Correction of crowding teeth in adults. FDI Annual World Dental Congress 2013

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Many patients have slightly crowded or overlapping anterior teeth. There is no doubt that the best way to treat the anterior crowding in the upper and in the lower arches requires the bonding of brackets to the teeth. However this is not satisfactory for the adult patients. If a patient is unable to accept comprehensive orthodontic procedures, the practitioner must determine whether the patient can be treated with minor tooth movement, restorations (bonding, laminate or crowning), reconturing/striping, extraction or a combination of these procedures. A thorough evaluation of the patient needs and expectations will establish the correct approach for the potential treatment options.
Using a 0,018 inch NiTi wire as a flexible lingual retainer to solve the relapse of the lower anterior teeth was for the first time an application of ERIC and his Co-workers.
The aim of this case presentation is to explain these different clinical application, especially the application procedures of a 0,014 NiTi at lingual/ palatine arches used to solve the crowding case. The 0.014 preformed NiTi wire must be cut longer then the intercanine length regarding the degree of crowding. The lingual/palatine surfaces of the teeth are cleaned, etched and bonded as a normal retainer. The wire is tightly tied to fit each tooth using a inter dental floss and after that the retainer was bonded. The result achieved is a good tooth alignment in a short period of time ( 6-8 months) and with very good aesthetic in such simple ways.

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  • Orthodontics is generally the first consideration when the patient presents with crowded teeth, but when this treatment is not possible, there are menyather treatment options, from crown &bridgis, to direct composite restaurations, bonded laminate veneers, recontouring, striping or minor tooth movement. The practicioner must determine the right path to choose.
  • Choosing the correct approach is the most important aspect of the treatment. The question is how to treat these cases?
  • Changes can be additive, subtractive, or both, in this patient we decided correcting the malshaped anterior upper tooth using porcelain veneers, and crowded lower tooth using recontouring.
  • The condition of the existing dentition is a factor in determining which restorative option is ideal. therefore the best treatment choice in this case was fixed prosthodontics.
  • existing restorations are easily incorporated into other restorative treatments. As the patient was seeking immediate esthetic improvement, the only option was direct composite restaurations.
  • Repetedfrakturesoftooth 36 andpatientkeptcomplainingfrompreviouswork, not at all happy aboutit, he wants a final solutiontotheproblemt. The examshowedbesidetheanteriorcrowdedteeth, a posteriorcrossbite, wich in fact was causingocclusalinterference, resulting in failieroftherestauration. thatswhywedecidedtofirstcorrectthecrossbite, andthentoimproveesthetics.
  • This is the final result of the treatment.
  • Diastemas are present at both upper and lower anterior tooth. She presented occlusalinterfernces & TMD, cosed even by the early missing of # 36 and 46.
  • UpperNiTi 0,014 retainer was usedfortheminortoothmovementrequiredtoclosediastemeand a goodaglinementofanteriorteeth, after thattheFiber reinforcedSplinting– In theloweranteriorteethdirectcompositerest. Wasused.-thesecondstageconsisted in 2 bridgesofporcelainfussedtometal.
  • Improuvement of both arches is shown in this slide.
  • Correction of crowding teeth in adults. FDI Annual World Dental Congress 2013

