whateverthe type of appliance, put this at or across the border ofcomprehensive treatment. Neither stripping nor incisorextraction should be undertaken without a diagnostic setupto verify feasibility. Remember that stretched gingivalfibers are a potent force for relapse after rotations have beencorrected, and that good long-term stability may require afiberotomy (see Chapter 16). Whether clear aligners or afixed appliance was used, retention is necessary untilrestorative or other treatment is completed. This can be thefinal aligner in a sequence (though this may be too flexibleto be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right laterala fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B, Maxillary occlusal. Note the rotation of the maxillary right canine. C,retainer, or a bonded fixed retainer. 10 Mandibular occlusal. The plan was extraction of the primary incisor and Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners andcan provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and onundertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called forundesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not tracking, and an elastic to additional bonded attachments was used alongone lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upperincisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canineare part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued at night as the maxillary retainer. J, Panoramic radiograph at the completiontime and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 monthsat or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)stripping nor incisor extraction should be undertakenwithout a diagnostic setup to verify feasibility. 637
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