    1. 1. Correction of crowding teeth in adults, simple approaches. Cases report PhD. Doris Mingomataj1, Ph.D. Edlira Baruti2 1Faculty of Dentistry, Albanian University, Tirana, Albania 2Faculty of Dentistry, American University of Tirana, Albania
    2. 2. Porcelain Veneers Direct Composite Restauration Reconturing of tooth Striping Crown Crowding- Overlapping Teeth Minor Tooth Movement Regular Orthodontics
    3. 3. ?
    4. 4. A. G. 31 Year Male Diagnoza • Open Bite • Super Cl I • Missing # 13 Before AfterTreatment • Porcelain laminate veneers #12 to #23 • Implant at # 13 position • 4/5 crowns: # 14, 24, 25 • Direct composite rest. #16 & #26. Years later Orthodontics was presented as a first option, but the patient declined this treatment option because of the long time treatment required.
    5. 5. Diagnosis: • Dissaligned anterior teeth • Crowded anterior inferior teeth Treatment: • 11, 21, Porcelain laminate veneers • Recontouring of lower anterior teeth M. K. 34 Year Female Before Few years later After Treatment time: • 2 weeks
    6. 6. Diagnosis: • Disaglined theeth • Missing teeth Treatment: • Endodontics & restaurations • Crowns, bridge • Implant at # 36 W. H. 54 Year Male Before After Treatment time: • 3 months
    7. 7. Diagnosis: • Anterior crowding teeth Treatment: • Direct composite restauration V. S. 28 Year Female Before After Treatment time: • One stop
    8. 8. V. S. 28 Year Female 4 years later The restorations are still in good conditions & all we have to do is just polish them.
    9. 9. Diagnoses: • Anterior crowded teeth • Posterior crossbite • Occlusal interference • # 36 Continues failure of restauration • TMD Treatment: Stage I: • Direct restoration • Fixed prosthodontics Stage II: • Orthodontics I. T. 25 Year Female Treatment time: • Almost 5 months
    10. 10. Aim: Correction of: • Posterior crossbite • Oclusale interference Stage I: • Direct restoration • Fixed prosthodontics I. T. 25 Years Female Before After Treatment time: • 9 days (3 stops)
    11. 11. Orthodontic Stage: • Upper NiTi 0.014 retainer • TMJ appl at the end Treatment tjme: • Almost 4 months Aim: Correction of: • Anterior crowding teeth •Orthodontic stage consisted in a upper NiTi 0,014 retainer I. T. 25 Years Female
    12. 12. I. T. Before After
    13. 13. Diagnoses: • Anterior disaglined teeth • Oclusale interference • TMD • Early missing of 36, 46 Treatment: Stage I: • Orthodontics Stage II: • Direct restoration • Fixed prosthodontics Treatment time: • Nearly 3 months Before D. S. 26 Year Female
    14. 14. Treatment: Stage I • Direct composit restauration (Lower) • Upper Ni Ti 0,014 retainer • Fiber reinforced splinting Stage II • Fixed prosthodontics D. S. 26 Year Female Before After StageIStageII
    15. 15. D. S. 26 Year Female Before After
    16. 16. L. LL. 30 Year Female Diagnoses: • Cl. II malocclusion • Slight anterior crowding • Already treated orthodonticly Treatment: • Upper Ni Ti 0,014 retainer • Reshape after aglinement • TMD appliance Treatment time: • Nearly 3 months (3 stops)
    17. 17. L. I 35 years old Diagnoses: • Cl. II malocclusion • infraocclusion of the tooth nr 12 • Already treated orthodonticly Treatment: • Upper Ni Ti 0,014 retainer Treatment time: • 1 months (2 stops)
    18. 18.  Periodontal problems at tooth nr 12 because of the occlusal trauma Intrusion of the tooth nr 12 Beefore After
    19. 19. Beefore After
    20. 20. Skaner show that roots are at the cortical bone so the retreatment with regular orthodontics will cause damages and probably fenestration of vestibular cortex L.LL 30 years old , female
    21. 21. Treatment: • Upper Ni Ti 0,014 retainer • Reshape after aglinement Treatment time: • Nearly 3 months • 3 stops Before After As she insisted for the treatmentwe used upper NiTi 0.014 retainer, reshaped the teeth after alignement . This short and easy treatment was very satisfactory for her. L.LL 30 years old , female
    22. 22. Diagnosis: • Crowded anterior teeth • Cl. I molar relationship Treatment: • Alignement using: • Striping • Duble NiTi 0.014 retainer • Fiber reinforced splinting E. J. 35 Year Female Before Treatment time: • 9 months
    23. 23. E. J. 35 Year Female After
    24. 24. E. J. 35 Year Female
    25. 25. Before After
    26. 26. Before After
    27. 27. There are many option of treatment available for correcting crowded teeth, including esthetic contouring, bonding, porcelain laminates, and crowns. The condition of the existing dentition is a factor in determining which restorative option is ideal, without undervaluating the patients wills.

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